Constipation

From Ganfyd

Neither frequency nor quantity defines constipation and in the absence of disturbance to the patient these should be carefully left alone.

A particular subclass are young women with a sluggish bowel.

Aetiology

Congenital

Hirschsprung's disease. A short aganglionic segment in the bowel may not be obvious at first, and thus present later with severe constipation and dilation of the colon.

Psychological

Iatrogenic

A large number of drugs can cause constipation, sometimes severe

• Narcotics
• 5HT₃ antagonists
• Oral iron therapy

Clinical

Complications and Sequelae

• Diverticulosis is assumed to result from chronic constipation.
• Soiling in connection with stool withholding results from constipation in children
• Anal fissure

Investigations

Blood tests

• Thyroid function tests to exclude hypothyroidism.

Radiology

• Large bowel transit studies.

Treatment

Medical

• Poor evidence base for functional childhood constipation in terms of one agent better than others
• Increasing water intake alone is unlikely to be benefical^[1] as it neither shortens colon transit time or determines stool bulk.

Surgical

• Anterograde continence enema
• Sigmoid colectomy (if severe megacolon)
• Colostomy

References