Constipation/ Faecal Impaction

A condition characterised by a change in usual bowel habits and dry, hard stools. There is a decreased frequency of bowel action and patients should be assessed individually. Constipation may have many causes:

» incorrect diet (fibre and fluid);

» lack of exercise;

» pregnancy;

» old age;

» psychogenic disorders

chronic use of enemas and laxatives;

GENERAL MEASURES

Dietary advice preferably by dietician. Dietary measures i.e. balanced diet with unprocessed foods, e.g. cereals, legumes, fruit and vegetables. Correct dehydration. Ensure adequate fluid intake. Wheat bran: introduce slowly and take with sufficient fluid. Side-effects include: bloating, cramps and flatulence. Manual removal of impacted stools. Encourage regular bowel habits. Physical exercise.

MEDICINE TREATMENT

Osmotic laxatives

• Lactulose, oral, 10–20 mL daily. o Titrate to effect i.e. up to 60 mL daily. Stimulant laxatives For short term use only, except in the elderly where long-term treatment may be indicated:

• Sennosides A and B, oral, 7.5–15 mg at night 2–3 times a week for up to 4 weeks. Polyethylene glycol-based purges For acute bowel preparation or for chronic constipation on specialist advice. Saline or phosphate enemas May occasionally be indicated in acute constipation.

REFERRAL

» For investigation for organic disease.