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Constipation

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Definition

Increase in the dryness and hardness of stools (poo), making it hard to poo. This often presents with reduced frequency, pain and sometimes no pooing at all.

Epidemiology

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Around 2% of the population, more common in women, elderly people and children.

Pathophysiology

Two main causes:

  • Problems with poo itself, from poor diet, etc.
  • Problems with your insides: neurological problems, weakness, scarring, etc.

Clinical and Associated Features

  • Infrequent pooing - generally less that 3 times a week.
  • Difficulty pooing - straining, pain on pooing, stools that seem hard.
  • Incomplete pooing - incomplete bowel evacuation.

Differential Diagnosis

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Medical Emergency - Severe cases may feature symptoms of bowel obstruction (vomiting, tender abdomen) and "paradoxical diarrhoea", where a little diarrhoea squeezes out past the massive impacted stool.

Hard poo

Paralysed or diminished bowels

Obstructed bowels

  • Mechanical problems from herniation and stuff, like rectal prolapse, rectocele, and enterocele.
  • Retained foreign body or a bezoar
  • Psychosomatic constipation
  • Abdominal surgery

Seen in children

  • Switching from breast milk to bottle feeds, or to solid meals
  • Hirchsprung's disease - seen in neonates, congenital absence of nerves on part of bowel, treated surgically.

Investigations

Kick off with a good history, screening for cancer symptoms like steadily progressing symptoms, weight loss, abdominal distention, abdominal or rectal pain, blood in stool, etc. Dietary habits are worth asking about, especially fibre, and

Then examination kicks off, looking for abdominal masses, and doing a pr (finger up the bum).

Then you do an abdominal Xray, looking for air, impacted faecal matter, and masses.