Tenesmus (sensation of incomplete evacuation on defecation)
Abdominal pain
Systemic features
Past medical history
Previous bowel surgery
Inflammatory bowel disease
Medications
See list of causes
Allergies
Family history
Colorectal carcinoma
Social history
Diet
Smoking
Psychological history
Examination of constipation
Most examinations will be normal
Lymphadenopathy, abdominal mass, anaemia would be suspicious for colorectal carcrinoma
Digital rectal examination is essential: look for fissures/haemorrhoids, impacted stool, blood/mucus
Initial management of constipation
Most patients present with mild symptoms and need little more than taking a thorough history and a proper examination.
Blood tests:
FBC, Calcium, U+Es (dehydration), Thyroid function tests
Abdominal X-ray (often performed in hospital to rule out obstruction)
The management for most patients will be reassurance plus advice to eat plenty of fibre and keep well hydrated.
Laxatives can be used for mild-moderate symptoms if general measures do not work:
Bulking agents e.g. Bran, Ispaghula hulk, methycellulose
Stimulant laxatives e.g. Senna (2 tablets/7.5mg at night), Bisacodyl, glycerol suppositories, docusate sodium (also has softening properties, up to 500mg daily in divided doses)
Stool softeners e.g. arachis oil enemas, liquid paraffin
Osmotic laxatives e.g. Lactulose (initially 10-15 ml twice daily but can be increased, especially in hepatic encephalopathy), phosphate enemas (useful if faecal impaction present or pre-endoscopy)
Further management of constipation
A few patients will need further investigation and support.
