Constipation

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Clinical Description

Absent or reduced frequency of passage of stools; when passed, stool is harder than usual. Commonly related to inadequate dietary fiber intake and/or psychological factors. Investigate and treat the underlying cause.

Clinical Features

SIGNS AND SYMPTOMS

  • Hard stools or no passage of stools/flatus

INVESTIGATIONS

  • Digital rectal examination
  • Abdominal erect and supine x-rays

Treatment 

NON-PHARMACOLOGICAL

  • High residue diet e.g. papaya seeds and increased fluid intake
  • Do not use oral laxatives in children. Glycerine infant and paediatric suppositories can be used in the short term.
  • If increased fiber and oral fluids are insufficient to cure constipation, a laxative is considered necessary

In the event of an acute constipation that is not responding to fluids and oral laxatives, consider a soap enema.

PHARMACOLOGICAL

Adults:

  • liquid paraffin 5 -10 mls every day for 5 days OR
  • bisacodyl 5-10mg nocte for 5 days
  • Reserve medication for severe cases only confirmed by examination.

Alternatively

  • glycerol suppositories prn

Constipation in the neonate is usually due to a significant underlying problem such as bowel atresia or Hirschsprung's disease. 

If a neonate has not passed stools in the first 48 hours of life: Refer urgently for surgical and/or paediatric assessment especially if there is abdominal distension and/or vomiting

Refer all infants with constipation for specialist assessment.

  • In the event of chronic constipation that is not responding to fluids and laxatives, please refer to a specialist for further investigations.