Constipation is a clinical condition in which a person has uncomfortable or infrequent bowel movements and/or passage of hard stools. Generally, a person is considered to be constipated when bowel movements result in passage of small amounts of hard, dry stool, usually fewer than three times a week.
Causes of Constipation
- Inadequate fibre in diet (simple constipation)
- Drugs e.g. antidepressants, narcotic analgesics, etc
- Diseases of the anus, rectum and colon e.g. fissures, haemorrhoids, cancer
- Irritable bowel syndrome
- Metabolic diseases e.g. hypothyroidism, hypercalcaemia
Symptoms of Constipation
- Dry, hard and/or lumpy stools
- Abdominal bloating
- Excessive flatulence.
- Fewer than three bowel movements a week.
- Difficult or painful defecation
- A possible stomach ache or cramps.
- A feeling of incomplete bowels emptying after a movement.
Complications of Constipation
- Anal fissures/tears
- Rectal bleeding
- Stool examination including microscopy.
- Barium enema
- Serum hormonal levels e.g. thyroxine, triiodotyronine, thyroid stimulating hormone to exclude hypothyroidism
Treatment objectives of Constipation
- Identify and eliminate cause(s)
- Evacuate hard faecal matter
Where to use of laxatives in Constipation
This means situations where straining will exacerbate pre-existing medical/surgical conditions. The conditions are:
- Risk of rectal bleeding
- Increased risk of anal tear
When to use laxatives apart from as noted above include
- In drug-induced constipation
- To clear the alimentary tract before surgery or radiological procedures
Non-drug treatment of Constipation
- Avoid precipitants
- Eat high fibre diet (including fruits and vegetables).
- Take adequate fluid
- Megacolon: Saline enema
- Surgical: resection of large bowel
Senna 7.5 mg tablet (as sennoside B)
Adult: 2-4 tablets at night
6-12years: 1-2 tablet stat at night (or in the morning if preferred)
12-18 years: 2-4 tablets at night
Bisacodyl tablets 10 mg orally at night; bisacodyl suppositories 10 mg per rectum at night
Laxatives should generally be avoided. Most times these drugs are needed for only a few days
In children, laxatives should be prescribed by a healthcare professional experienced in the management of constipation in children.