Constipation

K59.0

DESCRIPTION

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

  • incorrect diet (insufficient fibre and fluid)
  • lack of exercise
  • pregnancy
  • old age
  • medicines, e.g. opiates and anticholinergics
  • ignoring the urge
  • hypothyroidism
  • neurogenic
  • lower bowel abnormalities
  • psychogenic disorders
  • chronic use of enemas and laxatives
  • cancer of the bowel
  • behavioural problems in children

CAUTION

In adults be especially suspicious of a change in bowel habits, as this may indicate cancer of the large bowel.

GENERAL MEASURES

  • Encourage exercise.
  • Increase intake of fibre-rich food, e.g. vegetables, coarse maize meal, bran and cooked dried prunes.
  • Ensure adequate hydration.
  • Encourage regular bowel habits.
  • Discourage continuous use of laxatives.

MEDICINE TREATMENT

Children > 12 months of age

  • Lactulose, oral, 0.5 mL/kg/dose once daily. See: paediatric dosing tool.
    • If poor response, increase frequency to 12 hourly.

Adults and children > 15 years of age

  • Sennosides A and B, oral, 13.5 mg, 1 tablet at night.
    • In resistant cases increase to 4 tablets.

OR

Lactulose, oral, 10–20 mL once or twice daily.

CAUTION

Prolonged severe constipation may present with overflow “diarrhoea”.
Rectal examination should be done in all adults.

REFERRAL

  • Recent change in bowel habits.
  • Faecal impaction.
  • Poor response to treatment.
  • Uncertain cause of constipation.