CONSTIPATION/ FAECAL IMPACTION

DESCRIPTION

A condition characterised by a change in usual bowel habits and dry, hard stools. There is a decreased frequency of bowel action and patients should be assessed individually.

Constipation may have many causes:

» incorrect diet (fibre and fluid);                »  certain drugs;

» lack of exercise;                                    » metabolic;

» pregnancy;                                              » endocrine;

» old age;                                                  » neurogenic;

» psychogenic disorders;                            » lower bowel abnormalities;

» chronic use of enemas and

laxatives;

» ignoring the urge;

» cancer of the bowel;                              » behavioural problems in

children.

GENERAL MEASURES

Dietary advice preferably by dietician.

Dietary measures i.e. balanced diet with unprocessed foods, e.g. cereals,

legumes, fruit and vegetables.

Correct dehydration. Ensure adequate fluid intake.

Wheat bran: introduce slowly and take with sufficient fluid. Side-effects

include: bloating, cramps and flatulence.

Manual removal of impacted stools.

Encourage regular bowel habits.

Physical exercise.

MEDICINE TREATMENT

Osmotic laxatives

• Lactulose, oral, 10–20 mL daily.

o Titrate to effect i.e. up to 60 mL daily.

Stimulant laxatives

For short term use only, except in the elderly where long-term treatment may

be indicated:

• Sennosides A and B, oral, 7.5–15 mg at night 2–3 times a week for up to 4

weeks.

Polyethylene glycol-based purges

For acute bowel preparation or for chronic constipation on specialist advice.

Saline or phosphate enemas

May occasionally be indicated in acute constipation.

REFERRAL

» For investigation for organic disease.

Reference and further reading

Standard Treatment Guidelines and Essential Medicines List for South Africa 2012 Edition

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