Constipation
By definition it goes 'infrequent passage of hard stools'. Patients mostly complain of straining, a sensation of incomplete evacuation or abdominal discomfort. There are many gastrointestinal causes as well as other medical disorders behind it. Most common gastrointestinal cause is lack of fiber diet or fluid intake. Issues such as Irritable bowel syndrome(IBS) or colonic carcinoma must also be considered. Other non gastrointestinal causes include certain drugs such as opiates, iron supplements and anitcholinergis. History of psychological matters like depression or neurological problems like cereberovascular accidents(stroke) or multiple sclerosis must be looked over. How will you assess a patient with complain of constipation? Well the onset, duration and characteristic of stool is very important. For example a neonatal onset suggests Hirschsprung's disease. Sudden change in bowel habits and weight loss in middle age patient hints towards colonic carcinoma. A history of childhood constipation and emotional distress is suggestive of IBS. A proper digital rectal examination, routine biochemistry including serum calcium and TFTs and full CBC should be done. Proctoscopy and sigmoidoscopy is done to detect anorectal disease. Proper diet planing and hydration is prime management. If no certain cause is found for persistent constipation with disabling symptoms a specialist referral for further investigation is necessary.
