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CPD: Key questions on constipation

Dr Simon Smale, consultant gastroenterologist, on impaction, laxatives and Hirschsprung’s

Learning Objectives

This module will update you on managing constipation, including:

  • Tips for diagnosis
  • Different types of laxatives
  • Red flags for Hirschsprung’s disease
  • Using suppositories 

Author

Dr Simon Smale is a consultant gastroenterologist at Manchester University NHS Foundation Trust

How common is constipation? Why is it twice as common in women, and for what proportion of the population is it a chronic condition?

Constipation is a symptom-defined condition that is characterised by disordered defaecation, difficulty passing stools and often a sensation of incomplete emptying. Hard, infrequent stools are typical. In any given year 10-15% of the population will have an episode of constipation, although many never present to doctors and might self-medicate. Often acute constipation may be provoked by an intercurrent illness, a long journey or a short period of immobility. Such episodes often resolve without resorting to the GP and patients may not even visit the pharmacy, preferring remedies such as prunes.

In the general population, 1-2% will consult their GP, making the GP prevalence approximately 10-15 patients per 1,000 people. While some of this constipation may be acute, much will be chronic. This often reflects slow colonic transit, sometimes in combination with poor dietary and lifestyle habits.

Constipation appears to be commoner in women. This may be because of the pelvic anatomy, or because of the disruption that may follow childbirth and associated dysfunction of the defaecatory mechanisms. In such individuals it is worth considering treatment such as biofeedback.

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