Constipation is infrequent or hard to pass bowel movements (fewer than three bowel movements per week). This could be multifactorial but predominantly influenced by food, lifestyle, medications and certain bowel conditions. It is extremely important to rule out intestinal obstruction before treating constipation.
Medications:
- Eva Q fiber granules (Lactitol 10 gm; Isapghula 3.5 mg) 15 grams in one glass of water, two hours after dinner for 3 nights.
- If no relief – Syrup Cremaffin Plus (Liquid paraffin, Magnesium hydroxide, Sodium picosulfate) – 10 mls 2 hours after dinner on as needed basis (do not combine with Lactitol and Isapghula).
General advice:
- Drink at least 2 litres of water per day.
- Ensure high fibre diet and reduce processed foods.
- Reduce medicines which reduce gastro-intestinal motility.
- Avoid coffee and tea.
- Advice regular exercise.
Investigations:
- TSH – hypothyroidism can cause chronic constipation.
- Serum electrolytes – to monitor electrolyte imbalance due to excessive laxatives.
- Serum calcium – if raised then rule out malignancy.
- Upright X ray of abdomen – to identify multiple air fluid levels which can suggest intestinal obstruction.
- CT abdomen – to rule out abdominal mass and intestinal obstruction.
- Colonoscopy – to rule out malignancy.
Referral:
Consider referral to gastroenterologist if patient fails to respond or presents with additional complications. Consider urgent referral if constipation is associated with weight loss, fever, evidence of intestinal obstruction or bleeding.