Constipation

Clinical Description

• Absent or reduced frequency of passage of stools; when passed, stool is harder than usual. Commonly related to inadequate dietary fiber intake and/or psychological factors. Investigate and treat the underlying cause

Signs and Symptoms

• Hard stools or no passage of stools/flatus

Investigations

• Digital rectal examination
• Abdominal erect and supine x-rays

Non-pharmacological

• High residue diet e.g. papaya seeds and increased fluid intake
• Do not use oral laxatives in children. Glycerine infant and paediatric suppositories can be used in the short term.
• If increased fiber and oral fluids are insufficient to cure constipation and a laxative is considered necessary

In the event of an acute constipation that is not responding to fluids and oral laxatives, consider a soap enema.

Pharmacological

Adults

• liquid paraffin 5 -10 mls every day for 5 days OR
• bisacodyl 5-10mg nocte for 5 days
• Reserve medication for severe cases only confirmed by examination.

Alternatively

• glycerol suppositories prn

Constipation in the neonate is usually due to a significant underlying problem such as bowel atresia or Hirschsprung's disease.

If a neonate has not passed stools in the first 48 hours of life: Refer urgently for surgical and/or paediatric assessment especially if there is abdominal distension and/or vomiting

Refer all infants with constipation for specialist assessment.

• In the event of chronic constipation that is not responding to fluids and laxatives, please refer to a specialist for further investigations.