Chapter 14 CHALLENGING CONSTIPATION
• There are three subtypes of functional constipation (no structural or biochemical cause): slow transit constipation, pelvic floor dysfunction and normal tests (normal transit and normal pelvic floor function).
• Irritable bowel syndrome may present as normal transit constipation but abdominal pain is characteristic.
• A careful digital rectal examination should be performed to identify the presence of obstruction or abnormal pelvic floor function, as well as looking for evidence of rectal cancer.
INTRODUCTION
It is important to take a detailed history from a patient presenting with constipation and, in particular, to decide whether it is a new symptom or the first presentation of a long-term complaint. Investigations and treatment will be determined by these factors.
CONSTIPATION IN ADULTS
It is important to differentiate between two important disorders of colonic motility:
• Slow transit constipation—slower than normal movement of contents from the proximal to the distal colon and rectum
ASSESSMENT
History
• Is cereal eaten for breakfast and what type of cereal is it? (Some commercial cereals contain almost no fibre.)
• How much water, juice or tea is consumed per day? Patients are often surprised to hear that a couple of short black coffees are not sufficient fluid intake.
Simple suggestions on dietary modification can make quite a deal of difference.
Ask the patient to keep a diet diary for a few days. Most people overestimate the amount of fibre and underestimate the amount of fat they consume.
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