Constipation in adults

• Constipation (NHS Choices), Constipation (CKS), Constipation in adults (patient.info), Bristol Stool Chart (www.sthk.nhs.uk)

Constipation in children

Question

A five-year-old boy has had constipation for six months. It began when he started school.

Which SINGLE ONE of the following is NOT recommended as part of your INITIAL routine examination?

1. Observation of gait

2. Digital rectal examination

3. Lower limb strength

4. Abdominal examination

5. Height

A digital rectal examination should only be performed by clinicians competent in the recognition of Hirschsprung`s disease and anatomical abnormalities. All of the others are routinely recommended as part of the initial assessment of a child with constipation.

You see a six-week-old, bottle-fed baby girl who had previously been seen and started on treatment for constipation by another colleague four weeks ago.

Her mother is still concerned that she is struggling to open her bowels and the treatment has not helped. She was born at term and passed meconium at three days of age. She has passed stools twice a week since then. She has no abdominal distension. She is gaining weight appropriately and examination is otherwise normal.

Which is the SINGLE MOST appropriate INITIAL management step? 

1. Refer to paediatrician

2. Reassess after she is weaned

3. Refer to the health visitor

4. Reassess after changing her milk

5. Prescribe laxatives

If a child younger than one year has a diagnosis of idiopathic constipation that does not respond to optimum treatment within four weeks, refer them urgently to a healthcare professional competent to perform a digital rectal examination and interpret features of anatomical abnormalities or Hirschsprung's disease.

'Red flags' for an underlying condition rather than idiopathic constipation here include onset within the first few weeks of life and failure to pass meconium within 48 hours of birth.

Resources:

• Curriculum Topic Guides: children and young people (RCGP, 2019)

• Constipation in Children and Young People: diagnosis and management (NICE CG99 (updated 2017).

• Constipation in children (CKS)​

• Constipation in children (patient.info)

Hirschsprung's disease

• Hirschsprung's disease (NHS Choices)

​Intussusception

• Intussusception (GOSH)

Diverticular disease

• Diverticular disease (CKS)