Constipation
Description General Measures Medicine Treatment Referral ICD-10 code: K59.0 DESCRIPTION A condition characterised by a change in usual bowel habits, along with dry, hard stools. There is a decreased frequency of bowel action. Constipation may have many causes, including: incorrect diet (insufficient fibre and fluid) lack of exercise pregnancy old age medicines, e.g. opiates and anticholinergics i
ICD-10 code: K59.0
DESCRIPTION
- A condition characterised by a change in usual bowel habits, along with dry, hard stools.
- There is a decreased frequency of bowel action.
- Constipation may have many causes, including:
- incorrect diet (insufficient fibre and fluid)
- lack of exercise
- pregnancy
- old age
- medicines, e.g. opiates and anticholinergics
- ignoring the urge
- hypothyroidism
- neurogenic
- lower bowel abnormalities
- psychogenic disorders
- chronic use of enemas and laxatives
- bowel cancer
- behavioural problems in children
CAUTION
Be especially suspicious of a change in bowel habits in adults, as this may indicate cancer of the large bowel.
GENERAL MEASURES
- Patients should be assessed individually.
- Encourage exercise.
- Increase intake of fibre-rich food, e.g. vegetables, coarse maize meal, bran, and cooked dried prunes.
- Ensure adequate hydration.
- Encourage regular bowel habits.
- Discourage continuous use of laxatives.
- Refer people at risk of neurogenic bowel dysfunction to rehabilitation services for multidisciplinary bowel care (e.g. frail older people, postpartum women following obstetric injury, and people with neurological or spinal disease/injury, severe cognitive impairment, urinary incontinence, pelvic organ prolapse and/or rectal prolapse and who have had colonic resection or anal surgery.
MEDICINE TREATMENT
Children >12 months of age:
- Lactulose, oral, 0.5 mL/kg/dose once daily. See dosing tables.
- If poor response, increase frequency to 12 hourly.
Children > 15 years of age and adults:
- Sennosides A and B, oral, 13.5 mg, 1 tablet at night.
- Total daily dose may be increased up to 4 tablets if initial response is inadequate.
OR
- Lactulose, oral 10–20 mL once or twice daily.
CAUTION
Prolonged severe constipation may present with overflow “diarrhoea”. Rectal examination should be done in all adults.
REFERRAL
- Recent change in bowel habits.
- Faecal impaction.
- Poor response to treatment.
- Uncertain cause of constipation.
Click here for the NEMLC Recommendations for medicine amendments (2020-4 review cycle).
Standard Treatment Guidelines And Essential Medicines List For South Africa, Primary Healthcare, 2020-4_Version 1_June 2024
Chapter 2: Gastro-Intestinal Conditions, 2.8 Constipation