Definitions
‘Normal’ bowel habit varies widely from person to person. Alterations in bowel habit are common manifestations of GI disease. Constipation is defined as infrequent or difficult evacuation of faeces and can be acute or chronic. Absolute constipation is defined as the inability to pass either faeces or flatus. Diarrhoea is an increase in the fluidity of stool. Tenesmus is the sensation of incomplete or unsatisfactory evacuation, often with rectal pain/discomfort.
Key Points
- Acute constipation often indicates intestinal obstruction. The cardinal symptoms of obstruction are colicky abdominal pain, vomiting, absolute constipation and distension.
- Chronic constipation may be a lifelong problem or may develop slowly in later life.
- All alterations in bowel habit that persist must be investigated for an underlying cause – colorectal neoplasms are common causes, especially in the elderly.
- IBS is a diagnosis of exclusion and should rarely be considered for new symptoms age >55.
- Always do a PR examination and a rigid sigmoidoscopy – anorectal causes must be excluded.
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