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Pathology
Defined as hard stools with straining on defecation, sensation of incomplete evacuation and fewer than three defecations per week
Aetiology
Increased age, inadequate fibre, drugs (opiates, anticholinergics, iron), slow bowel transit, constipation, spinal cord lesions, Hirschsprung’s disease, Chagas’ disease, autonomic neuropathy, hypothyroidism, hypercalcaemia, hypopituitarism, Addison’s disease
Signs
Tenesmus.
Symptoms
Straining, sensation of incomplete evacuation, requiring manoeuvres to open bowels, manual evacuation
Investigations
Bloods: FBC, U&E, LFT, TFTs and Calcium
Imaging: Colonic transit study
Treatment
Conservative: Lifestyle advice and increased dietary fibre
Medical: Laxatives
Prognosis
Good prognosis with treatment
Anal fissure, chronic haemorrhoids, faecal impaction
Key Facts
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Key References
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