Bowels – quick and slow

Diarrhoea

• Increased stool water and hence stool volume e.g. >200ml per day

Tests

• Bloods
  • FBC – iron deficiency, increased MCV in coeliac disease, increased alcohol and ileal Crohn’s
  • U&Es – reduced K+
  • ESR – raised in cancer and IBD
  • CRP – raised in infection and IBD
  • TSH – thyrotoxicosis?
  • Coeliac serology
• Consider stool culture

Management

• Treat cause
• Give oral rehydration if possible
• Codeine phosphate or loperimide

Constipation

• It is essential to do a PR

Causes;

• General;
  • Poor diet
  • Dehydrtation
  • Immobility
  • Irritable bowel disease
• Anorectal disease
  • Anal fissure
  • Anal stricture
  • Rectal prolapse
• Intestinal obstruction
  • Colorectal carcinoma
  • Strictures
  • Pelvic masses
  • Pseudo-obstruction
• Metabolic/endocrine
  • Hypothydroidism
  • Hypocalcaemia
  • Hypokalaemia
• Drugs
  • Opiates
  • Iron
  • Anticholinergics
• Neuromuscular causes;
  • Spinal or pelvic nerve injury
  • Diabetic neuropathy
  • Aganglionosis
  • Systemic sclerosis

• Generally reassure. It is time to get worried when the patient is >40, there is a change in bowel habit and there are associated symptoms

Investigations

• Bloods – FBC, U&Es, Calcium, TFTs
• Sigmoidoscopy
• Barium enema
• Colonoscopy