Scenarios

Scenario 9: Constipation

Martin Angelou is a 7-year-old boy who is brought to see you at the GP surgery by his mother as he has not passed stool for 6 days. Prior to that, he has been straining to pass small hard stools. He has a past medical history of constipation and has been seen by one of your colleagues in the past who has given dietary and lifestyle advice and started on maintenance Movicol treatment. This led to an improvement of his constipation, and therefore his parents did not request a repeat prescription for the Movicol when it ran out 2 months ago.

There are no concerning features in the history or examination, but you think that he currently has faecal impaction.

His details are as follows:

DOB: 14/4/07

Address: 15 Raspberry Close, Wakefield WF3 5RT

Weight:

• 1. What will you prescribe for Martin?

  Show Answer

  Correct answer:
  The NICE guidelines on 'Constipation in Children and Young People' contain helpful information on what to assess in the history and examination as well as outlining medical management, including a disimpaction regime. The same disimpaction regime is also listed in the BNFc.
  
  Martin sounds like he will require a disimpaction regime prior to restarting on maintenance medication for his constipation.
  
  Prescribe him disimpaction regime of Macrogol '3350' (brand name is Movicol Paediatric), which is four sachets on the first day, then increased in steps of two sachets per day up to a maximum of 12 sachets daily. Once disimpaction is achieved, he should switch to maintenance treatment of two sachets daily.
  
  Make sure to differentiate clearly on your prescription between the two different regimes – disimpaction and maintenance.