Gastrointestinal

Constipation

قبض

Passage of hard stools or difficult defecation. Check for red-alert signs before treating with lifestyle changes and laxatives.

ICD-10: —
Source: OPD handbook pp.94–97
Status: Draft

Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.

Symptoms

Hard stools / unable to pass stools for 2 days (if the patient is passing flatus, no worries)

Red flags Refer urgently if any are present

Loss of weight
Blood mixed in stools
Associated vomiting, abdominal distension, or bowel sounds not audible

Diagnosis

Palpate the abdomen for any mass
Bowel sounds: audible or not

Treatment

Step 1 of 5

1. Lifestyle modification (Urdu notes)

Drink more water
Drink a glass of water on an empty stomach in the morning and walk
Salad of vegetables, cucumber, carrot
Fruits: guava and pomegranate with seeds; melon and watermelon
Create an exercise routine
Breakfast: isphagol husk (psyllium) mixed in curd

Step 2 of 5

2. Laxatives

Sodium picosulphate: Skilax 5 mg or Laxoberon 5 mg, 2 tabs BD (as in the sample: 2+2 morning and evening; stop when motions become loose)
Lactulose: Syp Duphalac / Lilac, 2 tsf TDS

Prescription

Sodium picosulphateStimulant laxative

Dose2 tabs BD; stop if motions loosen

Brand Skilax 5 mg / Laxoberon 5 mg

Also sold as Laxoberon, Skilax

LactuloseOsmotic laxative / stool softener

Dose2 tsf TDS

Brand Syp Duphalac / Lilac

Also sold as Duphalac, Lilac

Step 3 of 5

3. Pregnant females

Duphalac is safe

Step 4 of 5

4. Paediatrics

Skilax drops, 4–6 drops orally
If the patient has a recurrent history and examination shows pallor: deworm

Prescription

Sodium picosulphateStimulant laxative

Dose4–6 drops orally

Brand Skilax drops

Also sold as Laxoberon, Skilax

Step 5 of 5

5. Deworming

Syp Albendazole 200 mg/5 mL (Zentel): if age under 2.5 years, ½ syrup (half the dose) stat and repeat the day after tomorrow; if age over 2.5 years, Syp Zentel 10 mL stat
Plus add iron and B12 supplements

Prescription

AlbendazoleAnthelmintic (deworming)

DoseUnder 2.5 y: ½ dose stat and again after 2 days; over 2.5 y: 10 mL stat

Brand Syp Zentel 200 mg/5 mL

Iron syrupOral iron

Dose1 tsf daily

Brand Syp Sangobion (iron)

B-complex syrupVitamin supplement

Dose1 tsf daily

Brand Syp Leaderplex (B-complex)

Also sold as Leaderplex, Neurobion

MultivitaminSupplement

Dose1+1 tsf

Brand Syp Vidaylin (multivitamin)

Also sold as Vidaylin, Surbex-Z, Surbex-T, Theragran

Sample prescriptions from the book (patient details removed)

Female child, difficulty passing stools and eating non-food things like clay; pallor positive (worms, constipation and anaemia): Skilax drops 4–6 drops as required; Syp Zentel 200 mg/5 mL 2 tsf tonight; Syp Sangobion 1 tsf daily; Syp Leaderplex 1 tsf daily in the evening; Syp Vidaylin 1+1 tsf; eat half an apple daily and use salad/vegetables.
Male, 18 y, difficulty passing stools with hard stool: Tab Laxoberon 5 mg 2+2 morning/evening (stop if motions become loose); drink more water; isphagol husk in curd; guava and pomegranate with seeds; salad and cucumber; a glass of water on an empty stomach in the morning then walk; exercise.