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Constipation overflow — DGM MCQ

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EasyContinenceConstipation overflowDGM

An 86-year-old man has faecal leakage and abdominal bloating. He has not passed a formed stool for a week and takes codeine for back pain. Rectal examination reveals hard stool in the rectum. Current medicines include codeine and amlodipine. What is the most likely diagnosis?

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Correct answer: E — Overflow faecal incontinence from constipation

Faecal leakage with rectal loading and opioid use suggests overflow incontinence from constipation. Gastroenteritis causes diarrhoea without faecal impaction, inflammatory bowel disease and coeliac disease are less likely at this presentation, and fissure causes pain and bleeding. Treating constipation can resolve apparent diarrhoea in frail older adults.

Reference: NICE CKS constipation; NICE CG49