Presentation will be pregnant lady having constipation
Take hx of presenting complaint
Fresh blood? Or blood mixed with stool? Pain?
All the obs questions
Hows pregnancy goimg? Baby kicks? Nausea vomiting? Diet? Tummy pain?
Water intake? Fibre intake?
Explore constipation
How many times they pass stool? Consistency? In between dairheaa?
ICE
PAF
Will have hx of haemorrhoids
How coping up?
What strategies they have tried so far?
Thn proceed to examination
If they say its so painful i dont want respect them but always first proceed n make sure i will try to be as gentle as we can
There will be a tear in anal muscle
Treatment conservative
Lignocaine gel
GTN gel
Deitary changes if you found any in hx
Increase water intake n fibre
Also laxatives if severe constipation
Adress concerns!
