A 35-year-old woman, 4 weeks postpartum after an uncomplicated vaginal delivery, presents to the GP reporting she has not opened her bowels for 5 days...

Question

A 35-year-old woman, 4 weeks postpartum after an uncomplicated vaginal delivery, presents to the GP reporting she has not opened her bowels for 5 days. She has perineal discomfort from a second-degree tear repair and has been avoiding defecation due to fear of pain. Which is the single most appropriate management?

Accepted Answer

Reassure that constipation is common postpartum, advise increased fluid and fibre intake, prescribe a gentle laxative (lactulose or macrogol), and address her fear of defecation by reassuring that the perineal repair will not be damaged by normal bowel movements

Answer

Refer for a colonoscopy

Answer

Prescribe codeine for pain relief

Answer

Advise a suppository only

Answer

Advise continued avoidance of defecation until the perineum has healed

uk-drcog MCQ (SBA): Postpartum Constipation - Fear of Defecation