CONSTIPATION Causes Risk Factors and Constipation Treatment Management

CONSTIPATION

• Constipation is a decrease in frequency of passage of stools to less than 3 per week, passage of hard stools, with straining, abdominal fullness and a sense of in­complete evacuation.
• hard stools, excessive straining, prolonged time spent on the toilet, a sense of incomplete evacuation, and abdominal discomfort/bloating.
• A group of syndromes with similar findings that include unsatisfactory defecation characterized by infrequent stools, difficult stool passage, or both. Characteristics include fewer than 3 bowel movements a week

Constipation Causes

• · Colonic obstruction – neoplasm, stricture
• · Medications
• · Anal fissures
• · Irritable bowel syndrome
• · Rectal prolapse
• · Hypothyroidism
• · Pregnancy
• · Depression
• · Parkinsonism.

Constipation Risk Factors

• Extremes of life (very young and very old)
• Polypharmacy
• Sedentary lifestyle or condition
• Improper diet and inadequate fluid intake

Constipation Etiology

• Constipation may be conceptually regarded as disordered movement of stool through the colon or anorectum since, with few exceptions, transit through the proximal gastrointestinal tract is often normal
• Primary constipation:
  • Slow colonic transit time (13%)
  • Pelvic floor/anal sphincter dysfunction (25%)
  • Functional—normal transit time and sphincter function, yet problems (bloating, abdominal discomfort, perceived difficulty going, presence of hard stools) (69%)
• Secondary constipation:
  • Diseases associated with constipation include neurologic and metabolic disorders, obstructing lesions of the gastrointestinal tract, including colorectal cancer, and endocrine disorders such as diabetes mellitus
  • Irritable bowel syndrome (IBS)
  • Endocrine dysfunction (diabetes mellitus, hypothyroid)
  • Metabolic disorder (increased calcium, decreased potassium)
  • Colonic and anorectal motor functions are coordinated by enteric, sympathetic, and parasympathetic nerves.
  • Mechanical (obstruction, rectocele)
  • Pregnancy
  • Neurologic disorders (Hirshsprung, multiple sclerosis, spinal cord injuries)
• Severe idiopathic chronic constipation —
  • Patients may complain of infrequent defecation, excessive straining when defecating, or both; these symptoms often fail to improve with fiber supplements or mild laxatives.
  • Severe idiopathic chronic constipation in adults is predominantly a disease of women

Constipation Epidemiology

• Prevalence rates have been lower in studies using Rome II criteria to define constipation compared with studies based upon self-reporting.
• A systematic review estimated that 63 million people in North America fulfilled the Rome II criteria for constipation
• Predominant age: May affect all ages, but more pronounced in children and elderly
• Predominant sex: Female > Male 2:1
• Non-whites > whites
• The prevalence of chronic constipation rises with age, most dramatically in patients 65 years of age or older

Constipation Associated Conditions

• Debility, either general as in the aged or that imposed by specific underlying illness
• Dehydration
• Hypothyroidism
• Hypokalemia
• Hypercalcemia

Constipation Treatment

• Counselling Laxatives Colectomy
• Biofeedback techniques Yoga. Management of dyssynergic defecation involves biofeedback, relaxation exercises, and suppository programs.
• Management of chronic constipation due to slow transit includes patient education, behavior modification, dietary changes, and drug therapy.
• Bulking agents (need to be accompanied by adequate amounts of liquid to be useful)
• dose response between fiber intake, water intake, and fecal output,The recommended amount of dietary fiber is 20 to 35 g/day.

Osmotic laxatives:

• Polyethylene glycol (MiraLax) (0.8 mg/kg/d) 17 g daily
• Saccharines Lactulose (Chronulac) 15–60 ml q.h.s. (flatulence, bloating, cramping side effects)
• Sorbitol 15–60 ml q.h.s. (as effective as lactulose)
• Magnesium salts (Milk of Magnesia) avoid in renal insufficiency

List of all Main laxatives for treatment of constipation —