CONSTIPATION Causes Risk Factors and Constipation Treatment Management

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

CONSTIPATION Causes Risk Factors and Constipation Treatment Management


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

Constipation diet

CONSTIPATION Causes Risk Factors and Constipation Treatment Management


List of all Main laxatives for treatment of constipation —

Laxative Usual adult dose Onset of action Side effects
Bulk-forming laxatives
Psyllium Up to 1 tablespoon 3 times/day 12 to 72 h Impaction above strictures, fluid overload, gas and bloating
Methylcellulose Up to 1 tablespoon 3 times/day 12 to 72 h Impaction above strictures, fluid overload, gas and bloating
Calcium polycarbophil 2 to 4 tabs/day 24 to 48 h Impaction above strictures, fluid overload, gas and bloating
Wheat dextrin 1 to 6 caplets daily (3 to 18 g fiber) 24 to 48 h Impaction above strictures, fluid overload, gas and bloating
Emollients (softeners)
Docusate sodium 100 mg 2 times/day 24 to 72 h Skin rash
Osmolar agents
Polyethylene glycol 8.5-34 g in 240 mL liquids 2 to 4 days Nausea, bloating, cramping
Lactulose 15 to 30 mL every other day, or 2 times/day 24 to 48 h Abdominal bloating, flatulence
Sorbitol 120 mL of 25 percent solution 1 time/day 24 to 48 h Abdominal bloating, flatulence
Glycerine 3 g suppository 1 time/day 15 to 60 min Rectal irritation
Magnesium sulfate 15 g 1 time/day 0.5 to 3 h Magnesium toxicity (with renal insufficiency)
Magnesium citrate 200 mL 1 time/day 0.5 to 3 h
Stimulant laxatives
Bisacodyl 10-30 mg po 1 time/day 6 to 10 h Gastric irritation
10 mg suppository 1 time/day 15 to 60 min
Senna 2 to 4 tabs 1 time/day 6 to 12 h Melanosis coli
New agents
Lubiprostone 24 micrograms 2 times/day 1 to 2 days Nausea, diarrhea
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