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DEESHAN RAJ SIVASANKER 082013100017 IMS BANGALORE
CONSTIPATION
LEARNING OUTCOMES WHAT IS CONSTIPATION ???
CLASSIFICATION OF CONSTIPATION
CAUSES OF CONSTIPATION
TREATMENTS
WHAT IS CONSTIPATION Failure of voiding of feces , hence
producing discomfort Constipation is defined as having 2 or
more of following symptoms for 12 weeks :
1) Infrequent passage of stools (<3 weeks)
2) Passage of hardstool3) Incomplete evacuation 4) Sensation of anorectal blockage
CLASSIFICATION OF CONSTIPATION
Constipation can be classified into 3 broad classification :
1) Normal Transit Through The Colon(59%)
2) Defecatory Disorders(25%) 3) Slow Transit(13%)
NORMAL – TRANSIT CONSTIPATION Stool traverses the colon at normal rate
Stool frequency is normal
Patients yet believes they are constipated
OCCURANCE -Due to perceived difficulties of evacuation or passage of hard stools
SLOW – TRANSIT CONSTIPATION Occurs predominantly in young women with
infrequent bowel movements
Condition often starts at puberty
The symptoms are :1) Infrequent Urge to Defecate 2) Bloating 3) Abdominal Pain 4) Discomfort
Patients with severe slow – transit constipation have delayed Emptying of Proximal Colon
Consistent with diagnosis of Chronic Idiopathic Intestinal Pseudo - Obstruction
DEFECATORY DISORDERS Due to ‘Paradoxical’ Contraction of the
Puborectalis & External Anal Sphincter
Hence preventing evacuation of stool
Due to dysfunction of Anal Sphincter & Pelvic Floor
Anterior Rectocele
Weakness of Rectovaginal Septum
Resulting in Protuberance of Anterior Wall
Hence Trapping of Stool
Impeding the passage of Stool , due to prolapse of mucosa of Anterior Rectal Wall
Rectum becomes unduly
sensitiveDue to presence of small amount
of Stool
Resulting in urge to pass small volume of stools
Sensation of Incomplete Evacuation
CAUSES OF CONSTIPATION Causes of constipation are : A)General i)Pregnancy ii)Inadequate Fiber Intake iii)Immobility B)Metabolic/Endocrine i)Diabetes Mellitus ii)Hypothyroidism iii)Porphyria
C)Functional i)Irritable Bowel Syndrome ii)Idiopathic Slow Transmit D)Physiological i)Depression ii)Anorexia E)Neurological i)Spinal Cord Lesions ii)Parkinson’s Disease
F)Drugs i)Calcium – Channel Blockers ii)Iron G)Gastrointestinal Disease i)Intestinal Obstruction & Pseudo Obstruction ii)Colonic Disease eg : Carcinoma & Diverticula Disease iii)Painful Anal conditions , Anal Fissure
TREATMENTS Patients with Normal & Slow Transit
Constipation – Increasing Fiber content in Diet in conjunction with Increasing Fluid Intake
Osmotic laxative - increases colonic inflow of fluid & electrolytes - stimulates colonic contractility - softens the stool
Patients With Defecatory Disorders -referred to Specialist Centre as Surgery maybe indicated -eg : Anterior Rectocele
LAXATIVE & ENEMAS A)Bulk – Forming Laxatives i)Dietary Fibers ii)Wheat Bran iii)Methylcellulose B)Osmotic Laxative i)Magnesium Sulphate ii)Lactulose
C)Enemas i)Arachis Oil ii)Hypertonic Phosphate iii)Sodium Citrate
REFERENCE KUMAR & CLARCK’S , CLINICAL
MEDICINE , PUBLISHED BY ELSEVIER , SEVENTH EDITION , UK
GUYTON & HALL , TEXTBOOK OF MEDICAL PHYSIOLOGY , PUBLISHED BY ELSEVIER , A SOUTH ASIAN EDITION
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