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