Constipation : Definition, Symptoms, Diagnosis, And Treatment

Thursday, February 27th 2014. | Anatomy

Constipation Definition, Symptoms, Diagnosis, and Treatment

Constipation does not have a single, generally agreed upon definition Normal people pass at least three stools per week. Some of the definitions of constipation include: fewer than three stools per week for women and five for men despite a high-residue diet or a period of greater than 3 days without a bowel movement; straining at stool greater than 25% of the time and/or two or fewer stools per week; or straining at defecation and less than one stool daily with minimal effort.
Pathophysiology of Constipation:
  • Constipation is not a disease but a symptom of an underlying disease or problem.
  • Disorders of the gastrointestinal (GI) tract (e.g., irritable bowel syndrome or diverticulitis), metabolic disorders (e.g., diabetes), or endocrine disorders (e.g., hypothyroidism) may cause constipation.
  • Constipation commonly results from a diet low in fiber or from use of constipating drugs such as opiates.
  • Constipation may sometimes be psychogenic in origin.
Diseases or conditions that may cause constipation are:

Gastrointestinal disorders
  1. Gastroduodenal obstruction from ulceration or cancer
  2. Irritable bowel syndrome
  3. Diverticulitis
  4. Hemorrhoids, anal fissures
  5. Ulcerative proctitis
  6. Tumors

Metabolic and endocrine disorders
  1. Diabetes mellitus
  2. Hypothyroidism
  3. Panhypopituitarism
  4. Pheochromocytoma
  5. Hypercalcemia
Neurogenic constipation
  1. Head trauma
  2. Central nervous system tumors
  3. Stroke
  4. Parkinson’s disease
Psychogenic constipation
  1. Psychiatric disorders
  2. Inappropriate bowel habits
Causes of drug-induced constipation are :
All opiate derivatives are associated with constipation, but the degree of intestinal inhibitory effects seems to differ between agents. Orally administered opiates appear to have greater inhibitory effect than parenterally administered agents; oral codeine is well known as a potent antimotility agent.
Treatment of Constipation :
  • General measures believed to be beneficial in managing constipation include dietary modification to increase the amount of fiber consumed daily, exercise, adjustment of bowel habits so that a regular and adequate time is made to respond to the urge to defecate, and increasing fluid intake.
  • If an underlying disease is recognized as the cause of constipation, attempts should be made to correct it. GI malignancies may be removed through a surgical resection. Endocrine and metabolic derangements are corrected by the appropriate methods.
  • Potential drug causes of constipation should be identified. For some medications (e.g., antacids), nonconstipating alternatives exist. If no reasonable alternatives exist to the medication thought to be responsible for constipation, consideration should be given to lowering the dose. If a patient must remain on constipating medications, then more attention must be paid to general measures for prevention of constipation, as discussed next.
Pharmacology Therapy :
The various types of laxatives are discussed in this section. The agents are divided into three general classifications: (1) those causing softening of feces in 1 to 3 days (bulk-forming laxatives, docusates, and lactulose); (2) those that result in soft or semifluid stool in 6 to 12 hours (diphenylmethane derivatives and anthraquinone derivatives); and (3) those causing water evacuation in 1 to 6 hours (saline cathartics, castor oil, and polyethylene glycol-electrolyte lavage solution).

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