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20-September-2008 09:55:47 - Constipation Constipation Classification and external resources ICD-10 K59.0 ICD-9 564.0 DiseasesDB 3080 MedlinePlus 003125 eMedicine med/2833 MeSH D003248 Constipation, costiveness, or irregularity, is a condition of the digestive system in which a person or animal experiences hard feces that are difficult to expel. This usually happens because the colon absorbs too much water from the food. If the food moves through the gastro-intestinal tract too slowly, the colon may absorb too much water, resulting in feces that are dry and hard. Defecation may be extremely painful, and in severe cases fecal impaction lead to symptoms of bowel obstruction. The term obstipation is used for severe constipation that prevents passage of both stools and gas. Causes of constipation may be dietary, hormonal, anatomical, a side effect of medications e.g. some painkillers, or an illness or disorder. Treatments consist of changes in dietary and exercise habits, the use of laxatives, and other medical interventions depending on the underlying cause. Contents 1 Signs and symptoms 2 Diagnosis 3 Causes 4 Treatment 4.1 Laxatives 4.2 Physical intervention 5 Prevention 6 Epidemiology 7 In animals 8 See also 9 References 10 External links Signs and symptoms Types 1 and 2 on the Bristol Stool Chart indicate constipation Types 1 and 2 on the Bristol Stool Chart indicate constipation In common constipation, the stool is hard, difficult, and painful to pass. Usually, there is an infrequent urge to void. Straining to pass stool may cause hemorrhoids and anal fissures, which are painful in themselves. In later stages of constipation, the abdomen may become distended and diffusely tender and crampy, occasionally with enhanced bowel sounds. The definition of constipation includes the following:1 infrequent bowel movements typically three times or fewer per week difficulty during defecation straining during more than 25% of bowel movements or a subjective sensation of hard stools, or the sensation of incomplete bowel evacuation. Severe cases fecal impaction may feature symptoms of bowel obstruction vomiting, very tender abdomen and paradoxical diarrhea, where soft stool from the small intestine bypasses the impacted matter in the colon. Diagnosis The diagnosis is essentially made from the patient's description of the symptoms. Bowel movements that are difficult to pass, very firm, or made up of small rabbit-like pellets qualify as constipation, even if they occur every day. Other symptoms related to constipation can include bloating, distention, abdominal pain, or a sense of incomplete emptying.2 Inquiring about dietary habits may reveal a low intake of dietary fiber or inadequate amounts of fluids. Constipation as a result of poor ambulation or immobility should be considered in the elderly. Constipation may arise as a side effect of medications especially antidepressants and opiates.citation needed Rarely, other symptoms suggestive of hypothyroidism may be elicited.citation needed During physical examination, scybala manually palpable lumps of stool may be detected on palpation of the abdomen. Rectal examination gives an impression of the anal sphincter tone and whether the lower rectum contains any feces or not; if so, then suppositories or enemas may be considered. Otherwise, oral medication may be required. Rectal examination also gives information on the consistency of the stool, presence of hemorrhoids, admixture of blood and whether any tumors or abnormalities are present. X-rays of the abdomen, generally only performed on hospitalized patients or if bowel obstruction is suspected, may reveal impacted fecal matter in the colon, and confirm or rule out other causes of similar symptoms. Chronic constipation symptoms present for more than 3 months at least 3 days per month associated with abdominal discomfort is often diagnosed as irritable bowel syndrome IBS when no obvious cause is found. Physicians caring for patients with chronic constipation are advised to rule out obvious causes through normal testing.3 Colonic propagating pressure wave sequences PSs are responsible for discrete movements of content and are vital for normal defaecation. Deficiencies in PS frequency, amplitude and extent of propagation are all implicated in severe defecatory dysfunction. Mechanisms that can normalise these aberrant motor patterns may help rectify the problem. Recently the novel therapy of sacral nerve stimulation SNS has been utilized for the treatment of severe constipation. 4 Causes The main causes of constipation include: Hardening of the feces Improper mastication chewing of food Insufficient intake of dietary fiber Dehydration from any cause or inadequate fluid intake Medication, e.g. diuretics and those containing iron, calcium, aluminum Paralysis or slowed transit, where peristaltic action is diminished or absent, so that feces are not moved along Hypothyroidism underactive thyroid gland Hypokalemia Injured anal sphincter patulous anus Medications, such as loperamide, opioids e.g. codeine morphine and certain tricyclic antidepressants Severe illness due to other causes Acute porphyria a rare inherited condition Lead poisoning Dyschezia usually the result of suppressing defecation Constriction, where part of the intestine or rectum is narrowed or blocked, not allowing feces to pass Stenosis Strictures Diverticula Tumors, either of the bowel or surrounding tissues Obstructed defecation, due to: Mechanical causes from morphological abnormalities of the anorectum including megarectum, rectal prolapse, rectocele, and enterocele Functional causes from neurological disorders and dysfunction of the pelvic floor muscles or anorectal muscles, including anismus, descending perineum syndrome, and Hirschsprung's disease Retained foreign body or a bezoar Psychosomatic constipation, based on anxiety or unfamiliarity with surroundings. Functional constipation Constipation-predominant irritable bowel syndrome, characterized by a combination of constipation and abdominal discomfort and/or pain5 Smoking cessation nicotine has a laxative effect6 Abdominal surgery, other types of surgery, childbirth Treatment In people without medical problems, the main intervention is to increase the intake of fluids preferably water and dietary fiber. The latter may be achieved by consuming more vegetables and fruit and whole meal bread, and pulses such as baked beans and chick peas and by adding linseeds to one's diet. The routine non-medical use of laxatives is to be discouraged as this may result in bowel action becoming dependent upon their use. Enemas can be used to provide a form of mechanical stimulation. However, enemas are generally useful only for stool in the rectum, not in the intestinal tract. Lactulose, a non absorbable synthetic sugar that keeps sodium and water inside the intestinal lumen, relieves constipation. It can be used for months together. Among the other safe remedies, fiber supplements, lactitiol, sorbitol, milk of magnesia, lubricants etc. may be of value. Electrolyte imbalance e.g. Hyponatremia may occur in some cases especially in diabetics. In alternative and traditional medicine, colonic irrigation, enemas, exercise, diet and herbs are used to treat constipation. The mechanism of the herbal, enema, and colonic irrigation treatments often include the breakdown of impacted and hardened fecal matter. Laxatives Main article: laxative Laxatives may be necessary in people in whom dietary intervention is not effective or is inappropriate. Most laxatives can be safely used long-term, although some are associated with cramping and bloatedness and can cause the phenomenon of melanosis coli. Physical intervention Constipation that resists all the above measures requires physical intervention. Manual dissimpaction the physical removal of impacted stool is done for those patients who have lost control of their bowels secondary to spinal injuries. Manual dissimpaction is also used by physicians and nurses to relieve rectal impactions. Finally, manual dissimpaction can occasionally be done under sedation or a general anesthetic-this avoids pain and loosens the anal sphincter. Many of the products are widely available over-the-counter. Enemas and clysters are a remedy occasionally used for hospitalized patients in whom the constipation has proven to be severe, dangerous in other ways, or resistant to laxatives. Sorbitol, glycerin and arachis oil suppositories can be used. Severe cases may require phosphate solutions introduced as enemas. Prevention Constipation is usually easier to prevent than to treat. The relief of constipation with osmotic agents, i.e. lactulose, polyethylene glycol PEG, or magnesium salts, should immediately be followed with prevention using increased fiber fruits, vegetables, and grains and a nightly decreasing dose of osmotic laxative. With continuing narcotic use, for instance, nightly doses of osmotic agents can be given indefinitely without harm to cause a daily bowel movement. Recent controlled studies have questioned the role of physical exercise in the prevention and management of chronic constipation, while exercise is often recommended by published materials on the subject.7 In various conditions such as the use of codeine or morphine, combinations of hydrating e.g. lactulose or glycols, bulk-forming e.g. psyllium and stimulant agents may be necessary to prevent constipation. Epidemiology Depending on the definition employed, constipation occurs in 2% of the population; it is more common in women, the elderly and children. 8 In animals Hibernating animals can experience tappens that are usually expelled in the spring. For example, bears eat many foods that create a rectal plug before hibernation. Canines may also experience constipation, which they usually attempt to rectify by ingesting grass and other plant materials. See also Defecation Diarrhea Feces References ^ Emedicine, constipation. ^ MedicineNet ^ Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC 2006. Functional bowel disorders. Gastroenterology 130 5: 1480-91. doi:10.1053/j.gastro.2005.11.061. PMID 16678561. ^ Philip G. Dinning 2007. Colonic manometry and sacral nerve stimulation in patients with severe constipation. Pelviperineology 26 3: 114-116. 1 ^ Caldarella MP, Milano A, Laterza F, et al 2005. Visceral sensitivity and symptoms in patients with constipation- or diarrhea-predominant irritable bowel syndrome IBS: effect of a low-fat intraduodenal infusion. Am. J. Gastroenterol. 100 2: 383-9. doi:10.1111/j.1572-0241.2005.40100.x. PMID 15667496. ^ Nicotine withdrawal symptoms:Constipation. helpwithsmoking.com 2005. Retrieved on 2007-06-29. ^ MESHKINPOUR H. ; SELOD S. ; MOVAHEDI H. ; NAMI N. ; JAMES N. ; WILSON A. ; 1998. Effects of regular exercise in management of chronic idiopathic constipation. Digestive diseases and sciences 43 11: 2379-2383. ISSN 0163-2116. ^ Sonnenberg A, Koch TR 1989. Epidemiology of constipation in the United States. Dis. Colon Rectum 32 1: 1-8. doi:10.1007/BF02554713. PMID 2910654. External links 09-129b. at Merck Manual of Diagnosis and Therapy Home ion MedlinePlus Overview constipation Constipation Guideline - the World Gastroenterology Organisation WGO Constipation Information v d e Digestive system - Digestive disease - Gastroenterology primarily K20-K93, 530-579 Upper GI tract Esophagus Esophagitis Candidal - Boerhaave syndrome - UES Zenker's diverticulum - LES Barrett's esophagus, Mallory-Weiss syndrome - Esophageal motility disorder Nutcracker esophagus, Achalasia, Diffuse esophageal spasm, GERD - Esophageal stricture Stomach Peptic gastric ulcer - Gastritis Atrophic, Ménétrier's disease - Gastroenteritis - Dyspepsia - Pyloric stenosis - Achlorhydria - Gastroparesis - Gastroptosis - Portal hypertensive gastropathy - Gastric antral vascular ectasia - Gastric dumping syndrome Intestinal Duodenum/ileum Peptic duodenal ulcer - Duodenitis - Ileitis Enteritis colitis/ enterocolitis noninfective: IBD Crohn's disease, Ulcerative colitis - noninfective gastroenteritis infective: Pseudomembranous colitis Vascular Abdominal angina - Mesenteric ischemia - Ischemic colitis - Angiodysplasia Malabsorption Coeliac - Tropical sprue - Blind loop syndrome - Whipple's - Short bowel syndrome - Steatorrhea Motility/ functional Ileus/Bowel obstruction Intussusception, Volvulus - Constipation - Diarrhea Functional colonic disease IBS, Intestinal pseudoobstruction/Ogilvie syndrome Rectum/anus Proctalgia fugax - Anal fissure/Anal fistula - Anal abscess - Rectal prolapse - Proctitis Radiation proctitis Other Diverticulitis/Diverticulosis - Megacolon/Toxic megacolon - Appendicitis Accessory Liver Hepatitis Viral hepatitis, Autoimmune hepatitis, Alcoholic hepatitis - Cirrhosis PBC - Fatty liver NASH - vascular Hepatic veno-occlusive disease, Portal hypertension, Nutmeg liver - Alcoholic liver disease - Liver failure Hepatic encephalopathy, Acute liver failure - Liver abscess - Hepatorenal syndrome - Peliosis hepatis Gallbladder Gallstones - common bile duct Choledocholithiasis, Biliary dyskinesia - Cholecystitis - Cholesterolosis - Rokitansky-Aschoff sinuses - Postcholecystectomy syndrome Biliary tree Cholangitis PSC, Ascending - Cholestasis/Mirizzi's syndrome - Biliary fistula - Haemobilia Pancreatic Pancreatitis Acute, Chronic, Herary - Pancreatic pseudocyst - Exocrine pancreatic insufficiency - Pancreatic fistula Hernia Diaphragmatic: Congenital diaphragmatic - Hiatus Abdominal hernia: Inguinal Indirect, Direct - Umbilical - Incisional - Femoral Obturator hernia Peritoneal Peritonitis Spontaneous bacterial peritonitis - Hemoperitoneum - Pneumoperitoneum GI bleeding Upper Hematemesis, Melena - Lower Hematochezia See also congenital, neoplasia Retrieved from http://en..org/wiki/Constipation Categories: General practice | Gastroenterology | Feces | Water-borne diseases | Symptoms | Digestive disease symptoms | Conditions diagnosed by stool testHidden categories: All articles with statements | Articles with statements since February 2007 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages العربية БългарÑ?ки ÄŒesky Deutsch Español Ù?ارسی Français í•œêµì–´ हिनà¥?दी Hrvatski Bahasa Indonesia Italiano עברית Lietuvių Nederlands 日本語 ‪Norsk bokmÃ¥l‬ ‪Norsk nynorsk‬ Polski Português Runa Simi РуÑ?Ñ?кий Simple English Suomi Svenska తెలà±?à°—à±? Türkçe УкраїнÑ?ька ä¸æ–‡ This page was last modified on 12 August 2008, at 23:20
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