Constipation (Chronic)
Evaluation
General—Rome II diagnostic criteria necessitates two or more of the following for ≥12 weeks in the past year:
Straining during ” class=LK href=”javascript:void(0)” target=right xpath=”/CT{06b9ee1beed59419a81e5e1e1a4f60b0cc8cd1057525de73425b2b43f4df7f1b8d46dc14f08b72e3e54f2ce1a6e3642e}/ID(AB1-M10)”>>25% of bowel movements (BMs)
Hard stools for ” class=LK href=”javascript:void(0)” target=right xpath=”/CT{06b9ee1beed59419a81e5e1e1a4f60b0cc8cd1057525de73425b2b43f4df7f1b8d46dc14f08b72e3e54f2ce1a6e3642e}/ID(AB1-M10)”>>25% of BMs
Sensation of incomplete evacuation for ” class=LK href=”javascript:void(0)” target=right xpath=”/CT{06b9ee1beed59419a81e5e1e1a4f60b0cc8cd1057525de73425b2b43f4df7f1b8d46dc14f08b72e3e54f2ce1a6e3642e}/ID(AB1-M10)”>>25% of BMs
Sensation of anorectal blockage for ” class=LK href=”javascript:void(0)” target=right xpath=”/CT{06b9ee1beed59419a81e5e1e1a4f60b0cc8cd1057525de73425b2b43f4df7f1b8d46dc14f08b72e3e54f2ce1a6e3642e}/ID(AB1-M10)”>>25% of BMs
Manual maneuvers to assist with ” class=LK href=”javascript:void(0)” target=right xpath=”/CT{06b9ee1beed59419a81e5e1e1a4f60b0cc8cd1057525de73425b2b43f4df7f1b8d46dc14f08b72e3e54f2ce1a6e3642e}/ID(AB1-M10)”>>25% of BMs
Epidemiology—3♀: 1♂; nonwhites ” class=LK href=”javascript:void(0)” target=right xpath=”/CT{06b9ee1beed59419a81e5e1e1a4f60b0cc8cd1057525de73425b2b43f4df7f1b8d46dc14f08b72e3e54f2ce1a6e3642e}/ID(AB1-M10)”>> whites; elderly ” class=LK href=”javascript:void(0)” target=right xpath=”/CT{06b9ee1beed59419a81e5e1e1a4f60b0cc8cd1057525de73425b2b43f4df7f1b8d46dc14f08b72e3e54f2ce1a6e3642e}/ID(AB1-M10)”>> young adults
Risk factors—inactivity, low income, limited education, sexual abuse history, and major depression
Classification
Normal-transit constipation—most common type
Clinical
BMs have a normal frequency, yet patients perceive being constipated.
Usually have hard stools, bloating, and abdominal discomfort.
Treatment—use dietary fiber. May add an osmotic laxative if needed.
Defecatory disorders (anismus)
Clinical
It is usually due to pelvic floor or anal sphincter dysfunction.
May result from resisting urge to defecate, structural abnormality, and so on.
Some patients have a history of abuse or an eating disorder.
Slow-transit constipation
Clinical—often starts at puberty and seen in ♀ who have infrequent BMs (<A onclick="get_content(event,'AB1-M12'); return false;" onmouseover="window.status=this.title; return true;" onmouseout="window.status=''; return true;" title="<1/week).
Pathology—some studies have shown alteration in myenteric plexus neurons.
Treatment—dietary fiber.
Differential diagnosis
Primary constipation
Functional (irritable bowel syndrome [IBS], anismus, slow-transit constipation, etc.)
Structural—obstructive (Crohn’s disease, colon cancer, stricture, etc.)
Gynecologic (pelvic relaxation, large rectocele, etc.)
Neuropathic (Hirschsprung’s disease, spinal cord injury, etc.)
Secondary constipation
Endocrine and metabolic (diabetes mellitus, hypothyroidism, hypercalcemia, pregnancy, etc.)Related posts:
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