Constipation (Chronic)
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Evaluation
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General—Rome II diagnostic criteria necessitates two or more of the following for ≥12 weeks in the past year:
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Sensation of incomplete evacuation for ” class=LK href=”javascript:void(0)” target=right xpath=”/CT{06b9ee1beed59419a81e5e1e1a4f60b0cc8cd1057525de73425b2b43f4df7f1b8d46dc14f08b72e3e54f2ce1a6e3642e}/ID(AB1-M10)”>>25% of BMs
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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
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Classification
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Normal-transit constipation—most common type
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Clinical
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BMs have a normal frequency, yet patients perceive being constipated.
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Usually have hard stools, bloating, and abdominal discomfort.
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Treatment—use dietary fiber. May add an osmotic laxative if needed.
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Defecatory disorders (anismus)
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Clinical
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It is usually due to pelvic floor or anal sphincter dysfunction.
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May result from resisting urge to defecate, structural abnormality, and so on.
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Some patients have a history of abuse or an eating disorder.
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Slow-transit constipation
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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).
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Pathology—some studies have shown alteration in myenteric plexus neurons.
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Treatment—dietary fiber.
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Differential diagnosis
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Primary constipation
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Secondary constipation
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Endocrine and metabolic (diabetes mellitus, hypothyroidism, hypercalcemia, pregnancy, etc.)
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