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Constipation
ICD-10 K590
ICD-9 564.0
OMIM [1]
DiseasesDB 3080
MedlinePlus 003125
eMedicine med/2833
MeSH {{{MeshNumber}}}


This is a background article. See

Main article: Psychological aspects of constipation

Constipation or irregularity, is a condition of the digestive system where a person (or animal) experiences hard feces that are difficult to eliminate; it may be extremely painful, and in severe cases (fecal impaction) lead to symptoms of bowel obstruction. Obstipation refers to severe constipation. Causes of constipation may be dietary, hormonal, a side effect of medications, an illness or disorder, and anatomical. Treatment is with a change in dietary and exercise habits.

Signs and symptomsEdit

Bristol Stool Chart

Types 1 and 2 on the Bristol Stool Chart indicate constipation

In common constipation, the stool is hard and difficult to pass. Usually, there is an infrequent urge to void. Straining to pass stool may cause hemorrhoids and anal fissures. In later stages of constipation, the abdomen may become distended and diffusely tender and crampy, occasionally with enhanced borborygmus {bowel sounds}.

While many feel that one should have a bowel movement every day, some people may only feel the need to defecate one to three times a week. Medical authorities seem to accept wide variations in toilet frequency as long as this does not cause any other symptoms. Defecating depends on dietary habits, exercise, fluid intake, and various other factors.

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.

Constipation in children can lead to soiling (enuresis and encopresis).

DiagnosisEdit

The diagnosis of constipation 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.[How to reference and link to summary or text]

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).[How to reference and link to summary or text] Rarely, other symptoms suggestive of hypothyroidism may be elicited.[How to reference and link to summary or text]

During physical examination, scybala (manually palpable lumps of stool) may be detected when a diagnostician presses on 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, and whether any tumors or abnormalities are present.

X-rays of the abdomen, generally only performed on hospitalized patients, 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.[1]

Gastro psychology
Brain animated color nevit

Specialities
Functional gastrointestinal disorder
Other disorders
Related topics

CausesEdit

The main causes of constipation include:

TreatmentEdit

In people without medical problems, the main intervention is the increase of fluids (preferably water) and dietary fiber. The latter may be achieved by consuming more vegetables and fruit, whole meal bread 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.

Laxatives may be necessary in people in whom dietary intervention is not effective or is inappropriate. Stimulant laxatives (e.g. senna) are generally avoided, as they may worsen crampy sensations commonly experienced in constipation. 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. 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.

Constipation that resists all the above measures requires physical intervention. Manual disimpaction (the physical removal of impacted stool) is done by patients who have lost control bowels secondary to spinal injuries. Manual disimpaction is also a used by physicians and nurses to relieve rectal impactions. Finally, manual disimpaction can occasionally be done under sedation or a general anesthetic—this avoids pain and loosens the anal sphincter.

In alternative and traditional medicine, colonic irrigation, enemas, exercise, diet and herbs are used to treat constipation.

Constipation is usually easier to prevent than to treat. The relief of constipation with osmotic agents, i.e. lactulose, Polyethyleneglycol(PEG), or magnesium salts, should immediately be followed with prevention using increased fiber(fruits and vegetables) 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.[[#fn_{{{1}}}|{{{1}}}]]


In animalsEdit

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.

See alsoEdit

ReferencesEdit

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