Constipation

Constipation is a common gastrointestinal symptom due to the absence of peristaltic activity in the colon. A person is considered constipated if there is less than 3 bowel movements a week. Increased incidence in older persons.

Aetiology:
Most cases are due to a simple inadequate intake of dietary fibre or dehydration.
Increased risk in those with lack of exercise or poor mobility, especially if bedridden.
Higher levels of stress, anxiety and depression increase the risk.
Chronic disease: GI disease (irritable bowel syndrome, hernia’s, diverticulosis, neoplasms; celiac disease); neurological diseases (multiple sclerosis, Parkinson’s disease); psychiatric conditions (stress, depression); metabolic (hypokalaemia, diabetes mellitus, hypothyroidism)
Drugs: analgesics (eg codeine, morphine); antihistamines; tricyclic antidepressants; MAOI’s; antihypertensives; NSAID’s; antacids; anticholinergics

Clinical features:
Constipation is a subjective complaint that varies from person to person in its presentation.
Three or less stools per week; lumpy or hard stools; difficulty passing stools; straining to have bowel movements.
Can also have: nausea; ‘bloated’ feeling; cramping.

Complications: hemorrhoids; anal fissures; fecal impaction; rectal prolapse.

Diagnosis:
Important to distinguish an evacuation disorder (functional outlet obstruction) from a constipation that results from a slow transit or other causes.

Treatment:
Management of underlying cause.
Initially may need physical disimpaction and enemas.
Dietary changes: increase in daily intake of fibre; decrease in fats, especially cheese; increased fluid intake
Regular exercise
Laxatives (eg methylcellulose); stool softeners (eg dioctyl sodium sulfosuccinate)
Refractory and severe cases may need surgery

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