Constipation overview
|
Constipation Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Constipation On the Web |
|
American Roentgen Ray Society Images of Constipation |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Constipation or irregularity, is a condition of the digestive system where a person (or animal) experiences hard feces that are difficult to egest. It may be extremely painful, and in severe cases (fecal impaction) lead to symptoms of bowel obstruction. The term obstipation is used for severe constipation. 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.
Historical Perspective
The Egyptian Ebers papyrus, from 16th century BC, is the first book that presented a basic description for constipation. Ebers papyrus defined constipation as intoxication of body with hazardous agents from feces in bowels. In early 1900s, all-bran products first introduced to the prevent and treatment of auto-intoxicated patients due to constipation. In 1970s and 1980s, Denis Burkitt an English surgeon, claimed the hypothesis about dietary fibers followed by the definition of "The Commonest Western disease".
Classification
Constipation may be classified according to etiology into seven subtypes include lesions of gut, neurologic, metabolic, endocrine, psychiatric, drugs, and idiopathic.
Pathophysiology
About 1.5 liter fluid is entered the colon from small intestine every day. Colon has to excrete out only 200-400 mL stool. The defecation process is consisted of three important stages, include filling of the rectum, feeling the rectum filled, and relaxation of pelvic floor muscles in a coordinated fashion. Primary constipation is caused by anorectal and colonic problems, while secondary constipation is caused by organic and metabolic diseases or medications. Diseases that disturbed the nervous system may lead to constipation, such as diabetes mellitus, autonomic neuropathy, Chagas' disease, and Hirschsprung's disease. Chronic use of the laxative may lead to melanosis coli, which is identified by hyperpigmentation and brownish discoloration of colonic mucosa. The main microscopic histopathological finding in melanosis coli is brown granular pigment in lamina propria.
Causes
Constipation in adults may be due to side effects of medications, such as antispasmodics, anticholinergics, analgesics; or may be associated with systemic disorders, such asdiabetes mellitus and hypothyroidism. Idiopathic constipation should be considered once the secondary causes are ruled out and it may be associated with normal or slow colonic transit, dysfunction in defecation, or both. Constipation in childhood often resolves with age after proper guidance regarding diet, toilet training, and toileting behaviors.
Differentiating Constipation overview from Other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications, and Prognosis
Natural History
Complications
Prognosis
Diagnosis
History and Symptoms
When the stool is hard, infrequent, and requires significant effort to pass, you have constipation. The passage of large, wide stools may tear the mucosal membrane of the anus, especially in children. This can cause bleeding and the possibility of an anal fissure.
Physical Examination
Laboratory Findings
Abdominal X Ray
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.
CT
MRI
Ultrasound
Ultrasound may be used to detect tumors, fibroids, ovarian cysts or pregnancy
Treatment
Medical Therapy
In people without medical problems, the main intervention is to increase the intake of fluids (preferablywater) and dietary fiber. The latter may be achieved by consuming more vegetables and fruit and 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.
In alternative and traditional medicine, colonic irrigation, enemas, exercise, diet and herbs are used to treat constipation.