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Overview of constipation

Constipation is a common problem affecting 2–27% of the general population in Western countries.1 Although constipation may affect all ages, it is commonly seen among older adults.

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Chronic constipation is associated with decreased general well being and quality of life.

The problem comprises of a group of symptoms that include

  • Excessive straining
  • Hard stools
  • Feeling of incomplete evacuation
  • Infrequent defecation

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A careful history and physical examination can provide clues to find out the etiology of constipation. Only a minority of symptomatic patients seeks treatment for constipation. Treatment aims at symptomatic relief and improving the quality of life. Apart from high fiber diet and improvement in physical activity, prescription of laxatives may provide relief.

Pathophysiology (How constipation develops)

Constipation is the end effect of several factors including

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  • Low fiber diet,
  • Lack of exercise,
  • Motility abnormalities,
  • Anatomic defects,
  • Prolonged bed rest and
  • Chronic consumption of drugs.2

Functional constipation consists of two subtypes:slow-transit constipation and dyssynergic defecation.

Slow-transit constipation is the failure of coordinated motor activity to move the stool through the colon.  The other type involves pelvic floor dysfunction or disorders of the anorectum and pelvic floor, leading to inability to adequately evacuate rectal contents. As both mechanisms may coexist in some patients, it may be difficult to ascertain the exact underlying mechanisms for constipation.3

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Secondary constipation may be associated with conditions such as irritable bowel syndrome or with various medications.

Causes of constipation

Diagnosis of constipation

No specific diagnostic tests have been shown to be useful in routine initial evaluation of patients with constipation. The etiologic diagnosis of chronic constipation can be achieved in most patients on a clinical basis.

Indications for physiologic tests should be based on specific clinical parameters. Patients with long-standing constipation, patients over the age of 50 years who have new-onset constipation, those whose constipation is severe and/or refractory to empiric conservative treatment, those with necessity for enemas, digital assistance and evidence of rectocele require diagnostic testing to define the cause of constipation.4

Management of constipation

Diet and lifestyle modifications constitute the first approach to the treatment.

  • Increases in dietary fiber intake
  • Water consumption
  • Increase in physical activity

Only if this approach fails should osmotic laxatives such as lactulose and polyethylene glycol, or stimulants like senna or bisacodyl be used.5 Stimulant laxatives and paraffin are best used intermittently because of their side-effects.

For patients with pelvic floor dyssynergia, biofeedback therapy is the first therapeutic option. If the constipation has been identified as being secondary to another condition, the primary cause should be addressed.

Patients who are resistant to all the conservative modalities may require surgical intervention.1

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1.Sung IK. Classification and treatment of constipation. Korean J Gastroenterol. 2008; 51(1): 4–10.

2.Ghoshal UC. Review of pathogenesis and management of constipation. Trop Gastroenterol. 2007; 28(3): 91–95.

3.Cheung O, Wald A. Review article: The management of pelvic floor disorders. Aliment Pharmacol Ther. 2004; 19: 481– 495.

4.Lacerda-Filho A, Lima MJ, Magalhães MF, Paiva Rde A, Cunha-Melo JR. Chronic constipation—the role of clinical assessment and colorectal physiologic tests to obtain an etiologic diagnosis. Arq Gastroenterol. 2008; 45(1): 50–57.

5.Remes-Troche JM. Constipation: Initial evaluation and diagnostic approach. Rev Gastroenterol Mex. 2005; 70(3): 312–322.

Written by: healthplus24.com team

Date last updated: December 29, 2014

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