Dr. Ertan Beyatlı

Why is constipation important?

(Update: ) - Digestive System Diseases

Constipation (Constipation, English = Constipation). Constipation refers to infrequent or difficult bowel movements. Stools are usually hard and dry. Other symptoms include abdominal pain, bloating, and feeling like you haven't passed a bowel movement completely.

Obstipation It is one step ahead of constipation and is characterized by the inability to pass gas together with the accumulation of dry hard stools. In other words, there is both feces and gas accumulation. This can cause collision along the entire length of the column and, if present for a significant period of time, cause permanent damage.

Complications from constipation hemorrhoidsanal fissure or fecal impaction. The normal frequency of bowel movements in adults is between three a day and three a week. Babies usually have three to four bowel movements a day, while young children typically have two to three bowel movements a day.

Constipation has many causes. Common causes of stool are slow movement in the colon, irritable bowel syndrome and pelvic floor disorders. Underlying associated diseases include hypothyroidism, diabetes, Parkinson's disease, celiac disease, non-celiac gluten sensitivity, Colon cancerdiverticulitis, Meckel's diverticulum ve inflammatory bowel disease takes place. Medications associated with constipation include opioids, certain antacids, calcium channel blockers, and anticholinergics. Approximately 90% of those who take opioids develop constipation. Constipation is more often related to weight loss or anemia, when blood is present in the stool, when a person has a family history of inflammatory bowel disease or colon cancer, or when an older person has just started.

Constipation in a young child seen on an x-ray. Circles represent areas of fecal matter (stool is white surrounded by black intestinal gas). What is constipation and how is it treated? What is constipation and how is it treated? constipation child
Constipation in a young child seen on an x-ray. Circles represent areas of fecal matter (stool is white surrounded by black intestinal gas).

Treatment for constipation depends on the underlying cause and duration of its existence. Precautions that could include drinking enough fluids, eating more fiber, and exercising. If this is not effective, laxatives of the bulk conditioning agent, osmotic agent, stool softener, or lubricant type may be recommended. Stimulant laxatives are usually reserved when other types are not effective. Other treatments may include biofeedback or, in rare cases, surgery.

Constipation rates in the general population are 2-30 percent. Constipation rate is 50-75 percent among the elderly living in a nursing home. In the United States, people spend more than $ 250 million a year on constipation medications.

Term

Constipation is not a disease but a symptom. Most often constipation is thought of as infrequent bowel movements, usually less than 3 stools per week. However, individuals may also have other complaints:

  • Straining with bowel movements
  • Excessive time required to pass a bowel movement
  • Hard stools
  • Pain in bowel movements due to strain
  • Abdominal pain
  • Abdominal bloating.
  • feeling of incomplete bowel evacuation.

The Rome III Criteria are a set of symptoms that help standardize the diagnosis of constipation in various age groups. These criteria help doctors better define constipation in a standardized way.

What is Bristol Stool Scale constipation and how is it treated? What is constipation and how is it treated? bristol disc scale
Bristol Stool Scale

Causes

Causes of constipation can be divided into congenital, primary and secondary. The most common type is primary and not life threatening. It can also be divided by age group affected, such as children and adults.

Primary or functional constipationis defined by symptoms that persist for more than six months that are not due to an underlying cause, such as drug side effects or an underlying medical condition. It is distinguished from irritable bowel syndrome as it is not associated with abdominal pain. It is the most common type of constipation and is usually multifactorial. In adults, such primary causes include: dietary choices such as insufficient dietary fiber or fluid intake, or behavioral causes such as decreased physical activity. In the elderly, common causes are insufficient dietary fiber intake, insufficient fluid intake, decreased physical activity, side effects of drugs, hypothyroidism and occlusion caused by colorectal cancer. However, the evidence to support these factors is weak.

Secondary causes include side effects of drugs such as opiates, metabolic disorders such as endocrine and hypothyroidism, and obstruction such as colorectal cancer. Celiac disease and non-celiac gluten sensitivity can also occur with constipation. Cystocele may develop as a result of chronic constipation.

Diet

Constipation can be caused or aggravated by a low fiber diet, low fluid intake, or diet. Dietary fiber helps reduce colonic transport time, increases stool volume, but also softens stools. Therefore, low fiber diets can cause primary constipation.

Medicines

Many drugs have constipation as a side effect. Some include opioids, diuretics, antidepressants, antihistamines, antispasmodics, anticonvulsants, tricyclic antidepressants, antiarrhythmics, beta-adrenoceptor antagonists, anti-diarrhea, 5-HT3 receptor antagonists, such as ondansetron and aluminum antacids (but not limited to them). Certain calcium channel blockers such as nifedipine and verapamil can cause severe constipation due to motility dysfunction in the rectosigmoid colon. Supplements such as calcium and iron supplements can also have constipation as a notable side effect.

Medical conditions

Metabolic and endocrine problems that can cause constipation include: hypercalcemia, hypothyroidism, hyperparathyroidism, porphyria, chronic kidney disease, pan-hypopituitarism, diabetes mellitus, and cystic fibrosis. Constipation is also common in people with muscular and myotonic dystrophy.

Systemic diseases that can occur with constipation include celiac disease and systemic sclerosis.

Constipation has a number of structural (mechanical, morphological, anatomical) causes; By creating space-occupying lesions in the colon that stop the passage of stool, such as colorectal cancer, strictures, rectocols, anal sphincter damage or malformation, and postoperative. Changes. Like other malignancies, extraintestinal masses can cause constipation due to external compression.

Constipation also has neurological causes such as anismus, descending perineum syndrome, and Hirschsprung disease. Hirschsprung disease in infants is the most common medical condition associated with constipation. Anismus occurs in a small minority of people with chronic constipation or obstructed stools.

Spinal cord lesions and neurological disorders such as Parkinson's disease and pelvic floor dysfunction can also lead to constipation.

Psychological

Voluntary passing of stool is a common cause of constipation. Choosing to give up may depend on factors such as fear of pain, fear of public toilet, or laziness. When a child holds stools, a combination of stimulus, fluid, fiber, and laxative can be helpful to overcome this problem. Early intervention with holding is important as it can lead to anal fissures.

Congenital

A number of diseases that occur at birth can cause constipation in children. Hirschsprung disease (HD) is rare as the most common group. There are also congenital structural anomalies that can lead to constipation, such as anterior displacement of the anus, non-perforated anus, strictures and small left colon syndrome.

Diagnostic approach

Diagnosis is typically made based on a person's description of the symptoms. Bowel movements (such as those thrown out by rabbits) that are difficult to pass, are very tight, or consist of small hard lumps are considered constipation, even if they occur every day. Constipation is traditionally defined as three or fewer bowel movements per week. Other symptoms associated with constipation include bloating, bloating, abdominal pain, headaches, feeling tired and nervous tiredness or incomplete emptying. While constipation is a diagnosis, it is typically seen as a symptom that requires evaluation to distinguish a cause.

Prominent constipation on plain X-ray of an 8 year old child ADBG constipation What is constipation and how is it treated? What is constipation and how is it treated? constipation film
Prominent constipation (ADBG) on plain X-ray of an 8-year-old child

Clarification

Distinguish between acute (days to weeks) or chronic (months to years) onset of constipation because this information changes the differential diagnosis. This helps doctors discover the cause of constipation in the context of accompanying symptoms. People often describe constipation as difficult bowel movements, lumpy or firm stools, and excessive strain during bowel movements. Constipation is often accompanied by bloating, abdominal distension and abdominal pain. Chronic constipation associated with abdominal discomfort (symptoms present at least three days a month for more than three months) is often diagnosed as irritable bowel syndrome (IBS) when no obvious cause is found.

Poor eating habits, previous abdominal surgeries, and some medical conditions can contribute to constipation. Diseases associated with constipation include hypothyroidism, certain types of cancer, and irritable bowel syndrome. Low fiber intake, insufficient fluid, inadequate ambulation or inactivity, or medications can contribute to constipation. After determining the presence of constipation as a result of the symptoms described above, the cause of constipation must be determined.

Separating those that are not life-threatening from serious causes may be partly due to symptoms. For example, colon cancer may be suspected if a person has a family history of colon cancer, fever, weight loss, and rectal bleeding. Other worrying signs and symptoms include a family or personal history of inflammatory bowel disease, age of onset over the age of 50, change in stool caliber, nausea, vomiting and weakness, numbness and neurological symptoms such as difficulty urinating.

Examination

Physical examination should include at least an abdominal and rectal exam. Abdominal examination can reveal an abdominal mass if significant stool load is present and reveal abdominal discomfort. Rectal examination gives an impression of anal sphincter tone and whether the lower rectum contains any stool. Rectal examination (Proctology) It also provides information about the consistency of the stool, the presence of hemorrhoids, blood and skin tags, fissures, and whether there are perineal irregularities such as anal warts. The physical exam is done manually by a doctor and is used to guide which diagnostic tests to order.

Diagnostic tests

Functional constipation is common and does not warrant diagnostic testing. Imaging and laboratory tests are typically recommended for those with alarm signs or symptoms.

Laboratory tests performed depend on the suspected underlying cause of constipation. Tests, CBC (complete blood count), thyroid function tests, serum calcium, serum potassium, etc. May contain.

Abdominal X-rays (ADBG film) is usually done only if bowel obstruction is suspected, widely buried stool may occur in the colon and can confirm or rule out other causes of similar symptoms.

If an abnormality such as a tumor in the colon is suspected colonoscopy can be done. Other tests that are rarely ordered include anorectal manometry, anal sphincter electromyography, and defecography.

Colonic emitted pressure wave sequences (PSs) are responsible for discrete movements of intestinal contents and are vital for normal defecation. Lack of PS frequency, amplitude, and extent of spread all play a role in severe defecation dysfunction (SDD). Mechanisms that can normalize these abnormal motor patterns can help rectify the problem. Recently, new sacral nerve stimulation (SNS) therapy has been used to treat severe constipation.

criteria

The Roman III Criteria for functional constipation should include two or more of the following, and for the past three months, symptoms should begin at least 6 months before diagnosis.

  • Straining for at least 25% of bowel movements during defecation
  • Lumpy or hard stools in at least 25% of stools
  • Feeling incomplete evacuation in at least 25% of stools
  • Anorectal obstruction / feeling of obstruction in at least 25% of stools
  • Manual maneuvers to facilitate at least 25% of defecations
  • Less than 3 bowel movements a week
  • Loose stools are rarely found without the use of laxatives
  • Insufficient criteria for irritable bowel syndrome

Prevention

Constipation is often easier to prevent than to cure. Following the relief of constipation, adequate exercise, fluid intake and maintenance with a high fiber diet is recommended.

Treatment

A limited number of causes require immediate medical attention or cause serious consequences.

Treatment of constipation should focus on the underlying cause, if known. The National Institute for Health and Care Excellence (NICE) divides constipation in adults into two categories - chronic constipation of unknown cause and opiate-related constipation.

The main treatment for chronic constipation of unknown cause involves increased water and fiber intake (as a diet or supplement). Routine use of laxatives or enemas is not recommended, as bowel movements may be due to their use. [Citation needed]

Fiber supplements

Soluble fiber supplements like psyllium are often considered first-line treatment for chronic constipation compared to insoluble fiber like wheat bran. Side effects of fiber supplements include bloating, gas, diarrhea, and possible iron, calcium malabsorption, and some medications. However, patients with opiate-induced constipation likely won't benefit from fiber supplements.

Laxatives

If laxatives are used, milk of magnesia or polyethylene glycol is recommended as the first choice because of their low cost and safety. Stimulants should only be used when this is not effective. Appears to be superior to polyethylene glycol lactulose in cases of chronic constipation. Prokinetics can be used to improve gastrointestinal motility. A number of new agents have shown positive results in chronic constipation; these include prukaloprid and lubiprostone. Cisapride is commonly found in third world countries, but has been withdrawn in most of the west. While potentially causing cardiac arrhythmias and deaths, it has not been shown to benefit constipation.

Enema

Enemas (eg Fleet enema, BT enema, Libalax enema) can be used to provide some form of mechanical stimulation. A large volume or high enema can be given to flush as much colon as possible from the stool, and the solution usually contains castile soap, which irritates the lining of the colon, increasing the urgency of defecation. However, a low enema is usually only useful for stool in the rectum, not the intestinal tract.

Physical intervention

Resisting the above measures, constipation may require physical intervention such as manual dispensing (physical removal of affected stool using hands; see stool effect). Regular exercise can help improve chronic constipation.

Surgical intervention

In refractory cases, procedures can be applied to help relieve constipation. Sacral nerve stimulation has been shown to be effective in a small number of cases. Ileorectal anastomosis colectomy is another intervention performed in patients with or without defecation disorder, which is known to have a slow colonic transit time only. Since this is a major surgery, side effects can include significant abdominal pain, small bowel obstruction, and postoperative infections. It also has a very variable success rate and is very context dependent.

weather

Complications that can result from constipation include hemorrhoids, anal fissures, rectal prolapse, and fecal impaction. Having difficulty removing stool can cause hemorrhoids. In the later stages of constipation, the abdomen may become bloated, firm, and widely tender. Severe cases ("stool tightness" or malignant constipation) may exhibit symptoms of intestinal obstruction (nausea, vomiting, tender abdomen) and encopresis; Here soft stool from the small intestine bypasses the affected stool material in the colon.

Epidemiology

Constipation is the most common chronic gastrointestinal disorder in adults. It occurs in 2% to 20% of the population, depending on the definition used. It is more common in women, the elderly, and children. Constipation, which has no known specific cause, affects women more often than men. The reasons for its occurrence more frequently in the elderly are due to the increase in health problems and decrease in physical activity as people age.

Worldwide, 12% of the population report having constipation.
Chronic constipation accounts for 3% of all visits to pediatric outpatient clinics each year.
Healthcare for constipation totals $ 6,9 billion annually in the United States.
More than four million Americans suffer from frequent constipation, which makes 2,5 million doctor visits a year.
Approximately $ 725 million is spent each year on laxative products in the United States.

Tarih

Since ancient times, different societies have published medical opinions on how healthcare providers should respond to constipation in patients. Doctors at various times and places claimed that constipation had all sorts of medical or social causes. Doctors in history have treated constipation in reasonable and unreasonable ways, including the use of a spatula mundani.

What is constipation and how is it treated? What is constipation and how is it treated? constipation in history
19th century satirical caricature of a monkey stuffed with marshmallow and opium, refusing an old-fashioned grief for a new design

After the emergence of the disease microbe theory, the idea of ​​"self-poisoning" entered popular Western thought in a new way. Enema as a scientific medical treatment and colon cleansing as an alternative medical treatment have become more common in medical practice.

Since the 1700s in the West, there are some popular notions that people with constipation have had some moral failures due to gluttony or indolence.

Special populations

Constipation in children

Approximately 3% of children have constipation, boys and girls are equally affected. With constipation accounting for about 5% of general pediatric visits and 25% of pediatric gastroenterologist visits, the symptom has a significant financial impact on the healthcare system. Although the exact age at which constipation occurs most commonly is difficult to assess, children often suffer from constipation with life changes. Examples include: toilet training, starting a new school or transition to a new school, and dietary changes. Feeding changes or switching from breast milk to formula can cause constipation, especially in babies. Most cases of constipation are not due to a medical illness, and treatment can only focus on relieving symptoms.

Postpartum women

The six-week period after pregnancy is called the postpartum stage. During this time, women have an increased risk of constipation. In many studies, the prevalence of constipation is estimated to be around 3% in the first 25 months. Constipation can cause discomfort for women as they are still recovering from the birthing process, especially if they have had a perineal tear or episiotomy. Risk factors that increase the risk of constipation in this population include:

  • Damage to the levator ani muscles (pelvic floor muscles) during labor
  • Forceps-assisted delivery
  • The long second phase
  • Giving birth to a big child
  • Hemorrhoids

Hemorrhoids are common during pregnancy and can be exacerbated by constipation. Anything that can cause pain with stool (hemorrhoids, perineal tears, episiotomy) can lead to constipation because patients can interfere with bowel movements to avoid pain.

The pelvic floor muscles play an important role in helping pass bowel movement. Damage to these muscles by some of the above risk factors (examples - giving birth to a large child, second stage of labor, delivery with forceps) can cause constipation. Enemas can be administered during labor, and these can also change bowel movements in the days after birth. However, there is insufficient evidence to draw conclusions about the efficacy and safety of laxatives in this group of people.

Source: Doktorca.com

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