Ubumenyi busangiwe bugira agaciro,inkuru nyinshi z'uru rubuga ziba zaraciye k'umuseke.com

Ubumenyi busangiwe bugira agaciro,inkuru nyinshi z'uru rubuga ziba zaraciye k'umuseke.com

lundi 13 février 2012

Constipation



Constipation is a problem to the population.in this article I am going to show to the medical personnel especially but also you Rwandans the features of this Symptoms and its management.

Always the patient must be asked exactly what he means by constipation.
 formal  definitions of constipation are: the infrequent passage of stool (<3 times weekly) or difficulty in defecation, with straining or discomfort, is a reasonably practical working definition

Causes of constipation
  • Poor diet
  • Inadequate fluid intake or dehydration
  • Immobility (or lack of exercise)
  • Irritable bowel syndrome
  • Old age
  • Post-operative pain
  • Hospital environment (lack of privacy, having to use a bed pan)
  • Distant, squalid, or otherwise unsatisfactory toilets
Anorectal disease
  • Anal fissure
  • Anal stricture
  • Rectal prolapse
Intestinal obstruction
  • Colorectal carcinoma
  • Strictures (eg Crohn's disease)
  • Pelvic mass (eg fetus, fibroids)
  • Diverticulosis (rectal bleeding is a commoner presentation)
  • Congenital abnormalities
  • Pseudo-obstruction
Metabolic/endocrine
  • Hypothyroidism
  • Hypercalcaemia
  • Hypokalaemia
  • Porphyria
  • Lead poisoning
Drugs
  • Opiate analgesics (eg morphine, codeine)
  • Anticholinergics (tricyclics, phenothiazines)
  • Iron
Neuromuscular

  • Spinal or pelvic nerve injury
  • Aganglionosis (Chagas' disease, Hirschsprung's disease)
  • Systemic sclerosis
  • Diabetic neuropathy
Other causes
  • Chronic laxative abuse
  • Idiopathic slow transit
  • Idiopathic megarectum/colon
  • Psychological (eg associated with depression or abuse as a child)

Clinical features

The doctor asks the patient  about frequency, nature, and consistency of the stool.
Is there blood or mucus in/on the stools?
Is there diarrhoea alternating with constipation?
Has there been a recent change in bowel habit?
Ask about diet and drugs.
Rectal examination is essential for you,don’t feel bad while doing this.

Tests

Most constipation do not need investigation.
Indications for investigation:
1)      age >40yrs;
2)      recent change in bowel habit; associated symptoms (weight loss, rectal bleeding, mucous discharge, or tenesmus).
Blood tests: FBC, U&E, Ca2+, TFT.
Sigmoidoscopy and biopsy of abnormal mucosa.
Barium enema if suspected colorectal malignancy.
Special investigations (eg transit studies; anorectal physiology) are rarely needed.

Treatment

The aim is to treat the cause .
Advise exercise and a good fluid intake (a high-fibre diet is often advised, but this may cause bloating without helping the constipation).

Consider drugs only if these measures fail, and try to use them for short periods only.
 Often, a stimulant such as  bulking agent is more effective and cheaper than agents such as lactulose(Known as Duphalac)
Bulking agents

Stimulant laxatives

Stool softeners:

Osmotic laxatives

What if laxatives don't help?

A multi-disciplinary approach with behaviour therapy, psychological support, habit training and sphincter-action biofeedback may help.

 5HT4 agonists are under development (tegaserod; prucalopride).
Corneille Ntihabose
nckilly2011@gmail.com

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