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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