Adult constipation

Question 1

Rome III Criteria for constipation

Answer 1

Two or more of the following for at least 3 months
straining during 1/4 defiecations
lumpy/hard stools
sensation of incomplete evacuation
sensation of anorectal blockage
Manual maneuvers to help with 1/4 of defecations
fewer than 3 defecations per week
loose stools are rare w/o laxatives
no criteria for IBS

Question 2

What are the red flag symptoms?

Answer 2

Hematochezia, positive occult blood tests, obstructive symptoms, onset of acute constipation in the elderly, weight loss of > 10 lbs, family Hx of colon cancer/ inflammatory bowel, anemia, severe persistent problem not responsive to treatment

Question 3

Common drugs causing constipation

Answer 3

antihistamines, antispasmodics, antidepressants, antipsychotics, iron supplements, antacids containing aluminum, opiates/analgesics/sedatives, Ca channel blocker/beta blocker, OTC/supplements

Question 4

Constipation therapies

Answer 4

Bulk laxatives, osmotic laxatives, stimulant laxatives, enemas, stool softeners, suppositories

Question 5

Define encopresis

Answer 5

Prolonged and repetitive stool withholding and avoidance of defecation leads to large amounts of retained stool in the rectum. Fecal mass becomes impacted and extremely difficult to evacuate. Peristaltic movement of colon pushes semiformed and liquid stool lower in the colon, resulting in leakage around the large mass of stool into the child’s underpants

Question 6

What is infantile dyschezia

Answer 6

straining with passage of soft stool is normal in neonates and infants under 6 m. It’s related to inability to coordinate pelvic floor relaxation with the Valsalva maneuver and to straighten the anorectal canal when lying down. NOT constipation

Question 7

What is most important aspect of toilet training toddlers

Answer 7

Praise, no matter what

Question 8

what is meconium ileus

Answer 8

Meconium ileus causes delayed passage of meconium in children with cystic fibrosis

Question 9

What are the 3 phases of medical management of constipation

Answer 9

Complete evacuation or disimpaction, sustained evacuation to restore normal colorectal tone, weaning from intervention

Question 10

What is goal of sustained evacuation?

Answer 10

Allow the distended colon to return to normal caliber and tone. Phase 2 takes 3-9 months.