Constipation

Question 1

the most common cause of constipation

Answer 1

The large majority (> 90%) of cases arc idiopathic! Lifestyle habits, such as a change to low-fiber diet; sudden, prolonged inactivity; and high stress may result in constipation

Question 2

Recent onset of constipation (e.g., no changes to diet. no new medications) suggests what?

Answer 2

suggests an obstructing lesion (neoplasm. stricture, foreign body).

Question 3

What common gynecologic surgery leads to constipation in 5% of patients?

Answer 3

Hysterectomy

Question 4

Chagas disease

Answer 4

is found in Central and S. America. It is caused by infection with Trypanosoma cruzi resulting in achalasia, cardiomyopathy, and acquired megacolon.

Question 5

Whom do you work up?

Answer 5

Patients with constipation who additionally have weight loss. rectal bleeding, or anemia should get:
• Sigmoidoscopy + BE or a colonoscopy (to exclude structural disease: e.g., cancer, strictures)
• Serum Ca++ and TSH (to exclude hyper/hypocalcemia and hypothyroidism; DM is usually evident from the history)

Question 6

For intractable constipation

Answer 6

test for colonic transit function.
If the markers are spread throughout the colon, the cause is generalized colonic inertia. Clustering of markers in the rectosigmoid colon indicates pelvic floor dysfunction

Question 7

treatment of constipation

Answer 7

dietary fiber to 25-30 gm/day and assuring fluid intake > 2.0 liters/day.
Increase exercise
Short-term use of an osmotic laxative and/or stool softener is okay
Surgical treatment is indicated only for Hirschsprung disease