CONSTIPATION Flashcards
what are the types of constipation and duration?
- acute (< or equal to 12 weeks)
- chronic (> 12 weeks)
What is constipation?
infrequent, irregular, or difficult evacuation of the bowels
do women or men get constipation more?
women
epidemiology of constipation?
15% adults
1/3 of elderly patients
etiology of primary constipation :
idiopathic or functional
not attributed to any structural abnormalities or systemic disease; 3 subtypes
etiology of secondary constipation :
caused by systemic disease, medications, or obstructing colonic lesions
what are the 4 most common causes of constipation? KNOWW THISS
- inadequate fiber or fluid intake
- poor bowel habits
- physical inactivity
- slow colonic transit
how long is normal colonic transit?
about 35 hours
what are the other common sx of constipation that aren’t the big 4?
- systemic dz-> hypothyroidism, hypercalcemia, paraplegia
- meds-> opioids, diuretics, iron
- structural abnormalities
what is the PRIMARY MECHANISM that causes constipation?
- altered stool consistency
- altered bowel motility
what is the first step of defecation?
- colonic mass movements/peristalsis moves intestinal contents distally into rectum
what is the second step of defecation?
- rectal filling activates mechanoreceptors in the rectal wall causing awareness of the need to defacate
what is the third step of defecation?
- a small amount of is allowed to pass through to the anal canal by an involuntary relaxation of the internal anal sphincter (rectoanal inhibitory reflex) -> determine if the rectal contents is gaseous, solid, or liquid form
what is the fourth step of defecation?
- abdominal muscles contract and a Valsalva maneuver is performed while simultaneously relaxing the external anal sphincter and puborectalis muscle (pressure gradient generated between the rectum and anal canal expels the feces)
what are the s/sx of constipation?
- infrequent bowel movements (<3/week)
- hard stools
- excessive straining
- sense of incomplete evacuation
- BLOATING
- abdominal cramping or pain
- tenesmus
- overflow diarrhea
what can a dx of constipation be based upon?
based on complete hx and PE to include a digital rectal exam
what people need additional dx testing for constipation?
- age >50
- severe constipation
- alarm sx
- inadequate response to empiric therapy
what are the 3 ALARM SX of constipation?
- hematochezia
- weight loss
- +FOBT
what management do you do for patients with red flag features?
order a Colonoscopy or flexible sigmoidoscopy and biopsy to r/o colorectal cancer
what management do you do for patients with NO red flag features?
- assess for secondary causes of constipation
- CBC w/diff with differential, serum electrolytes, calcium, glucose and TSH
- Review medications
what 2 tests are done for a patient who has inadequate response to empiric therapy?
- anorectal manometry and a balloon expulsion test
- colonic transit studies
what are the 3 main tx modalities for constipation?
- dietary and lifestyle measurements
- d/c meds linked to constipation
- pharmacotherapy
what is overflow diarrhea?
pts w/ firm stool in sigmoid/rectum that they can not pass and softer stool above the firm stool
what are the 4 main hx questions to ask for dx?
- stool frequency, consistency, and color
- length of time for a bowel movement
- use of laxatives or enemas
- review prescription medications
