Constipation Flashcards
At what age is adult bowel opening pattern established?
At age 4.
Children- 4-9 per week.
Adults- 3 per day to 3 a week
What the 3 common reasons for constipation?
Psychobehavioral- following painful evacuation and withholding
Posture- toilet seat/squatting
Colonic transit
What are the downsides of increased fibre intake?
Reduced caloric intake
Increased faecal energy loss
Decreased bioavailability of minerals
Increased gas formation
What are the intrinsic colonic factors that cause constipation?
Reduced interstitial cells of Cajal. This is the pacemaker of the gut.
What are the 2 types of contractions that occur in the GIT that help in bowel opening?
- Repeated non-propulsive contractions leading to mixing and absorption
- Larger coordinated contractions that move stools forward
What happens to colonic motility during sleep?
Colonic motility is strongly inhibited during sleep. If there is nocturnal Incontinence, needs further investigations
What is RAIR?
Rectoanal inhibitory Reflex
When do neonates pass meconium?
<1500 g- 35% in first 24 hrs
<2500 g- 80% in first 24 hrs
>2500 g- 99%
What is a well known presentation of anal stenosis?
Baby strains and passes paste like stools but seems to improve with laxatives.
Does a normal neurological exam exclude spinal dysraphism?
No! But cremasteric reflex may be useful
What are the red flags for a sacral dimple?
> 0.5 cm in size
2.5 cm cranially from anal margin
Overlying skin showing hemangioma or tuft of hair
Gluteal cleft deviation
What does Picolax contain?
Sodium picosulphate and Mg citrate
Does prebiotics help in constipation?
May be associated with change in consistency of stools but no change in frequency. Possibly less pain understandably
Does probiotics help in constipation?
Possibly increases transit time but not much difference
When is Ba enema indicated in evaluating constipation?
To assess extent of anganglionic segment in HD