Constipation Flashcards
Def
Typical # of bowel movements per week
Other signs of constipation
Persistent, dufficult, infrequent or incomplete defecation
3
Excessive straining, hard stools, incomplete evacuation
Primary cz
Secondary c
related to diet/lifestyle/colorectal dysfunction
Functional/anatomic/neuro abnormalities that prevent passage of stool
Most frequent predisposing factor
Addtl
low fiber/fluids- delays passgae
Physical inactivity/immobility- delays transit
Children causes
Complications
Behavior- avoid bc of pressure, wanting to play or social
Hard bowel mvment, anal fissure, continues to hold stool
Colorectal dysfunction
Due to
Leads to
Delayed emptying of ascending/trasnverse colon
Reduced freq of high amplitude propagated contractions (HAPCs)
inc time for water reasborption, hard stool
Muscle dyssenergy
At rest
Mass movement
w strain
Any process that causes
puborectalis/IS muscle are tonically contracted (90 angle btw rectum & anal canal)
Feces enters rectum, distenstion causes invol relaxation of IAS/contraction of EAS
relax puborectalis and EAS t widen angle to allow stool flow
failure w cause incomplete evac
Secondary disorders
impair luminal passage leads to
Distl lesions
Anorectal pathology obstruction
Neuro disorders
retention of bulky stool
Direct prevention of stool passage
Dec luminal diamter or contrbuting to muscle dysfunction
impair ANS, delay HAPCs, leading to intestinal peristalsis
Secondary causes of constipation
Gastro
Neuro
Metabolic
Drug/toxin
G- Obstruction (tumor/stricture), anorectal patho, paralytic ileus
N- Cerebral palsy, neuropaty, paraplegia, PD
M- hypo thyroid/K/Mg, hyperCa
D- lead/narcotics/anticholinergics/antipsychotics, diuretics. CCB, cholestyramine
MCC constipation in infants/kids
usually due to
Anatomic cz
Neurologic cz
Functional- no clear etiology
behavior/diet
congenital imperforate anus, anal stenosis, acquired via surgery
Hirschsprungs, spinal cord damage
Adulthood MCC constipation
Inadequate fiber/fluids
Red freq of HAPCs
IBS (one subset has cons)
Pelvic floor dyssenergia
Bristol Stool Chart
Type 1 2 3 4 5 6 7
1- separate, hard lumps like nuts (hard to pass)
2- sausage shaped, lumpy
3- like sausage, cracks on surface
4- smooth and soft
5- soft blobs, clean edges (easy to pass)
6- fluffy, ragged edges, mushy
7- entirely liquid
Children
Functional const considered if 2 of following are present for 1 mnth
<2 defecations/wk Incontinence Hx of excessive stool retetion Hx of pain/hard stools Large fecal mass in rectum Hx of large diameter stools
Encopresis
W chronic constipation
passing of semisolid/liquid stool
rectume distends, shortens anal canal and dilates anal sphincter
Liquid stool leaks and released with relaxed EAS
Hirschprungs
Suggestive sx
Distal colon not relaxed, functional obstruction
Sx t birth or 1st few months
Meconeum delayed
Ab distension/vomitting
May not present until later
Adults
Functional cons if 2+ present for 3 nths
IBS
Cons subset
Mixed subset
Straining Lumpy/hard Incomplete evac Anorectal obstruction/blockage Requires manual maneuvers Less than 3 defecations/wk
All >25% of time
Bowel discomfort for 6+ mnths
3 days every month
hard/lumpy stools, pain relieved w defecation
hard or loose stools, pain relieved w defecation
