Gastroenterology- Constipation Flashcards
What is constipation?
Constipation is a symptom, not a disease.
What is the prevalence of constipation in different age groups?
All Ages: Approximately 16%
> 60 Years: Approximately 33%
What are the symptoms that define constipation?
Infrequent Bowel Movements: Typically less than 3 per week.
Hard (and Lumpy) Stools.
Feeling of Incomplete Evacuation.
Excessive Straining.
Sense of Anorectal Blockage.
Abdominal Discomfort, Bloating, or Distension.
What are the primary causes of constipation?
Chronic Idiopathic Constipation (CIC)
Pelvic Floor Dyssynergia
Slow Transit Constipation
Normal Transit Constipation
Irritable Bowel Syndrome with Predominant Constipation
What are some secondary colonic causes of constipation?
Benign Stricture
Cancer
Anal Fissure
Rectocele
Proctitis
Primary Neuromuscular Disease (e.g., Hirschsprung’s Disease)
What are some extra colonic causes of constipation?
Dietary Factors
Medications
Neurological Disorders
Psychiatric Conditions
Metabolic and Endocrine Disorders
Extrinsic Compression
Neurogenic disorders that causes constipation
Peripheral
- Diabetes mellitus
- Autonomic neuropathy
- Hirshsprung disease
- Chagas disease
- Intestinal pseudoobstruction
Central
- Multiple sclerosis
- Spinal cord injury
- Parkinson disease
Irritable bowel syndrome
Drugs
Non neurogenic disorders that causes constipation
Hypothyroidism
Hypokalemia
Anorexia nervosa
Pregnancy
Panhypopituitarism
Systemic sclerosis
Myotonic dystrophy
Idiopathic causes of constipation
- Normal colonic transit
-Slow transit constipation
-Dyssynergic defecation
Drugs associated with constipation
Anticholinergics
- antihistamine
- antispasmodics
- antidepressants
-antipsychotics
Cation- contianing agents
- iron supplements
- aluminum (antacids, sucralfate)
- barium
Neurally active agents
- opiates
- antihypertensive
- ganglionic blockers
- vinca blockers
- calcium channel blockers
- 5HT3 antagonists
History
Symptoms defining constipation
Alarm features/symptoms
Diet
Medication use
Physical activity
Surgical history
Sexual and physical abuse
Physical examination
Signs of systemic disease
Abdominal examination
- Presence of faeces (left quadrant)
- Abdominal mass
Digital rectal examination
Normal examination common
Digital rectal examination
- Inspection of anus and surrounding area – fissures, etc
- Testing of perineal sensation and ano-cutaneous reflex
- Assess resting anal tone
- Palpate for rectal masses, prostate in men
- Squeeze manoeuvre – squeeze and hold my finger as long as possible
- Push my finger out
Exclude secondary features
Alarm features:
Abrupt/recent onset constipation
Iron deficiency anaemia/ haematochezia
Age > 50 years
Unexplained weight loss
+ve family history colon ca
+ve FOBT
Investigations
FBC
Calcium
TSH
Glucose
Colonoscopy
Primary/Functional constipation
Chronic idiopathic constipation
Irritable bowel syndrome
What is Chronic Idiopathic Constipation (CIC)?
Chronic Idiopathic Constipation is a condition characterized by persistent constipation with no identifiable underlying cause. It is a diagnosis of exclusion.
What are the features of Irritable Bowel Syndrome (IBS) with predominant constipation?
IBS with predominant constipation is characterized by abdominal pain or discomfort associated with constipation, along with changes in bowel habits. Patients may experience bloating and may not always have infrequent bowel movements.
chronic idiopathic constipation
- normal transit constipation
- slow transit constipation
- defecatory disorder