UW revision constipation/impaction/proctalgia fugax Flashcards
Constipation. secondary causes. lifestyle?
low fiber diet, dehydration, inactivity
Constipation. secondary causes. functional?
irritable bowel syndrome, depression
Constipation. secondary causes. medications?
opioids,
iron supplements,
anticholinergics (antipsychotics, antidepresants, antihistamines, antispasmodics),
CCBs
Constipation. secondary causes. metabolic?
hypothyroidism, DM, hypercalcemia
Constipation. secondary causes. obstruction?
colon cancer, inflammatory/ischemic/surgical stricture
Constipation. secondary causes. neurologic?
spinal cord injury, multiple sclerosis, parkinson disease
Fecal impaction. Dx?
DRE, but impaction in the proximal rectum only on abdominal xray.
Fecal impaction. acute Tx?
Manual disimpaction [break up hard stool] + enemas [to dislodge fecal fragments].
Fecal impaction. following Tx?
Bowel regimen = laxatives, dietary alterations.
Fecal impaction. mechanism?
obstruction of fecal flow in rectum can cause backup of stool proximal to the impaction. passage of liquid stool around the impaction leads to incontinence. Urinary incontinence is also common due to pressure against the bladder.
Fecal impaction. risk factors?
common in elderly with impaired mobility, inadequated fluid or dietary fiber intake, chronic constipation or decreased sensation of stool in the rectal vault (spinal cord injury, dementia)
Proctalgia fugax. pathophysiology?
Spastic contraction of the anal sphincter
Pudendal nerve compression
Proctalgia fugax. risk factors?
female sex
other functional pathologies (irritable bowel syndrome)
Psychosocial stress, anxiety
Proctalgia fugax. manifestation?
recurrent rectal pain unrelated to defecation
episodes lasting seconds to minutes (=< 30 min)
no pain between episodes
Proctalgia fugax. evaluation?
normal physical examination (rectal, pelvic, prostate)
no lab abnormalities
