This document discusses diarrhea and constipation. It defines diarrhea as increased frequency and decreased consistency of stool compared to normal, and constipation as difficult or infrequent bowel movements. Diarrhea is usually caused by viral, bacterial, or parasitic infections and can be acute (<14 days), persistent (14-30 days), or chronic (>30 days). Constipation has many possible causes including GI disorders, medications, lifestyle factors, and neurological issues. Both are typically treated by managing underlying causes, oral rehydration, antidiarrheals like loperamide, and laxatives respectively. Diet, lifestyle changes, and surgery may also help in some cases.

1. Diarrhea and Constipation
vs
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2. Diarrhea
• Defined as an increased frequency and
decreased consistency of fecal discharge as
compared with an individual’s normal bowel
pattern.
• It can be
Acute diarrhea is commonly defined as <14 days’
duration,
persistent diarrhea as >14 days’ duration, and
chronic diarrhea as >30 days’ duration.
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3. Epidemiology and Etiology
• Approximately 5% of the adult population and ranges from 3% to 20% in children
worldwide
• In developing countries, diarrhea is a leading cause of illness and death in children,
creating a tremendous economic strain on healthcare costs.
• Most cases of acute diarrhea are caused by infections with
• viruses-Norwalk and rotavirus group
• Bacteria-Shigella, Salmonella, Campylobacter, Staphylococcus, and
Escherichia coli
• Protozoa- Entamoeba histolytica , giardia lamblia
• Are generally self-limited
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4. Pathophysiology
• Four general pathophysiologic mechanisms disrupt
water and electrolyte balance which lead to diarrhea
• These are
A change in active ion transport by either decreased
sodium absorption or increased chloride secretion
 Change in intestinal motility
 Increase in luminal osmolarity
 Increase in tissue hydrostatic pressure.
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5. Cont’d…
 Diarrhea groups
1. Secretory diarrhea
• occurs when a stimulating substance either increases
secretion or decreases absorption of large amounts of
water and electrolytes
• Substances that cause excess secretion include
vasoactive intestinal peptide (VIP) from a
pancreatic tumor,
unabsorbed dietary fat in steatorrhea, laxatives,
hormones (such as secretion), bacterial toxins,
and excessive bile salts
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6. Cont’d…
• Recognized by large stool volumes (>1 L/day)
• Fasting does not alter the stool volume in these patients.
2. Osmotic diarrhea
• Occur when poorly absorbed substances retain intestinal fluids
• occurs with malabsorption syndromes, lactose intolerance,
administration of divalent ions (e.g., magnesium-containing
antacids)
• consumption of poorly soluble carbohydrate (e.g., lactulose)
• Clinically, osmotic diarrhea is distinguishable from other
types, as it ceases if the patient resorts to a fasting state.
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7. Cont’d…
3. Exudative diarrhea
• occur when inflammatory diseases of the GI tract
discharge mucus, serum proteins, and blood into
the gut.
4. Altered intestinal motility
resulted through
• Reduction of contact time in the small intestine,
• Premature emptying of the colon
• Bacterial overgrowth
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8. Meds causing diarrhea
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9. Clinical presentation
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10. Treatment of Diarrhea
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13. Cont’d…
• Dietary management is a first priority in the treatment
of diarrhea
• Oral solutions are strongly recommended
• A separate oral supplement of zinc 20 mg daily for 14
days in addition to ORS significantly reduces the
severity and duration of acute diarrhea.
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14. Treatment
• The main stay of treatment of chronic diarrhea is
treating the underlying cause.
• Antidiarrheal agents should only be used as
symptomatic management and should be avoided
in patients with bloody diarrhea, suspected
bacterial diarrhea, and pseudomembranous colitis.
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15. • Loperamide
- Dosing initially 4 mg, PO, followed by 2 mg after each
loose stool (maximum: 16 mg/day)
- Dose should be decreased to minimum required to
control symptoms (usual: 4 to 8 mg/day)
- If improvement is not observed after 10 days of
treatment with 16 mg/day, symptoms are unlikely to be
controlled.
• Referral
Adults patients with chronic diarrhea, the cause of which
is not clearly identified should be referred to a hospital
with gastroenterology specialty service.
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16. Selected Antidiarrheal Preparations
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17. CONSTIPATION
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18. Cont’d….
• Defined as difficult or infrequent passage of stool, at times
associated with straining or a feeling of incomplete defecation.
• Although frequency of bowel movements can vary from person to
person, constipation commonly expressed as fewer than three
bowel movements per week.
• More common in women (2.4-fold more likely) and the elderly
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19. Possible causes of constipation
• GI disorders
• Metabolic disorders
• Pregnancy
• Drugs(opioids ,Ca, Al containing anti acids,
anticholinergics)
• Life style factors
• Neurological and psychological causes
• Cardiac disorder
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20. Clinical presentation
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21. Treatment
• Goal
• The major goals of treatment are to
• (a) relieve symptoms;
• (b) reestablish normal bowel habits
(c) improve quality of life by minimizing adverse effects
of treatment.
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22. Rx Algorism
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23. Cont’d…
• Non pharmacological
• Dietary modification
• Surgery
• Biofeedback
• Electrical stimulation
• Pharmacological
• those causing softening of feces in 1 to 3 days
• those that result in soft or semifluid stool in 6 to 12
hours
• those causing watery evacuation in 1 to 6 hours
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24. Cont’d….
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25. Prevention
• straining at defecation should be avoided in
those recovering from myocardial infarction or
rectal surgery……bulk-forming laxatives
• In pregnant patients…bulk-forming laxatives
and docusates should be the first line of
prevention.
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