2. Constipation is a symptom, not a
disease
SOME CAUSES:
IBS
DIABETES MELLITUS,
HYPOTHYROIDISM
3. What is the right number of daily or
weekly bowel movements?!
4. Clinical definition
Any of two of following symptoms for at least 3
month (not necessarily consecutive) in a year
• Straining
• Hard or lumpy stool
• Sensation of incomplete evacuation
• Fewer than 3 defecation per week
• Pale- Icteric-Anorexia-Headache-Abdominal pain
Rate of empting: carbohydrate>protein>Lipid
5. Causes of constipation
↓ fiber :(most common)
↓ liquid ( 8 glasses/d is needed for constipated)
↓ Exercise : bedridden, coma
Ignoring urge to defecate
Systemic: Hypothyroidism, DM, Uremia, pregnancy, hypercalcemia, Hypokalemia
Neurological: Stroke, Parkinsonism, Multiple sclerosis
GI-related: IBS, Hemorrhoid, Anal fissure, Anorectal & Colorectal carcinoma
,obstruction
Medication: Opiate, Anticholinergics, Al(OH)3
Iron, cholestyramine, Antihypertensive drugs (CCBs, diuretics), relaxants, chronic
use of laxatives, Antiepileptics, progesterone
Uncertain: idiopathic chronic constipation
6. Diagnosis
Good history is enough for most cases (Duration, frequency,
Consistency, blood in the stool, weight loss, Diet, Exercise, Toilet
habits, Laxative use (what), other drugs)
Basic laboratory tests:
CBC, Electrolytes, BS, BUN, Cr, TSH
Structural:
Barium enema, Sigmoidoscopy, Colonoscopy
7. Treatment
Treatment of underlying disease
(Malignancies, Hypothyroidism,…)
Alteration of lifestyle (Diet, Exercise, Liquids)
Laxatives
8.
9. Acute constipation
Glycerin suppository
Sorbitol powder
Bisacodyl
Anthraquinones ( C-lax)
Saline laxative (MOM)
Tap-water enema
If laxative treatment is required for > 1 week, refer to a physician
10. Chronic constipation
Most common in bedridden or geriatrics
Choice: Psyllium (with enough liquids)
Low doses of other laxatives:
Docusate, MOM, Sorbitol, Lactulose
11. Constipation in hospitalized patients
May be related to general anesthesia or opiates
Glycerin suppository
Milk of magnesium
Tap water enema
12. Constipation in infants & children
If constipation is a persistent problem:
Consider neurological, metabolic or anatomical abnormalities
If No:
Approach as adults
13. Glycerin
Is very safe and acceptable for intermittent basis particularly in infants
Supp: 1g, 3g
Onset: less than 30 min
14. Tap-water enema
200 ml results in a bowel movement within 0.5hr
Soapsuds are no longer recommended (colitis)
