A presentation on CONSTIPATION AND DIARRHOEA

1. CONSTIPATION AND DIARRHEA
A brief review

2. CONSTIPATION

3.  Inability to completely evacuate the bowels or passing
very hard stools is known as Constipation.
 This prevalent problem is due to an incorrect lifestyle
and poor eating patterns. Although constipation is often
looked upon as a common problem, it can lead to
further problems such as fissures, fistulas, piles, lack of
appetite and indigestion.
DEFINITION

4. Organic Constipation results from a documented
pathological condition
 Anatomical malformation
 Intestinal
 Connective tissue disorders
 Gastrointestinal disorders
 Neuropathic Disorders
Organic Constipation

5. Functional Constipation accounts for the majority of
diagnoses (95%) and is caused by psychological,
developmental or dietary issues
 Food Allergy: Milk , egg and wheat being the most
common allergens associated with constipation
 Dietary Factors: Fluid and dietary fiber intake are
contributors in the development of functional
constipation.
Functional Constipation

6.  Incomplete evacuation of bowel or passing of hard
stools is the main symptom
 Pain in the stomach
 Flatulence
 Pain at the anus while defecating
 Lack of appetite
 Heaviness of Body
 Indigestion
 Acid eructation (belching)
SYMPTOMS

7.  Fecal continence is maintained by involuntary muscles,
internal anal sphincter and voluntary muscle
contractions in perineum
 External anal sphincter is under voluntary control.
 Causes of constipation can be divide into
 Primary
 Secondary
Pathophysiology

8. Primary causes
They do not have any underlying cause.
Secondary Causes
 Immobility
 Improper Diet
 Endocrine and metabolic disorders
 Impaired Defecation
Contd..

9. Medical management
 Laxatives: Methyl cellulose
 Stool softener: Docusate calcium, Docusate
potassium
 Stimulants: Bisacodyl, Castor oil
 Increasing fluid intake
 Regular exercises
 Regular monitoring of bowel pattern
MANAGEMENT

10. MANAGEMENT
Fig.1 Tips to Relieve Constipation

11.  Normal maintenance oral fluids should be
given in addition to maintain hydration.
 No net fluid input and there is a risk of
dehydration.
 Polyethylene glycol appears to be a reasonable
first choice for maintenance therapy.
INPATIENT MANAGEMENT

12. HOME REMEDIES
Fig.2 Home Remedies to get rid of Constipation

13.  Increase intake of fiber , especially fruits and cooked
vegetables.
 Drink 7-8 glasses of water each day , preferably
lukewarm in winters and room temperature water in
summers.
 Take daily morning and evening walks for at-least 20-
30 minutes.
 Avoid removing bran from the flour because the bran is
an insoluble fiber that clears off the intestines and
relieves constipation.
DIET AND LIFESTYLE ADVICE

14.  High protein foods like cheese, red meat and soybeans
can cause constipation, so these must be taken with a
bowl of salad and lots of liquids.
 Meat is constipating and should be avoided.
 Natural antacid, baking soda can neutralize stomach
acids and reduce heartburn.
Contd..

15.  Disturbing psychological factors should be removed.
 Meals should be taken in a relaxed and calm
atmosphere.
 The food should be warm and freshly prepared, as cold
and stale the food slows down the digestive power.
 Having excessively cold food like icecream or chilled
drinks reduces the Bowel movement.
PSYCHOLOGICAL FACTORS

16. DIARRHEA

17.  Diarrhea is an increase in the volume of stool or
frequency of defecation.
 It is one of the most common clinical signs of
gastrointestinal disease, but also can reflect primary
disorders outside of the digestive system. Certainly,
disorders affecting either the small or large bowel can
lead to diarrhea.
DEFINITION

18.  Acute watery diarrhea-Lasts several hours or days , and
includes cholera.
 Acute bloody diarrhea-also called Dysentery.
 Persistent diarrhea-lasting 14 days or longer.
Types of diarrhea

19.  A bacterial infection.
 Food intolerances.
 Irritable bowel syndrome.
 Food poisoning.
 Gastroenteritis.
 Small intestinal bacterial growth.
CAUSES:

20.  There are numerous causes of diarrhea, but in almost
all cases, this disorder is a manifestation of one of the
four basic mechanisms described below.
 Osmotic Diarrhea
 Secretory Diarrhea
 Inflammatory and Infectious Diarrhea
 Diarrhea Associated with Deranged Motility
Pathophysiology of Diarrhea

21.  Absorption of water in the intestines is dependent on adequate
absorption of solutes. If excessive amounts of solutes are retained in
the intestinal lumen, water will not be absorbed and diarrhea will
result. Osmotic diarrhea typically results from one of two situations:
 Ingestion of a poorly absorbed substrate: The offending molecule
is usually a carbohydrate or divalent ion. Common examples include
mannitol or sorbitol, epson salt (MgSO4) and some antacids
(MgOH2).
Osmotic Diarrhea

22.  Malabsorption: Inability to absorb certain
carbohydrates is the most common deficit in this
category of diarrhea, but it can result virtually any type
of malabsorption.
 A distinguishing feature of osmotic diarrhea is that it
stops after the patient is fasted or stops consuming the
poorly absorbed solute.
Contd..

23.  Large volumes of water are normally secreted into the
small intestinal lumen, but a large majority of this
water is efficiently absorbed before reaching the large
intestine. Diarrhea occurs when secretion of water into
the intestinal lumen exceeds absorption.
 Exposure to toxins from several other types of bacteria
(e.g. E. coli heat-labile toxin) induce the same series of
steps and massive secretory diarrhea that is often lethal
unless the person or animal is aggressively treated to
maintain hydration.
Secretory Diarrhea

24.  In addition to bacterial toxins, a large number of other
agents can induce secretory diarrhea by turning on the
intestinal secretory machinery, including:
 Some laxatives
 Hormones secreted by certain types of tumors (e.g.
vasoactive intestinal peptide)
 A broad range of drugs (e.g. some types of asthma
medications, antidepressants, cardiac drugs)
 Certain metals, organic toxins, and plant products (e.g.
arsenic, insecticides, mushroom toxins, caffeine)
 In most cases, secretory diarrheas will not resolve during a
2-3 day fast.
Contd..

25.  The epithelium of the digestive tube is protected from insult
by a number of mechanisms constituting the gastrointestinal
barrier , but like many barriers, it can be breached.
Disruption of the epithelium of the intestine due to microbial
or viral pathogens is a very common cause of diarrhea in all
species.
 Examples of pathogens frequently associated with infectious
diarrhea include:
 Bacteria: Salmonella, E. coli, Campylobacter
 Viruses: rotaviruses, coronaviruses, parvoviruses (canine
and feline), norovirus
 Protozoa: coccidia species, Cryptosporium, Giardia
Inflammatory and Infectious Diarrhea

26.  In order for nutrients and water to be efficiently
absorbed, the intestinal contents must be adequately
exposed to the mucosal epithelium and retained long
enough to allow absorption.
 It can be caused by,
 Infectious and parasitic gastroenteritis
 Intestinal bacterial over growth
 Inflammation
Diarrhea Associated with Deranged Motility

27.  Objective of treatment
 Restore weight gain
 Restore normal intestinal function
 Treatment consists of:
 Appropriate fluids to prevent or treat dehydration
 Antimicrobials to treat diagnosed infections
 Supplementary vitamins and minerals
MANAGEMENT: