Constipation is characterized by infrequent in incomplete evacuation of the bowels. Hard, dried stools are difficult to pass.

1. SEMINOR ONSEMINOR ON
CONSTIPATIONCONSTIPATION
 INSTRUCTOR-INSTRUCTOR-
 Dr. Sadhna singhDr. Sadhna singh
Head of department-Head of department-
Food Science and NutritionFood Science and Nutrition
Name-Mr. Sukhveer singhName-Mr. Sukhveer singh
I.D.No. H-4799/09I.D.No. H-4799/09
B.Sc(H.Sc)4B.Sc(H.Sc)4thth
yearyear
College of Home Science.College of Home Science.
N.D.U.A.&T.Kumarganj, Faizabad (224229)N.D.U.A.&T.Kumarganj, Faizabad (224229)

2. ContentContent
 INTRODUCTION OF CONSTIPATIONINTRODUCTION OF CONSTIPATION :-:-
 Symptoms of constipationSymptoms of constipation
 Type of constipationType of constipation
 Causes of constipation
 Other causes of constipationOther causes of constipation
 Dietary prescription
 Treatment: DietTreatment: Diet
 SupplementsSupplements
 Some medications associated with constipationSome medications associated with constipation
 Stimulant LaxativesStimulant Laxatives
 Stool Softeners & LubricantsStool Softeners & Lubricants
 Helping to prevent constipationHelping to prevent constipation

3. INTRODUCTION OFINTRODUCTION OF
CONSTIPATION :-CONSTIPATION :-
 Constipation is characterized by infrequent inConstipation is characterized by infrequent in
incomplete evacuation of the bowels. Hard, dried stoolsincomplete evacuation of the bowels. Hard, dried stools
are difficult to pass.are difficult to pass.
 Autonomous nervous system normally controls theAutonomous nervous system normally controls the
bowel movement .bowel movement .
 Though most people have a bowel movement daily.Though most people have a bowel movement daily.
Some people feel normal even with a bowel evacuationSome people feel normal even with a bowel evacuation
on every second or third day.on every second or third day.
 Constipation is also known as costiveness or dyscheziaConstipation is also known as costiveness or dyschezia
refers to bowel movements that are infrequent or hard torefers to bowel movements that are infrequent or hard to
pass.pass.
 Constipation is one of the most commonConstipation is one of the most common
gastrointestinal complaints in the united states, moregastrointestinal complaints in the united states, more
than four million Americans.than four million Americans.

4.  It is a common problem in pregnancy, affecting at least half
of all pregnant women.
 The word constipation comes from the Latin constipare
meaning to press.

5. Symptoms of constipationSymptoms of constipation
Nausea +/- vomitingNausea +/- vomiting
Abdominal and Rectal painAbdominal and Rectal pain
FlatulenceFlatulence
Loss of appetiteLoss of appetite
LethargyLethargy
DepressionDepression
Patients may not associate these with constipationPatients may not associate these with constipation

6. Type of constipationType of constipation
 Atonic constipation- it is the most type of constipation. in it theAtonic constipation- it is the most type of constipation. in it the
intestinal walls lack muscular tone so that peristaltic action isintestinal walls lack muscular tone so that peristaltic action is
impaired .impaired .
 Spastic constipation- this is charactrised by increased tonicity ofSpastic constipation- this is charactrised by increased tonicity of
the musculature .the musculature .
Temporary or chronic constipation can be due to any one of aTemporary or chronic constipation can be due to any one of a
number of factors as -number of factors as -
Inadequate diet.Inadequate diet.
• Interference with the urge to defecate brought on by poorInterference with the urge to defecate brought on by poor
personal hygiene or injury to the nervous mechanism .personal hygiene or injury to the nervous mechanism .
• Chronic use of laxatives .Chronic use of laxatives .
• Ingestion of drugs ,large amounts of sedatives , ganglionicIngestion of drugs ,large amounts of sedatives , ganglionic
blocking agents or opiatesblocking agents or opiates

7. Type of constipationType of constipation

8. Causes of constipation:
There are many causes of constipation including
Low fibre diets.
Lack of fluids.
Poor bowel habits.
Consumption of concentrated foods.
Deficiency of fats and thiamine.
Nervous disturbances.
 Excessive use of laxatives and regular enemas.
Lack of potassium.
Irritating foods.
Excessive use of alcohol, tea or coffee.

9. Other causes of constipationOther causes of constipation
 ↓↓ fiber :fiber :(most common)(most common)
 ↓↓ liquidliquid ( 8 glasses/d is needed for constipated)( 8 glasses/d is needed for constipated)
 ↓↓ ExerciseExercise : bedridden, coma: bedridden, coma
 Ignoring urge to defecateIgnoring urge to defecate
 Systemic:Systemic: Hypothyroidism, DM, Uremia,Hypothyroidism, DM, Uremia,
pregnancy, hypercalcemia, Hypokalemiapregnancy, hypercalcemia, Hypokalemia
 Neurological:Neurological: Stroke, Parkinsonism, MultipleStroke, Parkinsonism, Multiple
sclerosissclerosis

10. Dietary prescription:
Fibre rich foods.
Low fat diets.
Carbohydrate, protein, vitamin and minerals should be taken in
proper amount.
Food avoided-
 Junk food, butter, ghee, meat, egg, refined, cholesterol and fatty
food.
Food included-
All pulses, mix vegetables, all fruits and vegetable except banana
and jackfruit. 8 to10 glasses fluid per day, plain or with lemon hot
water with lemon are helpful in initiating peristalsis when taken
before breakfast

11. Dietary prescription:

12. Treatment: DietTreatment: Diet
 Reduce: Sugar, Milk/Dairy, Coffee, Alcohol, Meat, SaturatedReduce: Sugar, Milk/Dairy, Coffee, Alcohol, Meat, Saturated
Fats, Processed refined flour based foods (white bread, pastries)Fats, Processed refined flour based foods (white bread, pastries)
 Increase: FiberIncrease: Fiber Fruits and VegetablesFruits and Vegetables
 Apricots, Figs, Dates, Plums, PrunesApricots, Figs, Dates, Plums, Prunes
 Beans, Lentils, Ground Flax, SesameBeans, Lentils, Ground Flax, Sesame
 Wheat Bran (two to six tablespoons with each meal)Wheat Bran (two to six tablespoons with each meal)
 Whole GrainsWhole Grains
 Fruits and juices that containFruits and juices that contain sorbitolsorbitol and fructose such asand fructose such as
apples, peaches, pears, cherries, raisins, grapes, and nutsapples, peaches, pears, cherries, raisins, grapes, and nuts..
 Olive Oil 2 T QDOlive Oil 2 T QD
 Chew Food 20-30x (stimulates peristalsis)Chew Food 20-30x (stimulates peristalsis)
 Water (minimum= ½ oz per # of Body Wt/QDWater (minimum= ½ oz per # of Body Wt/QD))

14. SupplementsSupplements
 Probiotics—Bifidus encourages peristalsisProbiotics—Bifidus encourages peristalsis
 Magnesium—400-500mg QD (citrate or aspartate)Magnesium—400-500mg QD (citrate or aspartate)
 Vitamin C—5000-10000mg QD !Vitamin C—5000-10000mg QD !
 Can titrate up to effectCan titrate up to effect

15. Some medications associated withSome medications associated with
constipationconstipation
Aluminium and calcium containing antacidsAluminium and calcium containing antacids
Anticholinergic agentsAnticholinergic agents
Calcium supplementsCalcium supplements
AntipsychoticsAntipsychotics
IronIron
OpioidsOpioids

16. Stimulant LaxativesStimulant Laxatives
 Increase peristalsis by irritating colonIncrease peristalsis by irritating colon
 bisacodyl (Correctol®, Dulcolax®)bisacodyl (Correctol®, Dulcolax®)
 senna (Senokot®, ex-lax)senna (Senokot®, ex-lax)
 Long Term Use can lead to dependency “lazy bowel”, electrolyteLong Term Use can lead to dependency “lazy bowel”, electrolyte
disorders (hypo K, Hyper Na)disorders (hypo K, Hyper Na)

17. Stool Softeners & LubricantsStool Softeners & Lubricants
eg docusate (Coloxyl®), paraffin oil (Agarol®)eg docusate (Coloxyl®), paraffin oil (Agarol®)
Efficacy of docusate is controversialEfficacy of docusate is controversial
May be useful with anal fissures of haemorrhoids or when straining is aMay be useful with anal fissures of haemorrhoids or when straining is a
hazardhazard
Liquid paraffin is not recommended for treatment ofLiquid paraffin is not recommended for treatment of constipationconstipation
 -- risk of aspiration and lipid pneumoniarisk of aspiration and lipid pneumonia
 -- long term use may result in depletion oflong term use may result in depletion of
Vitamins A, D, E and KVitamins A, D, E and K

18. Helping to prevent constipationHelping to prevent constipation
Patient educationPatient education
Diet and Fluid IntakeDiet and Fluid Intake
ExerciseExercise
Effective Bowel HabitsEffective Bowel Habits
Toileting FacilitiesToileting Facilities
Medication ReviewMedication Review
Ensure a laxative is prescribed with opioidsEnsure a laxative is prescribed with opioids

19. ReferencesReferences
 Up To Date: “Treatment of chronic constipation in adults”Up To Date: “Treatment of chronic constipation in adults”
 American Gastroenterological Association Medical PositionAmerican Gastroenterological Association Medical Position
Statement: Guidelines on ConstipationStatement: Guidelines on Constipation ;;
GASTROENTEROLOGYGASTROENTEROLOGY 2000;119:1761–17782000;119:1761–1778
 Natural Standard: “Constipation”Natural Standard: “Constipation”
 Burkitt;Burkitt; An Epidemiological Approach to GastrointestinalAn Epidemiological Approach to Gastrointestinal
CancerCancer CA Cancer J ClinCA Cancer J Clin 1970;20;146-1491970;20;146-149
 Anderson, RA;Anderson, RA; Clinicians Guide to Holisitic Medicine;Clinicians Guide to Holisitic Medicine; McGraw-Hill:McGraw-Hill:
20012001
 Nutrition and diet therapy, by Ms. Sangeeta KarnikNutrition and diet therapy, by Ms. Sangeeta Karnik..
 Dietetics, by B. Srilakshmi.Dietetics, by B. Srilakshmi.