Constipation can negatively impact women's quality of life at any age. It is defined as infrequent bowel movements, hard stools, straining, and incomplete evacuation. Common causes include low fiber intake, pregnancy, medications, and irritable bowel syndrome. Treatment focuses on increasing fiber and fluid intake, exercise, and if needed, laxatives. Laxatives include bulk-forming, osmotic, and stimulant types. The goals of treatment are to relieve constipation and maintain regular bowel movements through lifestyle changes.
Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation. Severe constipation includes obstipation (failure to pass stools or gas) and fecal impaction, which can progress to bowel obstruction and become life-threatening.
Constipation is a symptom with many causes. These causes are of two types: obstructed defecation and colonic slow transit (or hypo mobility). About 50 percent of people evaluated for constipation at tertiary referral hospitals have obstructed defecation. This type of constipation has mechanical and functional causes. Causes of colonic slow transit constipation include diet, hormonal disorders such as hypothyroidism, side effects of medications, and rarely heavy metal toxicity. Because constipation is a symptom, not a disease, effective treatment of constipation may require first determining the cause. Treatments include changes in dietary habits, laxatives, enemas, biofeedback, and in particular situations surgery may be required.
Constipation is common; in the general population rates of constipation varies from 2–30 percent. In elderly people living in care homes the rate of constipation is 50–75 percent.[4] In the United States expenditures on medications for constipation are greater than US$250 million per year.
The definition of constipation includes the following:
infrequent bowel movements (typically three times or fewer per week)
difficulty during defecation (straining during more than 25% of bowel movements or a subjective sensation of hard stools; straining in this context is a strong effort to push out stool often by holding one's breath and by pushing the respective muscles in the abdominal area hard), or
the sensation of incomplete bowel evacuation.
The Rome III criteria are widely used to diagnose chronic constipation, and are helpful in separating cases of chronic functional constipation from less-serious instances.
Another definition states that less than three bowel movements per week and straining on more than 75% of occasions represents constipation in clinical surveys.
Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation. Severe constipation includes obstipation (failure to pass stools or gas) and fecal impaction, which can progress to bowel obstruction and become life-threatening.
Constipation is a symptom with many causes. These causes are of two types: obstructed defecation and colonic slow transit (or hypo mobility). About 50 percent of people evaluated for constipation at tertiary referral hospitals have obstructed defecation. This type of constipation has mechanical and functional causes. Causes of colonic slow transit constipation include diet, hormonal disorders such as hypothyroidism, side effects of medications, and rarely heavy metal toxicity. Because constipation is a symptom, not a disease, effective treatment of constipation may require first determining the cause. Treatments include changes in dietary habits, laxatives, enemas, biofeedback, and in particular situations surgery may be required.
Constipation is common; in the general population rates of constipation varies from 2–30 percent. In elderly people living in care homes the rate of constipation is 50–75 percent.[4] In the United States expenditures on medications for constipation are greater than US$250 million per year.
The definition of constipation includes the following:
infrequent bowel movements (typically three times or fewer per week)
difficulty during defecation (straining during more than 25% of bowel movements or a subjective sensation of hard stools; straining in this context is a strong effort to push out stool often by holding one's breath and by pushing the respective muscles in the abdominal area hard), or
the sensation of incomplete bowel evacuation.
The Rome III criteria are widely used to diagnose chronic constipation, and are helpful in separating cases of chronic functional constipation from less-serious instances.
Another definition states that less than three bowel movements per week and straining on more than 75% of occasions represents constipation in clinical surveys.
Constipation is generally defined as infrequent and/or unsatisfactory defecation fewer than 3 times per week.
Patients may define constipation as passing hard stools or straining, incomplete or painful defecation. It's a symptom NOT a disease.
Constipation has many causes and may be a sign of undiagnosed disease.
Constipation is one of the most frequent GIT disorders encountered among older adults in clinical practice.
Up to 50% of elderly experiencing constipation at some point in their lives.
Elderly women are having 2–3 times more constipation than men.
Approximately, 30% of older adults are regular nonprescription laxative users, such as stimulant and bulking laxatives.
The Newer Concepts In Endometriosis Management : Dr Sharda JainLifecare Centre
The Newer Concepts In
Endometriosis Management
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DELEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
The Newer Concepts forReduced Surgery to preserve fertility in Endometrios...Lifecare Centre
The Newer Concepts forReduced Surgery to preserve fertility in Endometriosis
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DILEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
Anemia Free India Gynaecologist to focuss on *12gm Haemoglobin at Delivery I...Lifecare Centre
Important Highlights
Prophylactic Iron and Folic Acid Supplementation in all six target age groups.
Intensified year-round Behaviour Change Communication (BCC) Campaign for:(a) improving compliance to IFA and deworming, (b) enhancing appropriate infant and young child feeding practices, (c) encouraging increase in intake of iron-rich food through diet and/or fortified foods (d) ensuring delayed cord clamping .
Testing and treatment of anaemia, using digital methods and point of care treatment, with special focus on pregnant women and school-going adolescents.
Addressing non-nutritional causes of anaemia
in endemic pockets with special focus on malaria, hemoglobinopathies and fluorosis
Strategies for Improving Success Rates in ART PARTLifecare Centre
Strategies for Improving Success Rates in ART
Part - 2
Strategies for Improving Success Rates in ART
Tailoring Controlled Ovarian Stimulation
Strategies for Luteal Phase in ART cycles
Endometrial Receptivity Array
How to optimize success rates in ART? : Dr Sharda JainLifecare Centre
How to optimize success rates in ART? : Dr Sharda Jain
How to improve success rates in ART?
The big debate कार्य में आनंद
Evolution of In-vitro Fertilization (IVF)
Factors Influencing IVF Success Ist Part
Strategies for Improving Success Rates in ART Second Part
Innovations & Breakthroughs in IVF Part Three
OPEN DEBATE
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda JainLifecare Centre
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda Jain
Introduction
Social egg freezing (oocyte cryopreservation for non-medical reasons) has evolved as a proactive option for women looking to extend their reproductive possibilities past their peak childbearing years
It is the process of saving or protecting eggs, or reproductive tissues so that a person can use them to have biological children in future
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
3. •Constipation can negatively Impact
HER quality of life during pregnancy at any stage
Post-operative
Pregnancy
Nursing Mother
See our another presentation constipation I pregnancy & postpartum in slide share .net
4. CONSTIPATION Definition
•Constipation is a symptom of many conditions.
Commonly it refers to
-Infrequent passage of stools
-Straining
-passage of hard stool
-incomplete evacuation.
• It is estimated to affect over 12 to 30% of the
woman population.
5. Rome III criteria
for functional constipation
• At least 2 or more of the following criteria:
• -Straining during at least 25% of the defecations
• -Lumpy or hard stools in at least 25% of the defecations - Sensation of
incomplete evacuation for at least 25% of defecations
• -Sensation of anorectal obstruction/blockage for at least 25% of
defecations
• -Manual manoeuvres to facilitate defecation for at least 25% of
defecations
• -Fewer than three defecations per week
Nutr J. 2012; 11: 80.
6. Another definition states that less than three
bowel movements per week and straining on
more than 75% of occasions represents
constipation in clinical surveys.
7. IMPACT OF CONSTIPATION
•Disturbed defecation can result in the development
of utero-vaginal Prolapse in woman.
• Therefore it is important to recognize the
symptoms of constipation early …Not ignore it and
treat this complain in an early stage it self.
9. . The most common cause is PRIMARY and not
life-threatening.
In the ELDERLY, causes include: insufficient dietary fiber intake,
inadequate fluid intake, decreased physical activity, side
effects of medications, hypothyroidism, and obstruction by
colorectal cancer.
Constipation with no known organic cause, i.e. no medical
explanation, exhibits Great gender differences in prevalence:
females are more often affected than males.
THE CAUSES OF CONSTIPATION CAN BE DIVIDED INTO
CONGENITAL, PRIMARY, AND SECONDARY
12. Psychological causes
Voluntary withholding of the stool is a
common cause of constipation.
The choice to withhold can be due to
factors such as fear of pain, fear of
public restrooms, or laziness.
16. •Opiates , anti depressants
•Anticholinergic, antispasmodics, anticonvulsants
•Calcium channel blockers eg nifedipin
•Anti depressant
•Iron
•Magnesium salts, aluminum antacids
Drugs can cause Constipation
17. Diet
Constipation can be caused or
exacerbated by a low-fiber diet, low
liquid intake, or dieting.
Childhood chronic constipation can
be manifests as an intolerance to
cow’s mild.
20. CAREFUL HISTORY
•A recent change in bowel habit in
association with other symptoms,
line rectal bleeding requires
urgent Investigations
21. DIAGNOSIS
The diagnosis is essentially made from the patient's description of the
symptoms. Bowel movements that are difficult to pass, very firm, or
made up of small hard pellets (like those excreted by rabbits) qualify as
constipation, even if they occur every day.
Other symptoms related to constipation can include
bloating, distension, abdominal pain, headaches, a feeling of fatigue
and nervous exhaustion, or a sense of incomplete emptying
22. DIETARY HISTORY
•Inquiring about dietary habits will
often reveal a low intake of dietary
fiber, inadequate amounts of fluids,
poor ambulation or immobility, or
medications that are associated with
constipation
23. IRRITABLE BOWEL SYNDROME (IBS)
•Chronic constipation (symptoms present at
least three days per month for more than
three months) associated with abdominal
discomfort is often diagnosed as irritable
bowel syndrome (IBS) when no obvious
cause is found
24. INVESTIGATIONS
This will usually involves
• Rectal examine
• Sigmoidoscopy
• Colonoscope
• X. ray of the abdomen
• A Barium enema
• A Barium enema should always be preceded by a rectal
examination and rigid sigmoidoscopy to exclude
anorectal lesion
25. THE TWO CLINICAL TYPES OF
CONSTIPATION
•Slow transit
•Obstructive
26. • In the slow-transit form--Patients rarely Experience
a call to stool.
• In the obstructive form--Patients experience a call to
stool but are not able to evacuate properly because of
coexisting organic and functional anorectal disease.
THE TWO CLINICAL TYPES OF
CONSTIPATION
27. SEVERITY ASSESS MENT
Slow Transit constipation--A simple abdominal x-ray
& marker studies of colonic transit –
can assess the severity of slow –transit-constipation .
Obstructive constipation is assessed by performing
evacuation procto graphy.
28. PREVENTION
Constipation is usually easier to prevent
than to treat. Following the relief of
constipation, maintenance with
adequate exercise, fluid intake, and
high-fiber diet is recommended.
29. TREATMENT
•The treatment of constipation should focus on
the underlying cause if known.
•The National Institute of Health and Care
Excellence (NICE) break constipation in adults into
two categories - chronic constipation of unknown
cause and constipation due to know causes.
30. TREATMENT
• In chronic constipation of unknown cause, the main treatment involves
the increased intake of water and fiber (either dietary or as
supplements).
• The routine use of laxatives is discouraged, as having bowel
movements may come to be dependent upon their use.
• Enemas can be used to provide a form of mechanical stimulation.
However, enemas are generally useful only for stool in the rectum, not
in the intestinal tract.
31. Dictum of TREATMENT
•Give relief from constipation with an increase in
dietary fibre and fluids, as well as daily exercise.
• Probiotics that alter the colonic flora might also
improve bowel function.
• If these are ineffective, laxatives are the second line
of therapy
Canadian Family Physician August 2012 vol. 58 no. 8 836-838
32. TREATMENT OPTIONS
• Foods like "bran," which incidentally contains a lot of iron,
increase the bulk of the faeces and relieve constipation quite
effectively.
• The patient may be told that the risks of over-purgation are far
greater than the risks of constipation.
Br Med J. 1964 Mar 21;1(5385):749-52.
34. TREATMENT
• Laxatives ,in combination with increasing fibre ,fluid intake
and increasing physical activity level are usually effective
and should be tailored to the needs of the patient .
• Regular treatment is more effective than ad hoc use, and
stimulant laxatives should be used very cautiously.
• Excessive use of laxatives may lead to electrolyte
disturbances.
35. TREATMENT
The treatment of constipation should focus on
the underlying cause if known.
The National Institute of Health and Care
Excellence (NICE) break constipation in
adults into two categories –chronic constipation
of unknown cause and constipation due to
opiates.
36. TREATMENT
In chronic constipation of unknown cause, the main
treatment involves the increased intake of water and
fiber (either dietary or as supplements).
The routine use of laxatives is discouraged, as having
bowel movements may come to be dependent upon
their use.
Enemas can be used to provide a form of mechanical
stimulation. However, enemas are generally useful only
for stool in the rectum, not in the intestinal tract.
37. KNOW THE TYPES OF LAXATIVES
Bulk-forming laxatives- relieve constipation
by increasing faecal mass which stimulates
peristalsis.The full effect may take some days to
develop .
They include methylcellulose, ispa-ghula, and
sterculia
38. Osmotic laxative- act by increasing colonic
inflow of fluid and electrolyte which soften stool
and stimulate colonic contractility. They include
lactulose, macro gold, magnesium salts and
phosphate enemas
39. STIMULATE LAXATIVES
Stimulant laxatives- increase in testing motility
and often cause abdominal cramp: they should
be avoided in intestinal obstruction, Excessive
use can cause diarrhea and related effects such
as hypokalemia They include bisacodyl, dantron,
docusate sodium, glycerol senna and sodium
Pico sulfate
40. Faecal softeners- these preparation's contain oil which
soften stool.
These include
arachis oil and liquid paraffin.
Nice guidelines 99.(2010)
41. TYPES OF LAXATIVES
Stimulant laxatives- increase in testing motility and often cause abdominal
cramp: they should be avoided in intestinal obstruction, Excessive use can cause
diarrhea and related effects such as hypokalemia They include bisacodyl,
dantron, docusate sodium, glycerol senna and sodium Pico sulfate
Faecal softeners- these preparation's contain oil which soften stool.
These include arachis oil and liquid paraffin.
Nice guidelines 99.(2010)
42. PRACTICAL TIP ON LAXATIVES
• If laxatives are used, milk of magnesia is recommended as
a first-line agent due to its low cost and safety.
• Stimulants should only be used if this is not effective.
• In cases of chronic constipation, polyethylene
glycol appears superior to lactulose.
• Prokinetics may be used to improve gastrointestinal
motility. A number of new agents have shown positive
outcomes in chronic constipation; these
include prucalopride andlubiprostone.
43. Faecal softeners- these preparation's
contain oil which soften stool.
These include
arachis oil and liquid paraffin.
Nice guidelines 99.(2010)
44. PROGNOSIS
Complications that can arise from constipation include hemorrhoids, anal
fissures, rectal prolapse, and fecal impaction.
Straining to pass stool may lead to hemorrhoids. In later stages of
constipation, the abdomen may become distended, hard and diffusely
tender.
Severe cases ("fecal impaction" or malignant constipation) may exhibit
symptoms of bowel obstruction (vomiting, very tender abdomen)
and encopresis, where soft stool from the small intestine bypasses the
mass of impacted fecal matter in the colon.
45. TAKE HOME MESSAGES
Constipation is the most common digestive complaint in
women
10 -20% of women population worldwide reports having
constipation. Over 50% elderly women have this
complaint
LAXATIVES should be only used when dietary & fluid
modification & increase exercise does not work