Constipation is passage or non passage of small hard feces, dry bowel movements

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Constipation is passage or non passage of small hard feces, dry bowel movements, usually fewer than a couple of times per week. People who are constipated may find it difficult and painful to have a bowel movement. Other symptoms of constipation include feeling bloated, uncomfortable, and sluggish.

Many people think they are constipated when, in fact, their bowel movements are regular. For example, some people believe they are constipated, or irregular, if they do not have a bowel movement every day. However, there is no right number of daily or weekly bowel movements. Normal may be three times a day or three times a week depending on the person. In addition, some people naturally have firmer stools than others.

At one time or another almost everyone gets constipated. Poor diet and lack of exercise and dehydration are usually the causes. In most cases, constipation is temporary and not serious. Understanding causes, prevention, and treatment will help most people find relief.
Constipation can be broken down into four categories.
Mild Constipation, Major Constipation, Severe Constipation, Impaction

A simple warm water ENEMA will relieve constipation in just a few minutes.

Common Causes of Constipation:

  • Not enough fiber in diet
  • Not enough liquids ( water / Juices )
  • Lack of exercise
  • Medications
  • Irritable bowel syndrome
  • Changes in life or routine such as pregnancy, older age, and travel
  • Abuse of laxatives
  • Ignoring the urge to have a bowel movement
  • Specific diseases such as multiple sclerosis and lupus
  • Problems with the colon and rectum
  • Problems with intestinal function (Chronic idiopathic constipation).

DEFINITION:

The infrequent passage of stool.

"psychogenic constipation" - Inadequately managed acute problem.  Coercive toilet training  at home / school or camp

HISTORY:

History of drugs (diuretics, antidepressants, antispasmodics)
constipation since early childhood (Hirschsprung Disease)
concurrent bladder incontinence or abnormal anal tone (neuralgic)
hypothyroidism (dry skin, lethargy, slowing growing hair and nails)
99% of constipation is idiopathic
Look for a precipitating event  (anal fissure)

CLINICAL FEATURES:

Constipation +/- abdominal pain
Complications:  overflow incontinence with fecal soiling ("diarrhea")
Impaction with chronic dilatation and or intestinal obstruction

INVESTIGATIONS:

1. Imaging Studies

Abdominal x-rays may show rectal/recto sigmoid impaction .
2. Sigmoidoscopy
with or without biopsy for Hirschrung Disease



MANAGEMENT:

1. Options

1. Bulking agents (soluble fibers) bran - oat, wheat  psyllium - Metamucil, ProDiem

2. Laxatives  magnesium - Milk of Magnesia, Epson Salts

3. Stimulants
Phosphate - phosphate enemas
phenolphthalein,  Senna,  Aloe Vera Juice, rhubarb,  castor oil,  Bisacodyl

4. Stool Softeners

SDS

5. Lubricants

mineral oil, glycerin, olive oil, vegetable oil

6. Enemas

Note: In the treatment of constipation in young people, enemas seem to be better choice than laxatives in treatment.

 

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Warning: Do not use enemas or laxatives if abdominal pain, nausea, or vomiting are present unless directed by your health care provider.
 Rectal bleeding or failure to have a bowel movement after use of a laxative or enema may indicate a serious condition.
 Discontinue use and consult your health care provider.
 Statements contained within these web pages are for informational purposes only,
and have not been evaluated by the FDA.
 These products are not intended to diagnose, treat, cure, or prevent any disease.
 If pregnant or have an existing medical condition consult your healthcare provider before using.