STUDY - Technical - New Dacian's Medicine
Constipation
(Classical / Allopathic Medicine)
Constipation is
defined as small, infrequent, or difficult bowel movements.
Because normal bowel movements can vary in frequency and from
individual to individual, constipation must be determined in
relation to the patient's normal elimination pattern.
Constipation may be a minor annoyance or, uncommonly, a sign
of a life-threatening disorder such as acute intestinal
obstruction. If untreated, constipation can lead to headaches,
anorexia, and abdominal discomfort and can adversely affect
the patient's lifestyle and well-being.
Constipation most
commonly occurs when the urge to defecate is suppressed and
the muscles associated with bowel movements remain contracted.
Because the autonomic nervous system controls bowel movements
- by sensing rectal distention from fecal contents and by
stimulating the external sphincter - any factor that
influences this system can cause bowel dysfunction.
Acute constipation
usually has an organic cause, such as an anal or rectal
disorder. In a patient older than age 45, the recent onset of
constipation may be an early sign of colorectal cancer.
Conversely, chronic constipation typically has a functional
cause and may be related to stress.
HISTORY:
Ask the patient to describe the frequency of his bowel movements and the size and consistency of his stools. How long has he been constipated?
Ask the patient if he has pain related to constipation. If so, when did he first notice the pain and where is it located?
Ask the patient if defecation worsens or helps relieve the pain.
Ask the patient to describe a typical day's menu. Estimate his daily fiber and fluid intake. Ask him about changes in eating habits, in drug or alcohol use, or in physical activity.
Ask the patient if he has experienced recent emotional distress. Has constipation affected his family life or social contacts?
Review the patient's medical history for GI, rectoanal, neurologic, or metabolic disorders; abdominal surgery; and radiation therapy.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient to describe the frequency of his bowel movements and the size and consistency of his stools. How long has he been constipated?
Ask the patient if he has pain related to constipation. If so, when did he first notice the pain and where is it located?
Ask the patient if defecation worsens or helps relieve the pain.
Ask the patient to describe a typical day's menu. Estimate his daily fiber and fluid intake. Ask him about changes in eating habits, in drug or alcohol use, or in physical activity.
Ask the patient if he has experienced recent emotional distress. Has constipation affected his family life or social contacts?
Review the patient's medical history for GI, rectoanal, neurologic, or metabolic disorders; abdominal surgery; and radiation therapy.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
PHYSICAL
ASSESSMENT:
Inspect the abdomen for distention or scars from previous surgery.
Auscultate for bowel sounds, and characterize their motility.
Percuss all four quadrants, and gently palpate for abdominal tenderness, a palpable mass, and hepatomegaly.
Examine the rectum, and inspect for inflammation, lesions, scars, fissures, and external hemorrhoids.
Inspect the abdomen for distention or scars from previous surgery.
Auscultate for bowel sounds, and characterize their motility.
Percuss all four quadrants, and gently palpate for abdominal tenderness, a palpable mass, and hepatomegaly.
Examine the rectum, and inspect for inflammation, lesions, scars, fissures, and external hemorrhoids.
SPECIAL
CONSIDERATIONS:
If the patient is on bed rest, reposition him frequently and help him perform active or passive exercises, as indicated. If the patient's abdominal muscles are weak, teach abdominal toning exercises. Also, teach him relaxation techniques to help him reduce stress related to constipation.
If the patient is on bed rest, reposition him frequently and help him perform active or passive exercises, as indicated. If the patient's abdominal muscles are weak, teach abdominal toning exercises. Also, teach him relaxation techniques to help him reduce stress related to constipation.
PEDIATRIC
POINTERS:
The high content of casein and calcium in cow's milk can produce hard stools and possible constipation in bottle-fed infants. Other causes of constipation in infants include inadequate fluid intake, Hirschsprung's disease, and anal fissures.
In older children, constipation usually results from inadequate fiber intake and excessive intake of milk; it can also result from bowel spasms, mechanical obstruction, hypothyroidism, reluctance to stop playing for bathroom breaks, and the lack of privacy in some school bathrooms.
The high content of casein and calcium in cow's milk can produce hard stools and possible constipation in bottle-fed infants. Other causes of constipation in infants include inadequate fluid intake, Hirschsprung's disease, and anal fissures.
In older children, constipation usually results from inadequate fiber intake and excessive intake of milk; it can also result from bowel spasms, mechanical obstruction, hypothyroidism, reluctance to stop playing for bathroom breaks, and the lack of privacy in some school bathrooms.
AGING ISSUES:
Acute constipation in elderly patients is usually associated with underlying structural abnormalities.
Chronic constipation is chiefly caused by lifelong bowel and dietary habits and laxative use.
Acute constipation in elderly patients is usually associated with underlying structural abnormalities.
Chronic constipation is chiefly caused by lifelong bowel and dietary habits and laxative use.
PATIENT
COUNSELING:
Caution the patient did not strain during defecation to prevent injuring rectoanal tissue. Instruct him to avoid using laxatives or enemas. If he has been abusing these products, begin to wean him from them.
Stress the importance of a high-fiber diet, and encourage the patient to drink plenty of fluids. Also encourage him to exercise at least 1½ hours each week, if possible.
Caution the patient did not strain during defecation to prevent injuring rectoanal tissue. Instruct him to avoid using laxatives or enemas. If he has been abusing these products, begin to wean him from them.
Stress the importance of a high-fiber diet, and encourage the patient to drink plenty of fluids. Also encourage him to exercise at least 1½ hours each week, if possible.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)