CONSTIPATION 3 Types of Constipation Atonic Constipation o A condition experienced by older people, obese individuals, before surgery and during

pregnancy. Feces are huge and stiff. Causes are inadequate diet, irregular meals, lack of liquids and fiber in the diet and irregular defecation. Spastic Constipation o Is a type of constipation caused by over stimulation of the intestinal nerve endings resulting to asymmetrical contractions of the bowel. Causes are extreme use of cathartics, laxatives and tobacco, too much tea, coffee and alcohol, stress, poor hygiene, lock of fluids and irregular defecation. Obstructive Constipation o Is a condition in which there is an impediment to the passage o0f feces or a compression by surrounding tissue that cause drying and enlargement of fecal mass. Physiology of Defecation

Feces end up in the rectum via mass peristalsis.

Receptors signal distension of the rectum to the brain.

Defecation reflex is initiated when parasympathetic (involuntary) stimulation from the spinal cord contracts the longitudinal rectal muscles.

Causes pressure to increase in the rectum. Pressure is added to the rectum by voluntary contraction of the abdominal muscles.

Parasympathetic stimulation (again involuntary) relaxes the internal sphincter of the anus.

Increases the urge to defecate.

PATHOPHYSIOLOGY

Predisposing factors Poor diet, lack of exercise, motility abnormalities, Medications Stress Rectal and anal disorders obstruction Ignored urge to defecate

Interference

Stimulation of the inhibitory of rectoanal reflex Relaxation of the initial sphincter muscle Relaxation of external sphincter muscle Increased intraabdominal pressure

Insensitive rectal mucous membrane and musculature to the presence of stool Decreased appetite Headache Fatigue Indigestion Sensation of incomplete evacuation Diagnostic tests Elimination of small volume, lumpy, hard dry Colorectal transit study stool Fecal retention Irritability of colon Spasm(after meals) Colicky midabdominal pain

Constipation

This test shows how well food moves through the colon. The patient swallows capsules containing small markers that are visible on an x ray. The movement of the markers through the colon is monitored by abdominal x rays taken several times 3 to 7 days after the capsule is swallowed. The patient eats a high-fiber diet during the course of this test.

Anorectal function tests These tests diagnose constipation caused by abnormal functioning of the anus or rectumalso called anorectal function Anorectal manometry- evaluates anal sphincter muscle function. For this test, a catheter or air-filled balloon is inserted into the anus and slowly pulled back through the sphincter muscle to measure muscle tone and contractions. Balloon expulsion tests- consist of filling a balloon with varying amounts of water after it has been rectally inserted. Then the patient is asked to expel the balloon. The inability to expel a balloon filled with less than 150 mL of water may indicate a decrease in bowel function.

Defecography Is an x ray of the anorectal area that evaluates completeness of stool elimination, identifies anorectal abnormalities, and evaluates rectal muscle contractions and relaxation. During the exam, the doctor fills the rectum with a soft paste that is the same consistency as stool. The patient sits on a toilet positioned inside an x-ray machine, then relaxes and squeezes the anus to expel the paste. The doctor studies the x rays for anorectal problems that occurred as the paste was expelled.

Sigmoidoscopy or Colonoscopy. An examination of the rectum and lower, or sigmoid, colon is called a sigmoidoscopy. An examination of the rectum and entire colon is called a colonoscopy.

Complications 1. 2. 3. 4. 5. Hypertension Fecal impaction Hemorrhoids Fissures Megacolon