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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.
Constipation is a symptom,
NOT a disease.
Constipation has many causes
and may be a sign of undiagnosed
disease.
The following factors can increase a person’s likelihood of becoming constipated; however, these do not need to be present for constipation to occur:
Female gender - Pregnancy
Over 65 years of age
Low caloric intake (eating less food)
Greater number of medications used
Sedentary lifestyle (lack of exercise)
Ignoring the urge to defecate
Smoking – Tobacco addiction
• High fibre diet
• Minimum fluid consumption of 1500mL daily
• Regular, private toilet routine
• Heed the urge to defecate
• Use of a laxative if using constipating medication
or in presence of diseases associated with
constipation
A) Acute – functional Constipation
B) Chronic – Organic Constipation
A) Acute – functional Constipation
- -Dehydration
- -Acute illness
- -Sedentary Life style
- -Lack of dietary fibers
- -Acute intestinal Obstruction
B) Chronic – Organic Constipation
Endocrine disorder
Psychiatric disorder
Drug Induces
Anorectal disorder
Pelvic disorder
Metabolic disorder
Drug Measures:
Purgatives / Cathartics / Aperients / Evacuant /
Laxatives
Laxatives / Aperients – milder in action, elimination of
soft & formed stool.
Purgatives / Cathartics -Stronger in action,
evacuation of more fluids.
Many drugs act in low concentration as laxatives &
in high concentration as purgatives.
There are many different types of drugs that can
be used for constipation:
1) Bulk-forming Agents
2) Stool Softeners
3) Osmotics
4) Stimulants
1) Bulk-Forming Agents:
Are the drug of choice for prevention; not for
immediate relief.
Dietary fibers
Bran
Ispaghula husk (seeds of Plantago ovata)
Methyl cellulose
2) Stool Softeners
Docusate (DOSS) – Di Octyl Sodium
Sulfosuccinate
Liquid Paraffin
Eg – Cremmafin (Liq Paraffin + Mag
sulphate)
3) Osmotics:Magnesium salts (Hydroxide & Sulphate)
Sodium salts (Sulphate & Phospahte)
Sod. Pot. Tartrate
Lactulose
Eg - Milk of Magnesia
4) Stimulants:
A) Diphenyl Methanes
Phenolphthalin
Bisacodyl
Sod. Picosulfate
B) Anthraquinones (glycosides)
Seena (Cassia)
Cascara sargada
C) 5-HT4 agonist – Tegaserod
D) Fixed oil – Castor Oil emulsion
-Examples: Senokot, Dulcolax (bisacodyl)
-This group produces rhythmic muscle contractions in the
intestines and may be recommended if osmotic laxatives fail or
are not tolerated.
-Are usually given at bedtime and they usually provide overnight
relief (work within 8-12 hours).
Constipation is very common in the elderly
and nursing home residents.
There are many causes of constipation; it
should be considered a symptom, not a
disease.
There are many options for prevention and
treatment. The choice should be tailored to
each individual person.
Talk to your health care provider if you have
any concerns or if constipation lasts for
longer than one week.
-Increase in frequency, size or loosening of
bowel movements.
-Differentiate from fecal incontinence or
functional bowel disease- normal stool weight
Transmissible agents
Noninfectious - abnormal mucosa
Inflammatory Bowel disease
Celiac disease, microscopic colitis, eosinophilic
and allergic gastroenteritis, radiation enteritis
Noninfectious - normal mucosa
Osmotic diarrhea
Mal-absorption
Watery
Enterotoxigenic-
Vibrio cholera
Enterotoxigenic E.coli
Food borne toxins-
Bacillus cereus
Clostridium perfringens
Mycobacterium avium-intracellular complex
Bloody
Invasive
Campylobacter jejuni
Destructive
Shigella
Enteropathogenic E.coli
Clostridium difficile
Rotavirus Children less than 2 years
Most common cause of diarrhea in children all over the world
Norwalk Older children and adults
These viruses injure the small intestinal mucosa
Watery diarrhea
CMV Immunocompromised
Protozoa Giardia lamblia
Entamoeba histolytica
Cryptosporidium
Helminths Ascaris lumbricoides
Ancylostoma
Strongyloides stercoralis
Trichinella spiralis
Capillaria philippensis
Chronic diarrhea Malnutrition
Weight loss
Muscle wasting
Tetany
Oral and skin lesions
Peripheral neuropathy
Ataxia
Edema
Stool culture
Positive in only 40 to 60%
Stool for ova and parasites
Stool for Clostridium difficile toxin
Stool Sudan test for fat
Stool Electrolytes-differentiates secretory
diarrhea from osmotic diarrhea
Stool pH-<7 indicates carbohydrate
malabsorption
Fluid therapy Persons with moderate to severe diarrhea lose large
amounts of Na, CL, K, HCO3 & H20
Pre renal azotemia, hypokalemia, metabolic acidosis
ORS
IV Fluids
Saline solution (water plus Na+) by mouth
- no beneficial effect
Na+ absorption is impaired in the diarrhoeal
state
if the Na+ is not absorbed water cannot be
absorbed.
Excess Na+ in the lumen of the intestine causes
increased secretion of water and the diarrhoea
worsens.
Glucose - absorbed through the intestinal wall - unaffected by the diarrhoeal disease state - sodium is carried in conjunction through by a co-transport coupling mechanism. This occurs in a 1:1 ratio, one molecule of glucose co-transporting one sodium ion (Na+).
Starch –
metabolized in the intestine to glucose and
therefore it has the same properties of
enhancing sodium absorption
less osmotic effect in the lumen of the intestine.
First developed in the early 1950’s and was formulated to mirror ions lost in stool.
In the early 1960’s the mechanism by which ORT works, the coupled transport of sodium and glucose, was discovered.6
In 1971, the efficacy of ORT demonstrated during an epidemic of cholera in a refugee camp in Bangladesh. ORT reduced the death rate from more than
50% to only 5%.7 By the early 1970’s a consensus was reached about the effectiveness of ORT.
Sodium Chloride - 2.6gm -3.5
gm
Potassium Chloride- 1.5 gm -1.5gm
Tri Sod Citrate- 2.9 gm -2.9gm
Glucose 13.5 gm -
20gm
Recommended