Colonic Diseases

Constipation

Done By : Rawan AlsulmiCASE 1A

A 55 y/o women requested your consultationbecause of change in her bowel movements.Since about 6 months, she experiencesinfrequent passage of stools and hard stools; shedenies diarrhea or rectal bleeding. Her weight isstable and her appetite is unchanged. She eats 3meals per day. But she admitted consuming littledietary fiber. her previous medical history isuneventful. However she worried because afriend diagnosed with colonic carcinoma. A nieceof her uses a thyroid hormone preparation forhypothyroidism.

Case 1A

A 55 y/o women requested your consultationbecause of change in her bowel movements.Since about 6 months, she experiencesinfrequent passage of stools and hard stools; shedenies diarrhea or rectal bleeding. Her weight isstable and her appetite is unchanged. She eats 3meals per day. But she admitted consuming littledietary fiber. her previous medical history isuneventful. However she worried because afriend diagnosed with colonic carcinoma. A nieceof her uses a thyroid hormone preparation forhypothyroidism.

Case 1A

OBJs

1- Which further issues need to be clarified before you can diagnose constipation in this patients?

2- What do you expect in physical examination?

Introduction

Constipation is a common complaint, especially in women and older adults. It results in millions of physician visits per year, with hundreds of millions of dollars spent on laxatives. Untreated it can lead to serious morbidity and can be a contributing factor in mortality. A rational approach to the patient presenting with constipation includes a detailed history, general and focused physical examination, specific investigations, and appropriate therapy.

What is constipation?

Constipation is difficult or infrequent bowel movements, hard stool, or a feeling that the rectum is not totally empty after a bowel movement.

The patient's view

• Infrequent passage of stools <3 times per week

• Straining >25% of time

• Passage of hard stools

• Incomplete evacuation and sensation of anorectal blockage

Rome III criteriaHaving 2 or more of the following for at least 12 ws

The clinical view

Rome III criteria IBS

Risk factorsThe following factors can increase a person’s likelihood of

becoming constipated;

1. Female gender

2. Over 65 years of age

3. Low caloric intake (eating less food)

4. Greater number of medications used

5. Sedentary lifestyle (lack of exercise)

6. Ignoring the urge to defecate

What is the right number of daily or weekly bowel

movements?!

Causes

Diet Changes

Laxative overuse

Disordered defecation

Drugs

Causes

1. Distended, swollen abdomen

2. Vomiting

3. Blood in stool

4. Weight loss

5. New/worsening severe constipation in older people

Not every episode of constipation requires immediate

evaluation by a doctor.

Warning symptoms

•History taking

•Physical examination

Evaluation

Stool

Bleeding

Age of onset

Other symptoms

Pain

Diet Drug

Urge present

Aggravating factors

History taking

Physical Examination•Inspection

•Abnormal appearance/position/patency of anus

•Abdominal examination

Gross abdominal distension

•Spine/lumbosacral region/gluteal examination

abnormal

•Lower limb

Deformity/abnormal neuromuscular exam/abnormal reflexes

• Rectal examination

presence of hemorrhoids, admixture of blood tumors, polyps

Summary

• Constipation is very common in women and elderly

• There are many causes of constipation; it should be considered a symptom, not

a disease.

• History taking

• Physical examination

References

1. NICE guidelines, May 2010, Constipation in children and young

people: Diagnosis and management of idiopathic childhood

constipation in primary and secondary care

2. Merck manual

3. Kumar and Clark

Thank you...