ConstipationPresented by:

Ghaida Al-Rashed

Diagnosis of constipation

Learning objectives

• Investigations

• Treatment

Diagnosis

Constipation is a very common condition.

Your GP will not usually need to carry out any tests or procedures, but will confirm a diagnosis of constipation based on:

• Symptoms • Medical history

• If the patient experiencing severe symptoms, your doctor may request further tests and investigations .

• Indications for investigation include:• Age >40 years.• A recent change in bowel habit.• Associated symptoms (weight loss, rectal bleeding, mucous

discharge).

Further tests

Do You Order Additional Laboratory Studies or Other Investigations?

Laboratory Studies• Blood tests, Serum chemistry and thyroid tests, to

diagnose or rule out other conditions.

• Fecal occult blood test.

Flexible Sigmoidoscopy or Colonoscopy

Both tests have similar procedure.

• Flexible Sigmoidoscopy: to view just the rectum and sigmoid until the splenic flexure is identified.

• Colonoscopy : to view the rectum and entire colon.

Initially Sigmoidoscopy if reveals no abnormal findings we will use Colonoscopy.

o During these tests, the doctor may perform a biopsy (several small pieces of tissue from different areas) .

Colorectal transit studieso Tests show how the stool moves through your colon.

o Determined in patients suspected of having a colonic motility disorder.

o Achieve by observing the passage of orally administered radioactive markers and more X-rays are taken

Con ..

• A patient with outlet obstruction tends to retain the markers in the left colon and sigmoid, whereas a patient with colonic dysmotility may move the markers throughout the colon.

:Type of radioactive marker

Radiopaquemarkers

Scintigraphy

 the patient will swallow capsules with small radioactive markers.

 the patient will eat a meal that contains radioactive substances.

Anorectal Function TestsAnorectal Manometry Insert a thin tube that has pressure sensors + balloon that

attached to one end is inserted into your rectum and is attached to a machine to check:

1. Sensitivity of your rectum is and how well it works.2. The tightness of the muscles around your anus.

3. How well they respond to nerve signals.

Lower GI series• X-ray exam of colon to help diagnose

problem.

• Determined in patients suspected of having obstructing colon cancer in the setting of chronic constipation

•  Before procedure Follow  a clear liquid diet for 1 to 3 days before the procedure.

• During the procedure the doctor will fills the patient’s colon with barium, to make the colon problem more visible on x-rays

Defecography• X-ray of the rectum during defecation.

• Should be performed if an obstruction is suspected at the level of the anal canal.

• During this procedure, the doctor inserts a soft paste made of barium into the patient’s rectum, then pass the barium paste as you would stool.

Computed Tomography

• Abdominal CT can reveal abdominal tumor.

Treatment

Suppose your additional studies do not provide a clue to underlying disorders, which treatment options do you

discuss with this patient?

Treatment For Constipation may Include The Following:

oGeneral management:• Treat the cause.• Diet and lifestyle changes.

• Drug therapy (Consider drugs only if the above measures fail)

If failed

Diet and Lifestyle Changes1. Increased fluid intake.2. Eating more fruits and vegetables .3. Eating more fiber. 4. Exercise most days of the week.5. Don't ignore the urge to have a bowel movement.

Drug therapy Laxatives:

• Use laxatives only if a doctor says you should.

• There is Several types of laxatives each one have different mechanism.

Laxatives Therapy

I. Fiber supplements are best choice

• Absorb water and make stool softer.• Safe to use everyday.• Be sure to drink at least 8 to 10

glasses of water everyday.

Con..• Other types of laxatives should only be used for

a short timeI. Lubricants (mineral oil)• Soften and lubricate stool.

II. Stool Softeners• Provide moisture to stool.

III. Stimulants• Cause muscle contractions in intestines

IV. Saline laxatives• Draw water into colon.

Points to Remember

• Eat a variety of foods. whole grains, and fresh fruits and vegetables.• Drink plenty of liquids.• Exercise regularly.• Don’t ignore the urge to have a bowel movement.• Most people do not need laxatives. Your doctor may

recommend them for a limited time only.• Some Medicines may cause constipation

Summary

What can we do to treat the

constipation ?

When we do

additional

investigation ?

How can we

diagnose the

constipation?

References • http://

www.mayoclinic.org/diseases-conditions/constipation/basics/treatment/con-20032773

• http://emedicine.medscape.com/article/184704-treatment#aw2aab6b6b2

• http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/constipation/Pages/treatment.aspx