What is Constipation
Most common complaint seen in day to day clinical practice is Constipation. Most frequently patient complain of difficult, infrequent or incomplete defecation. It is difficult to define it as there is wide range of normal bowel habit. More than 90% of population have at least three bowel movements per week.But frequency is not the only criteria as most patients who complain it have a normal frequency of defecation. Most commonly these patients complain of hard stools, excessive staining, a sense of incomplete evacuation and lower abdomen fullness
Usually due to less fluid intake, low fibre diet and decreased colonic transit time.
Colonic obstruction: Due to colorectal cancer, ischemic stricture, diverticular disease.
Painful anal spasm which may be due to anal fissure or painful hemorrhoids
Chronic constipation: irritable bowel syndrome with constipation predominant.
Medical causes: Hypothyroidism, hypercalcemia.
There are some medications which on long term can cause constipation. Slow colonic transit time is common
Colonoscopy: It is advised to rule out mechanical cause such as colonic stricture or malignancy especially in old age patients and with recent history associated with anorexia and weight
Lifestyle: Regular time for defecation is important. Always respond to defecatory urge. Physical activity should be encouraged for those who have inactive lifestyle.The drugs which cause it should be avoided
Psychological Support: It can be result of emotional disturbance and can be aggravated by stress. Counselling is required for these patients
Fluid Intake: Less fluid intake causes salt and water absorption by the large intestine,it causes passage of small, hard stools. Thats why patient is encouraged to take plenty of fluids
Laxatives: Two types, Bulk laxatives and osmotic laxatives