Constipation

Constipation ( constipation ) is a disorder of intestinal motility and defecation, it is divided into several types according to reason of occurence. It can be defined as the difficulty of emptying solid stools and the impossibility of spontaneous defecation. This is partially a subjective symptom. It can be a separate problem (habitual, addictive constipation) or a symptom accompanying another disease (organic, secondary constipation).

The definition of constipation according to Rome II criteria (1999)
Some of the following apply:


 * less than 3 stools per week;
 * solid stool in more than 25% of defecations ;
 * feeling of incomplete emptying in more than 25% of defecations;
 * the need for manual maneuvers to facilitate more than 25% of defecations (digital stool evacuation, pelvic floor support).

Pathogenesis
Decreased water content in the stool, prolonged passage time through the digestive tract, or the presence of a mechanical barrier in the terminal part of the digestive tract contribute to constipation.

Acute constipation

 * Acute functional constipation

A harmless episode accompanying, for example, a change of residence while traveling, the need to defecate in an unusual environment, etc.


 * Acute intestinal obstruction

Sudden constipation can be a sign of intestinal obstruction ( mechanical ileus). Other symptoms include colic and gas withdrawal. It is usually accompanied by a bloated abdomen with a high tympanic sound on percussion above the dilated intestinal loop (Wahl's symptom).

Simple, addictive, habitual constipation (dyschezia)
It is caused by the attenuation of the defecation reflex unconditionally due to low volume stool commonly caused by the absence of fiber and fluids or lack of exercise; and / or conditionally suppressing spontaneous urges for defecation due to being in a hurry, unsatisfactory hygienic conditions or shame.

Spastic constipation
It is one of the forms of irritable bowel syndrome. Constipation is usually accompanied by spastic pain before or after defecation. Insufficient emptying is common.

Inert bowel syndrome (constipation from hypomotility, Lane's syndrome)
It occurs in young women. The cause of the defecation reflex attenuation is unknown. Constipation develops slowly and does not respond to therapy.

Constitutional constipation
Most family members suffer from constipation, usually since childhood.

Constipation from impaired evacuation area in the recto-anus ( "outlet obstruction" )
It occurs on the basis of rectal prolapse, intussusception or rectocele, or pelvic floor dyssynergia (often in women after severe childbirth).

Regimen and dietary measures
Regular daily routine and diet, sufficient fluid intake, enough fiber in the diet (whole grains, fruits, vegetables). Plenty of exercise, belly massage and no laxatives. Training of defecation reflex with the use of physiological gastrocolic reflex (after waking up a glass of water, usual morning tasks, breakfast, with an interval of 20–30 minutes attempted defecation).

Pharmacological treatment
Lactulose, saline laxatives, laxative minerals, enemas, drugs stimulating colonic motility.

Source

 * ws:Zácpa

Related Articles

 * Constipation (pediatrics)
 * Bowel emptying disorders

References [ modify | edit source ]

 * KLENER, Pavel, et al. Internal Medicine. 3rd edition. Prague: Galén, 2006. pp. 608-609.  ISBN 80-7262-430-X.