Constipation
Difficulty in passing stool or passes once in 2 / 3 days, stools can be hard or soft is termed as constipation. which is also defined as infrequent passage of hard stool. Even ineffectual urge or a sensation of incomplete stools can be termed as constipation.
It may occur in many gastrointestinal and other medical disorders.
Demography
According to northern Indian community study, 555/4767 (11.6%) reported symptoms ofconstipation. Likewise in the former group, 1404 (53%) had self-perceived constipation. And in the latter, 846 (18%), 1030 (23%) reported straining at stools, and incomplete stool evacuation, respectively. Similarly in another community survey in rural northern India, the prevalence ofconstipation-predominant irritable bowel syndrome (IBS-C) was 2.4%.
Two smaller community surveys from Chandigarh and Bangalore reported the prevalence ofconstipation of 24.8% and 8.6%, respectively. Though the latter study was conducted exclusively among elderly population, in an eastern Indian study, of 331 consecutive patients with ChronicConstipation. In which 65% were older than 60 years.
1. Gastrointestinal disorders
Dietary i.e.
- Lack of fibers also fluid intake Motility
- Slow-transit of constipation
- Irritable bowel syndrome
- Drugs (see below)
- Chronic intestinal pseudo-obstruction
Structural i.e.
- Colonic carcinoma
- Diverticular disease
- Hirschsprung’s disease
Defecation i.e.
- Anorectal disease (e.g. Crohn’s, fissures, hemorrhoids)
- Obstructed defecation
2. Non-gastrointestinal disorders
Drugs i.e.
- Opiates
- Anticholinergics
- Calcium antagonists
- Iron supplements
- Aluminum-containing antacids
Neurological i.e.
- Multiple sclerosis
- Spinal cord lesions
- Cerebrovascular accidents
- Parkinsonism
Metabolic/endocrine i.e.
- Diabetes mellitus
- Hypercalcemia
- Hypothyroidism
- Pregnancy
Others
- Any serious illness with immobility, especially in the elderly
- Either emotional or psychological problems
- Sedentary life
- Eating too much of meat also dairy products
- Chronic abuse of laxatives
- Bottle fed babies
- Pregnancy
- Drugs for instance; antacids, iron, calcium, blood pressure medications
- Certain digestive tract diseases
- Some School going children develop a habit to ignore the urge
- Cooking in aluminum, iron vessel
It results in various degrees of subjective symptoms and is associated with abnormalities (eg, colonic diverticular disease, hemorrhoidal disease, anal fissures) that occur secondary to an increase in colonic luminal pressure and intravascular pressure in the hemorrhoidal venous cushions.
There are three types:
Obstructive constipation: is the result of actual physical obstruction of the passage of feces. Causes include cystic fibrosis (in children), tumors, adhesions, scars formed in the abdomen (mostly after abdominal surgery), strictures firmed within the intestine (mostly caused by inflammation, like in Crohn’s disease), or damaged pelvic nerves (injuries, neurological diseases) that prevent relaxation of anal muscles.
- Atonic constipation: is the result of lack of intestinal muscle tone (tension) of the colon, abdominal wall or pelvic floor, also known as lazy colon. Person with this kind simply does not feel the urge to defecate even when the colon is full of feces. It may occur in elderly or bedridden patients or after prolonged dependence on laxatives. Most common among old people (weak muscle tone), woman (pelvic floor weakness), and diabetics (damage to intestinal nerves).
- Spastic constipation: is result from colonic spasms caused by irritation of the bowel or intestines. In this case, a diet that is low in fiber is usually suitable. It is also a symptom of irritable bowel syndrome.
Based on the duration they are of two types
- Acute constipation (occasional problem) – constipation occurs suddenly and last for few days. Acute constipation with worrisome symptoms such as rectal bleeding, abdominal pain and cramps, nausea and vomiting, and involuntary loss of weight needs urgent diagnosis.
- Chronic constipation (persistent problem) – is the constipation that lasts for longer durations. Your need medication and lifestyle change to normalize bowel movement.
- Complain of straining
- Moreover, Sensation of incomplete evacuation
- Either perianal or abdominal discomfort
- Stools every 2nd or 3rd day
- Additionally, Difficulty in expelling faeces from rectum
- Painful evacuation of faeces
- Besides this, Pain sometimes remains for hours after passing stool
- Lastly, Occasional blood in stool due to fissure, either fistula or piles
- Physical examination of patients with constipation is usually remarkable for anal fissure or palpable lumpy mass in abdomen (particularly in left quadrant).
- The presence of thrombosed external hemorrhoids, skin tags, rectal prolapse, anal fissure, anal warts ,excoriation or evidence of pruritus ani due to fecal soiling on physical examination are suggestive of constipation.
Appearance of the Patient
- Patients with chronic constipation usually appear to be discomfort while sitting due to anal pain
Skin
Dry skin may be seen in systemic sclerosis
HEENT
Extra-ocular movements may be abnormal
Neck
Thyromegaly/thyroid nodules may be seen in hypothyroidism
Abdomen
Abdominal distention
Abdominal tenderness in the left lower abdominal quadrant
- A palpable abdominal mass in the left lower abdominal quadrant
Neuromuscular
Altered mental status
Clonus may be present
Hyperreflexia
- Positive (abnormal) Babinski
Muscle rigidity
Abnormal gait (Parkinsonian gait)
- Unilateral/bilateral tremor(pill-rolling)
Careful examination contributes more to the diagnosis than extensive investigation
First visit
Digital rectal examination
Proctoscopy and sigmoidoscopy (especially for detect anorectal disease)
Routine biochemistry including serum calcium and thyroid function tests
Full blood count should be carried out
If these are normal, a 1-month trial of dietary fibre and/or laxatives is justified
Next visit
If symptoms persist, then examination of the colon by barium enema or CT colonography is indicated to look for structural disease.
Further investigation
Generally, If no cause is found and disabling symptoms are present, then specialist referral for investigation of possible dysmotility may be necessary
- Malignancy
- Diabetic autonomic neuropathy
- Irritable bowel syndrome
- Rectocele
Fissure
- Anismus
- Systemic sclerosis
- Hypothyroidism
- Parkinson’s disease
- Multiple sclerosis
- Hypomagnesemia,
- Hypocalcemia,
Depression
It is usually easier to prevent than to treat. The relief of constipation with osmotic agents, i.e., lactulose, polyethylene glycol (PEG), or magnesium salts, should also be immediately followed by prevention using increased fiber (fruits, vegetables, and grains) and a nightly decreasing dose of osmotic laxative.
- Effective measures for the primary prevention of constipation include fiber supplementation, appropriate fluid intake, toilet habits, and exercise.
Fiber supplementation
- Including enough fibers in the daily diet is the most important primary prevention measure.
Fluid intake
- Fluid intake is the key factor to maintain the body hydration status and firm consistency of stools.
- Caffeine, alcohol, and fizzy drinks should be limited, preferably avoided completely.
Toilet habits
- Ignorance to toilet urge can lead to constipation.
- Never delay the defecation in case of urgency
Physical exercise
- It is postulated that 150 minutes of physical exercises can prevent constipation.
- The sufficient fiber intake for general gastrointestinal health is 30 g per day, while more is better.
- Haemorrhoids
- Anal fissure
- Faecal impaction
- Rectal bleeding after continually straining to pass stools
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Homeopathic Medicines for Constipation:
The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.
So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).
Medicines:
Opium
An inclination to evacuate but feeling as if the orifice were closed; no regular pressure; sensation as if a load on abdomen; heavy drowsy feeling; dry mouth, thirst, want of appetite. Stool hard round black balls like marbles.
Nux vomica
In sedentary persons and those accustomed to drink spirits. Bad taste in the mouth, want of appetite, especially in the morning, slimy tongue, irritability, headache; frequent urging, little or nothing passes
Pulsatilla
After taking rich or fat food; with moroseness also taciturnity.
Bryonia
With indigestion, weight at stomach after food also pain between shoulders; patient irritable, feels chilly, subject to rheumatism. Furthermore, Stool hard, large, light-coloured, and dry.
Lycopodium
Constipation with sadness, complete loss of appetite. Moreover, When there is much flatulence and gravelly urine.
Plumbum met.
Constipation of hard round balls; colic; abdomen drawn in; also constipationof children with large bellies in mesenteric disease
Aesculus hip.
In brief,Constipation of hard round balls, backache aggravated by walking.
Nat. mur
Constipation in chilly subjects; earthy complexion; feeling of contraction at the anus; and as if something were lodged in the rectum (in other words, lower bowel).
Sulphur
Frequent disposition to go to stool with ineffectual efforts. Sinking sensation at stomach, hot flushes, and faintly spells.
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Increased fluid intake
- Exercise
- Judicious use of laxatives.
- Eat high fibre diet – whole grains, bran, oat, green leafy vegetables, peas, beans, potatoes, raw vegetables, salads, dried fruits also fresh fruits
- Eat fruits also vegetables with the skin
- Avoid food that can cause constipation like pomegranate etc
- You can take one spoon Isabagul (e.g. fibre, Psyllium) in water before retiring to bed
- Walk after every meal
https://link.springer.com/journal/12664
https://www.medicalnewstoday.com/articles/150322.php
- Davidson’s Principles and Practice of Medicine (22nd edition)
- Hompath Zomeo Ultimate lane software/Diet and nutrition
Constipation physical examination – wikidoc
What is Constipation
Difficulty in passing stool or passes once in 2 / 3 days, stools can be hard or soft is termed as constipation.
Constipation is also defined as infrequent passage of hard stool.
Homeopathic Medicines used by Homeopathic Doctors in treatment of Constipation
- Opium
- Nux vomica
- Pulsatilla
- Bryonia
- Lycopodium
- Plumbum met
- Aesculus
What are the symptoms of Constipation?
- Complain of straining
- Sensation of incomplete evacuation
- Either perianal or abdominal discomfort
- Stools every 2nd or 3rd day
- Difficulty in expelling faeces from rectum
- Painful evacuation of faeces
- Pain- remains for hours after passing stool
- Occasional blood
Causes
- Lack of fibers and fluid intake
- Slow-transit constipation
- Irritable bowel syndrome
- Chronic intestinal pseudo-obstruction
- Anorectal disease
- Obstructed defecation
- Opiates, Calcium antagonists, Iron supplements
- Diabetes mellitus, Hypothyroidism
- Pregnancy
- Any serious illness with immobility