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Diseases » Constipation » Causes

Causes of Constipation



Contents

List of causes of Constipation

Following is a list of causes or underlying conditions (see also Misdiagnosis of underlying causes of Constipation) that could possibly cause Constipation includes:

More causes: see full list of causes for Constipation

Causes of Constipation (Diseases Database):

The follow list shows some of the possible medical causes of Constipation that are listed by the Diseases Database:

Source: Diseases Database

Constipation as a complication of other conditions:

Other conditions that might have Constipation as a complication may, potentially, be an underlying cause of Constipation. Our database lists the following as having Constipation as a complication of that condition:

Constipation as a symptom:

Conditions listing Constipation as a symptom may also be potential underlying causes of Constipation. Our database lists the following as having Constipation as a symptom of that condition:

Medications or substances causing Constipation:

The following drugs, medications, substances or toxins are some of the possible causes of Constipation as a symptom. This list is incomplete and various other drugs or substances may cause your symptoms. Always advise your doctor of any medications or treatments you are using, including prescription, over-the-counter, supplements, herbal or alternative treatments.

See full list of 1742 medications causing Constipation


Drug interactions causing Constipation:

When combined, certain drugs, medications, substances or toxins may react causing Constipation as a symptom.

The list below is incomplete and various other drugs or substances may cause your symptoms. Always advise your doctor of any medications or treatments you are using, including prescription, over-the-counter, supplements, herbal or alternative treatments.

  • Cyclobenzaprine and narcotic pain reliever interaction
  • Flexeril and narcotic pain reliever interaction
  • Cyclobenzaprine and ipratropium interaction
  • Flexeril and ipratropium interaction
  • Cyclobenzaprine and other anticholinergic drug interaction
  • more interactions...»

See full list of 513 drug interactions causing Constipation

What causes Constipation?

Article excerpts about the causes of Constipation:

Constipation: NIDDK (Excerpt)

Diet

The most common cause of constipation is a diet low in fiber found in vegetables, fruits, and whole grains and high in fats found in cheese, eggs, and meats. People who eat plenty of high-fiber foods are less likely to become constipated.

Fiber--soluble and insoluble--is the part of fruits, vegetables, and grains that the body cannot digest. Soluble fiber dissolves easily in water and takes on a soft, gel-like texture in the intestines. Insoluble fiber passes almost unchanged through the intestines. The bulk and soft texture of fiber help prevent hard, dry stools that are difficult to pass.

On average, Americans eat about 5 to 20 grams of fiber daily, short of the 20 to 35 grams recommended by the American Dietetic Association. Both children and adults eat too many refined and processed foods in which the natural fiber is removed.

A low-fiber diet also plays a key role in constipation among older adults. They often lack interest in eating and may choose fast foods low in fiber. In addition, loss of teeth may force older people to eat soft foods that are processed and low in fiber.

Not Enough Liquids

Liquids like water and juice add fluid to the colon and bulk to stools, making bowel movements softer and easier to pass. People who have problems with constipation should drink enough of these liquids every day, about eight 8-ounce glasses. Other liquids, like coffee and soft drinks, that contain caffeine seem to have a dehydrating effect.

Lack of Exercise

Lack of exercise can lead to constipation, although doctors do not know precisely why. For example, constipation often occurs after an accident or during an illness when one must stay in bed and cannot exercise.

Medications

Pain medications (especially narcotics), antacids that contain aluminum, antispasmodics, antidepressants, iron supplements, diuretics, and anticonvulsants for epilepsy can slow passage of bowel movements.

Irritable Bowel Syndrome (IBS)

Some people with IBS, also known as spastic colon, have spasms in the colon that affect bowel movements. Constipation and diarrhea often alternate, and abdominal cramping, gassiness, and bloating are other common complaints. Although IBS can produce lifelong symptoms, it is not a life-threatening condition. It often worsens with stress, but there is no specific cause or anything unusual that the doctor can see in the colon.

Changes in Life or Routine

During pregnancy, women may be constipated because of hormonal changes or because the heavy uterus compresses the intestine. Aging may also affect bowel regularity because a slower metabolism results in less intestinal activity and muscle tone. In addition, people often become constipated when traveling because their normal diet and daily routines are disrupted.

Abuse of Laxatives

Myths about constipation have led to a serious abuse of laxatives. This is common among older adults who are preoccupied with having a daily bowel movement.

Laxatives usually are not necessary and can be habit-forming. The colon begins to rely on laxatives to bring on bowel movements. Over time, laxatives can damage nerve cells in the colon and interfere with the colon's natural ability to contract. For the same reason, regular use of enemas can also lead to a loss of normal bowel function.

Ignoring the Urge to Have a Bowel Movement

People who ignore the urge to have a bowel movement may eventually stop feeling the urge, which can lead to constipation. Some people delay having a bowel movement because they do not want to use toilets outside the home. Others ignore the urge because of emotional stress or because they are too busy. Children may postpone having a bowel movement because of stressful toilet training or because they do not want to interrupt their play.

Specific Diseases

Diseases that cause constipation include neurological disorders, metabolic and endocrine disorders, and systemic conditions that affect organ systems. These disorders can slow the movement of stool through the colon, rectum, or anus. Figure 3 lists the diseases that cause constipation.

Figure 3

Diseases That Cause Constipation

Neurological disorders that may cause constipation include:
  • Multiple sclerosis
  • Parkinson's disease
  • Chronic idiopathic intestinal pseudo-obstruction
  • Stroke
  • Spinal cord injuries.
Metabolic and endocrine conditions include:
  • Diabetes
  • Underactive or overactive thyroid gland
  • Uremia.
Systemic disorders include:
  • Amyloidosis
  • Lupus
  • Scleroderma.

Problems with the Colon and Rectum

Intestinal obstruction, scar tissue (adhesions), diverticulosis, tumors, colorectal stricture, Hirschsprung's disease, or cancer can compress, squeeze, or narrow the intestine and rectum and cause constipation.

Problems with Intestinal Function (Chronic Idiopathic Constipation)

Also known as functional constipation, chronic idiopathic (of unknown origin) constipation is rare. However, some people are chronically constipated and do not respond to standard treatment. This chronic constipation may be related to multiple problems with hormonal control or with nerves and muscles in the colon, rectum, or anus. Functional constipation occurs in both children and adults and is most common in women.

Colonic inertia and delayed transit are two types of functional constipation caused by decreased muscle activity in the colon. These syndromes may affect the entire colon or may be confined to the left or lower (sigmoid) colon.

Functional constipation that stems from abnormalities in the structure of the anus and rectum is known as anorectal dysfunction, or anismus. These abnormalities result in an inability to relax the rectal and anal muscles that allow stool to exit. (Source: excerpt from Constipation: NIDDK)

Constipation - Age Page - Health Information: NIA (Excerpt)

People may become constipation if they start eating fewer vegetables, fruits, and whole grains. These foods are all high in fiber, and, according to some studies, high fiber diets can help prevent constipation. Eating more high fat meats, dairy products, and eggs can be another cause of constipation. So can eating more rich desserts and other sweets high in refined sugars.

People who live alone may lose interest in cooking and eating. As a result they start using a lot of convenience foods. These tend to be low in fiber, so they may help cause constipation. In addition, bad teeth may cause older people to choose soft, processed foods that contain little, if any, fiber. (Source: excerpt from Constipation - Age Page - Health Information: NIA)

Constipation - Age Page - Health Information: NIA (Excerpt)

Lack of exercise or lengthy bedrest, such as after an accident or illness, may cause constipation. For people who stay in bed and who suffer from chronic constipation, medications may be the best solution. But simply being more active, when possible, is best.

If people ignore the natural urge to have a bowel movement, they may become constipated. Some people prefer to have their bowel movements only at home, but holding a bowel movement can cause ill effects if the delay is too long. (Source: excerpt from Constipation - Age Page - Health Information: NIA)

Medical news summaries relating to Constipation:

The following medical news items are relevant to causes of Constipation:

Related information on causes of Constipation:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Constipation may be found in:

Causes of Constipation: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Constipation.

Constipation: Differential Diagnosis
(In a Page: Signs and Symptoms)

  • Medications
    –Narcotic analgesics
    –Antihypertensives (e.g., calcium channel blockers)
    –Tricyclic antidepressants
    –Aluminum hydroxide in antacids
    –Iron supplements
  • Inadequate dietary fiber or liquid intake
  • Neurological dysfunction
    –Diabetes mellitus
    –Multiple sclerosis
    –Hirschsprung's disease
  • Mechanical difficulties
    –Colorectal cancer
    –Hernia
    –Diverticulitis
    –Inflammatory bowel syndrome
    –Adhesion
    –Stricture
    –Torsion
    –Volvulus
  • Metabolic and endocrine
    –Hypothyroidism
    –Hypercalcemia
    –Hypokalemia
  • Chronic laxative abuse

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Constipation: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

  • Functional constipation
    –By far the most common etiology
    –Rome II criteria define chronic functional constipation in infants and young children as at least 2 weeks of scybalous, pebble-like, hard stools for the majority of stools, or firm stools two or fewer times per week
    –Presents with stool-withholding behavior
    –Often due to inadequate fluid/fiber intake
  • Drugs: Antacids (with aluminium and calcium), anticholinergics, antidepressants, bismuth, calcium antagonists, cough suppressants, opioid analgesics, phenobarbitol
  • Irritable bowel syndrome
    • Endocrine disorders
      –Hypercalcemia
      –Hypothyroidism
      –Hyperparathyroidism
      –Pregnancy
      –Reduction of steroid hormones in luteal and follicular phases of menstrual cycle
    • Hirschsprung disease
      –1/5,000 births, male to female ratio 4:1
      –94% do not pass meconium within 24 hours of birth
      –61% diagnosed by 12 months of life
    • Neurologic disease
      –Myelomeningoce
      –Hypotonia (e.g., Down, myopathies, prune-belly syndrome)
      –Cerebral palsy
  • Celiac disease
  • Cystic fibrosis
  • Inflammatory bowel disease
  • Lead toxicity
  • Structural abnormalities
    –Anal disorders (imperforate anus, anteriorly displaced anus, perianal fissures, strep infection, anal stenosis)
    –Colonic strictures (primary or secondary)
    –Pelvic masses (sacral teratoma)
  • Infectious disease
    –Infantile botulism
    –Chagas disease
  • Metabolic disorders
    –Uremia
    –Hypokalemia
    –Amyloid neuropathy
  • Ogilvie syndrome

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Constipation: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Anal fissure.

 A crack or laceration in the lining of the anal wall can cause acute constipation, usually due to the patient's fear of the severe tearing or burning pain associated with bowel movements. He may notice a few drops of blood streaking toilet tissue or his underwear.

Anorectal abscess.

 In anorectal abscess, constipation occurs together with severe, throbbing, localized pain and tenderness at the abscess site. The patient may also have localized inflammation, swelling, and purulent drainage and may complain of fever and malaise.

Cirrhosis.

In the early stages of cirrhosis, the patient experiences constipation along with nausea and vomiting and a dull pain in the right upper quadrant. Other early findings include indigestion, anorexia, fatigue, malaise, flatulence, hepatomegaly and, possibly, splenomegaly and diarrhea.

Diabetic neuropathy.

Diabetic neuropathy produces episodic constipation or diarrhea. Other signs and symptoms include dysphagia, orthostatic hypotension, syncope, and painless bladder distention with overflow incontinence. A male patient may also experience impotence and retrograde ejaculation.

Diverticulitis.

 In diverticulitis, constipation or diarrhea occurs with left lower quadrant pain and tenderness and possibly a palpable, tender, firm, fixed abdominal mass. The patient may develop mild nausea, flatulence, or a low-grade fever.

Hemorrhoids.

Thrombosed hemorrhoids cause constipation as the patient tries to avoid the severe pain of defecation. The hemorrhoids may bleed during defecation.

Hepatic porphyria.

 Abdominal pain, which may be severe, colicky, localized, or generalized, precedes constipation in hepatic porphyria. The patient may also have a fever, sinus tachycardia, labile hypertension, excessive diaphoresis, severe vomiting, photophobia, urine retention, nervousness or restlessness, disorientation and, possibly, visual hallucinations. Deep tendon reflexes may be diminished or absent. He may also have skin lesions causing itching, burning, erythema, altered pigmentation, and edema in areas exposed to light. Severe hepatic porphyria can produce delirium, coma, seizures, paraplegia, or complete flaccid quadriplegia.

Hypercalcemia.

With hypercalcemia, constipation usually occurs along with anorexia, nausea, vomiting, polyuria, and polydipsia. The patient may also display arrhythmias, bone pain, muscle weakness and atrophy, hypoactive deep tendon reflexes, and personality changes.

Hypothyroidism.

Constipation occurs early and insidiously in patients with hypothyroidism, in addition to fatigue, sensitivity to cold, anorexia with weight gain, menorrhagia in women, decreased memory, hearing impairment, muscle cramps, and paresthesia.

Intestinal obstruction.

Constipation associated with an intestinal obstruction varies in severity and onset, depending on the location and extent of the obstruction. With partial obstruction, constipation may alternate with leakage of liquid stools. With complete obstruction, obstipation may occur. Constipation can be the earliest sign of partial colon obstruction, but it usually occurs later if the level of the obstruction is more proximal. Associated findings include episodes of colicky abdominal pain, abdominal distention, nausea, or vomiting. The patient may also develop hyperactive bowel sounds, visible peristaltic waves, a palpable abdominal mass, and abdominal tenderness.

Irritable bowel syndrome (IBS).

IBS commonly produces chronic constipation, although some patients have intermittent, watery diarrhea and others complain of alternating constipation and diarrhea. Stress may trigger nausea and abdominal distention and tenderness, but defecation usually relieves these signs and symptoms. Patients typically have an intense urge to defecate and feelings of incomplete evacuation. Typically, the stools are scybalous and contain visible mucus.

Mesenteric artery ischemia.

Mesenteric artery ischemia is a life-threatening disorder that produces sudden constipation with failure to expel stool or flatus. Initially, the abdomen is soft and nontender, but soon severe abdominal pain, tenderness, vomiting, and anorexia occur. Later, the patient may develop abdominal guarding, rigidity, and distention; tachycardia; syncope; tachypnea; a fever; and signs of shock, such as cool, clammy skin and hypotension. A bruit may be heard.

Spinal cord lesion.

Constipation may occur with a spinal cord lesion, in addition to urine retention, sexual dysfunction, pain and, possibly, motor weakness, paralysis, or sensory impairment below the level of the lesion.

Other causes

Diagnostic tests.

Constipation can result from the retention of barium given during certain GI studies.

Drugs.

Patients commonly experience constipation when taking an opioid analgesic or other drugs, including vinca alkaloids, calcium channel blockers, antacids containing aluminum or calcium, anticholinergics, and drugs with anticholinergic effects (such as tricyclic antidepressants). Patients may also experience constipation from excessive use of laxatives or enemas.

Surgery and radiation therapy.

Constipation can result from rectoanal surgery, which may traumatize nerves, and abdominal irradiation, which may cause intestinal stricture.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Constipation: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Anal fissure

A crack or laceration in the lining of the anal wall can cause acute constipation, usually due to the patient’s fear of the severe tearing or burning pain associated with bowel movements. He may notice a few drops of blood streaking toilet tissue or his underwear.

Anorectal abscess

In this disorder, constipation occurs together with severe, throbbing, localized pain and tenderness at the abscess site. The patient may also have localized inflammation, swelling, and purulent drainage and may complain of fever and malaise.

Cirrhosis

In the early stages of cirrhosis, the patient experiences constipation along with nausea and vomiting, and a dull pain in the right upper quadrant. Other early findings include indigestion, anorexia, fatigue, malaise, flatulence, hepatomegaly and, possibly, splenomegaly and diarrhea.

Diabetic neuropathy

This type of neuropathy produces episodic constipation or diarrhea. Other signs and symptoms include dysphagia, orthostatic hypotension, syncope, and painless bladder distention with overflow incontinence. A male patient may also experience impotence and retrograde ejaculation.

Diverticulitis

In this disorder, constipation or diarrhea occurs with left-lower-quadrant pain and tenderness and possibly a palpable, tender, firm, fixed abdominal mass. The patient may develop mild nausea, flatulence, or a low-grade fever.

Hemorrhoids

Thrombosed hemorrhoids cause constipation as the patient tries to avoid the severe pain of defecation. The hemorrhoids may bleed during defecation.

Hepatic porphyria

Abdominal pain, which may be severe, colicky, and localized or generalized, precedes constipation in hepatic porphyria. The patient may also have a fever, sinus tachycardia, labile hypertension, diaphoresis, severe vomiting, photophobia, urine retention, nervousness or restlessness, disorientation and, possibly, visual hallucinations. Deep tendon reflexes may be diminished or absent. Some patients have skin lesions causing itching, burning, erythema, altered pigmentation, and edema in areas exposed to light. Severe hepatic porphyria can produce delirium, coma, seizures, paraplegia, or complete flaccid quadriplegia.

Hypercalcemia

In hypercalcemia, constipation usually is accompanied by anorexia, nausea, vomiting, polyuria, and polydipsia. The patient may also display arrhythmias, bone pain, muscle weakness and atrophy, hypoactive deep tendon reflexes, and personality changes.

Hypothyroidism

Constipation occurs early and insidiously in patients with hypothyroidism; it may be accompanied by fatigue, sensitivity to cold, anorexia with weight gain, menorrhagia, decreased memory, hearing impairment, muscle cramps, and paresthesia.

Intestinal obstruction

Constipation associated with this disorder varies in severity and onset, depending on the location and extent of the obstruction. In a partial obstruction, constipation may alternate with leakage of liquid stools. In a complete obstruction, obstipation may occur. Constipation can be the earliest sign of partial colon obstruction, but it usually occurs later if the level of the obstruction is more proximal. Associated findings include episodes of colicky abdominal pain, abdominal distention, nausea, and vomiting. The patient may also develop hyperactive bowel sounds, visible peristaltic waves, a palpable abdominal mass, and abdominal tenderness.

Irritable bowel syndrome

This common syndrome usually produces chronic constipation, although some patients have intermittent watery diarrhea and others complain of alternating constipation and diarrhea. Stress may trigger nausea and abdominal distention and tenderness, but defecation usually relieves these signs and symptoms. Many patients have an intense urge to defecate and feelings of incomplete evacuation. Typically, the stools are scybalous and contain visible mucus.

Mesenteric artery ischemia

This life-threatening disorder produces sudden constipation with failure to expel stool or flatus. Initially, the abdomen is soft and nontender but soon severe abdominal pain, tenderness, vomiting, and anorexia occur. Later, the patient may develop abdominal guarding, rigidity, and distention; tachycardia; syncope; tachypnea; fever; and signs of shock, such as cool, clammy skin and hypotension. A bruit may be heard.

Multiple sclerosis (MS)

This disorder can produce constipation in addition to ocular disturbances, such as nystagmus, blurred vision, and diplopia; vertigo; and sensory disturbances. The patient may also have motor weakness, seizures, paralysis, muscle spasticity, gait ataxia, intention tremor, hyperreflexia, dysarthria, or dysphagia. MS can also produce urinary urgency, frequency, and incontinence as well as emotional instability. A male patient may experience impotence.

Spinal cord lesion

Constipation may occur in this disorder along with urine retention, sexual dysfunction, pain, and possibly motor weakness, paralysis, or sensory impairment below the level of the lesion.

Tabes dorsalis

In tabes dorsalis, constipation is accompanied by an ataxic gait; paresthesia; loss of sensation of body position, deep pain, and temperature; Charcot’s joints; Argyll Robertson pupils; diminished deep tendon reflexes; and possibly impotence.

Ulcerative colitis

Constipation may occur in patients with chronic ulcerative colitis, but bloody diarrhea with pus, mucus, or both is the hallmark of this disorder. Other signs and symptoms include cramping lower abdominal pain, tenesmus, anorexia, low-grade fever and, occasionally, nausea and vomiting. Bowel sounds may be hyperactive. Later, weight loss, weakness, and arthralgias occur.

Ulcerative proctitis

This disorder produces acute constipation with tenesmus. The patient feels an intense urge to defecate but is unable to do so. Instead, he may eliminate mucus, pus, or blood.

Other causes

Diagnostic tests

Constipation can result from the retention of barium given during certain GI studies.

Drugs

Many patients experience constipation when taking an opioid analgesic or other drugs, including vinca alkaloids, calcium channel blockers, antacids containing aluminum or calcium, anticholinergics, and drugs with anticholinergic effects (such as tricyclic antidepressants). Patients may also experience constipation from excessive use of laxatives or enemas.

Surgery and radiation therapy

Constipation can result from rectoanal surgery, which may traumatize nerves, and abdominal irradiation, which may cause intestinal stricture.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Constipation: Differential Overview
(Field Guide to Bedside Diagnosis)

❑ Lifestyle

❑ Drugs

❑ Depression

❑ Irritable bowel syndrome

❑ Pelvic floor dysfunction

❑ Hypothyroidism

❑ Hypokalemia

❑ Colon cancer

❑ Anorectal pathology

❑ Voluntary retention

❑ Megacolon

❑ Mechanical obstruction

❑ Spinal cord pathology

❑ Hypercalcemia

❑ Scleroderma

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Chronic constipation: Causes
(Handbook of Diseases)

Chronic constipation usually results from some deficiency in the three elements necessary for normal bowel activity: dietary bulk, fluid intake, and exercise. Other possible causes can include habitual disregard of the impulse to defecate, emotional conflicts, overuse of laxatives, or prolonged dependence on enemas, which dull rectal sensitivity to the presence of stool. Certain medications (tranquilizers, anticholinergics, opioids, antacids) can cause it, and patients with certain disorders (Parkinson’s disease, multiple sclerosis, hypothyroidism, scleroderma, lupus erythematosus) are more prone to develop it.

Clinical tip  Anal fissure can also precipitate chronic constipation.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Constipation: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Anal fissure

An anal fissure, a crack or laceration in the lining of the anal wall, can cause acute constipation, usually due to the patient’s fear of the severe tearing or burning pain associated with bowel movements. He may notice a few drops of blood streaking toilet tissue or his underwear.

Anorectal abscess

With an anorectal abscess, constipation occurs with severe, throbbing, localized pain and tenderness at the abscess site. The patient may also have localized inflammation, swelling, and purulent drainage and may complain of fever and malaise.

Diverticulitis

With diverticulitis, constipation or diarrhea occurs with left-lower-quadrant pain and tenderness and possibly a palpable, tender, firm, fixed abdominal mass. The patient may develop mild nausea, flatulence, or a low-grade fever.

Hemorrhoids

Thrombosed hemorrhoids cause constipation as the patient tries to avoid the severe pain of defecation. The hemorrhoids may bleed during defecation. The patient may notice bright red blood on stools or toilet tissue.

Hepatic porphyria

Abdominal pain, which may be severe, colicky, localized, or generalized, precedes constipation in hepatic porphyria. The patient may also have fever, sinus tachycardia, labile hypertension, excessive diaphoresis, severe vomiting, photophobia, urine retention, nervousness or restlessness, disorientation and, possibly, visual hallucinations. Deep tendon reflexes may be diminished or absent. Some patients have skin lesions causing itching, burning, erythema, altered pigmentation, and edema in areas exposed to light. Severe hepatic porphyria can produce delirium, coma, seizures, paraplegia, or complete flaccid quadriplegia.

Hypercalcemia

With hypercalcemia, constipation usually occurs along with anorexia, nausea, vomiting, polyuria, and polydipsia. The patient may also display arrhythmias, bone pain, muscle weakness and atrophy, hypoactive deep tendon reflexes, and personality changes.

Hypothyroidism

Constipation occurs early and insidiously in patients with hypothyroidism, in addition to fatigue, sensitivity to cold, anorexia with weight gain, menorrhagia, decreased memory, hearing impairment, muscle cramps, and paresthesia.

Intestinal obstruction

Constipation associated with intestinal obstruction varies in severity and onset, depending on the location and extent of the obstruction. With partial obstruction, constipation may alternate with leakage of liquid stools. With complete obstruction, obstipation may occur. Constipation can be the earliest sign of partial colon obstruction, but it usually occurs later if the level of the obstruction is more proximal. Associated findings include episodes of colicky abdominal pain, abdominal distention, nausea, or vomiting. The patient may also develop hyperactive bowel sounds, visible peristaltic waves, a palpable abdominal mass, and abdominal tenderness.

Irritable bowel syndrome

Irritable bowel syndrome, a common disorder, usually produces chronic constipation, although some patients have intermittent, watery diarrhea and others complain of alternating constipation and diarrhea. Stress may trigger nausea and abdominal distention and tenderness, but defecation usually relieves these signs and symptoms. Patients with irritable bowel syndrome commonly have an intense urge to defecate and feelings of incomplete evacuation. Typically, the stools are scybalous and contain visible mucus.

Mesenteric artery ischemia

Mesenteric artery ischemia, a life-threatening disorder, produces sudden constipation with failure to expel stools or flatus. Initially, the abdomen is soft and nontender but soon severe abdominal pain, tenderness, vomiting, and anorexia occur. Later, the patient may develop abdominal guarding, rigidity, and distention; tachycardia; syncope; tachypnea; fever; and signs of shock, such as cool, clammy skin and hypotension. A bruit may be heard.

Multiple sclerosis

Multiple sclerosis (MS) can produce constipation in addition to ocular disturbances, such as nystagmus, blurred vision, and diplopia; vertigo; and sensory disturbances. The patient may also have motor weakness, seizures, paralysis, muscle spasticity, gait ataxia, intention tremor, hyperreflexia, dysarthria, or dysphagia. MS can also produce urinary urgency, frequency, and incontinence as well as emotional instability. A male patient may experience impotence.

Spinal cord lesion

Constipation may occur with a spinal cord lesion, in addition to urine retention, sexual dysfunction, pain and, possibly, motor weakness, paralysis, or sensory impairment below the level of the lesion.

Ulcerative colitis

Constipation may occur in patients with chronic ulcerative colitis, but bloody diarrhea with pus, mucus, or both is the hallmark of this disorder. Other signs and symptoms include cramping lower abdominal pain, tenesmus, anorexia, low-grade fever and, occasionally, nausea and vomiting. Bowel sounds may be hyperactive. Later, weight loss, weakness, and arthralgia occur.

Other causes

Diagnostic tests

Constipation can result from the retention of barium given during certain GI studies.

Drugs

Patients often experience constipation when taking an opioid analgesic or other drugs, including vinca alkaloids, calcium channel blockers, antacids containing aluminum or calcium, anticholinergics, and drugs with anticholinergic effects (such as tricyclic antidepressants). Patients may also experience constipation from excessive use of laxatives or enemas.

Surgery and radiation therapy

Constipation can result from rectoanal surgery, which may traumatize nerves, and abdominal irradiation, which may cause intestinal stricture.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Constipation: Principal Causes of Constipation
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)

  1. Constitutional
    1. Geneticpredisposition
    2. Colonic inertia
  2. Dietary factors
  3. Developmental, situational, and psychologicdisturbances
  4. Gastrointestinal disorders
    1. Anal fissure
    2. Anal stenosis
    3. Anterior location of the anus
    4. Proctitis
    5. Congenital aganglionic megacolon
    6. Cystic fibrosis
    7. Celiac disease
    8. Chronic intestinal pseudoobstruction
  5. Abdominal, pelvic, and sacral masses
  6. Neurologic disorders
    1. Mentalretardation
    2. Spinal dysraphism
    3. Spinal cord injury
    4. Spinal tumor
    5. Neuromuscular disorders
  7. Metabolic disorders
  8. Drugs

» READ BOOK EXCERPT ONLINE »

Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006

Constipation: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Anal fissure.A crack or laceration in the lining of the anal wall can cause acute constipation, usually due to the patient's fear of the severe tearing or burning pain associated with bowel movements. He may notice a few drops of blood streaking toilet tissue or his underwear.

Anorectal abscess.In anorectal abscess, constipation occurs together with severe, throbbing, localized pain and tenderness at the abscess site. The patient may also have localized inflammation, swelling, and purulent drainage and may complain of fever and malaise.

Cirrhosis.In the early stages of cirrhosis, the patient experiences constipation along with nausea and vomiting and a dull pain in the right upper quadrant. Other early findings include indigestion, anorexia, fatigue, malaise, flatulence, hepatomegaly and, possibly, splenomegaly and diarrhea.

Diabetic neuropathy.Diabetic neuropathy produces episodic constipation or diarrhea. Other signs and symptoms include dysphagia, orthostatic hypotension, syncope, and painless bladder distention with overflow incontinence. A male patient may also experience impotence and retrograde ejaculation.

Diverticulitis.In diverticulitis, constipation or diarrhea occurs with left lower quadrant pain and tenderness and possibly a palpable, tender, firm, fixed abdominal mass. The patient may develop mild nausea, flatulence, or a low-grade fever.

Hemorrhoids.Thrombosed hemorrhoids cause constipation as the patient tries to avoid the severe pain of defecation. The hemorrhoids may bleed during defecation.

Hepatic porphyria.Abdominal pain, which may be severe, colicky, localized, or generalized, precedes constipation in hepatic porphyria. The patient may also have a fever, sinus tachycardia, labile hypertension, excessive diaphoresis, severe vomiting, photophobia, urine retention, nervousness or restlessness, disorientation and, possibly, visual hallucinations. Deep tendon reflexes may be diminished or absent. He may also have skin lesions causing itching, burning, erythema, altered pigmentation, and edema in areas exposed to light. Severe hepatic porphyria can produce delirium, coma, seizures, paraplegia, or complete flaccid quadriplegia.

Hypercalcemia.With hypercalcemia, constipation usually occurs along with anorexia, nausea, vomiting, polyuria, and polydipsia. The patient may also display arrhythmias, bone pain, muscle weakness and atrophy, hypoactive deep tendon reflexes, and personality changes.

Hypothyroidism.Constipation occurs early and insidiously in patients with hypothyroidism, in addition to fatigue, sensitivity to cold, anorexia with weight gain, menorrhagia in women, decreased memory, hearing impairment, muscle cramps, and paresthesia.

Intestinal obstruction.Constipation associated with an intestinal obstruction varies in severity and onset, depending on the location and extent of the obstruction. With partial obstruction, constipation may alternate with leakage of liquid stools. With complete obstruction, obstipation may occur. Constipation can be the earliest sign of partial colon obstruction, but it usually occurs later if the level of the obstruction is more proximal. Associated findings include episodes of colicky abdominal pain, abdominal distention, nausea, or vomiting. The patient may also develop hyperactive bowel sounds, visible peristaltic waves, a palpable abdominal mass, and abdominal tenderness.

Irritable bowel syndrome (IBS).IBS commonly produces chronic constipation, although some patients have intermittent, watery diarrhea and others complain of alternating constipation and diarrhea. Stress may trigger nausea and abdominal distention and tenderness, but defecation usually relieves these signs and symptoms. Patients typically have an intense urge to defecate and feelings of incomplete evacuation. Typically, the stools are scybalous and contain visible mucus.

Mesenteric artery ischemia.Mesenteric artery ischemia is a life-threatening disorder that produces sudden constipation with failure to expel stool or flatus. Initially, the abdomen is soft and nontender, but soon severe abdominal pain, tenderness, vomiting, and anorexia occur. Later, the patient may develop abdominal guarding, rigidity, and distention; tachycardia; syncope; tachypnea; a fever; and signs of shock, such as cool, clammy skin and hypotension. A bruit may be heard.

Spinal cord lesion.Constipation may occur with a spinal cord lesion, in addition to urine retention, sexual dysfunction, pain and, possibly, motor weakness, paralysis, or sensory impairment below the level of the lesion.

Other causes

Diagnostic tests.Constipation can result from the retention of barium given during certain GI studies.

Drugs.Patients commonly experience constipation when taking an opioid analgesic or other drugs, including vinca alkaloids, calcium channel blockers, antacids containing aluminum or calcium, anticholinergics, and drugs with anticholinergic effects (such as tricyclic antidepressants). Patients may also experience constipation from excessive use of laxatives or enemas.

Surgery and radiation therapy.Constipation can result from rectoanal surgery, which may traumatize nerves, and abdominal irradiation, which may cause intestinal stricture.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Constipation: Constipation - pathophysiology
(The 5-Minute Pediatric Consult)

  • Retention of stool allows water to move out of stool, increasing size and firmness.
  • Decreased motility leads to retention of stool. Often there is a family history of motility disturbances or constipation.

Constipation - etiology

  • Most patients will have idiopathic or functional constipation with no identifiable cause: Usually an acute event followed by chronicity.
  • Intentional or unintentional withholding of stool may result in hard stools, anal pain, and fissures that perpetuate and lead to constipation: Rectal dilatation, decreased sensation of the urge to defecate, shortening of the anal canal, decreased tone of the external anal sphincter, and encopresis can result.
  • Precipitating events include:
    • Transition from breast milk to cow’s milk
    • Power struggle in toddlers
    • Refusal to use toilets outside the home
    • Perianal streptococcal infection
    • Transient viral illness (diarrhea followed by constipation)
    • Zealous toilet training
  • Constipation also can be caused by anatomic anomalies in the lower GI tract, decreased propulsion, impaired rectal sensation (primary or secondary), or a functional outlet obstruction (muscular spastic levator ani or impaired relaxation of the puborectalis).
  • Neurologic causes:
    • Abnormalities of the myenteric plexus
    • Intestinal pseudo-obstruction
    • Congenital aganglionosis
    • Intestinal neuronal dysplasia
    • Muscular diseases (visceral myopathies)
    • Lesions of the spinal cord result in loss of rectal tone and sensation and reduced anal closure, affecting the sacral reflex center (e.g., myelomeningocele, spina bifida occulta, tethered cord).
  • Anatomic disorders of anus and rectum (stricture, stenosis, mass, ectopic anus, imperforate anus, fistula)
  • Endocrine abnormalities (hypothyroidism), drugs, electrolyte abnormalities

» READ BOOK EXCERPT ONLINE »

Source: The 5-Minute Pediatric Consult, 2008


 » Next page: Risk Factors for Constipation

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