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Is the constipation acute or chronic? If the constipation is acute and there is abdominal pain or vomiting, one must consider the possibility of intestinal obstruction. An examination may disclose an empty rectum, in which case it is more ... DIAGNOSTIC WORKUP
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Is the stool volume small or large? A small volume of stool should suggest anal fissure; hemorrhoids, diarrhea, or postoperative incontinence from a fistulectomy; or other types of surgery in the perirectal area.
Is the incontinence ... DIAGNOSTIC WORKUP
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Is the volume of urine large or small? If the volume of urine released is small, stress incontinence and vesicovaginal fistula should be considered. If the amounts released are large, one should consider a neurologic condition or an ... DIAGNOSTIC WORKUP
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... Stress incontinence occurs most commonly in women who have had many pregnancies or who are in menopause. The patient loses control of the bladder when he or she coughs, laughs, or sneezes and consequently leaks small amounts of urine. Nocturia is rare... DIAGNOSTIC WORKUP
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Is there blood in the stool? From the algorithm, blood in the stool should indicate that there is
Salmonella
,
Shigella
,
Campylobacter jejuni
, ulcerative colitis, and amebic dysentery. Without blood in the ... DIAGNOSTIC WORKUP
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Is there a positive drug or alcohol history? It is well known that alcohol can cause diarrhea, as do drugs in common use, such as digitalis, diuretics, beta-blockers, aspirin, colchicine, and other nonsteroidal anti ... DIAGNOSTIC WORKUP
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Constipation is a common complaint that must be accurately defined by the patient before initiating an extensive evaluation. Constipation may include fewer than three bowel movements (BMs) in a week, excessive straining during BMs, a feeling of incomplete evacuation after BM, or... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Incontinence, defined as the involuntary loss of urine, is one of the ten most common medical problems in the U.S. However, most patients do not seek treatment despite the significant effects on self-esteem and social interactions. Prevalence is estimated at 13–60... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Diarrhea is defined as an increase in the volume of bowel movements. Acute diarrhea is designated as being of less than 4 weeks’ duration. Many patients describe increased frequency or decreased consistency of bowel movements as diarrhea, so the... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Chronic diarrhea is defined as increased volume bowel movements persisting for more than 4 weeks. Mechanisms of diarrhea are categorized as increased secretion, decreased absorption, osmotic diarrhea, or abnormal intestinal motility. Many patients mistakenly identify... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Constipation is a common complaint, accounting for 3% of all pediatric office visits. Stool frequency can be variable in infants, who average 4 per day (SD 1.8) at 1 week, 2.2 per day (SD 1.6) at 1 month, and 1.8 per day (SD 1.2) at 1 year. After 4 years... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Chronic diarrhea (nonbloody, without weight loss) is defined as increased total daily stool output (greater than 10 g/kg/day), associated with increased stool water content; diarrhea is classified as chronic when it lasts longer than 2 weeks. Per liter, normal stool of... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Diarrhea is considered chronic when it last longer than 14 days. Weight loss with diarrhea should always be concerning and deserves thorough investigation. Collectively the malabsorption syndromes are the most common etiologic factors.
... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Acute diarrhea is an abrupt onset of increased fluid content of stool above about 10 mL/kg/day and increased frequency from 4–5 to more than 20 times daily. It is a major problem worldwide because of excessive loss of fluid and electrolytes in stool. In the U.S., every... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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... The causes of constipation can be recalled on a physiologic basis. Normal defecation requires feces that are of proper consistency, good muscular contraction of the walls of the large intestine, and unobstructed passage of the stool. It follows that constipation will result from insufficient
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... The differential diagnosis of diarrhea may be approached from either an anatomic or a physiologic basis. The anatomic approach is used in Table 22. In the stomach and duodenum, pernicious anemia and Zollinger–Ellison
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... Incontinence may be due to loss of voluntary control of urination, in which case neurologic disorders are usually the cause, or it may result from overflow of a distended bladder (overflow incontinence), in which case the cause may be bladder neck obstruction or a
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... Constipation is defined as small, infrequent, or difficult bowel movements. Because normal bowel movements can vary in frequency and from individual to individual, constipation is relative and must be determined in relation to the patient's normal elimination pattern. Constipation may... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pictures
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... Usually a chief sign of an intestinal disorder, diarrhea is an increase in the volume of stools compared with the patient's normal bowel habits. It varies in severity and may be acute or chronic. Acute diarrhea may result from acute infection, stress, fecal impaction, or the effect... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pictures
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... Fecal incontinence, the involuntary passage of feces, follows a loss or an impairment of external anal sphincter control. It can result from many GI, neurologic, and psychological disorders; the effects of drugs; or surgery. In some patients, it... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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... Incontinence, the uncontrollable passage of urine, can result from a bladder abnormality, a neurologic disorder, or an alteration in pelvic muscle strength. A common urologic sign, incontinence may be transient or permanent and may involve large volumes... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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... Behavioral/Psychiatric Factors
Low-residue diet
Chronic laxative and/or enema abuse
Immobility
Reduced food intake
Repressed urge to defecate
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... Acute Diarrhea
Infections
Viral gastroenteritis (adenovirus, Norwalk agent, rotavirus, etc.)
Bacterial
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... Constipation is defined as small, infrequent, or difficult bowel movements. Because normal bowel movements can vary in frequency and from individual to individual, constipation must be determined in relation to the patient’s normal elimination pattern.... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Usually a chief sign of an intestinal disorder, diarrhea is an increase in the volume of stools compared with the patient’s normal bowel elimination habits. It varies in severity and may be acute or chronic. Acute diarrhea may result from acute infection, stress, fecal impaction,... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Fecal incontinence, the involuntary passage of feces, follows any loss or impairment of external anal sphincter control. It can result from various GI, neurologic, and psychological disorders; the effects of drugs; or surgery. In some patients, it may even be a purposeful... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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... Incontinence, the uncontrollable passage of urine, can result from a bladder abnormality, a neurologic disorder, or an alteration in pelvic muscle strength. A common urologic sign, incontinence may be transient or permanent and may involve large volumes... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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... W. Robert Kiser
Approach Constipation, defined as the passage of two or fewer stools per week (1), is the most frequently reported gastrointestinal (GI) complaint in primary care, responsible for as many as 1.25 million patient visits annually (2). ... History ... Physical examination ... Diagnostic testing ... Diagnostic assessment
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... Francis G. O’Connor
Diarrhea is one of the most common clinical complaints encountered by primary care providers. Although diarrhea infrequently requires a significant diagnostic evaluation and no more than symptomatic oral... Approach ... History ... Physical examination ... Testing (5) ... Diagnostic assessment ... Pictures
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... Richard Rathe
Urinary incontinence (UI) in adults is one of the most prevalent and underdiagnosed afflictions in the United States (>25 million effected individuals, >50% of nursing home residents). The economic impact is... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment ... Pictures
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... Differential Overview
❑ Lifestyle
❑ Drugs
❑ Depression
❑ Irritable bowel syndrome
❑ Pelvic floor dysfunction ... Diagnostic Approach ... Clinical Findings
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... Differential Overview
❑ Cystitis
❑ Benign prostatic hypertrophy
❑ Pelvic floor relaxation
❑ Drugs
❑... Diagnostic Approach ... Clinical Findings
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... Differential Overview
❑ Viral gastroenteritis
❑ Staphylococcal enterotoxin
❑ E. coli
❑ Salmonella
... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
Altered Intestinal Motility
❑ Irritable bowel syndrome
❑ Diabetic enteropathy
Inflammatory
❑... Diagnostic Approach ... Clinical Findings
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... Also known as lazy colon, colonic stasis, colonic inertia, and atonic constipation, chronic constipation may lead to fecal impaction if left untreated. It’s common in elderly and disabled people because of their inactivity... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Usually a chief sign of an intestinal disorder, diarrhea is an increase in the volume of stools compared with the patient’s normal bowel habits. It varies in severity and may be acute or chronic. Acute diarrhea may result from acute infection, stress, fecal impaction, or... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Constipation is defined as small, infrequent, or difficult bowel movements. Because normal bowel movements can vary in frequency and from individual to individual, constipation must be determined in relation to the patient’s normal elimination pattern. Constipation may be a... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Usually a chief sign of an intestinal disorder, diarrhea is an increase in the volume of stools compared with the patient’s normal bowel habits. It varies in severity and may be acute or chronic. Acute diarrhea may result from acute infection, stress, fecal impaction, or the effect of... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Incontinence, the uncontrollable passage of urine, can result from a bladder abnormality, a neurologic disorder, or an alteration in pelvic muscle strength. A common urologic sign, incontinence may be transient or permanent and may involve large volumes of urine or scant... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Constipationis difficult passage of hard stools. Clinical problem is not infrequent passageper se, but difficult and painful bowel movements. Common manifestations include crampyabdominal pain, abdominal distension, anorexia, irritability, andurinary frequency.... Principal Causes of Constipation ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... Definedas stools that are more fluid and frequent than normal. Can be acute or chronic (>2–3wks in duration). Acute diarrhea is discussed in first section ofthis chapter, and chronic diarrhea is discussed in second section. ... Principle Causes of Acute Diarrhea ... Clinical Features and Diagnosis: Acute Diarrhea ... Diagnostic Approach: Acute Diarrhea ... Principle Causes of Chronic Diarrhea ... Clinical Features and Diagnosis: Chronic Diarrhea ... Diagnostic Approach: Chronic Diarrhea ... References
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... Definedas fecal soiling beyond 4 yrs of age. Until this age, children arelearning normal bowel control and bowel habits. Primary fecal incontinence exists whenchild has never achieved adequate bowel control; secondary fecalincontinence exists when child begins to soil after... Principal Causes of Fecal Incontinence ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... Urinaryincontinence or enuresis refers to the involuntary passage of urine. Most children have achieved urine continenceduring the day by 4 yrs of age, and during the night by 6 yrs ofage. Primary incontinence exists when achild has never gained bladder... Principal Causes of Urinary Incontinence ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... Constipation is defined as small, infrequent, or difficult bowel movements. Because normal bowel movements can vary in frequency and from individual to individual, constipation is relative and must be determined in relation to the patient's normal elimination pattern. Constipation may... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Usually a chief sign of an intestinal disorder, diarrhea is an increase in the volume of stools compared with the patient's normal bowel habits. It varies in severity and may be acute or chronic. Acute diarrhea may result from acute infection, stress,... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Fecal incontinence, the involuntary passage of feces, follows a loss or an impairment of external anal sphincter control. It can result from many GI, neurologic, and psychological disorders; the effects of drugs; or surgery. In some patients, it may... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Urinary incontinence, the uncontrollable passage of urine, can result from a bladder abnormality, a neurologic disorder, or an alteration in pelvic muscle strength. A common urologic sign, incontinence may be transient or permanent and may involve large volumes of urine or scant... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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...
The causes of constipation can be recalled on a physiologic basis.
Normal defecation requires feces that are of proper consistency, good
muscular contraction of the walls of the large intestine, and unobstructed
passage of the... Pictures
... READ EXCERPTS »
...
Incontinence may be due to loss of voluntary control of urination, in
which case neurologic disorders are usually the cause, or it may result from
overflow of a distended bladder (overflow incontinence), in which case the
cause may be bladder neck
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...
Anatomy will serve us well in recalling the various causes of
fecal incontinence. The pathway of voluntary control of this function begins
in the cerebrum and travels through the brainstem, spinal cord, and nerve
roots, to the &
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... Amanda K. Berry, BSN, MSN, CPNPSeth L. Schulman, MD Daytime Incontinence - BASICS Daytime Incontinence - description Daytime wetting in a child ≥5 years of age warrants evaluation. ... Daytime Incontinence - DIAGNOSIS ... Daytime Incontinence - TREATMENT ... Daytime Incontinence - FOLLOW UP ... Daytime Incontinence - bibliography ... Daytime Incontinence - CODES ... Daytime Incontinence - FAQ
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It's no secret that our bodies change as we age, and some adjustments are unavoidable. But urinary incontinence is one problem older people...
Diagnosing irritable bowel syndrome today is often simpler than it has been in the past. Doctors used to focus on ruling out other diseases and...
Some people with vague digestive symptoms needlessly suffer in silence believing there is no treatment. Abdominal discomfort, bloating, and either...
Pain and bowel irregularities caused by irritable bowel syndrome (IBS) can make a marked impact on day-to-day living. Abdominal discomfort, bloating,...