Chronic constipation
Chronic constipation: Excerpt from Handbook of Diseases
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 and is commonly relieved with diet and exercise. Left untreated, it can result in hemorrhoids, fissures and megacolon.
Causes
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.
Signs and symptoms
The patient typically strains to produce dry, hard stool accompanied by mild abdominal discomfort. Straining can aggravate other rectal conditions such as hemorrhoids.
Diagnosis
A patient history of dry, hard stool and infrequent bowel movements suggests chronic constipation due to an inactive colon. A digital rectal examination reveals stool in the lower portion of the rectum and a palpable colon. Analoscopy may show an unusually small colon lumen, prominent veins, and an abnormal amount of mucus. Diagnostic tests to rule out other causes include an upper GI series, barium enema, and examination of stool for occult blood from neoplasms.
Colonoscopy may be performed for inactive colon. Manometric studies may be done to exclude Hirschsprung’s disease, and internal and external sphincters may be evaluated.
Treatment
Effective treatment varies with the patient’s age and condition and depends on the cause. A diet high in fiber, sufficient exercise, and increased fluid intake should relieve constipation. (See Breaking the constipation habit.)
Treatment for severe constipation may include bulk-forming laxatives, such as psyllium, or well-lubricated glycerin suppositories; for fecal impaction, manual removal of stool is necessary. Administration of an oil-retention enema usually precedes stool removal; an enema is also necessary afterward. For lasting relief of constipation, the patient with inactive colon must modify his bowel habits.
Special considerations
❑ Autosuggestion, relaxation, and use of a small footstool to promote thigh flexion while sitting on the toilet may be helpful. To help the patient relax, suggest that he bring pleasant reading material.
❑ Tell the patient to respond promptly to the urge to defecate. If he worries about constipation, assure him that a 2- to 3-day interval between bowel movements can be normal.
❑ Advise the patient to take bulk-forming laxatives, such as psyllium, with at least 8 oz (240 ml) of liquid. Juices, soft drinks, or other pleasant-tasting liquids help mask this drug’s grittiness.
If the patient with inactive colon is hospitalized:
❑ Assist the patient with inactive colon to a bedside commode for a bowel movement because using a bedpan causes additional strain.
Clinical tip If the patient has a history of arteriosclerosis, heart failure, or hypertension, constipation and straining may induce a “bathroom coronary” or a stroke.
❑ If the patient must use a bedpan, have him sit in Fowler’s position or on the pan at the side of his bed to facilitate elimination.
❑ Occasional digital rectal stimulation or abdominal massage near the sigmoid area may help stimulate a bowel movement.
❑ If the patient requires enemas, alert him that frequent use should be avoided, especially use of sodium biphosphate enemas. Their hypertonic solution can absorb as much as 10% of the colon’s sodium content or draw intestinal fluids into the colon, causing dehydration.
Pictures
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
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