CONSTIPATION
CONSTIPATION: Excerpt from Differential Diagnosis in Primary Care
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 intake of food and water, inhibition of muscular contraction of
the bowels, or obstruction to the passage of stools. The obstruction can be
high or low and intrinsic or extrinsic.
-
Insufficient intake of food and water. Starvation or anything that
interferes with the appetite will cause constipation. Senility, anorexia
nervosa, chronic tonsillitis, and cardiospasm of the esophagus are examples.
Lack of fluid intake will cause a hard stool and constipation.
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Poor bowel motility and contractability. Neurologic conditions such
as poliomyelitis and tabes dorsalis may be considered in this group. In
Hirschsprung disease, there is lack of the myenteric plexus, causing poor
contraction of the bowel wall. Anxiety and depression may interfere with
bowel motility and lead to constipation. Certain drugs (such as atropine
derivatives, tranquilizers, opiates, and barbiturates) interfere with bowel
motility and cause constipation. Uremia and diabetic acidosis may cause a
paralytic ileus.
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Obstruction.
A. High obstruction includes pyloric stenosis, volvulus,
intussusception, regional ileitis, adhesions, and incarcerated hernias.
B. Low obstruction includes intrinsic lesions such as polyps,
carcinomas, fecal impactions, and conditions that cause spasm of the rectal
sphincter, such as proctitis, hemorrhoids, rectal fissures, rectal fistulas,
and abscesses and spinal cord lesions like multiple sclerosis.
C. Extrinsic conditions that cause low obstructions include pelvic
inflammatory disease, a retroverted uterus, endometriosis, pregnancy,
fibroids, ovarian cysts, and a large prostate or pelvic abscess.
Approach to the Diagnosis
Rectal examination for a fecal impaction and subsequent enemas are the
first steps if no contraindication exists. This may disclose a fissure,
inflamed hemorrhoid, or abscess. Pelvic examination must be done in all
female patients. If nothing is found here a proctoscopic examination and
barium enema would be indicated, provided the neurologic examination and a
flat plate of the abdomen are normal. Careful inquiry about diet, drugs, and
emotional stress should be made.
Other Useful Tests
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Glucose tolerance test (diabetic neuropathy)
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Stool for occult blood (rectal or colon carcinoma)
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Serum electrolytes (motility disorder)
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Thyroid function tests (hypothyroidism)
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Urine porphobilinogen (porphyria)
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Urine drug screen (drug abuse)
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Colonoscopy (colon carcinoma)
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Defecography (motility disorder)
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Anorectal manometry (neuropathy)
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Gastroenterology consult
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
More About Intestinal Conditions
More Medical Textbooks Online about Intestinal Conditions
Review other book chapters online related to Intestinal Conditions:
Medical Books Excerpts
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- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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- "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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