Constipation

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Constipation refers to an abnormal infrequency or irregularity of defecation, abnormal hardening of stools that makes their passage difficult and sometimes painful, decrease in stool volume, or prolonged retention of stool in the rectum. This types is referred to as colonic constipation. It can be caused by certain medications; rectal or anal disorders; obstruction; metabolic, neurologic, and neuromuscular conditions; endocrine disorders; lead poisoning; connective tissue disorders; and variety of disease conditions. Constipation develops when people do not take the time to defecate as the result of dietary habits (low consumption of fiber and inadequate fluid intake), lack of regular exercise, and a tress-filled life.  Perceived  constipation is a subjective problem that occurs when an individual’s bowel elimination pattern is not consistent with what he or she perceives as normal.  Chronic laxative use contributes to this problem, particularly in elderly people.

Clinical Manifestations

  • Abdominal distention, borborygmus (intestinal rumbling), pain and pressure
  • Decreased appetite, headache, fatigue, indigestion, sensation of incomplete emptying.
  • Straining at stool; elimination of small volume of hard, dry stool; fewer than three bowel movements per week
  • Complications such as hypertension, hemorrhoids and fissures, fecal impaction, and megacolon

Assessment and Diagnostic Methods

  • History
  • Physical examinaiton
  • Possibly a barium enema
  • Sigmoidoscopy
  • Stool foroccult blood
  • Anorectal manometry (pressure studies)
  • Defecography
  • Bowel transit studies

Medical Management

Treatment should be aimed at the underlying  cause of constipation

  • Discontinue laxative abuse; increase fluid intake; include fiber in diet; try biofeedback; exercise routine to strengthen abdominal muscles.
  • If laxative is necessary; use bulk-forming agents, saline and osmotic agents, lubricants stimulants, of fecal softeners
  • Specific medication therapy to increase intrinsic motor function (eg. cholinergies or cholinesterase inhibitors)

Reference:

Handbook for Brunner & Suddarth’s

Textbook of Medical-Surgical Nursing 11th edition

Joyce Young Johnson

Lippincott Williams & Wilkins pp.279-280

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