Welcome, today we'll discuss the
approach to the patient with constipation.
So first let's define
what is constipation?
Clinically speaking, it is defined by having at
least 2 of the following symptoms:
Straining with defecation, the passage of lumpy or
hard stools, a sensation of incomplete defecation,
having to use manual maneuvers
to facilitate the bowel movement,
and having a frequency of less
than 3 bowel movements a week.
Constipation is a very common problem.
It affects up to half of the general
population and has a much higher prevalence
in certain populations such as women,
the elderly and patients in nursing homes.
So because it's something you
will encounter very frequently,
you should know the important historical
risk factors you should ask your patients about.
So having an age greater
than 50 years at the onset,
unexplained weight loss,
a family or personal history of colon cancer
or a personal history of abdominal
surgery, cancer or irradiation.
All of these risk factors may prompt you to be a bit more
concerned about the typical patient coming in with constipation.
If multiple risk factors are present, you should
consider referring that patient for colonoscopy.
So, there are several
different types of constipation.
First we can divide this by primary constipation
and secondary constipation from other causes.
So under primary constipation, there is slow transit when
stool just takes a long time to transit through the colon.
Patients may also have what's
called dyssynergic defecation.
This is when they have the urge to defecate but then they
have difficulty expelling stool from the anal rectum.
Lastly, patients may have
irritable bowel syndrome.
This is when they have alterations in their bowel
habits along with abdominal pain.
Under the category of secondary constipation, is
the umbrella of medications.
Many medications can cause constipation.
The most common culprit
is opioid medications.
Patients may also have endocrine or metabolic
disorders that can contribute to constipation,
or neurologic disorders.