Constipation: Definition and Types

00:00 Welcome, today we'll discuss the approach to the patient with constipation.

00:06 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.

00:31 Constipation is a very common problem.

00:33 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.

00:45 So because it's something you will encounter very frequently, you should know the important historical risk factors you should ask your patients about.

00:52 So having an age greater than 50 years at the onset, rectal bleeding, unexplained weight loss, a family or personal history of colon cancer or a personal history of abdominal surgery, cancer or irradiation.

01:09 All of these risk factors may prompt you to be a bit more concerned about the typical patient coming in with constipation.

01:17 If multiple risk factors are present, you should consider referring that patient for colonoscopy.

01:25 So, there are several different types of constipation.

01:29 First we can divide this by primary constipation and secondary constipation from other causes.

01:36 So under primary constipation, there is slow transit when stool just takes a long time to transit through the colon.

01:44 Patients may also have what's called dyssynergic defecation.

01:48 This is when they have the urge to defecate but then they have difficulty expelling stool from the anal rectum.

01:56 Lastly, patients may have irritable bowel syndrome.

01:58 This is when they have alterations in their bowel habits along with abdominal pain.

02:05 Under the category of secondary constipation, is the umbrella of medications.

02:10 Many medications can cause constipation.

02:13 The most common culprit is opioid medications.

02:17 Patients may also have endocrine or metabolic disorders that can contribute to constipation, or neurologic disorders.