Q What is constipation Female 46 years Constipation
- Slides: 40
Q. What is constipation ?
Female, 46 years • Constipation for 20 years • “Hard, compacted stool like a chest nut” • “Bowel movement once a week” • “Straining during bowel movements” – Difficulties in passing stool out of the anus
Q. Why is my stool so hard ?
Functions of GI tract Digestion (소화) Motility (운동) Absorption (흡수) Secretion (분 비)
Stool consistency is dependent on water content !!
• Colonic transit time 장 통과 시간 Longer (peristalsis dec. ) -------- shorter (inc. peristalsis inc. ) – Shortened colonic transit • Too short to absorb water and nutrients Loose stool • Stimulation of bowel peristalsis – Laxative ex) Aloe(containing senna)
Q. Is my constipation due to slow colonic transit ? Hard and lumpy stool means slow colonic transit in some patients, but others…
Pelvic Floor Dysfunction; PFD = Dyssynergic Defecation; DD
Q. How can my constipation be managed ?
Diet control ? Constipation !! Decreased food intake small stool volume constipation 뭐가 있어야 밀지… Nothing to pass… What food ? Dietary fiber !!
Dietary fiber rich foods Whole grains 현미 보리 Legumes 콩 Sea weeds 미역 Fruits 사과 등 Vegetables 당근 오이 Others 고구마 감자 (결국 야채, 과일, 풀)
Q. I am trying to have lots of vegetable and fruits, so my fiber intake seems not short to recommended daily acquirement !!
Q. I will try to have more food. Is there any medication for me ?
Physiology Colonic Motility
High Amplitude Propagated Contractions; HAPCs
Q. I have been taking laxatives regularly as your prescription. But, still I have difficulties in passing stools !!
Q. I underwent hysterectomy due to uterine myoma. Since then, my constipation have been aggravated !!
Behavioral tx: Biofeedback
Approach to Constipation – Most patients with constipation are diagnosed as functional or motility disease. • Rule out organic lesion !!! ØAlarm symptoms or signs ‘Red flag sign’ • • Weight loss, bloody stool, anemia Night symptoms Persistent changes in bowel habit Onset >50 years old
Take Home Messages Constipation – Normal Transit / Slow Transit / Dyssynergic defecation (= functional evacuation disorder) • Overlap is common, especially STC/DD – Mass movement ‘HAPC’ and 5 -HT are important factors in colonic motility Ø Increase food intake, then laxatives !!!
Thank you for attention !! kshong 1@empas. com Feel free to email me, especially English-speaking student ^^; ;