5Constipation and evacuation disorders
Section snippets
Definition
A simple classification of constipation is the infrequent defaecation; passage of hard stools, which may or may not accompany difficulty in emptying, characterised by the need to strain; the feeling of incomplete emptying and/or digital manoeuvres. The 2006 Rome III collaboration on functional disorders have further defined more formal criteria to be used in defining both functional constipation and functional defaecatory disorders. Functional constipation is defined as a bowel disorder that
Epidemiology
Epidemiologic surveys on constipation and evacuation difficulties show wide variation in incidence and prevalence according to the definition used and population studied. The largest population survey in the literature suggests that one in five middle-aged apparently healthy persons have symptoms of functional constipation, and one in 10 have symptoms of obstructive defaecation [3]. Prevalence increases with age, with up to 20% of those above 65 years of age affected, being three times more
Aetiology
Colonic transit is mediated by the local enteric nervous system, under the influence of the autonomic nervous system, spinally mediated reflexes and central control. This nervous innervation modulates intrinsically generated contractions, which are of two primary types: low-amplitude motor complexes, which represent background colonic activity and are non-propulsive; and high-amplitude propagated contractions, which are propulsive and responsible for defaecation. A reduction of this type of
Questionnaires
To supplement clinical history taking, a number of validated instruments have been developed for patients with constipation, but none quantifies obstructed defaecation into a usable clinical and research tool. Some of the reported scores and questionnaires available for functional constipation include:
- (1)
the Wexner constipation score – a weighted questionnaire focussing on constipation and including a little quality-of-life focus [22];
- (2)
the Patient Assessment of Constipation Quality of Life
Investigations
Colonoscopy, computed tomography (CT) colonography or contrast-enema radiology are required if there is any suggestion of obstructing or other organic disease. The presence of common abnormalities such as diverticulosis and melanosos coli does not indicate causality.
Anorectal physiology assessment of patients with constipation is usually of little value, unlike the pivotal role in patients with faecal incontinence. The role of physiology was reviewed in the AGA statement of 1998 suggesting that
General measures
The patient's primary complaints should guide the initial therapy. In principle, simple, empiric measures should be undertaken before referral to a specialist centre. By contrast, patients in one of the special groups listed below may need specialist involvement at an early stage. Conservative measures will often include advice on ample fluid intake up to eight medium glasses per day, (maintenance fluids for an average 70-kg man being 3 l). Though the majority of this fluid is absorbed in the
Conclusion
Chronic constipation comprises a spectrum of intestinal and extra-intestinal complaints that whilst highly prevalent in society can be a major nuisance to quality-of-life in some patients. Patients have usually tried a variety of lifestyle alterations and over-the-counter remedies before seeing a specialist. It is important from the outset to clearly identify the patient's cardinal complaints and aspirations from treatment. Broadly classifying pathophysiology into either delayed gut transit,
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Cited by (68)
A Longitudinal Study of Predictors of Constipation Severity in Oncology Outpatients With Unrelieved Pain
2020, Journal of Pain and Symptom ManagementCitation Excerpt :In addition, one-third of our patients reported hard stools (Fig. 2b), another indicator of constipation.44,45 As highlighted in the definition,1–3 constipation should be characterized by the number of BMs per day and various stool characteristics. Given the relatively large number of potential predictors identified in the exploratory analyses, it is notable that only three clinical characteristics and one symptom were associated with interindividual variability in constipation severity.
Clinical, radiological and physiological assessment of anorectal function
2017, Surgery (United Kingdom)Citation Excerpt :Constipation and related functional bowel disorders have been formally defined by the ROME III collaboration.3 They affect up to 25% of the population and comprise a symptom complex associated with infrequent defaecation, hard stools, difficulty in emptying, straining and a feeling of incomplete evacuation.4 A recent study suggested that 1 in 8 tertiary level students have an adverse quality of life as a result of bowel dysfunction.5
Epidemiology of constipation and its associated factors in an ageing population of people with an intellectual disability in Ireland: A cross-sectional study
2023, Journal of Intellectual and Developmental Disability