tailieunhanh - Chapter 040. Diarrhea and Constipation (Part 13)

CONSTIPATION Definition Constipation is a common complaint in clinical practice and usually refers to persistent, difficult, infrequent, or seemingly incomplete defecation. Because of the wide range of normal bowel habits, constipation is difficult to define precisely. Most persons have at least three bowel movements per week; however, low stool frequency alone is not the sole criterion for the diagnosis of constipation. Many constipated patients have a normal frequency of defecation but complain of excessive straining, hard stools, lower abdominal fullness, or a sense of incomplete evacuation. The individual patient's symptoms must be analyzed in detail to ascertain what is meant by "constipation". | Chapter 040. Diarrhea and Constipation Part 13 CONSTIPATION Definition Constipation is a common complaint in clinical practice and usually refers to persistent difficult infrequent or seemingly incomplete defecation. Because of the wide range of normal bowel habits constipation is difficult to define precisely. Most persons have at least three bowel movements per week however low stool frequency alone is not the sole criterion for the diagnosis of constipation. Many constipated patients have a normal frequency of defecation but complain of excessive straining hard stools lower abdominal fullness or a sense of incomplete evacuation. The individual patient s symptoms must be analyzed in detail to ascertain what is meant by constipation or difficulty with defecation. Stool form and consistency are well correlated with the time elapsed from the preceding defecation. Hard pellety stools occur with slow transit while loose watery stools are associated with rapid transit. Both small pellety or very large stools are more difficult to expel than normal stools. The perception of hard stools or excessive straining is more difficult to assess objectively and the need for enemas or digital disimpaction is a clinically useful way to corroborate the patient s perceptions of difficult defecation. Psychosocial or cultural factors may also be important. A person whose parents attached great importance to daily defecation will become greatly concerned when he or she misses a daily bowel movement some children withhold stool to gain attention or because of fear of pain from anal irritation and some adults habitually ignore or delay the call to have a bowel movement. Causes Pathophysiologically chronic constipation generally results from inadequate fiber or fluid intake or from disordered colonic transit or anorectal function. These result from neurogastroenterologic disturbance certain drugs advancing age or in association with a large number of systemic diseases that affect the .