3. •Constipation can negatively Impact
HER quality of life during pregnancy at any stage
Post-operative
Pregnancy
Nursing Mother
See our another presentation constipation I pregnancy & postpartum in slide share .net
4. CONSTIPATION Definition
•Constipation is a symptom of many conditions.
Commonly it refers to
-Infrequent passage of stools
-Straining
-passage of hard stool
-incomplete evacuation.
• It is estimated to affect over 12 to 30% of the
woman population.
5. Rome III criteria
for functional constipation
• At least 2 or more of the following criteria:
• -Straining during at least 25% of the defecations
• -Lumpy or hard stools in at least 25% of the defecations - Sensation of
incomplete evacuation for at least 25% of defecations
• -Sensation of anorectal obstruction/blockage for at least 25% of
defecations
• -Manual manoeuvres to facilitate defecation for at least 25% of
defecations
• -Fewer than three defecations per week
Nutr J. 2012; 11: 80.
6. Another definition states that less than three
bowel movements per week and straining on
more than 75% of occasions represents
constipation in clinical surveys.
7. IMPACT OF CONSTIPATION
•Disturbed defecation can result in the development
of utero-vaginal Prolapse in woman.
• Therefore it is important to recognize the
symptoms of constipation early …Not ignore it and
treat this complain in an early stage it self.
9. . The most common cause is PRIMARY and not
life-threatening.
In the ELDERLY, causes include: insufficient dietary fiber intake,
inadequate fluid intake, decreased physical activity, side
effects of medications, hypothyroidism, and obstruction by
colorectal cancer.
Constipation with no known organic cause, i.e. no medical
explanation, exhibits Great gender differences in prevalence:
females are more often affected than males.
THE CAUSES OF CONSTIPATION CAN BE DIVIDED INTO
CONGENITAL, PRIMARY, AND SECONDARY
12. Psychological causes
Voluntary withholding of the stool is a
common cause of constipation.
The choice to withhold can be due to
factors such as fear of pain, fear of
public restrooms, or laziness.
16. •Opiates , anti depressants
•Anticholinergic, antispasmodics, anticonvulsants
•Calcium channel blockers eg nifedipin
•Anti depressant
•Iron
•Magnesium salts, aluminum antacids
Drugs can cause Constipation
17. Diet
Constipation can be caused or
exacerbated by a low-fiber diet, low
liquid intake, or dieting.
Childhood chronic constipation can
be manifests as an intolerance to
cow’s mild.
20. CAREFUL HISTORY
•A recent change in bowel habit in
association with other symptoms,
line rectal bleeding requires
urgent Investigations
21. DIAGNOSIS
The diagnosis is essentially made from the patient's description of the
symptoms. Bowel movements that are difficult to pass, very firm, or
made up of small hard pellets (like those excreted by rabbits) qualify as
constipation, even if they occur every day.
Other symptoms related to constipation can include
bloating, distension, abdominal pain, headaches, a feeling of fatigue
and nervous exhaustion, or a sense of incomplete emptying
22. DIETARY HISTORY
•Inquiring about dietary habits will
often reveal a low intake of dietary
fiber, inadequate amounts of fluids,
poor ambulation or immobility, or
medications that are associated with
constipation
23. IRRITABLE BOWEL SYNDROME (IBS)
•Chronic constipation (symptoms present at
least three days per month for more than
three months) associated with abdominal
discomfort is often diagnosed as irritable
bowel syndrome (IBS) when no obvious
cause is found
24. INVESTIGATIONS
This will usually involves
• Rectal examine
• Sigmoidoscopy
• Colonoscope
• X. ray of the abdomen
• A Barium enema
• A Barium enema should always be preceded by a rectal
examination and rigid sigmoidoscopy to exclude
anorectal lesion
25. THE TWO CLINICAL TYPES OF
CONSTIPATION
•Slow transit
•Obstructive
26. • In the slow-transit form--Patients rarely Experience
a call to stool.
• In the obstructive form--Patients experience a call to
stool but are not able to evacuate properly because of
coexisting organic and functional anorectal disease.
THE TWO CLINICAL TYPES OF
CONSTIPATION
27. SEVERITY ASSESS MENT
Slow Transit constipation--A simple abdominal x-ray
& marker studies of colonic transit –
can assess the severity of slow –transit-constipation .
Obstructive constipation is assessed by performing
evacuation procto graphy.
28. PREVENTION
Constipation is usually easier to prevent
than to treat. Following the relief of
constipation, maintenance with
adequate exercise, fluid intake, and
high-fiber diet is recommended.
29. TREATMENT
•The treatment of constipation should focus on
the underlying cause if known.
•The National Institute of Health and Care
Excellence (NICE) break constipation in adults into
two categories - chronic constipation of unknown
cause and constipation due to know causes.
30. TREATMENT
• In chronic constipation of unknown cause, the main treatment involves
the increased intake of water and fiber (either dietary or as
supplements).
• The routine use of laxatives is discouraged, as having bowel
movements may come to be dependent upon their use.
• Enemas can be used to provide a form of mechanical stimulation.
However, enemas are generally useful only for stool in the rectum, not
in the intestinal tract.
31. Dictum of TREATMENT
•Give relief from constipation with an increase in
dietary fibre and fluids, as well as daily exercise.
• Probiotics that alter the colonic flora might also
improve bowel function.
• If these are ineffective, laxatives are the second line
of therapy
Canadian Family Physician August 2012 vol. 58 no. 8 836-838
32. TREATMENT OPTIONS
• Foods like "bran," which incidentally contains a lot of iron,
increase the bulk of the faeces and relieve constipation quite
effectively.
• The patient may be told that the risks of over-purgation are far
greater than the risks of constipation.
Br Med J. 1964 Mar 21;1(5385):749-52.
34. TREATMENT
• Laxatives ,in combination with increasing fibre ,fluid intake
and increasing physical activity level are usually effective
and should be tailored to the needs of the patient .
• Regular treatment is more effective than ad hoc use, and
stimulant laxatives should be used very cautiously.
• Excessive use of laxatives may lead to electrolyte
disturbances.
35. TREATMENT
The treatment of constipation should focus on
the underlying cause if known.
The National Institute of Health and Care
Excellence (NICE) break constipation in
adults into two categories –chronic constipation
of unknown cause and constipation due to
opiates.
36. TREATMENT
In chronic constipation of unknown cause, the main
treatment involves the increased intake of water and
fiber (either dietary or as supplements).
The routine use of laxatives is discouraged, as having
bowel movements may come to be dependent upon
their use.
Enemas can be used to provide a form of mechanical
stimulation. However, enemas are generally useful only
for stool in the rectum, not in the intestinal tract.
37. KNOW THE TYPES OF LAXATIVES
Bulk-forming laxatives- relieve constipation
by increasing faecal mass which stimulates
peristalsis.The full effect may take some days to
develop .
They include methylcellulose, ispa-ghula, and
sterculia
38. Osmotic laxative- act by increasing colonic
inflow of fluid and electrolyte which soften stool
and stimulate colonic contractility. They include
lactulose, macro gold, magnesium salts and
phosphate enemas
39. STIMULATE LAXATIVES
Stimulant laxatives- increase in testing motility
and often cause abdominal cramp: they should
be avoided in intestinal obstruction, Excessive
use can cause diarrhea and related effects such
as hypokalemia They include bisacodyl, dantron,
docusate sodium, glycerol senna and sodium
Pico sulfate
40. Faecal softeners- these preparation's contain oil which
soften stool.
These include
arachis oil and liquid paraffin.
Nice guidelines 99.(2010)
41. TYPES OF LAXATIVES
Stimulant laxatives- increase in testing motility and often cause abdominal
cramp: they should be avoided in intestinal obstruction, Excessive use can cause
diarrhea and related effects such as hypokalemia They include bisacodyl,
dantron, docusate sodium, glycerol senna and sodium Pico sulfate
Faecal softeners- these preparation's contain oil which soften stool.
These include arachis oil and liquid paraffin.
Nice guidelines 99.(2010)
42. PRACTICAL TIP ON LAXATIVES
• If laxatives are used, milk of magnesia is recommended as
a first-line agent due to its low cost and safety.
• Stimulants should only be used if this is not effective.
• In cases of chronic constipation, polyethylene
glycol appears superior to lactulose.
• Prokinetics may be used to improve gastrointestinal
motility. A number of new agents have shown positive
outcomes in chronic constipation; these
include prucalopride andlubiprostone.
43. Faecal softeners- these preparation's
contain oil which soften stool.
These include
arachis oil and liquid paraffin.
Nice guidelines 99.(2010)
44. PROGNOSIS
Complications that can arise from constipation include hemorrhoids, anal
fissures, rectal prolapse, and fecal impaction.
Straining to pass stool may lead to hemorrhoids. In later stages of
constipation, the abdomen may become distended, hard and diffusely
tender.
Severe cases ("fecal impaction" or malignant constipation) may exhibit
symptoms of bowel obstruction (vomiting, very tender abdomen)
and encopresis, where soft stool from the small intestine bypasses the
mass of impacted fecal matter in the colon.
45. TAKE HOME MESSAGES
Constipation is the most common digestive complaint in
women
10 -20% of women population worldwide reports having
constipation. Over 50% elderly women have this
complaint
LAXATIVES should be only used when dietary & fluid
modification & increase exercise does not work
