SAURABH WANIPGDPMGARWARE COLLEGE

DEFINE CONSTIPATION• Constipation is associated with

symptoms in which patients complains off very hard stools and finds difficulty in defecation as he needs to strain during defecation

CAUSES OF CONSTIPATIONSIMPLECONSTIPATION

• INADEQUATE FIBRE INTAKE

• INADEQUATE FLUIDS INTAKE

• LACK OF PHYSICAL ACTIVITY

• IGNORING TO DEFECATE

SECONDARY CONSTIPATION

• CAUSED BECAUSE OF DRUGS

• ANORECTAL DISORDERS

• ASSOCIATED WITH DIABETIS MELLITUS

ANAL FISSURES HEMORRHOIDS

DIAGNOSIS OF CONSTIPATION

• CAREFULL CLINICAL HISTORY OF PATIENT IS TAKEN

• PHYSICAL EXAMINATION ROUTINE BLOOD,URINE AND STOOL TEST

• OTHER DIAGNOSTIC TEST FOR DIAGNOSIS OF CONSTIPATION INCLUDES SIGMOIDOSCOPY AND COLONOSCOPY

• Sigmoidoscopy is medical examination of large intestine from the rectum through the last part of colon

• Colonoscopy is looking inside the colon and used to evaluate symptoms like constipation

• PROCTOSCOPY procedure is essentially a medical examination of the anal cavity or rectum with the help of a special metal or plastic scope that is known as a proctoscope

ENEMA IN CONSTIPATION• Enema introduces liquids through a tube

inserted into the bowel. Enemas are used to treat severe constipation and to introduce fluids in patients who can't receive them intravenously, as well as to administer certain drugs in liquid suspension. Done correctly, an enema is safe, effective and a natural alternative to laxatives

MANAGEMENT OF CONSTIPATION

• GENERAL MEASURES

• DIET

• LAXATIVES

GENERAL MEASURES

{1} ERADICATION OF ANY CAUSES LIKE DRUGS{2} DOING MORE PHYSICAL ACTIVITIES{3} ANY CALL TO STOOL MUST BE PROMPTLY ANSWERED{4} ALLOW SUFFICIENT TIME FOR DEFECATION{5} ADEQUATE FIBRE INTAKE{6} ADEQUATE FLUID INTAKE {1.5LITRE/DAY}

DIETIN CASES OF CONSTIPATION IT IS ADVISABLE TO TAKE DIET HAVING HIGH CONTENT OF FIBRE

FIBRE IS PART OF PLANT MATERIAL WHICH HELPS IN PROPER DIGESTIONWOMEN – 25grams/dayMEN – 38grams/day

LAXATIVES

• LAXATIVES ARE DRUGS WHICH PROMOTE DEFECATION

• DEPENDING ON MECHANISM OF ACTION LAXATIVES ARE CLASSIFIED AS

{1} BULK-FORMING LAXATIVES{2} STIMULANT LAXATIVES{3} OSMOTIC LAXATIVES{4} EMOLLIENT LAXATIVES

BULK FORMING LAXATIVES

E.g.isphagula , agar

Bulk forming laxatives add mass to feces and stimulate peristalsis and are useful in patients with small and hard stools these laxatives are to be taken with sufficient quantity of water

Stimulant LaxativesE g Sodium picosulphate, bisacodyl and senna Stimulant laxatives act directly on large intestine and do not act on small intestine except [Senna and bisacodyl] these laxatives if taken before going to bed produces entire bowel movement till morning

Osmotic LaxativesE g Milk of magnesia, LactuloseWhen osmotic laxatives like milk of magnesia are taken orally they are not absorbed and retained in gastrointestinal tract. These exert an osmotic effect basically they draw water from the cells in to the intestinal lumen because of this bulk of intestine is increased as result it facilitates clearing of bowel tract.

Emollient laxatives E g LIQUID PARAFFINEmollient laxatives basically softening agents which helps in softening of hard stoolsLIQUID PARAFFIN coats feces in colonic lumen as a result there is decrease in water reabsorption these leads to increase in bulk of stool and softens stool significantly

DIFFERENT BRANDS AVAILABLE LAXATIVES

• CREMAFFIN [ABBOTT]

• CREMAFFIN PLUS [ABBOTT]

• DUPHALAC [ABBOTT]

SMUTH [ARISTO]

AGAROL [PFIZER]

DULCOLAX [GERMAN REMEDIES]

CREMALAX [ABBOTT]

FIBRES• NATUROLAX [MSD]

• CREMADIET [ABBOTT]

• CREMADIET DUO [ABBOTT]

• LACTIFIBER [SUN]

• LAXITOL [MACLOEDS]

• SOFTOVAC [LUPIN]

PHENOLPTHALEIN CONSTIPATION

Phenolphthalein has been used over a century as a laxative but now it is removed from over the counter laxatives because of concerns of carcinogenicity

EPIDEMIOLOGY OF CONSTIPATION

• Constipation occurs in 2% to 20% of the population. It is more common in women, the elderly and children. The reasons it occurs more frequently in the elderly is felt to be due to an increasing number of health problems as humans age and decreased physical activity.

• 12% of the population worldwide reports having constipation.• Chronic constipation accounts for 3% of all visits annually to pediatric

outpatient clinics.• Constipation-related healthcare costs total $6.9 billion in the US

annually.• More than four million Americans have frequent constipation,

accounting for 2.5 million physician visits a year.• Around $725 million is spent on laxative products each year in

America.