Constipatin.doc

Constipation Author: Marc D Basson, MD, PhD, MBA, Professor, Chair, Department of Surgery, Michigan State University Introduction Background Constipation is a common symptom, but it often remains unrecognized until the patient develops sequelae, such as anorectal disorders or diverticular disease. Several definitions of constipation have been proposed based on stool frequency in different populations. However, for surgical purposes, the most useful definition of constipation is a change in the bowel habit or defecatory behavior that results in acute or chronic symptoms or diseases that would be resolved with relief of the constipation. Acute or subacute constipation in middle-aged or elderly patients should prompt a search for an obstructing colonic lesion. Acute constipation must be carefully distinguished from ileus secondary to intra-abdominal emergencies, including infections. Although chronic constipation may be associated with psychological disturbances, the reverse is true as well. However, these issues are beyond the scope of this article. The definition of constipation includes the following: infrequent bowel movements (typically 3 times per wk), difficulty during defecation (straining during more than 25% of bowel movements or a subjective sensation of hard stools), or the sensation of incomplete bowel evacuation. Pathophysiology Constipation is divided, with considerable overlap, into issues of stool consistency (hard, painful stools) and issues of defecatory behavior (infrequency, difficulty in evacuation, straining during defecation). Although hard stools frequently result in defecatory difficulties, soft bulky stools may also be associated with constipation, particularly in elderly patients with anatomic abnormalities and in patients with impaired colorectal motility. Constipation is the end effect of several factors: poor diet, lack of exercise, motility abnormalities, and anatomic defects, along with the patients expectations and psychological fact