Colorectal History

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Patients with complex disorders of evacuation will often have a confusing list of complaints, which can include both constipation and fecal incontinence. It is important, in the history of the present illness, to determine the patient's baseline bowel function. For patients with constipation, frequency and consistency of bowel movements should be ascertained. The sensation of the need to evacuate with significant straining leads the physician to consider outlet obstruction in the differential diagnosis. Infrequent bowel movements with no sensation of rectal fullness may lead to consideration of colonic inertia as a cause for constipation. It is always important to ask the patient if there is any prolapse of tissue from the anal canal. Often,patients will complain of severe hemorrhoidal prolapse, when in fact, the patient has full-thickness rectal prolapse. It is always important to determine whether there is any associated rectal bleeding. Obviously,occult malignancy must be ruled out in any patient with changes in bowel habits. For patients complaining of incontinence, the duration and severity of the symptoms are important initial questions. A detailed obstetric history as well as any history of anorectal surgery or inflammatory bowel disease can provide important insight into the etiology of fecal incontinence.

The independently validated Cleveland Clinic Florida Fecal Incontinence Score (0-20) provides an objective measurement of severity of incontinence both before and after intervention2,3 (Table 3-1.1). This score takes into account the frequency of incontinence to solid, liquid, and gas, as well as the need to wear protective undergarments and the impact on the patient's lifestyle. A detailed bowel history can also lead the physician to a better understanding of the etiology of the incontinence. Passive soiling, the unwanted loss of stool without the patient's awareness, may indicate internal sphincter pathology. Urge fecal incontinence, the unwanted loss of stool despite attempts to inhibit defecation, may signify external sphincter pathology. Post-defecation soiling, the unwanted loss of stool immediately after bowel movement with normal continence other times is often a sign of incomplete emptying or perianal disease. Stool consistency is an important component of continence. Frequent loose bowel movements can pose a particular challenge for those patients with borderline continence. Oftentimes, improvement in the consistency of the stool in these patients can provide great symptomatic relief. In any patient with pelvic floor dysfunction, it is important to assess the presence of anterior compartment symptoms, such as urinary incontinence or prolapse.

A detailed medical and surgical history is important in the evaluation of any patient. History of metabolic disturbances such as hypothyroidism or hypercalcemia may provide insight into the etiology of constipation. History of inflammatory bowel disease and proctitis will often contribute to a patient's symptoms of incontinence. Diabetes and peripheral neuropathy can also have an important role in incontinence. As mentioned previously, a detailed birth history with particular attention to previous episiotomy, high-birth-weight children, prolonged labor, and the use of forceps for delivery is of paramount importance. Surgical history, with a focus on previous anorectal surgery or bowel resection, will obviously contribute to the evaluation of these patients. Medications can also have a role in a patient's symptoms. Anticholinergic medications, narcotics, and calcium supplements will often contribute to constipation symptoms. Any medications that cause diarrhea will often worsen the severity of incontinence.

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Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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