Evaluation

When assessing potential therapies for constipation, we initially consider potentially reversible factors external to the gastrointestinal tract. Hypothyroidism and hypercal-cemia are metabolic causes of constipation,which occur with enough frequency that they require evaluation. Multiple drugs can cause constipation, with opiate analgesics the most classic example. Other potentially contributing medications include antispasmodics (often given for other gastrointestinal and genitourinary disorders), tricyclic antidepressants, antiparkinsonian agents, and a variety of antihypertensive agents (most classically calcium channel blockers).

Diagnostic studies, which can detect possible physiologic or neurologic abnormalities associated with consti pation, have already been discussed. Most constipated patients do not require extensive evaluation. Conversely, most constipated patients who are evaluated are not found to have an obvious cause to explain their symptoms. We recommend a trial of empiric therapy before pursuing diagnostic testing unless alarm symptoms such as rectal bleeding, weight loss, or abdominal distention are present. For patients seeking evaluation for constipation from a specialist, colonoscopy is the single most expensive part of the evaluation.

For the practicing clinician, it is helpful to try to differentiate patients with constipation with predominant irritable bowel syndrome from those with significantly delayed colonic transit or other physiologic disorders. Slow transit constipation is exhibited by slower than normal movement of fecal contents from the proximal to the distal colon. Slow transit constipation can result from delayed transit through the entire colon (colonic inertia) or uncoordinated motor activity in the distal colon. A colonic transit study is useful in confirming a diagnosis of colonic inertia by demonstrating generalized slow movement of the markers throughout the colon. Patients with uncoordinated motor activity of the distal colon are referred to as having pelvic floor dysfunction or dyssynergia. For these patients, colonic transit studies show a preferential accumulation of markers in the rectosigmoid. Anorectal physiology studies, addressed elsewhere, can identify more specifically the disorder in patients with pelvic floor dysfunction.

Most patients with significant pain associated with constipation have irritable bowel syndrome. Additionally, symptoms of bloating and incomplete evacuation are also suggestive of irritable bowel syndrome. This entity is addressed in more detail elsewhere. Even among patients whose symptoms are most suggestive of colonic inertia, approximately 30% will have normal colonic transit studies. These patients with normal transit have a psychological profile similar to those with irritable bowel syndrome, and perhaps should be addressed as a variation of irritable bowel syndrome.

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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