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CONSTIPATION

CONSTIPATION. Dr. M Baghbanian Gastroenterologist Shaheed Sadoughi university of medical scinces Yazd - 2012. What is the normal defication frequency? 2 _ 3 time/week. introduction. Dry & hard stool Evacuation is difficult & infrequent Excessive straining (dyschezia)

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CONSTIPATION

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  1. CONSTIPATION Dr. M Baghbanian Gastroenterologist Shaheed Sadoughi university of medical scinces Yazd - 2012

  2. What is the normal defication frequency?2 _ 3 time/week

  3. introduction • Dry & hard stool • Evacuation is difficult & infrequent • Excessive straining (dyschezia) • 1/8 of people taking laxatives at least once each month. • Pathophysiology: • Slow transit • Functional outlet obstruction

  4. INTRODUCTION • Constipation is the most common digestive complaint in the general population. • Medication costs of many hundreds of million dollars.

  5. Prevalence of constipation • 20 percent • 2-27% of the population depending in part upon the criteria used to define it.

  6. Prevalence of chronic functional constipation in IRAN 32.9 (ROME II-defined ) 9.6 % ( self-reported ). Adibi p and et al isfahan Alzahra.H.(Dig Dis Sci 2007) In female constipation ( passage of stools Two times per week or less ) • 9.6 % in the 40-69 year • 20.5 % in the over 70- year Massarat and et al DDRC Shariati .H ( Archive of Iranian Medicine Vol 5 No 2 ,2002 )

  7. Secondary : Endo. & metabolic Neurologic dis. Rectoanal dis. Iatrogenic dis. Dietary factors Idiopathic dis. Colonic inertia Functional outlet obstruction Classification & causes

  8. Should be considered only after other diseases (systemic or organic have been excluded. Functional constipation

  9. Slow-transit Constipation Pelvic floor dyssynergia IBS with constipation Chronic Functional Constipation Subtypes Slow transit 47 %

  10. Obstructed defecation Dyssynergia or Anismus • paradoxical contraction or inadequate relaxation of the pelvic Floor muscles during attempted defecation.

  11. Evaluation & management • History & rectal exam • fibre therapy(unless alarm symptoms). • 20-40 gr/day dietary fibre • 10-20 gr/day psyllium • Sigmoidoscopy,barium enema, • defaecography,anal manometry, • colon marker transit study

  12. Balloon 50 ml Balloon Syringe 100 ml 3- 5” 1- 2” Physiologic tests of Colonic motor function Syringe

  13. Summery Chronic Constipation Diagnostic strategy for constipation Supplemental trial fiber 25 g for 2 weeks 5 - day Colonic transit Anorectal manometry with Balloon expultion test Normal transit Normal Pelvic floor function Prolonged transit Normal pelvic floor function Normal transit Abnormal pelvic Floor function Abdominal pain + Abdominal pain - Pelvic Floor dyssynergia IBS with Constipation Functional Constipation Slow-transit Constipation

  14. Bulking or hydrophilic Osmotic agents Ions Disaccharides,sugar Glycerin Polyethylen glycol Lubricating agent Neuromuscular agents Cholinergic agonists 5-HT4 agonists Prostaglandin agonist Colchicine Stimulant laxatives Surface-active agents Diphenylmethane drivat. Ricinoleic acid Anthraquinones Classification ofdrugs:

  15. Guidelines • Mild complaints • Dietary fibre • Medicinal fibre • Severe or acute constipation • Osmotic agents • Stimulant laxatives • More chronic: • larger doses of osmotic agents • Misoprostol,bethanechol,colchicin

  16. Guidelines Cont. Dyschezia : • Moderate dose of osmotic laxatives • Mineral oil • Enema • If dyschezia is the major problem,fibre should be avoided .

  17. Constipation in pregnancy • Fibre • Lactulose • Castor oil may initiate premature labour.

  18. Outlet obstruction constipation • Biofeedback therapy • Surgery • Pharmacological therapy • Comb.(biofeedback+osmotic agents) • Comb.NSAIDs+ skeletal muscle relax. • Injection of botulinum toxin into the pelvic floor or anal sphincter

  19. surgery • Intrarectal intussusception • Entrocele • Refractory mechanical or functional outlet problems(fecal diversion) • Refractory slow-transit (subtotal colectomy+ileorectal anastomosis) • Patients with psychological problems do not respond to surgery

  20. Thank You

  21. Diagnostic algorithm for refractory constipation

  22. Diagnostic algorithm for refractory constipation

  23. Balloon Balloon Syringe 100 ml Diagnostic algorithm for refractory constipation

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