CONSTIPATION – Causes and Diagnosis

'Constipation' is a very common symptom, particularly in women and the elderly. It is often more of a perception than a real entity. A consensus definition used in research (The Rome II criteria) defines constipation as having two or more of the following for at least 12 weeks: infrequent passage of stools (less than 3 per week), straining more than 25% of time, passage of hard stools, incomplete evacuation and sensation of anorectal blockage. According to these definitions 'constipation' affects more than 1 in 5 of the population.

Many symptoms are attributed by patients to constipation and include headaches, malaise, nausea and a bad taste in the mouth. Other symptoms include abdominal bloating and/ or discomfort (undistinguishable from the irritable bowel syndrome) as well as local and perianal pain.


The causes of constipation are:

General

#Pregnancy
#Inadequate fibre intake
#Immobility

Metabolic/endocrine

#Diabetes mellitus
#Hypercalcaemia
#Hypothyroidism
#Porphyria

Functional

#Irritable bowel syndrome
#Idiopathic slow transit

Drugs

#Opiates
#Antimuscarinics
#Calcium-channel blockers, e.g. verapamil
#Antidepressants, e.g. tricyclics
#Iron

Neurological

#Spinal cord lesions
#Parkinson's disease

Psychological

#Depression Anorexia nervosa
#Repressed urge to defecate
#Gastrointestinal disease
#Intestinal obstruction and pseudo-obstruction Colonic
disease, e.g. carcinoma, diverticular disease Aganglionosis,
e.g. Hirschprung's disease, Chagas' disease Painful anal
conditions, e.g. anal fissure

Defecatory disorders

#Rectal prolapse, mucosal prolapse intussusception and
solitary rectal ulcer syndrome
#Large rectocele
#Pelvic floor dyssynergia/anismus
#Megarectum

Diagnosis of the cause of constipation

This relies on the history. When there has been a recent change in bowel habit in association with other symptoms (e.g. rectal bleeding) a barium enema or colonoscopy is indicated. A barium enema should always be preceded by a rectal examination and rigid sigmoidoscopy to exclude anorectal lesions that can otherwise be missed. By these means, gastrointestinal causes such as colorectal cancer and narrowed segments due to diverticular disease can be excluded.

Other Related Articles:

Constipation Causes and Diagnosis
Different Types of Constipation
Treatment Options Of Constipation