Constipation

Question 1

3 classification of constipation

Answer 1

1. Functional: 2/2 colonic and/or pelvic floor/anorectal dysfunction
2. Structural: cancer, fissure, stricture, proctitis
3. systemic: thyroid, DM, hyperCa, neuro disease

Question 2

medications that cause constipation

Answer 2

• antacids
• Iron
• opioids
• CCBs
• TCAs
• antihistamines, anticholenergic, antiparkinson, antipsychotics
• Ca supplements

Question 3

Rectal examination details

Answer 3

inspect: look for hemorrhoids, scars, perineum should descend 1-3.5cm bearing down

digital exam: r/o impaction, pain may indicate fissure, rectal Ca, tight sphincter,

Question 4

Diagnostics

Answer 4

• FOBT
• CBC
• glucose
• Ca
• TSH

other tests guided by history

Question 5

red flags

Answer 5

• hematochezia
• acute onset constipation in older pt
• FHx colon cancer
• anemia

Question 6

What is normal transit constipation?

Answer 6

most common, nl BM frequence but subjective sensation of constipation

Question 7

What is slow transit constipation?

Answer 7

-often in young women, onset at puberty, infrequent urge to defecate, BMs 1x/wk or less

Question 8

What is a defecatory disorder

Answer 8

Hx of need for manual disimpaction, abnl perineal descent or anismus (increased resting anal pressure ) on exam

Question 9

Mx of defecatory disorder

Answer 9

-Requires biofeedback aided pelvic floo retraining (60% respond)

Question 10

Lifestyle Mx of constipation

Answer 10

• discontinue offending meds
• increase exercise
• FIBER 1st line (can take weeks for desired effect)