Constipation

Constipation: infrequent or difficult evacuation of feces.  Millions of dollars are spent each year in an effort to remedy constipation.  Many people erroneously think of themselves as constipated if they have days during which there are no bowel movements.  Actually, this vary greatly, so that one person may be perfectly well although he has a bowel movement only once in two or there days, while another may be equally well with more than one elimination daily.  One must not go without a bowel movement for more than three days.  Disease and condition's also determine when one should be concern.

On the basis of its onset, constipation may be classified as acute or chronic.  Acute constipation occurs suddenly and may be due to appendicitis or to an intestinal obstruction.  Laxatives and enemas should be avoided and a physician should be consulted at once.  Chronic constipation, on the other hand, has a more gradual onset and may be divided into two groups:

1.) Spastic constipation in which the intestinal musculature is overstimulated, so that the canal becomes narrowed and the space (lumen) inside the intestine is not large enough to permit the passage of fecal material.

2.) Flaccid constipation which is characterized by a lazy or atonic intestinal muscle.

The overactive spastic type of constipation is probably much more common than the atonic lazy kind.  Nervous tensions, excessive amounts of bulky foods and the use of laxatives increase the muscle tone of the intestine.  The patient who has sluggish intestinal muscles may be helped by moderated exercise, and increase in vegetables and other bulky foods in the diet and an increase in fluid intake.

The use of enemas and so-called colonic flushings is unnecessary and should be discouraged for most persons.  The lining of the intestine may be injured by streams of water that remove the normal protective mucus.  In addition to this, those who have piles (hemorrhoids) will aggravate this condition by enemas.  Enemas should be done per doctors order.

Some medications will promote constipation such as most all narcotics (Codeine, Morphine)  and patients should discuss with your doctor in regards to using stool softeners or other laxative agents.

Postoperative constipation :  usually results from colonic ileus caused by diminished Gi mortility and impaired perception of rectal fullness.  Although primarily a problem of elderly postoperative patients, those also at risk are patient receiving opiates or anticholinergics.

Treatment:
Ambulation
 Increase fluid intake
stool softeners
Laxatives
Non-narcotic algesics (as ordered by your doctor)

Renal and urologic care:  Related to inadequate intake of fluid and bulk, constipation may be caused by prolonged immobility; fluid and dietary restriction such as high fiber foods-often contain too much potassium for renal patients.  The use of phosphate binders containing aluminum, which commonly causes serious constipation in dialysis patients.

Treatment:  to ensure correct fluid replacement therapy
Fluid intake -usually 2,500 ml daily to ensure correct fluid replacement therapy
Laxative or enema as ordered by your doctor
Increase fiber and bulk in the diet as prescribed by your doctor
Mild exercise

Gerontologic care:  Related to diminished GI motility, low roughage diet, decreased activity, abuse of enemas and laxatives, and weak abdominal muscles

Treatment:
Increase fluid intake (8 oz of water with each meal and to drink water or juice frequently between meals --UNLESS contraindicated by cardiovascular or renal disease )
Increase fiber in diet  Avoid high refined processed foods
Increase exercise (if not contraindicated)
Avoid laxatives, narcotic analgesics, aluminum, or barium products

For severe constipation, your doctor may prescribed glycerine suppository

NOTE:  with all medication and change in diet or activities: CONSULT with your DOCTOR.

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