• Constipation-patients having bowel movements less frequently than three times a week. If stool is hard and difficult to pass, patient is constipated whatever be the frequency.
Criteria for Defining Constipation
• Two or more of the following for at least 12 weeks with onset >6 months:
• Straining during >25% of defecations
• Lumpy or hard stools in at least 25% of defecations
• Sensation of incomplete evacuation for at least 25% of defecations
• Sensation of anorectal obstruction or blockade for at least 25% of defecations
• Digital evacuation to facilitate >25% of defecations
• Fewer than three defecations per week
• Loose stools are rarely present without the use of laxatives
• Insufficient criteria for irritable bowel syndrome
• Dehydration • Acute intestinal obstruction • Acute appendicitis
A. Rectal stasis-*Faulty habits *Impaired consciousness *Painful anal area (anal fissure)
B. Colonic stasis- *Decreased food intake *Decreased fibre residue *Endocrine dysfunction
C. Irritable bowel syndrome
A. Endocrine and metabolic diseases- *Myxoedema *Diabetes mellitus *Hypercalcaemia
B. Myopathic diseases- *Amyloidosis *Systemic sclerosis *Myotonic dystrophy
C. Neurologic diseases- *Autonomic neuropathy *Cerebrovascular disease *Hirschsprung's disease
*Multiple sclerosis *Parkinson's disease *Spinal cord diseases
D. Structural diseases-*Anal fissure *Haemorrhoids *Megacolon *Diverticulitis
E. Psychological conditions- *Depression
F. Medications (antacids, anticholinergics, antidepressants, antihistamines, calcium, calcium channel blockers, clonidine, diuretics, iron, opioids)
G. Others- *Pressure on rectum from tumours or gravid uterus
• Complete blood count, serum glucose, thyroid stimulating hormone, calcium and creatinine levels
• Stool examination including occult blood
• Sigmoidoscopy or colonoscopy
• Eliminate offending medication
•Treat underlying medical condition causing constipation
• If no secondary cause of constipation identified, empiric treatment for functional constipation
Non-pharmacologic methods to improve bowel regularity
• Maintain a diary for stool frequency, consistency, size and degree of straining. Many patients incorrectly believe that they need to have a bowel movement every day.
• Patients should be educated on recognising and responding to the urge to defecate.
• Patients should be encouraged to attempt defecation first thing in the morning, when the bowel is more active and 30 minutes after meals to take advantage of the gastrocolic reflex.
• Patients should be encouraged to increase their intake of fibre-rich foods such as bran, fruits, vegetables and nuts.
• Adequate hydration
• Patients should be encouraged to be as physically active as possible
TREATMENT AT DR. SOHAN LAL CLINIC
The integrated POLYCLINIC facility offers patients to select their treatment either from the Department of Homeopathy or from the Department of Medicine.
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