Constipation

Basics

Most common digestive complaint
May be due to organic cause or may be idiopathic/functional
Symptoms include hard stools, infrequent bowel movements, bloating, abdominal pain
More common in women, age >60, limited physical activity
Revised Rome Criteria for the diagnosis of constipation requires 2 or more of the following for at least 3 mo:
- Straining >25% of the time
- Lumpy or hard stools >25% of the time
- Incomplete evacuation >25% of the time
- Sensation of anorectal blockage >25% of the time
- 2 or fewer bowel movements per wk
- Use of manual maneuvers to facilitate bowel movements
- AND insufficient criteria for irritable bowel syndrome
- AND loose stools rarely present without laxative use

Often present with fecal incontinence despite toilet training due to fecal impaction
May present with urinary symptoms such as incontinence or UTIs
Most common cause of fecal retention and soiling in children is functional fecal retention:
- Caused by fear associated with defecation
- Associated with irritability, abdominal cramps, decreased appetite, early satiety

Chronic idiopathic constipation:
- Normal transit/functional constipation
- Slow transit constipation
- Defecation disorders
Organic causes of constipation:
- Anorectal conditions:
  - Enterocele/rectocele
  - Prolapse
  - Descending perineum syndrome
  - Traumatic
  - Anismus
- Intestinal conditions:
  - Carcinoma
  - Stricture
  - Hernia
  - Volvulus
  - Intestinal pseudo-obstruction
- Metabolic and endocrine:
  - Diabetes
  - Uremia
  - Porphyria
  - Hypothyroidism
  - Hypokalemia (severe)
  - Hypomagnesium (severe)
  - Hypercalcemia
  - Pheochromocytoma
  - Panhypopituitarism
  - Pregnancy
  - Menopause
  - Celiac disease
- Myopathy:
  - Systemic sclerosis
  - Amyloidosis
- Neurologic:
  - Parkinson’s disease
  - Multiple sclerosis
  - Cerebrovascular accidents
  - Spinal cord lesions/injury
  - Chagas disease
  - Autonomic neuropathy
  - Myelodysplasia
  - Myotonic dystrophy
  - Botulism
- Pharmacologic:
  - Analgesics
  - Anesthetics
  - Antacids
  - Anticholinergics
  - Anticonvulsants
  - Antidepressants
  - Antiemetics
  - Antihistamines
  - Antihypertensives
  - Antipsychotics
  - Calcium channel blockers
  - Diuretics
  - Ferrous compounds
  - Laxative abuse
  - Monoamine oxidase inhibitors
  - Opiates
  - Paralytic agents
  - Parasympatholytics
  - Phenothiazines
- Psychological conditions:
  - Disordered eating
  - Depression
- Other:
  - Dietary protein allergy
  - Immobility

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