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CLINICAL REVIEWChronic Constipation

An Evidence-Based Review

Lawrence Leung, MBBChir, FRACGP,FRCGP, Taylor Riutta, MD, Jyoti

Kotecha, MPA, MRSC, and alterRo!!er MD, MRCGP, FCFP

JABFM July-August 2011 Vol. 24No. 4

http://.!"#$%.o&g


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Introduction

Medical personnel defne constipationas 3 bowel movements per week,patients oten e!uate constipation

with stool consistenc", eelin#s oincomplete empt"in#, strainin#, andur#e or deecation$

%he normalc" o bowel habit ran#eswidel" rom 3 bowel movements perda" to 3 per week


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Introduction

%he Rome III criteria in &''( or constipationas havin# at least & o the ollowin#)

*+trainin# durin# &./ deecation0*&1ump" or hard stools in &./ o deecation0

*3ensation o incomplete evacuation in&./ o deecation0

*2ensation o anorectalobstructionblocka#e in &./ o deecation0

*. 4eed or manual maneuvers to acilitatein &./ o deecation0*( 5ewer than 3 deecations per week


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Introduction

Also, patients should rarel" have loose stoolswithout la6atives and be distinct romhavin# irritable bowel s"ndrome

5or constipation to be defned as chronic, apatient must be s"mptomatic or at least (months with applicable criteria or theprevious 3 months

Risk 5actor or chronic constipation )

+$5emale

&$Advanced a#e *78' "o


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E6trinsic Etiolo#" o ChronicConstipation

1ow fber intake

Inade!uateh"dration

Reduced mobilit" Reduced sensation

o thirst,

Electrol"te

disturbances

Endocrine andmetabolic disorders

4eurolo#ical disorders 9s"cholo#ical

comorbidities

Concurrent

medications *e#,anticholiner#ics,diuretics, b-blockers,opiates, iron

supplements, calciumchannel blockers,antidepressants,acetaminophen,aspirin and 4AI:s


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Intrinsic Etiolo#" o ChronicConstipation

9elvic ;oor d"sunction *95: 38/ 1a6it" o the pelvic ;oor muscles Impaired rectal sensation :ecreased luminal pressure in the anal canal

low colon transit time *%C &3/ Reduced choliner#ic enhanced adrener#ic responses miti#ated #astrocolic re;e6 d"s"ner#" o rectosi#moid colonic activities enteric neurode#eneration o both the m"enteric ple6us

#an#lia and the interstitial cells o Ca


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Complications o ChronicConstipation

5ecal incontinence

>emorrhoids

Anal fssure =r#an prolapse

5ecal impaction and bowel

obstruction Bowel peroration and stercoral

peritonitis


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Evidence-BasedManagement of Chronic

Constipation


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Metode ebuah pencarian literatur dari laporan medis "an# diterbitkan dalam

semua bahasa dilakukan dari 9ubMed, EMBAE, dan Cochrane :atabase o

"stematic Review dari awal sampai =ktober &'+' men##unakan the =vid9ortal dari ?ueen @niversit", in#ston, =ntario$

ata-kata kunci abstrak awal) konstipasi kronis, pen#obatan, dan u


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Evaluasi studi "an# dipilih dilakukan olehmasin#-masin# reviewer *11 dan %R tentan#kualitas dan bukti sesuai tren#th oRecommendations %a6onom" *=R%, den#an

tin#kat bukti dari I hin##a III dan rekomendasidari A ke C$

etiap ketidaksepakatan dibahas dan

diselesaikan antara pemeriksa untuk mencapaikonsensus bersama$


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>asil

+2. abstrak diidentifkasi den#an men##unakan kata-kata kunci konstipasi kronis :A4 9en#obatan :A4

u


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4on 5armakolo#i

Mo'()*"s( +"y" ,('up onsumsi serat makanan

Cairan

=lahra#a

B(o$'#"*

B"t&(oth&"py &o#(ot(s

u&g&y total colectom"

9artial colectom"

division o puborectalis


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9en#obatan 5armakolo#i

=bat untuk konstipasi kronis dapat dikate#orikanmen%2

A#onis reseptor #uan"late c"clase-c


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Conclusions

a common condition was ound in atleast one !uarter o patients, chronicconstipation is treated in a wide

variet" o wa"s, with relativel" littleevidence-based data, especiall"re#ardin# dietar" fber, ;uids and

e6ercise$


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9h"sical e6amination

*+ previous sur#ical scars

*& abdominal distension and bowel sounds

*3 palpable mass *ecoliths

*2 inspection o anus or skin ta#s, hemorrhoids,fssures, hematomas, and prolapse

*. rectal e6amination to assess anal re;e6, sphinctertone, tenderness, out-pouchin# *rectocele, or mass inthe rectum

*( G"necolo#ical e6amination to e6clude c"stoceles orva#inaluterine prolapse

*8 ull neurolo#ical e6amination to e6clude neurolo#icalcauses$


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Investi#ations include

*+Blood tests such as complete bloodcount, serum #lucose, and th"roid andrenal unctions

*&Colon transit time) Radio#raph stud" withthe itH, cinti#raph" with radioisotope

*3 Anorectal manometr"

*2 Balloon e6pulsion test*. :eeco#raph"

*( :"namic pelvic MRI


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A. I$ 3 o& $&

%"&*&s &%"(5

p"t(t h"s g&ossly

o&%"l olo(

t&"s(t.

B. Most &(gs "&

s"tt&' "#out

th olo. "t(t

%ost l(*ly h"s

hypo%ot(l(ty o&

olo( (&t(".

C. Most &(gs "&

g"th&' ( th

&tos(g%o('.

"t(t h"s

$ut(o"l outlt

o#st&ut(o.


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Increasin# dail" dietar" fber intake ma"help constipation caused b" fberdefcienc"$

E6ercise decreases constipation$

>i#her ;uid intake improved chronicconstipation in the presence o a hi#h-fber diet$

%he latest evidence does not support arole o senna in causin# colon cancer inrats and humans

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