Chronic Constipation
Constipation is a common gastrointestinal disorder characterized by infrequent stools, incomplete evacuation of bowel movement, hard stool, and pain when defecating (Forootan, Bagheri & Darvishi, 2018). Mounsey, Raleigh, & Wilson (2015) argue that 16 % of adults suffer from constipation in a year worldwide. However, experiences with older adults are more frequent. Severe constipation is described using both self-reported constipation and formal criteria (Sbahi & Cash, 2015). If not treated or even managed, severe constipation can cause the closure of the intestines, which requires surgery to treat (Krogh, Chiarioni & Whitehead, 2016). Management of chronic constipation requires an understanding of chronic constipation’s pathophysiology, diagnosis, and viable management options.
There are several risk factors associated with chronic constipation. Forootan, Bagheri & Darvishi (2018) estimated the condition to affect 16% of individuals worldwide, whereas 35.5% are people aged 60-110 years. Chronic constipation primarily links to an individual’s quality of life, their wellbeing, and their manner of resource consumption. Sbahi & Cash (2015) adds that there is a link between chronic constipation and lack of frequent bowel movement, improper diet, inadequate physical exercise, illness, and drugs. The condition’s pathogenesis is multifactorial since it is related to diet, genetic predisposition, and behavioral, biological, and pharmaceutical factors. According to Mounsey, Raleigh, & Wilson (2015), an inadequate intake of low fiber diets, inadequate water intake, delaying the urge to defecate, and old age are some of the factors that aggravate chronic constipation.
Diagnosis of chronic constipation may involve evaluating the condition’s clinical presentation, endoscopy, anorectal manometry, balloon expulsion testing, barium enema, and chronic transit study (Forootan, Bagheri & Darvishi, 2018). Using clinical presentation, a patient has to have two of these six symptoms including straining when defecating, hard stool, incomplete defecating, the anorectal blockage feeling, using manual tactics to ease defecating and less than three defecations in a week for three consistent months (Krogh, Chiarioni & Whitehead, 2016). Mounsey, Raleigh, & Wilson (2015) propose using clinical evaluation in chronic constipation diagnosis where the duration of stool consistency, size, and history of ignoring defecating is examined.
Apart from the above diagnostic criteria, a rectal examination should be conducted with chronic constipation patients with intentions to seek the secondary causes of constipation. In cases where the clinical assessments provide a secondary cause(s), appropriate treatments should be conducted. Clinical evaluation diagnostic criteria show rectal reflexes, sensation, and compliance at rest and during defecating maneuvering (Forootan, Bagheri & Darvishi, 2018). It is also the recommended procedure to evaluate the recto-anal inhibitory reflex (RAIR) presence. The determination of dyssynergic defecation occurs through balloon expulsion testing (BET). Forootan, Bagheri & Darvishi (2018) contend that the BET method is effective in differentiating patients with dyssynergia detection and constipation without pelvic floor dyssynergia.
Chronic constipation management mainly happens through dietary fiber and laxatives, biofeedback therapy, surgical treatment, and medications. From Forootan, Bagheri & Darvishi (2018), functional constipation can be managed through increased fiber intake. Osmotic and stimulant laxatives are also useful in the management of chronic constipation. Other newer treatment options include lubiprostone and linaclotide. Biofeedback is useful for improving bowel symptoms regarding therapist motivation and training. The surgical treatment is used if all the above strategies fail.
Constipation is a gastrointestinal disorder that primarily affects the older population. The condition affects approximately 16% of adults throughout the world. Therefore, knowing the causes, diagnostic and therapeutic options is imperative. Precise history, along with a comprehensive physical and digital rectal assessment, is useful to diagnose chronic constipation. A good understanding of the condition’s pathophysiology and the therapeutic option could help physicians treat and manage chronic constipation.
References
Forootan, M., Bagheri, N & Darvishi, M. (2018). Chronic Constipation: A Review of Literature. Systematic Review and Meta-Analysis, 97(20).1-9.
Krogh, K., Chiarioni, G., & Whitehead, W. (2016). Management of chronic constipation in adults. United European Gastroenterology Journal, 5(4), 465-472. Doi: 10.1177/2050640616663439
Mounsey, A., Raleigh, M & Wilson, A. (2018). Management of Constipation in Older Adults. American Academy of Family Physicians. Retrieved from https://www.aafp.org/afp/2015/0915/p500.html.
Sbahi, H., & Cash, B. (2015). Chronic Constipation: a Review of Current Literature. Current Gastroenterology Reports, 17(12). doi: 10.1007/s11894-015-0471-z