Constipation is characterized by difficult and infrequent bowel movements, hard stool consistency, and a feeling of incomplete emptying of the rectum.
Many people mistakenly believe that daily bowel movements are necessary and complain of bowel retention when bowel movements are less frequent. Others are concerned about the appearance (size, shape, color) or consistency of the stool. Sometimes the main complaint is dissatisfaction with the act of defecation. Stool retention can be the cause of many complaints (abdominal pain, nausea, fatigue, anorexia), which are actually signs of an underlying pathology (eg, irritable bowel syndrome, depression). Patients should not assume that all symptoms will disappear with daily bowel movements.
Because of these problems, many people abuse laxatives, suppositories, and enemas. This can lead to physical changes, including colonic atony (a “water pipe” sign with characteristic effacement or absence of haustra, seen on barium enema and resembling ulcerative colitis) and melanosis of the colon (deposits of brown pigment in the mucosa, seen on endoscopy and biopsy). colon preparations).
Patients with obsessive-compulsive disorder often feel the need to rid the body of “dirty” waste every day. Depression can be a result of not having a bowel movement every day. The condition can progress, with depression contributing to a decrease in the frequency of bowel movements, and the absence of bowel movements worsening the depression. Such patients often spend a lot of time and effort on the toilet or become chronic users of laxatives.
History of constipation
A history should be obtained regarding the frequency, consistency, and color of stool throughout life, including the use of laxatives or enemas. Some patients deny a history of bowel retention, but if asked specific questions, admit to a 15-20 minute bowel movement. An attempt should be made to determine the cause of metabolic and neurological disorders. The use of prescribed or over-the-counter medications should be investigated.
Chronic stool retention with frequent use of laxatives suggests colonic atony. Chronic retention of stool without feeling the urge to defecate suggests neurological disorders. Chronic stool retention alternating with diarrhea and associated intermittent abdominal pain suggests irritable bowel syndrome. Newly detected stool retention that persists for several weeks or develops periodically with increasing frequency and severity suggests a colon tumor or other causes of partial obstruction. Decreased stool volume suggests distal colon obstruction or irritable bowel syndrome.
Physical examination
General examination reveals signs of systemic disease, including fever and cachexia. Tension of the anterior abdominal wall, abdominal distension, and tympanitis indicate mechanical obstruction. Volumetric formations of the abdominal cavity are diagnosed by palpation, rectal examination allows one to assess the tone of the sphincter; sensitivity; the presence of a fissure, stricture, blood and space-occupying formations (including coprostasis).
Examinations for constipation
Stool retention with an identified etiology (medicines, trauma, prolonged bed rest) does not require further investigation and is subject to symptomatic therapy. Patients with signs of intestinal obstruction require radiography of the abdominal cavity in a horizontal and vertical position and, if indicated, a CT scan. Most patients with unknown etiology should undergo sigmoidoscopy and colonoscopy, as well as laboratory testing (complete blood count, thyroid-stimulating hormone and fasting blood glucose levels, electrolytes and Ca).
Further evaluation is usually necessary in patients with an unknown cause or failure of symptomatic therapy. If the patient’s primary complaint is infrequent bowel movements, colonic passage time should be measured using a radiopaque marker passage. If the primary complaint is related to the need to strain strongly during bowel movements, anorectal manometry is most appropriate.