How Does It Feel When Your Constipated – Aids in treatment – Treatment of chronic constipation is best managed by first identifying the underlying cause. There can be many contributing factors, but there are three broad subgroups:
Treatment depends on the assigned subgroup. For example, initial treatment of mild chronic constipation with normal motility usually involves recommending increased fiber intake, but there is evidence that patients with slow transit constipation or bowel obstruction benefit from fiber therapy.
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In addition to increasing fiber intake, people with common constipation are often advised to increase water consumption and physical activity. However, this method has some caveats.
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Many people eat only a fraction of the recommended daily amount of 20 to 35 grams of fiber, but some people already eat enough fiber. Many others do not tolerate fiber supplementation well, especially if fiber intake increases dramatically over a short period of time. Side effects can include bloating, gas, and cramping, which patients experience as worse than constipation.
Adding fiber slowly and gradually over a week or two may reduce or eliminate the discomfort. Individuals tolerate dietary and various commercial fiber supplements differently, so substituting one fiber source for another may help.
At least one small study suggested that adding a regular exercise program did little to treat chronic idiopathic (unknown cause) constipation.
If simple conservative measures fail, adding a laxative is the next step in treating chronic constipation.
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Where they usually start is as osmotic laxatives, which work by drawing water into the colon. Examples of this class are polyethylene glycol or PEG (eg Miralax), magnesium hydroxide (eg Milk of Magnesia), magnesium citrate (eg Citroma, Citro-Mag), sorbitol and lactulose (eg Acylac , annulose). Osmotic laxatives should be used with caution in patients with reduced kidney function (kidney failure) and heart disease.
Stimulant laxatives are another choice in treating constipation. Medicines in this class include senna (eg Senocote, X-Lex), cascara sagrada and bisacodyl (eg Dulcolax, Corectol). Chronic use of these drugs is believed to damage the enteric nervous system, but these concerns are now believed to be exaggerated.
Lubiprostone (Amitiza) is a prescription medication to relieve abdominal pain, bloating, and stress, and to make bowel movements easier and more frequent in men and women with chronic idiopathic (functional) constipation. It is also indicated for the treatment of irritable bowel syndrome with constipation in women over 18 years of age. Lubiprostone promotes secretion through intestinal chloride channels. It works by increasing the amount of fluid flowing through the intestines and allowing stool to pass more easily.
Prucalopride is a highly selective serotonin 5-HT4 receptor agonist. It is available in Canada and some European countries to treat women with chronic constipation, but not in the United States.
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Linaclotide (Linzes) is a prescription drug that improves symptoms of abdominal pain or discomfort, bloating, and bowel function. It is indicated for adults 18 years and older for chronic idiopathic constipation and IBS with constipation. Linaclotide belongs to a class of drugs known as GC-C receptor agonists. It increases the movement of contents through the gastrointestinal tract and blocks pain signals in the gut.
Initial treatment for slow transit constipation is to increase the laxative dose. Unfortunately, many people are using multiple medications with poor results when they consult their doctor.
When directed by a physician, some patients may benefit from simplification and standardization of laxative regimens. For example, stop all but one drug, such as polyethylene glycol, taken in the correct daily dose to achieve the desired effect. Alternatively, a trial of lubiprostone (as described above) may be considered.
A small number of select patients with well-documented slow-transit constipation who are resistant to medical treatment and have no evidence of functional outlet obstruction may be candidates for colectomy (surgical removal of the colon by attaching the small intestine to the remaining rectum). . This procedure, called total abdominal colectomy with ileorectal anastomosis, can be done using standard open surgery or laparoscopic surgery, which is done using several small incisions with special instruments. Surgery reliably increases bowel frequency. Patient satisfaction ranged from 39-100%.
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Despite these findings, there are several important issues to consider before deciding on a total abdominal colectomy.
Another procedure, the Malone anterior continous enema (ACE), involves making a small opening (stoma) in the appendix, upper colon, or small intestine using an open or laparoscopic technique. This stoma is flushed on a regular schedule to empty the large intestine. This technique is often used in children with urinary incontinence or severe constipation. However, limited experience has been reported in adults with constipation and success rates of about 50% have been reported. The most recent approach is to create a colonic tube in the lower (sigmoid) colon that is used to provide access for colonic irrigation. Although successful outcomes have been reported, experience with this technique to date is very limited. Finally, in rare cases of severe refractory constipation, creating an ileostomy may be the best option.
Biofeedback therapy is primarily the first step for patients with functional outlet obstruction for pelvic floor anismus. The main goal of treatment is to break the pattern of inappropriate (paradoxical) sphincter contractions by teaching the person to relax the pelvic floor muscles during stress.
This can be combined with pelvic floor retraining with sensory training to improve the effectiveness of abdominal pushing efforts and awareness of stool at work. About two-thirds of patients with constipation treated with biofeedback have reported successful outcomes, but larger controlled clinical trials are needed.
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There are anecdotal reports of botulinum toxin (Botox) injections to relieve spasms and involuntary or paradoxical contractions of the puborectal muscle. Although some cases appear to have been successfully treated, no formal endorsement of this therapy is provided until additional data are available.
Surgical options for outlet obstruction constipation are limited. A rectocele suture can help people with large rectoceles who need to support the back of the vagina with their fingers to pass a bowel movement (“splint”). A thorough pre-operative evaluation (preferably including faecal angiography with improved rectal emptying of the vagina) and careful patient selection are important to ensure optimal results.
Patients with a combination of slow transit constipation and pelvic floor dysfunction should receive biofeedback first. If constipation persists after successful pelvic floor retraining, subtotal colectomy may be considered if medical treatment options, including laxatives and other medications, do not relieve symptoms. Although good results can be obtained with this treatment, some patients continue to suffer from rectal emptying even after treatment.
The term constipation encompasses a complex of symptoms associated with slow, weak, difficult, or painful bowel movements. Because constipation is a symptom, not a disease, patients should be evaluated for a possible underlying cause. In particular, “alarm” symptoms trigger a full colon evaluation to rule out a serious underlying cause.
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Most functional constipation can be treated symptomatically with or without the addition of laxatives. Patients with constipation who are resistant to initial treatment should undergo professional evaluation to determine the presence of colonic transit obstruction or outlet obstruction. Treatment of these conditions may require medications, biofeedback, or surgery. However, most patients with constipation can be successfully treated when a thorough evaluation is performed and the individual patient and physician work together to follow a reasonable treatment plan.
Excerpt from IFFGD publication: Robert D. Evaluation and Treatment of Constipation by Madoff, MD, FACS, Department of Colorectal and Rectal Surgery, University of Minnesota, Minneapolis, MN.
IFFGD is a non-profit educational and research institute. Our mission is to inform, support and help those affected by gastrointestinal disorders.
Opioid-induced constipation, or OIC, is a condition that affects how your digestive system works. Opioids are powerful pain relievers that slow down bowel movements.
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Specialist examinations for constipation are usually reserved for patients with severe or difficult-to-treat chronic constipation. All these patients should undergo colonoscopy.
Aids in treatment – Treatment of chronic constipation is best managed by first identifying the underlying cause. There can be many contributing factors, but what are the 3 causes of constipation? If you’re like most people, you know how uncomfortable constipation can be. It happens to almost everyone from time to time. Constipation makes you miserable and prevents you from doing things you normally enjoy. It’s hard to plan your life around your bathroom activities. You strain to have a bowel movement or go days without having a bowel movement.
There are many causes of constipation. The most common cause of constipation is lack of water and fiber in the diet. Often, the problem goes away when you add more fiber-rich foods to your diet and increase your water intake. Sometimes people take over-the-counter laxatives to relieve constipation.
In the past, experts advised long-term laxative use. The formula used is
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