Constipation

ConstipationDone Bye: Mariam Droubi.What is constipation?Constipation refers to bowel movements that are infrequent or hard to pass.[2] Constipation is a common cause of painful defecation. Severe constipation includes obstipation (failure to pass stools or gas) and fecal impaction, which can progress to bowel obstruction and become life-threatening.You are considered constipated if you have two or more of the following for at least 3 months:Straining during a bowel movement more than 25% of the time.Hard stools more than 25% of the time.Incomplete evacuation more than 25% of the time.Two or fewer bowel movements in a week.

Causes:The causes of constipation can be divided into congenital, primary, and secondary.[2] The most common cause is primary and not life threatening.[12] In the elderly, causes include: insufficient dietary fiber intake, inadequate fluid intake, decreased physical activity, side effects of medications, hypothyroidism, and obstruction by colorectal cancer.[13]

Constipation is usually caused by a disorder of bowel function rather than a structural problem. Common causes of constipation include:Inadequate water intakeInadequate fiber in the dietA disruption of regular diet or routine; travelingInadequate activity or exercise or immobilityEating large amounts of dairy productsStressResisting the urge to have a bowel movement, which is sometimes the result of pain from hemorrhoidsOveruse of laxatives (stool softeners) which, over time, weaken the bowel musclesHypothyroidism Neurological conditions such as Parkinson's disease or multiple sclerosisAntacid medicines containing calcium or aluminumMedicines (especially strong pain medicines, such as narcotics, antidepressants, or iron pills)DepressionEating disordersIrritable bowel syndrome PregnancyColon cancer In some cases, lack of good nerve and muscle function in the bowel may also be a cause of constipation.

Symptoms:Infrequent bowel movements and/or difficulty having bowel movementsSwollen abdomen or abdominal painPainVomitingstomach aches and cramps feeling bloated feelingsick loss of appetite

How Is Constipation Diagnosed?

Most people do not need extensive testing to diagnose constipation. Only a small number of patients with constipation have a more serious medical problem. If you have constipation for more than two weeks, you should see a doctor so he or she can determine the source of your problem and treat it. If constipation is caused by colon cancer, early detection and treatment is very important.Tests your doctor may perform to diagnose the cause of your constipation include:Blood tests if a hormonal imbalance is suspectedBarium studies to look for obstruction of the colonColonoscopy to look for obstruction of the colonThe vast majority of patients with constipation do not have any obvious illness to explain their symptoms and suffer from one of two problems:Colonic inertia. A condition in which the colon contracts poorly and retains stoolObstructed defecation. A condition in which the person excessively strains to expel stool from the rectum

Preventions:

Constipation is usually easier to prevent than to treat. Following the relief of constipation, maintenance with adequate exercise, fluid intake, and high fiber diet is recommended.[5] Children benefit from scheduled toilet breaks, once early in the morning and 30 minutes after meals.PhysioTherapy MANAGEMENT OF CONSTIPATION:a. Lifestyle changesi. Modify Diet (increase fiber and fluid intake)ii. Exercise regularlyb. Educate the patient about toileting techniques to avoid straining during a bowel movement in order to decrease the risk of developing pudendal nerve dysfunction. These techniques are:i. Leaning forward while sitting on the toiled with feet positioned on a step stool (this position decreases the anorectal angle, thus easing the evacuation of stools)ii. Perform huffing (forced respiratory expiration) rather than straining during defecation (this technique activates the abdominal oblique muscles, which assist in the propulsion of stools)

c. Propulsive abdominal bowel massage to promote bowel mobility throughout the colon. It helps in increasing peristalsis in the gut. It is beneficial as its safe, non-invasive technique and can be performed by the patient independently.i. Technique: Apply constant moderate pressure to the abdomen with 2 or 3 fingers. Small, clockwise circular movements are initiated at the right anterior superior iliac spine, which is located at the base of the ascending colon. The progression of the massage occurs cranially, up the ascending colon towards the base of the rib cage, where it meets the transverse colon. The circular movements are continued across the transverse colon toward the left upper quadrant of the abdomen and then down over the descending colon toward the left anterior superior iliac spine. This massage should be performed daily for 10 minutes.d. Exercises to strengthen pelvic floor and sphincter muscles. Aerobic exercises also help in increasing gut transit.e. Retraining pelvic floor muscle functioning during evacuation. This can be done by using Biofeedback. Patients can be trained to relax their External Anal Sphincter (EAS) during straining as well as to coordinate abdominal contractions to assist stool propulsion into the rectumPHYSICAL THERAPY TREATMENT FOR CONSTIPATION / PELVIC FLOOR DYSSYNERGIA

Constipation is a common disorder primary care physicians and gastroenterologists diagnose on a regular basis. There are many causes, but when constipation is due to pelvic floor dyssynergia, which are restricted pelvic floor muscles around the anal region that contract instead of relax during attempted bowel movements, a licensed physical therapist, trained in pelvic floor dysfunction can reverse constipation and help you resume normal bowel function.The pelvic floor is a group of muscles at the base of the pelvis that help control sexual, urinary and bowel function. These muscles, namely the puborectalis, levator ani and coccyxgeus must relax and contract properly to maintain urinary and fecal continence, sexual function and proper voiding habits. When the pelvic floor muscles fail to relax and contract properly, this can be referred to as pelvic floor dyssynergia. The inability to relax and contract the pelvic floor muscles correctly can lead to symptoms of constipation, straining with bowel movements, and feelings of incomplete evacuation.Some of the physical therapy treatments for constipation include external and internal rectal myofascial release techniques, trigger point release techniques, biofeedback therapy to help down train tight muscles and/or up train weak muscles, instruction to correct bowel techniques to prevent straining, instruction in home exercise program to stretch and strengthen pelvic floor, hip and gluteal muscles.

Manual therapy is needed to reduce the tension, adhesions, and knots in muscles that cause them to become dysfunctional. This treatment is always with a patients permission, may be uncomfortable, but overall a very successful approach to rehabilitate faulty pelvic muscles patterns that resulted in constipation.Biofeedback therapy helps retrains your pelvic floor muscles ability to contract and relax within their full range of motion. It is a treatment which requires insertion of a rectal sensor (sensor is the size and length of a pinky) to measure pelvic floor muscle tension through electromyography (EMG). The EMG activity is visually displayed on the biofeedback unit so you can see what your muscles are doing and learn to better control these muscles with verbal and tactile cueing from the physical therapist. Identifying the internal sensations associated with the relaxation and how to maintain the ability for your pelvic floor muscles to be at a relaxed state throughout the day is taught as well.Specific stretching and strengthening exercises are taught for the pelvic floor; the abdomen and pelvic girdle (the gluteal, hamstring and adductor musculature). Manual therapy such as soft tissue mobilization and trigger point release are administered to tight and restricted tissue both to the lower abdominal region and pelvic floor musculature to help increase blood flow, decrease restrictions and promote healing. Education regarding normal bowel function and identification of problematic toileting habits is also an important step to recovery.By complying with a pelvic floor physical therapists recommendations, you can be well on your way to pain free and stress free bowel function no more constipation!

What Are the Treatments for Constipation?

Most cases of constipation respond to conservative treatment, such as dietary and exercise changes or mild laxatives.Your doctor will probably start treatment by recommending more fiber or bulk in your diet. Except for fiber or bulking agents, over-the-counter laxatives should be avoided. Your doctor will also encourage you to take adequate time for moving your bowels and not to suppress the urge to have a bowel movement. Increasing exercise is also important if you lead a sedentary lifestyle. For stubborn constipation in older children or adults, the doctor may recommend a non-digestible sugar called lactulose or specially formulated electrolyte solutions. Polyethylene glycol (MiraLAX) is available over the counter for short-term use in constipation in children and adults..Fecal impaction is a more serious form of constipation that sometimes affects the elderly and disabled. To release hardened material in the rectum, a doctor inserts a gloved finger and manually breaks up the solidified stool. A gentle enema using warm water or mineral oil may also be helpful.