Chapter 115 Constipation

Question 1

What is indicated for immediate referral in cases of constipation?

Answer 1

• Sudden change in bowel habits after age 50
• Weight loss
• Blood in the stool
• Anemia
• Family history of colon cancer or inflammatory bowel disease
• Acute constipation in the elderly

These factors warrant urgent medical evaluation.

Question 2

What percentage of the general population is affected by constipation?

Answer 2

Approximately 15% to 20%

Constipation is a common gastrointestinal complaint in the United States.

Question 3

Which groups are disproportionately affected by constipation?

Answer 3

• Women
• Children
• Older adults
• People of low socioeconomic status
• Non-White individuals
• People with a low-fiber diet

These demographics show higher prevalence rates of constipation.

Question 4

What is the definition of constipation according to practitioners?

Answer 4

Fewer than three bowel movements per week

Patients often report symptoms such as hard stools, straining, and incomplete defecation.

Question 5

According to Rome IV criteria, what symptoms must be present for at least 3 months to diagnose constipation?

Answer 5

• Fewer than three bowel movements per week
• Passage of hard or lumpy stools
• Straining in more than 25% of defecations
• Feeling of incomplete evacuation in more than 25% of defecations
• Use of manual maneuvers in more than 25% of defecations

Rome IV criteria were updated in 2016 to reflect current understanding of gastrointestinal disorders.

Question 6

What are the primary causes of chronic constipation?

Answer 6

• Irritable bowel syndrome (constipation predominant)
• Disordered colonic transit
• Evacuation disorders (e.g., dyssynergic defecation)

Chronic constipation can be classified as primary (idiopathic) or secondary.

Question 7

What are common medications associated with constipation?

Answer 7

• 5-HT3-receptor antagonists (ondansetron)
• Analgesics (NSAIDs, opioids)
• Antacids (calcium and aluminum)
• Anticholinergics
• Antidepressants (SSRIs, tricyclics)
• Antiemetics
• Antihistamines
• Anticonvulsants
• Antihypertensives
• Antipsychotics
• Bile acid binders
• Calcium supplements
• Iron supplements

This is not a complete list of medications that can cause constipation.

Question 8

What is the initial approach for managing constipation?

Answer 8

• Management of secondary causes
• Dietary measures
• Periodic exercise
• Bowel training

Addressing lifestyle factors is crucial in the management of constipation.

Question 9

What is the recommended fiber intake for patients with constipation?

Answer 9

20 to 30 g/day

Increasing fiber should be done gradually to avoid bloating and discomfort.

Question 10

What is the purpose of a stool diary in managing constipation?

Answer 10

• To note frequency of stooling
• To assess types of stools using the Bristol stool chart
• To track associated symptoms

A stool diary helps substantiate constipation and evaluate the effectiveness of interventions.

Question 11

What are alarm symptoms that may indicate a serious condition related to constipation?

Answer 11

• Sudden change in bowel habits after age 50
• Weight loss
• Blood in the stool
• Anemia
• Family history of colon cancer or inflammatory bowel disease

These symptoms require further evaluation to rule out serious underlying conditions.

Question 12

What diagnostic tests are essential if abdominal discomfort is present?

Answer 12

• Abdominal x-ray studies
• Abdominal CT scan
• Complete blood count (CBC) with differential

These tests help exclude obstruction, ileus, megacolon, and volvulus.

Question 13

What are the priority differentials for acute-onset constipation?

Answer 13

• Intraabdominal infection
• Ileus
• Toxic megacolon
• Obstructive lesion

These conditions require emergent evaluation.

Question 14

What is the Bristol stool chart used for?

Answer 14

To assess bowel transit time and stool consistency

It helps patients categorize their stool types for better understanding of their bowel health.

Question 15

What is the recommended daily intake of dietary fiber to help with constipation?

Answer 15

20–30 g/day

Foods high in fiber include prunes, bananas, bran, beans, broccoli, spinach, carrots, corn, potato, apple, and pears with skin.

Question 16

True or false: Fiber supplements are effective for all types of constipation.

Answer 16

FALSE

Fiber is unlikely to help constipation in patients with slow transit constipation or dyssynergic defecation.

Question 17

What is the gastrocolic response?

Answer 17

A physiological reaction that stimulates bowel movements after eating

Patients are encouraged to toilet 30 minutes after eating a meal.

Question 18

What technique may help improve constipation by accelerating colonic transit time?

Answer 18

Abdominal massage

The ‘I LOV U’ massage technique could improve constipation, but more research is needed.

Question 19

What is the role of biofeedback training in managing constipation?

Answer 19

Helps restore normal patterns of defecation

Patients learn to coordinate and relax anal and pelvic floor muscles during defecation.

Question 20

Name two types of pharmacologic management for constipation.

Answer 20

• Stool Softeners
• Osmotic Laxatives

Pharmacologic treatment is appropriate if there is no response to conservative measures.

Question 21

What are osmotic laxatives and how do they work?

Answer 21

Medications that cause secretion of water into the intestinal wall, resulting in diarrhea

Examples include magnesium hydroxide, polyethylene glycol (PEG), lactulose, and sorbitol.

Question 22

What is a common side effect of Lubiprostone?

Answer 22

Nausea

Lubiprostone is a chloride channel activator used to treat chronic constipation.

Question 23

What is the first-line treatment for chronic constipation?

Answer 23

Osmotic laxatives

PEG is more effective than lactulose and is preferred over stimulant laxatives.

Question 24

What are secretagogues and name two examples?

Answer 24

• Lubiprostone
• Linaclotide

Secretagogues increase fluid secretion into the lumen and improve colonic transit.

Question 25

What are the **phases of constipation management**?

Answer 25

* Phase 1: Lifestyle changes * Phase 2: Bulk-forming laxatives * Phase 3: Stool softeners * Phase 4: Osmotic laxatives * Phase 5: Stimulant laxatives * Phase 6: Intestinal secretagogues * Phase 7: Other treatments ## Footnote Each phase addresses different aspects of constipation management.

Question 26

What complications can arise from **constipation**?

Answer 26

* Ileus * Ischemic bowel * Megacolon * Hernia * Hemorrhoids * Fecal impaction * Rectal or uterine prolapse ## Footnote These complications highlight the importance of effective management of constipation.

Question 27

What should patients do if they experience changes in **bowel habits**?

Answer 27

Contact the health care provider ## Footnote Especially if constipation is associated with fever, bleeding, weight loss, or abdominal pain.

Question 28

What is the recommended fluid intake for patients to help manage constipation?

Answer 28

2 L/day ## Footnote Adequate fluid intake is essential for preventing constipation.