What is constipation?
Constipation is not a disease itself but rather a symptom that, given its enormous frequency, raises a number of family doctor consultations and in the worst cases of digestive specialist.
Constipation is difficult to define because it is a huge problem subject to individual variability or, which is, to a subjectivity that can be understood as a normal depositional rate. We understand how depositional rate, the frequency with which we come to service to evacuate. In the general healthy population, the depositional rate ranging from 3 times a day and 3 times a week, making defecation painlessly and without great effort in most cases, in addition to the end the feeling of complete evacuation.
If we accept this definition, we can then define constipation as the passage of excessively dry stools, scanty or infrequent (less than 3 times per week).
Constipation can be casual, meaning that lasts a short period of time and is associated with certain diets or habits, or may be chronic if it is perpetuated over time.
In turn, this constipation may be secondary, or have a cause at source (certain diseases cause chronic constipation, such as celiac disease, hypothyroidism, diabetes mellitus &) or otherwise be idiopathic with no known cause directly to justify it, but in these cases is usually due to problems with bowel motility.
Constipation, also known as constipation is a problem more common than it seems in today’s society, not having been able to quantify the true frequency of problem. However, it can claim to be more common in females and in old age, perhaps related to multifactorial conditions.
What are its causes?
As we mentioned above, one must distinguish occasional constipation, certain diet product, food or habit, chronic constipation is requiring a study by the medical practitioner. It is necessary to note that normally play in triggering multiple factors and is difficult to establish which one is more important.
Traditionally established pathological groups can cause constipation, including:
Functional problems or bowel motility: idiopathic constipation, Hirschsprung’s disease.
Specific diseases that present with constipation: Metabolic diseases such as diabetes, hypothyroidism, uremia, porphyria.
Mechanical obstacles in the stool, tumors, rectal stenosis.
Or iatrogenic side effects of drugs: Codeine, Antacids.
Dietary problems: low-fiber diet
Other: Certain social habits, cultural, emotional, physical inactivity, depression.
What are your symptoms?
In many cases, constipation is the only symptom, but is sometimes accompanied by secondary symptoms such as bloating, abdominal swelling, bloating, mild abdominal discomfort, headache, etc..
How is it diagnosed?
The careful history, inquiring about dietary factors, sociocultural, toxic habits, diseases and their treatments and have the characteristics of constipation are usually sufficient to guide the diagnosis.
It is important to assess the duration and the patient’s age is not the same as the occurrence of constipation in children than in adults. In children, chronic constipation etiology is almost always functional.
It is also important to inquire about the characteristics of the stool and if they are or not accompanied by abdominal pain. The issuance of escíbalos or “pellets” with mucus is characteristic of spastic constipation, while the issue of blood in the stool suggests or hemorrhoids, proctitis, or tumors.
It is important to determine where the fecal transit disorder and it is important to the history (questioning), asking the patient whether or not you have a bowel movement:
If you have a bowel movement but can not expel the stool, you have to think of an anorectal disorder.
If you rarely feel the urge to defecate, think of a disorder of the colon. In these cases the stool does not reach the rectum.
Routinely you can request a blood test determining blood glucose, ions, thyroid studies, serum calcium and occult blood in stool that will allow us to focus on some common causes of constipation.
The main maneuver digital rectal examination is an essential part of physical examination, and should never miss, helping you identify mechanical problems or anal sphincter tone.
Among the diagnostic tests that can be requested is the colonoscopy, which involves inserting into the anus of a probe light provided to visualize the inside of the large intestine. It also has the colonoscopy that uses a wider probe than the previous X-rays with contrast such as barium enema (x-ray per year after the introduction of a special solution to see intestine) so as to reveal lesions that obstruct the intestinal canal .
Only in very special cases other tests will be asked to refine or confirm an initial diagnosis: rectal manometry, electromyography, defecography, and so on.