Constipation and general practice – myths and facts
Authors:
Martínek Jan
Authors‘ workplace:
Primář: MUDr. Vladimír Nosek
; Gastroenterologické oddělení, Nemocnice Jablonec nad Nisou
Published in:
Prakt. Lék. 2008; 88(6): 328-336
Category:
Various Specialization
Overview
Constipation is a frequent symptom affecting approximately 20 % of the population. Secondary constipation is caused by a known disease (for example colorectal carcinoma). Primary constipation can be divided into two groups: colon inertia and outlet obstruction. Functional constipation means there is no organic or laboratory abnormality causing the constipation. Patients with colon inertia have prolonged transit time. Patients with outlet obstruction usually suffer from complicated defecation. If outlet obstruction is caused by a paradoxical contraction of the puborectalis muscle and of the external sphincter, the patients are classified as having anismus. Patients with anatomical obstruction of the anus (e.g. rectocele) are classified as having obstructive defecating syndrome (ODS). Physiotherapy is used for the management of patients with anismus while obstructive defecation syndrome is usually treated surgically. Often recommended measures (fluids, fiber) have only limited significance. Laxatives are often the only means of how to help people with severe constipation. No study has demonstrated any possible harmful effects of laxatives (dependence, tolerance, worsening of constipation, etc.), even though those myths are wide-spread. These drugs are very effective and safe, even when administered for a long period of time. Therefore, it does not make sense to discourage patients from such treatment if it helps. Hyperosmolar substances are also used as laxatives. In patients with constipation, the following examinations are frequently used: colonoscopy, transit time, defecography and anorectal manometry.
Key words:
constipation, colon inertia, anismus, laxatives, biofeedback.
Sources
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General practitioner for children and adolescents General practitioner for adultsArticle was published in
General Practitioner
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