Constipation is defined as a combination of changes in the frequency, size, consistency, and ease of stool passage, which leads to an overall decrease in volume of bowel movements.
Constipation can be caused by: electrolyte imbalances (hypercalcemia, hypokalemia); hormonal abnormalities (Hypothyroidism, Diabetes); Congenital impediments (aganglionic megacolon - Hirschsprung's disease; or excessively elongate, edundant, capacious bowel - dolichocolon); Congenital or acquired neuromuscular bowel impairment ("pseudo-obstruction"); Concomitant illness, injury, or debility; Mechanical bowel impediment (obstruction or ileus, due to any cause); Inadequate fluid intake; Sideeffect of drugs (e.g., anticholinergic agents, opiates); Chronic abuse of laxatives or cathartics; Psychiatric, cultural, emotional, environmental factors; and Painful fecal evacuation from anal disease (e.g., fissures).
Risk factors include: extremes of life (very young and very old); neurosis; polypharmacy; and a sedentary life style or condition.
Conventional labs are only necessary when other disorders are being considered, and include a CBC (to detect anemia which may indicate colorectal neoplasm); Thyroid function studies; Electrolytes, glucose, and calcium.
A digital rectal exam can rule out a rectal mass, check for blood in the stool, and define stool consistency.
Imaging studies include a plain (KUB) film of the abdomen and a barium enema or barium swallow with small bowel follow through looking for anatomical defects (mass lesions, ileus). Cineradiography of passage of barium, instilled in, then expelled from the rectosigmoid segment ("defecography"), may help define evacuation disorders in selected cases. Sigmoidoscopy or colonoscopy is seldom required, unless needed to define an abnormality discovered by barium enema or when there is evidence of iron deficiency anemia or blood in the stool.
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