Basic of Geriatrics and Internal Medicine for Physiotherapist by Rasheedy D - HTML preview

/ Home / Medical (Academic) / Basic of Geriatrics and Internal Medicine for Physiotherapist
PLEASE NOTE: This is an HTML preview only and some elements such as links or page numbers may be incorrect.
Download the book in PDF, ePub, Kindle for a complete version.
PREV   NEXT

 

Approach to Constipation

Constipation is a symptom and is not a disease

Constipation is the most common digestive complaint. It affects around 27 % of the population.

 Constipation is more common in women and the elderly

Signs and Symptoms (definition)

ROME-IV criteria for constipation: in a patient who does not take laxatives or have Irritable Bowel Syndrome, patient has at least two of the following over the preceding three months:

  1. Fewer than three spontaneous bowel movements per week
  2. Straining for more than 25% of defecation attempts
  3. Lumpy or hard stools for at least 25% of defecation attempts
  4. Sensation of anorectal obstruction or blockage for at least 25% of defecation attempts
  5. Sensation of incomplete defecation for at least 25% of defecation attempts
  6. Manual maneuvering required to defecate for at least 25% of defecation attempts

Pathophysiology:

Primary causes:

Secondary causes

1. normal transit (the most common):

chronic functional (idiopathic)

2. outlet dysfunction:

(defecation disorders, pelvic floor dysfunction) can be due to dyssynergia, excessive or inadequate perineal descent, rectal prolapse, anal stricture or fissure, hyposensitivity, rectocele

3. slow transit:

due to a reduced number of neurons within the myenteric plexus and/or interstitial cells of Cajal and increased intestinal collagen deposition.

Drugs: opiates,anticholinergic, antidepressant, antihistamine, anti- Parkinsonian, iron, calcium, calcium channel blockers, opiates.

Neurogenic: autonomic neuropathy, Parkinson’s disease, multiple sclerosis, CNS and spinal cord lesions, diabetes mellitus, pelvic nerve damage

Hormonal or endocrine disorders: hypothyroidism

Lifestyle : low fiber in diet, dehydration, immobility

Investigations:

Laboratory: KFT, electrolytes, RBS, TSH

 Colonoscopy

CT abdominal, pelvis

Dynamic pelvic floor magnetic resonance defectography

Colonic transit studies

Management

Most patients with constipation are initially managed with lifestyle changes including regular exercise, avoidance of constipating medications, and access to toileting.

The use of dietary fiber and hydration has been the mainstay of therapy in chronic constipation.

Laxatives:

1) Chloride channel activators (lubiprostone;) increases fluid content of stool

2) Bulking agents, fiber supplements

3) Stimulants: causes contraction of intestines, can cause dependency (Senna, bisacodyl)

4) Osmotics: increase water in intestines (Lactulose)

5) Stool softeners: moisture to stool (Colace)

6) Lubricants: grease stool for ease of expulsion (mineral oil); lubricants may decrease absorption of other medications and/or nutrients

7) 5-HT-4 agonists: (prucalopride); increase fluid secretion in the intestines and decrease colonic transit time.

Physiotherapy Intervention

1. Pelvic floor muscle exercises/training

  1. Contraction; Kegel exercises
  2. Relaxation/bulging: necessary for defecation
  3. Motor control, coordination
  4. sEMG biofeedback: assess behavior of Pelvic floor muscle while sitting on toilet to simulate defecation, provide feedback for pelvic floor muscle exercise training

2. Manual therapy:

a. Mobilize sacrococcygeal joint, release pain and trigger points in pelvic floor and coccygeus muscles

3. Abdominal muscle coordination training

4. Bowel training; defecation posture instruction

5. Abdominal massage

PREV   NEXT