Constipation Its Causes and Management

Constipation Its Causes and Management

Constipation is the inability to open the bowel for at least once a day for a minimum of three days, accompanied by the passage of dry, hard, small faeces.

Causes of Constipation

  1. Inadequate fibre in diet
  2. Inactivity (Sedentary lifestyle)
  3. Dehydration
  4. Postponement or neglect of the urge to defecate
  5. Hypo-motility of the Colon
  6. Weakened abdominal muscles
  7. Hyper-motility of the Colon (spasm leading to narrowing of the lumen)
  8. Systemic conditions such as Congestive cardiac failure, liver cirrhosis, etc.

Signs and symptoms

  1. Passage of dry, hard, small faeces
  2. Pain on defecation
  3. Rectal bleeding
  4. Systemic response e.g. Headache, anorexia, coated tongue, flatulence, etc.

Nearly 80 percent of the out-of-hospital arrests take place at home, and hence being trained to perform cardiopulmonary resuscitation (CPR) can mean the difference between life and death for a loved one. Effective bystander CPR, if administered immediately after the attack, can increase the victim’s chances of survival. A majority of the victims die due to lack of immediate medical assistance.

Nowadays it is mandatory for every health club, and other places where vigorous activities are performed to provide the AED facility for emergency. However, all the health experts are expected to undergo CPR training.

Pathophysiology of constipation

Hypomotility of the colon, inadequate fibre in diet or inactivity leads to the absorption of water from the faeces as it moves along the large intestine. The absorption of water makes the faeces small and unable to stimulate the defecation centre. This leads to further absorption from the faeces making it dry, hard and small.

Excessive muscular exertion and strain are required to provide sufficient intra abdominal pressure to propel the hard faeces along the colon to the rectum and out of the body. The hard faeces causes injury to the rectum producing pain and haemorrhage. Pain may further worsen the fear to defecate. Chronic constipation may cause faecal impaction, especially in older patients or those with neurological impairment.

Systemic responses:

Such as headache anorexia, flatulence, weakness, malaise and coated tongue may result due to prolonged distension of the rectum and anxiety aroused by constipation. Crack in the rectum may result in the passage of blood stained faeces.

Diagnosis

  1. Diagnosis can be made based on patient’s history of diet, activity as well as bowel habit.
  2. Proctosigmoidoscopy: Used to rule out other pathological conditions of the colon.
  3. Today when technology is moving forward so fast, we can still use some effective but old techniques taught to us through CPR training. Every year it is estimated that about 3, 25,000 deaths are caused by sudden cardiac arrest. It is observed that 95 percent of victims of this affliction die before they are transported to a hospital or any other source of emergency help arrives.

Complications

  1. Anal fissure: (painful crack in the mucous membrane of the anus)
  2. Abdominal hernia
  3. Rectal bleeding
  4. Faecal impaction
  5. Anaemia due to prolonged bleeding

Management of constipation

  1. Mild laxative: To increase colonic motility e.g. Dulcolax and liquid paraffin
  2. Cathatics: e.g. Milk of magnesia
  3. Fruits: e.g. Oranges or vegetables to provide roughage (to stimulate peristalsis)
  4. Regulated enema: e.g. Normal saline enema
  5. Stool softeners
  6. Methyl cellulose: To increase bulk of the diet
  7. Exercise: Encourage regular exercise as this usually aids normal defecation
  8. Observation: Monitor patient with neurological problem for faecal impaction. Carry out manual removal of impacted faeces if any.

Nursing advice

The nurse should advise the patient in the following areas:

Experts have concluded that this category of victims can be saved if a defibrillator device is immediately made available to deliver an electric shock and restore the normal rhythm of their heart. The automated external defibrillator (AED) is so effective that its usage procedure is added to the basic life support (BLS) measures. Also this is significantly easy to use.

  1. Prevention of dehydration
  2. Adequate fibre in diet
  3. Complete emptying of the bowel any time of defecation
  4. Daily or regular moderate exercise
  5. Avoidance of indiscriminate use of laxatives or anti-constipation drugs
  6. Adequate fluid intake
  7. Patient should establish a routine time for defecation.

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About the Author: Duncan Barret