Constipation
Constipation is defined as a delay or difficulty with defecation, present for 2 or more weeks. It is defined on the basis of the frequency of defecation (< 3 stools/week); size of stool; consistency of stool or discomfort/pain in passage of bowel movements. Distinguishing functional constipation (i.e., without evidence of a pathologic cause) from constipation with an organic cause is important.
Classification of Constipation:
Various schemas are available in the literature which utilize measures of segmental transit to classify constipation as normal transit time, delayed colonic transit, delayed rectal and colonic transit, or delayed rectal transit. Radio-opaque marker studies or scintigraphic studies can be used to make similar measurements in children but are only useful in the most refractory patiens. In most cases, it is most useful to classify constipation as being “non-organic” vs. “organic”.
Causes of Constipation
NON-ORGANIC Developmental Cognitive handicaps Attention deficit disorder Situational Coercive toilet training Toilet phobia School bathroom avoidance Excessive parental interventions Sexual abuse Depression ORGANIC Constitutional Colonic inertia Genetic predisposition Reduced stool volume & dryness Low Fiber Dehydration Underfeeding/Malnutrition Anatomic malformations Imperforate anus Anal stenosis Anterior displaced anus Pelvic mass (e.g. sacral teratoma) | Metabolic Hypothyroidism Hypercalcemia Hypokalemia Cystic fibrosis Diabetes mellitus Hypermagnesemia Adrenal insufficiency Neuropathic conditions Spina bifida/Myelomeningocele Familial dysautonomia Spinal cord trauma von Recklinghausen disease Static encephalopathy Intestinal Nerve or muscle disease Hirschsprung disease Intestinal Neuronal Dysplasia Visceral myopathies Visceral neuropathies Abnormal abdominal musculature Prune Belly Gastroschisis Down syndrome
| Connective tissue disorders Scleroderma Systemic lupus erythematosus Amyloidosis Drugs Opiates Sucralfate Antacids Antihypertensives Anticholinergics Tricyclic antidepressants Sympathomimetics Other Heavy metal ingestion Vitamin D intoxication Botulism
|
Rome III Diagnostic Criteria for Functional Constipation :
Diagnostic criteria
Must include two or more of the following:
- Straining during at least 25% of defecations
- Lumpy or hard stools in at least 25% of defecations
- Sensation of incomplete evacuation for at least 25% of defecations
- Sensation of anorectal obstruction/blockage for at least 25% of defecations
- Manual maneuvers to facilitate at least 25% of defecations (e.g., digital evacuation, support of the pelvic ?oor)
- Fewer than three defecations per week
Loose stools are rarely present without the use of laxatives
Insu?cient criteria for irritable bowel syndrome
Clinical Features
- Defecation frequency less than 3 per week
- Encopresis
- Large diameter stools - Stools of very large caliber are another associated symptom.
- Straining and or pain during defecation.
- Vomiting
- Enuresis - Enuresis is reported in approximately 30% of the children with encopresis. Many of them have daytime as well as nocturnal enuresis, which resolve when the constipation is treated.
- Urinary tract infection - It is a common complication in females with chronic constipation.
- Abdominal pain or distension -The most common symptom associated with constipation is chronic recurrent abdominal pain, which occurs in approximately 60% of patients. The pains are intermittent and localized to the periumbilical region and resemble functional abdominal pain.
- Poor appetite and poor growth occasionally are seen in association with constipation and may result from early satiety caused by the feeling of fullness of the colon.
- Rectal Bleeding
Differential diagnosis
Constipation predominant irritable bowel syndrome is the commonest differential diagnosis for constipation. In those with irritable bowel syndrome, abdominal pain or discomfort is the predominant symptom and they are likely to have pain relief after defecation and changing stool consistency and frequency.
Homoeopathic Approach
The selection of remedy is based upon the theory of individualization and symptom similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the signs and symptoms from which the patient is suffering. Homoeopathy treats the person as a whole. It means that homoeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homoeopathic medicines are selected after a full individualizing examination and case analysis, which includes the medical history of the patient, physical and mental constitution, etc. The selection of remedy is based not on the Quantitative but on the Qualitative evaluation. While assessing the total response, fundamental importance is given to the causative factors & to the peculiar characteristics of the ailment, especially the mental aspects. There are no two patients alike. No two people produce the same symptomatology, or experience the same feelings, ideas, and emotions. There are no two patients who have the same morbid process with the same sequence & concomitants. Hence, the need for strict individualization of each case with regards to the symptomatology the patient presents with.