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

 Cognitive handicaps
 Attention deficit disorder
 Coercive toilet training
 Toilet phobia
 School bathroom avoidance
 Excessive parental interventions
 Sexual abuse
 ORGANIC Constitutional  
 Colonic inertia Genetic predisposition
 Reduced stool volume & dryness
 Low Fiber
 Anatomic malformations
 Imperforate anus
 Anal stenosis
 Anterior displaced anus
 Pelvic mass (e.g. sacral teratoma)
 Cystic fibrosis
 Diabetes mellitus
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
 Down syndrome

 Connective tissue disorders
 Systemic lupus
 Tricyclic antidepressants
 Heavy metal ingestion
 Vitamin D intoxication

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.

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