Giới thiệu
Constipation is an unsatisfactory defecation distinguished by difficult stool passage, infrequent stools (<3 bowel movements/week), or both. A difficult stool passage may include lumpy/hard stools, straining, feeling of difficulty in passing stool, feeling of anorectal blockade, incomplete evacuation, prolonged time to defecate, the need for manual maneuver to pass stool, and abdominal discomfort. Other symptoms that may alert a physician of an underlying constipation include bloating, fullness, and the need for laxatives.
Constipation in Adults_Disease BackgroundChronic constipation is considered when the above symptoms have existed for ≥3 months and affect the activities of daily living. This is associated with an increased risk of cardiovascular, renal, and neurodegenerative disease (eg Parkinson’s disease).
Dịch tễ học
The prevalence of constipation ranges from 6.6-11.7%, according to a survey of individuals aged 18 and above across 33 countries. Constipation is also more commonly observed among women and individuals over 60 years of age. Chronic constipation is also seen among those of lower socioeconomic status. Constipation is more frequent in North America and Europe compared with Asian countries due to the differences in diet, culture and environment.
Nguyên nhân
The most recognized causes of constipation include sensorimotor disturbances in the colon and pelvic floor dysfunction. A thorough history and physical exam in many cases can rule out most secondary causes of constipation eg colonic diseases (anal fissure, hemorrhoids, cancer, proctitis, stricture), neurologic disorders (spinal cord lesions or injury, parkinsonism, multiple sclerosis), disturbances in metabolism (diabetes mellitus [DM], hypothyroidism, hypercalcemia), drug side effects (anticholinergics, antispasmodics, antidepressants, antipsychotics, antiepileptics, calcium channel blockers, diuretics, iron and calcium supplements, opioids, anticancer drugs [eg plant alkaloids and taxanes], aluminum-containing antacids, adsorbents and anion exchange resins), or other conditions (depression, schizophrenia, immobility, cardiac disease, cognitive impairment, scleroderma, patients on dialysis). If a secondary cause of constipation is identified, treat the condition appropriately.
Sinh lý bệnh
The symptoms of chronic constipation may be due to dysfunction of intestinal motility, visceral sensitivity (eg increased rectal sensory threshold or loss of urge to defecate), delayed colonic transit, anorectal musculature or the enteric nervous system. This may also include diet, intestinal bacteria, behavioral and psychological factors (eg anxiety, depression).
Yếu tố nguy cơ
The risk factors of constipation are increasing age, female gender, decreased caloric or fiber intake, immobility or inactivity, depression, medication side effects, history of abdominal surgery, physical and sexual abuse, and a low income and educational status.