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Difficult Defecation (Constipation), A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions
Di Kenneth Kee
Difficult Defecation (Constipation), A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions
Di Kenneth Kee
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This book describes Difficult Defecation, Diagnosis and Treatment and Related Diseases
3 weeks ago, an old lady of 80 years old came to consult me about her constipation which had caused her symptoms of lower abdominal pain and bloating for 2 weeks in spite of being treated by several doctors with laxatives and enema.
As she was supposed to go for a trip to Australia in 1 week’s time she hoped that I would be able to resolve her problem as soon as possible.
I could feel many lumps of stools in the left lower part of her abdomen which suggested impaction of her stools.
I informed her that the fastest way was to evacuate her stools manually or she could go the hospital for a soapy evacuation of her impacted stools.
As she did not want to go hospital, I decided to evacuate her stools manually.
I used a gloved hand to dig out the hard stools which was stuck in her anal region and managed to fill 2 large bags of hard stools.
It was a difficult work but after the evacuation she felt so much better.
As usual the stink of her stools filled the air in the clinic and the doors were opened to allow the smell to dissipate to the outside.
This was the second time I had to evacuate the stools impacted in the anal region of a patient, the last being 20 years ago on a male elderly patient.
I gave my patient some senokot tablets and liquid paraffin to help her defecation and advised her to drink more water, fruits and fiber and do mild exercise to help her defecation.
The next day she rang me to thank me and to inform me that her defecation was back to normal.
Difficult defecation is a common problem in the elderly
Constipation by definition is a disorder which is featured by fewer than normal bowel movements than normal or stools that are harder to pass.
It is followed by straining, incomplete excretion and passage of hard stools.
The causes are of two forms:
1. Obstruction of defecation
2. Colonic slow movement (or hypo-motility)
50% of patients evaluated for constipation at referral hospitals have blockage of defecation.
This form of constipation has mechanical and functional causes.
Causes of colonic slow movement constipation are:
1.Diet,
2.Hormonal disorders such as hypothyroidism,
3.Side effects of medicines
Constipation can be caused or aggravated by a low fiber diet, low liquid intake, or dieting.
Constipation is bowel movements that are:
1.Difficult to pass,
2.Very firm, or
3.Made up of small hard pellets (like those excreted by rabbits) even if they occur every day.
Other symptoms are:
1.Bloating,
2.Distension,
3.Abdominal pain,
Physically palpable lumps of stool may be found on palpation of the abdomen.
Rectal examination gives a feeling of the anal sphincter tone and whether the lower rectum has any feces or not.
X-rays of the abdomen is normally only done if bowel obstruction is indicated
Treatment
Since constipation is a symptom, not a disease, successful treatment of constipation may need first finding the cause.
The main treatment of constipation affects the higher intake of water and fiber (either dietary or as supplements).
The regular use of laxatives is not advised, as having bowel motions may become dependent upon their use.
Enemas can be given to provide a form of mechanical stimulation.
Broadly, categories of treatments are:
1.Bulk-forming products,
2.Stool softeners,
3.Osmotic agents and
4.Stimulant laxatives
Newer treatment for constipation is:
1.Prucalopride -prokinetic
2.Osmotic agent lubiprostone
3.Linaclotide and plecanatide -GC-C agonists
Surgical care may be used:
Rectal outlet obstruction
Hypomotile colon
Recently the new treatment of sacral nerve stimulation (SNS) has been utilized for the treatment of severe constipation.
TABLE OF CONTENT
Introduction
Chapter 1 Difficult Defecation
Informazioni sull'autore
Medical doctor since 1972.Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009.Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993.Dr Kenneth Kee is still working as a family doctor at the age of 70.However he has reduced his consultation hours to 3 hours in the morning and 2 hours inthe afternoon.He first started writing free blogs on medical disorders seen in the clinic in 2007 on http://kennethkee.blogspot.com.His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiography account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.comThis autobiography account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Disorders” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com.From which many free articles from the blog was taken and put together into 1000 eBooks.He apologized for typos and spelling mistakes in his earlier books.He will endeavor to improve the writing in futures.Some people have complained that the simple guides are too simple.For their information they are made simple in order to educate the patients.The later books go into more details of medical disorders.He has published 1000 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter.The purpose of these simple guides is to educate patient on health disorders and not meant as textbooks.He does not do any night duty since 2000 ever since Dr Tan had his second stroke.His clinic is now relocated to the Buona Vista Community Centre.The 2 units of his original clinic are being demolished to make way for a new Shopping Mall.He is now doing some blogging and internet surfing (bulletin boards since the 1980's) startingwith the Apple computer and going to PC.The entire PC is upgraded by himself from XT to the present Pentium duo core.The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive.He is also into DIY changing his own toilet cistern and other electric appliance.His hunger for knowledge has not abated and he is a lifelong learner.The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned.This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale.Dr Kee is the author of:"A Family Doctor's Tale""Life Lessons Learned From The Study And Practice Of Medicine""Case Notes From A Family Doctor"
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Anteprima del libro
Difficult Defecation (Constipation), A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions - Kenneth Kee
Difficult Defecation
(Constipation),
A
Simple
Guide
To
The Condition,
Diagnosis,
Treatment
And
Related Conditions
By
Dr Kenneth Kee
M.B.,B.S. (Singapore)
Ph.D (Healthcare Administration)
Copyright Kenneth Kee 2018 Smashwords Edition
Published by Kenneth Kee at Smashwords.com
Dedication
This book is dedicated
To my wife Dorothy
And my children
Carolyn, Grace
And Kelvin
This book describes Difficult Defecation, Diagnosis and Treatment and Related Diseases which is seen in some of my patients in my Family Clinic.
(What The patient Need to Treat Difficult Defecation)
This eBook is licensed for your personal enjoyment only. This eBook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each reader.
If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy.
Thank you for respecting the hard work of this author.
Introduction
I have been writing medical articles for my blog http://kennethkee.blogspot.com (A Simple Guide to Medical Disorder) for the benefit of my patients since 2007.
My purpose in writing these simple guides was for the health education of my patients.
Health Education was also my dissertation for my Ph.D (Healthcare Administration).
I then wrote an autobiolographical account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.com.
This autobiolographical account A Family Doctor’s Tale
was combined with my early A Simple Guide to Medical Disorders
into a new Wordpress Blog A Family Doctor’s Tale
on http://kenkee481.wordpress.com.
From which many free articles from the blog was taken and put together into 800 eBooks.
Some people have complained that the simple guides are too simple.
For their information they are made simple in order to educate the patients.
The later books go into more details of medical disorders.
The first chapter is always from my earlier blogs which unfortunately tends to have typos and spelling mistakes.
Since 2013, I have tried to improve my spelling and writing.
As I tried to bring the patient the latest information about a disorder or illness by reading the latest journals both online and offline, I find that I am learning more and improving on my own medical knowledge in diagnosis and treatment for my patients.
Just by writing all these simple guides I find that I have learned a lot from your reviews (good or bad), criticism and advice.
I am sorry for the repetitions in these simple guides as the second chapters onwards have new information as compared to my first chapter taken from my blog.
I also find repetition definitely help me and maybe some readers to remember the facts in the books more easily.
I apologize if these repetitions are irritating to some readers.
Chapter 1
Difficult Defecation (Constipation)
3 weeks ago, an old lady of 80 years old came to consult me about her constipation which had caused her symptoms of lower abdominal pain and bloating for 2 weeks in spite of being treated by several doctors with laxatives and enema.
As she was supposed to go for a trip to Australia in 1 week’s time she hoped that I would be able to resolve her problem as soon as possible.
I could feel many lumps of stools in the left lower part of her abdomen which suggested impaction of her stools.
I informed her that the fastest way was to evacuate her stools manually or she could go the hospital for a soapy evacuation of her impacted stools.
As she did not want to go hospital, I decided to evacuate her stools manually.
I used a gloved hand to dig out the hard stools which was stuck in her anal region and managed to fill 2 large bags of hard stools.
It was a difficult work but after the evacuation she felt so much better.
As usual the stink of her stools filled the air in the clinic and the doors were opened to allow the smell to dissipate to the outside.
This was the second time I had to evacuate the stools impacted in the anal region of a patient, the last being 20 years ago on a male elderly patient.
I gave my patient some senokot tablets and liquid paraffin to help her defecation and advised her to drink more water, fruits and fiber and do mild exercise to help her defecation.
The next day she rang me to thank me and to inform me that her defecation was back to normal.
Difficult defecation is a common problem in the elderly.
What is Difficult Defecation (Constipation)?
Difficult Defecation (Constipation) by definition is a disorder which is featured by fewer than normal bowel movements than normal or stools that are harder to pass.
It is followed by straining, incomplete excretion and passage of hard stools.
Constipation is a frequent symptom with many causes.
The causes are of two forms:
1. Obstruction of defecation
2. Colonic slow movement (or hypo-motility)
50% of patients evaluated for constipation at referral hospitals have blockage of defecation.
This form of constipation has mechanical and functional causes.
Causes of colonic slow movement constipation are:
1. Diet,
2. Hormonal disorders such as hypothyroidism,
3. Side effects of medicines, and rarely
4. Heavy metal toxicity.
Constipation is frequent.
The incidence of constipation in the general population differs from 2 to 30%.
Incidence of Difficult Defecation (Constipation)
It is particularly frequent among the elderly and younger children.
Constipation
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