Theme III: Diseases and types

Type: About Constipation

Source:
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3170709/
2. https://www.webmd.com/digestive-disorders/digestive-diseases-constipation#1
3. https://www.medicalnewstoday.com/articles/150322#symptoms
4. https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-
tract/constipation

Body:
About Constipation
Constipation is a common condition that affects people of all ages. It can mean
that you're not passing stools regularly or you're unable to completely empty
your bowel.
Constipation can also cause your stools to be hard and lumpy, as well
as unusually large or small.
The severity of constipation varies from person to person. Many people only
experience constipation for a short time, but for others, constipation can be a
long-term (chronic) condition that causes significant pain and discomfort and
affects quality of life.
Types of Constipation

1. Normal-transit constipation
a. Normal-transit constipation is probably the most common form of
constipation seen by general clinicians, although this has not
formally been studied.
b. Stool traverses at a normal rate through the colon and stool
frequency may be normal, but patients feel constipated

2. Slow-transit constipation
a. Approximately half of patients with symptoms refractory to
supplementary fiber have a prolonged intestinal transit time.
b. Patients has been found to have significant impairment of
propulsive colonic motor activity, and significantly diminished
colonic responses following a meal and on awakening in the
morning; however, diurnal rhythm is usually preserved.
 3. Defecation disorders
a. A number of patients with chronic constipation display a difficulty
in expelling stools from the rectum. This failure may be due to
impaired rectal contraction, paradoxical anal contraction, or
inadequate anal relaxation.
b. Lack of coordination, or dyssynergia, of the muscles involved in
defecation is thought to be the most likely cause, but a high
proportion of patients may also show impaired rectal sensation.

Theme I: How to save money on healthcare

Type: Treatment of Constipation
Source:
1. https://www.mayoclinic.org/diseases-conditions/constipation/diagnosis-treatment/drc-
20354259
2. https://www.medicalnewstoday.com/articles/150322#summary
3. https://www.webmd.com/digestive-disorders/chronic-constipation-treatment#1
4. https://www.webmd.com/digestive-disorders/prescription-medications-to-treat-
constipation#1
5. https://my.clevelandclinic.org/health/diseases/4059-constipation/management-and-
treatment

Body:
Treatment of Constipation
There are many treatments available for constipations which are:
1. Diet and lifestyle changes: doctor may recommend the following
changes to relieve your constipation:
a. Increase your fiber intake. Adding fiber to your diet increases the
weight of your stool and speeds its passage through your intestines.
Slowly begin to eat more fresh fruits and vegetables each day.
Choose whole-grain breads and cereals.
b. Exercise most days of the week. Physical activity increases
muscle activity in your intestines. Try to fit in exercise most days
of the week. If you do not already exercise, talk to your doctor
about whether you are healthy enough to start an exercise program.
c. Don't ignore the urge to have a bowel movement. Take your
time in the bathroom, allowing yourself enough time to have a
bowel movement without distractions and without feeling rushed.

2. Laxatives: Several types of laxatives exist. Each works somewhat

differently to make it easier to have a bowel movement. The following
are available over the counter:
a. Fiber supplements. Fiber supplements add bulk to your stool.
Bulky stools are softer and easier to pass. Fiber supplements
include psyllium (Metamucil, Konsyl, others), calcium
polycarbophil (FiberCon, Equalactin, others) and methylcellulose
(Citrucel).
b. Stimulants. Stimulants including bisacodyl (Correctol, Dulcolax,
others) and sennosides (Senokot, Ex-Lax, Perdiem) cause your
intestines to contract.
 c. Osmotics. Osmotic laxatives help stool move through the colon by
increasing secretion of fluid from the intestines and helping to
stimulate bowel movements. Examples include oral magnesium
hydroxide (Phillips' Milk of Magnesia, Dulcolax Milk of
Magnesia, others), magnesium citrate, lactulose (Cholac, Constilac,
others), polyethylene glycol (Miralax, Glycolax).
d. Lubricants. Lubricants such as mineral oil enable stool to move
through your colon more easily.
e. Stool softeners. Stool softeners such as docusate sodium (Colace)
and docusate calcium (Surfak) moisten the stool by drawing water
from the intestines.
f. Enemas and suppositories. Tap water enemas with or without
soapsuds can be useful to soften stool and produce a bowel
movement. Glycerin or bisacodyl suppositories also aid in moving
stool out of the body by providing lubrication and stimulation.

3. Other medications: If over-the-counter medications don't help your

chronic constipation, your doctor may recommend a prescription
medication, especially if you have irritable bowel syndrome.
a. Medications that draw water into your intestines. A number of
prescription medications are available to treat chronic constipation.
Lubiprostone (Amitiza), linaclotide (Linzess) and plecanatide
(Trulance) work by drawing water into your intestines and
speeding up the movement of stool.
b. Serotonin 5-hydroxytryptamine 4 receptors. Prucalopride
(Motegrity) helps move stool through the colon.
c. Peripherally acting mu-opioid receptor antagonists (PAMORAs). If
constipation is caused by opioid pain
medications, PAMORAs such as naloxegol (Movantik) and
methylnaltrexone (Relistor) reverse the effect of opioids on the
intestine to keep the bowel moving.

4. Training your pelvic muscles: Biofeedback training involves working

with a therapist who uses devices to help you learn to relax and tighten
the muscles in your pelvis. Relaxing your pelvic floor muscles at the right
time during defecation can help you pass stool more easily.

5. Surgery: Surgery may be an option if you have tried other treatments and
your chronic constipation is caused by a blockage, rectocele or stricture.
For people who have tried other treatments without success and who have
abnormally slow movement of stool through the colon, surgical removal
of part of the colon may be an option. Surgery to remove the entire colon
is rarely necessary.