conditions constipation

RECND4765

Constipation

Condition:Constipation
Other:Dyschezia
ICD-10 Codes:K59.0

Naturopathic Treatments

Acute constipation
• anthraquinones
- senna (Senna spp.)
- rhubarb (Rheum spp.)
- aloe resin (Aloe spp.)
- cascara (Rhamnus purshiana)
• castor oil
magnesium

Lifestyle - to promote regularity
• stress management
• exercise
• routine

General Diet Recommendations:
• increase water intake: 2L/day
• increase fruit and vegetable intake
• increase fiber intake
• avoid foods with saturated fats
• avoid foods high in cholesterol, sugars, animal protein

Specific Foods
• apples
• kiwi
• prunes
• oatmeal
aloe gel

Fiber supplements - will act as a bulk laxative
• psyllium (Plantago spp.)
• ground flax seeds (Linum usitatissimum)
marshmallow (Althea officinalis)
slippery elm (Ulmus rubra)
• probiotics

Topical
• castor oil packs

Other
bitter herbs - releases bile, which stimulates peristalsis & promotes regularly
vitamin C - osmotic laxative
• fish oil
• olive oil

Conventional Treatments

stimulant laxatives
• bulk forming laxatives
• lubricant laxatives
• stool softeners
• enemas
• suppositories

Signs & Symptoms

• infrequent bowel movement
• stools difficult to pass
• abdominal discomfort:
- fullness
- bloated
- pain
- colic

DDx

• dehydration
• IBS
• fecal impaction
hypothyroidism
depression
• diverticulitis
• hypercalcemia
• drug-Induced
• anorexia nervosa
• intestinal obstruction
• hypokalemia
• congenital megacolon
• lead poisoning

Pathogenesis

constipation occurs when peristalsis fails to move bowel contents at an adequate rate to have regular bowel movements

The following encourages effective peristalsis:
• nerve innervation
• parasympathetic system dominance
• bowel irritants (e.g. bile, insoluable fiber)
• stimulation of stretch receptors by voluminous stool (e.g. food, fiber, probiotics, water, etc)
• regular routine
• regular exercise massages the inner organs and keeps things moving

Causes of constipation:
• lack of fiber
• dehydration
• lack of exercise
• lack of routine
• laxative abuse
• sequelae of CNS condition
• metabolic conditions (e.g. hypothyroidism)
• chronic ignoring urge to have a bowel movement
• medications
- narcotics
- iron
- imipramine
- diuretics
- calcium channel blockers
- anticholinergics
- antacids
- decongestants
- anticonvulsants
- bismuth, lead

Diagnostics

• >3 days without a BM
• physical exam: abdominal exam, bowel sounds, weight loss/gain
• rectal exam if need to r/o fecal impaction, fissures, hemorrhoids

References

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