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SOURCE

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Source: Fabel PH, Shealy KM. Diarrhea, constipation, and irritable bowel syndrome. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=146059459. Accessed April 13, 2017.

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DEFINITION

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  • Functional constipation is bowel disorder characterized by difficult, infrequent, or seemingly incomplete defecation that does not meet criteria for irritable bowel syndrome (IBS).1

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ETIOLOGY

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  • Constipation may be primary (occurs without underlying identifiable cause) or secondary (result of constipating drugs, lifestyle factors, or medical disorders).

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PATHOPHYSIOLOGY

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  • Constipation is not a disease but symptom of underlying disease or problem.

  • Drugs that inhibit neurologic or muscular function of gastrointestinal (GI) tract, particularly colon, may result in constipation (Table 1).

    • All opiate derivatives associated with constipation to varying degrees.

    • Orally administered opiates appear to have greater inhibitory effect than parenterally administered agents.

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Table Graphic Jump Location
TABLE 1.Drugs Causing Constipation
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EPIDEMIOLOGY

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  • Prevalence depends on the definition used and whether the condition is self-reported or provider-diagnosed.

  • Prevalence in North America ranges from 12% to 19%.

  • More common in women and the elderly.

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PREVENTION

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  • Increase dietary fiber.

  • Initiate agents to soften stool when opiates are started.

  • Increase activity level.

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RISK FACTORS

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  • Lack of activity.

  • Lower socioeconomic status.

  • Lower income.

  • Symptoms of depression.

  • History of physical or sexual abuse.

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CLINICAL PRESENTATION

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SIGNS AND SYMPTOMS
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  • Infrequent bowel movements.

  • Stools that are hard, small, or dry.

  • Difficulty or pain on defecation.

  • Feeling of abdominal discomfort or bloating.

  • Incomplete evacuation.

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DIAGNOSIS

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MEANS OF CONFIRMATION AND DIAGNOSIS
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  • History and physical examination to clarify what patient means by constipation. Ask specifically about alarm signs and symptoms:

    • Hematochezia.

    • Melena.

    • Family history of colon cancer.

    • Family history of inflammatory bowel disease.

    • Anemia.

    • Weight loss.

    • Anorexia.

    • Nausea.

    • Vomiting.

    • Persistent constipation refractory to treatment.

    • New onset or worsening constipation in elderly patients without evidence of primary cause.

  • Rectal examination should be performed for presence of anatomical abnormalities, stricture, rectal mass, or fecal impaction.

  • Identify underlying secondary causes or conditions.

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LABORATORY TESTS
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  • No routine lab ...

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