Constipation

Key criteria and definition

In clinical propedeutics, constipation (obstipatio) is considered a pathological condition in which normal colonic transit is impaired, leading to a difficult, delayed, or insufficient act of defecation.

Diagnosis is based on two fundamental criteria:

• Time factor. There is a noticeable increase in intervals between bowel movements. It is important to compare the current condition not with averaged statistical data, but with the individual norm of the specific patient before the onset of the disease.
• Change in consistency. Feces lose their normal water content, leading to the formation of hard stools that impede the physiological evacuation process.

Dietary, behavioral, and psychogenic causes

The etiology of stool disorders is extremely diverse. The most frequent group of causes in modern clinical practice are factors associated with the patient's lifestyle and diet.

Dietary and behavioral triggers:

1. Insufficient physical activity (hypodynamia).
2. A sharp deficiency of plant fiber in the daily diet.
3. Chronically insufficient fluid intake.

Psychogenic factors also play a significant role. Impaired intestinal motor function often accompanies conditions such as clinical depression, dementia, and severe eating disorders (specifically, anorexia nervosa).

Iatrogenic (drug-induced) factors

Special attention in taking the pharmacological history should be paid to drugs capable of provoking drug-induced constipation. The main groups of medications with this side effect include:

• Opiates;
• Tricyclic antidepressants;
• Calcium channel blockers;
• Oral and parenteral iron preparations;
• Anticholinergics.

Discontinuation or dose adjustment of these drugs (if permitted by the clinical situation) often leads to stool normalization without additional interventions.

Organic, mechanical, and neurological pathologies

Constipation can be a consequence of severe systemic and local lesions. Organic and mechanical obstacles include intestinal tumors blocking the intestinal lumen. Pathology of the anorectal zone, such as an anal fissure, is distinguished separately. In this case, the mechanism of constipation is reflex in nature: due to severe pain during defecation, conscious or unconscious suppression of the physiological urge occurs.

Normal peristalsis is also impaired in neurological diseases that disrupt the innervation of the intestinal tube. This group includes:

• Parkinson's disease;
• Cerebrovascular diseases;
• Multiple sclerosis;
• Various spinal cord injuries.

Mandatory diagnostic minimum

Any patient presenting with complaints of persistent constipation dictates the need to rule out serious organic (primarily oncological) pathology. The physician must exhibit special clinical vigilance if the patient experiences periodic alternation of constipation and diarrhea.

To ensure patient safety and accurate verification of the diagnosis, a strict instrumental and laboratory minimum has been approved. It includes:

1. Thorough laboratory stool examination.
2. Performing a rectosigmoidoscopy for visual assessment of the rectal and sigmoid mucosa.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Pathological impurities in stool in various intestinal diseases.
• Features of the procedure and preparation for rectosigmoidoscopy.
• Mechanisms of malignant bowel obstruction development.
• Specifics of GI motor disorders in Parkinson's disease and multiple sclerosis.
• Impact of dietary fiber deficiency on fecal mass formation.

Other topics in the "Digestive System" section

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.