Constipation refers to the retention or delay of fecal material in the intestinal tract such that fewer than three bowel movements occur per week.
Constipation is often a symptom of another disease state, such as inflammation of the bowel (irritable bowel syndrome, or IBS), enlarged toxic colon (Hirschsprung's disease), low thyroid function (hypothyroidism), diminished inhalation/exhalation capacity of the lungs (chronic obstructive pulmonary disease, or COPD), stroke, paralysis from spinal cord injury or cauda equina syndrome, Parkinson's disease, colon cancer, tuberculosis, infection of the colon (diverticulitis), or loss of neural innervation to the colon (neurogenic disease).Incidence and Prevalence: Constipation is the most common digestive complaint in the US, with about 3 million people reporting frequent constipation ("Constipation"). |
Source: Medical Disability Advisor
| Constipation occurs most often in women and adults over the age of 65. It is also common in pregnancy and following childbirth or surgery and individuals who have taken narcotic drugs. Constipation may be complicated by high consumption of coffee or tea as well as low fiber diets and low caloric intake. |
Source: Medical Disability Advisor
History: Individuals will report problems having bowel movements or complain of hard, dry stools. Sensations of fullness or pressure in the rectum and a frequent urge to defecate are also common. After prolonged constipation, there may be a sense of stomach (epigastric) fullness along with nausea, belching, stomach distention, return of stomach contents into the mouth (regurgitation), or abdominal discomfort. Long-term, untreated constipation may produce headache, dizziness (vertigo), general weakness and discomfort (malaise), loss of appetite (anorexia), or a bad taste in the mouth. Physical exam: The exam may reveal increased anal canal muscle tone and crack-like lesions on the anus (anal fissures). The individual may also have a distended abdomen and there could be an accumulation (impaction) of hardened, dry (inspissated) feces that can be felt in the area of the lower bowel (rectum, or sigmoid/transverse colon). Tests: Tests are not ordinarily needed to ascertain that an individual has constipation because the history and physical exam will provide adequate information. However, in some cases, tests may be performed to identify the cause of constipation. Thyroid and parathyroid function tests may be performed along with a test for urinary tract infection. The interior of the colon can be inspected by inserting a flexible optic instrument (endoscope) through the rectal opening and up into the colon (colonoscopy). The colon can also be visualized on x-ray following a barium enema. Functional tests may include measurement of transit time through the colon (colorectal transit time) using radiopaque markers (colonic scintigraphy) or recording abnormal electrical activity of the colon (electromyography). Anorectal morphology and dynamics can be studied during defecation using a barium paste that reproduces stool consistency (defecography). |
Source: Medical Disability Advisor
| Constipation is one of the most common gastrointestinal complaints in the US and most individuals treat themselves without seeking medical help. Those that do see a doctor are advised to increase intake of fluids and dietary fiber, and to increase physical activity as much as possible. Consuming more raw fruits and vegetables, whole grain cereals and breads, or use of supplements will increase dietary fiber intake. In some cases, individuals may be given laxatives or gastrointestinal motility drugs. However, dependence on laxatives is a possibility and their use should be monitored closely. If there is an underlying cause for the constipation, such as low thyroid levels or colon cancer, the primary disease is treated appropriately with medication or surgery (colectomy). |
Source: Medical Disability Advisor
| Most individuals can expect a full recovery and a return to normal bowel function. However, more severe gastrointestinal symptoms may appear if problems with constipation continue. If surgery is required to remove a cancerous portion of bowel, the individual may require an artificial opening (stoma) of the colon through the abdominal wall for the purpose of fecal elimination (colostomy). A colostomy may be temporary or permanent depending upon the portion of bowel that was surgically removed. |
Source: Medical Disability Advisor
- Colon cancer
- Irritable bowel syndrome (IBS)
- Low thyroid function (hypothyroidism)
- Multiple sclerosis
- Progressive systemic sclerosis
- Toxic inflamed colon (Hirschsprung's disease)
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Source: Medical Disability Advisor
- Family Physician
- Gastroenterologist
- General Surgeon
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Source: Medical Disability Advisor
| Physical activity should be increased and may involve a supervised ambulatory program, 2 to 3 times per week, 30 to 90 minutes per session (average 45 minutes). Individuals with poor muscle tone may benefit from exercising the abdominal muscles. |
Source: Medical Disability Advisor
- Diabetes
- Diseases of the large intestine, including colon tumors and diverticulitis
- Hemorrhoids, fissures, or other anorectal lesions
- Low thyroid function (hypothyroidism)
- Neurogenic disorders such as Hirschsprung's and Parkinson's disease
- Obesity
- Urinary tract infection
- Urinary tract stones
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Source: Medical Disability Advisor
| Complications resulting from constipation include hemorrhoids, anal fissures and anal sphincter spasm. Very often, chronic constipation is a symptom of an underlying disease state or condition, and complications may be associated with that condition. |
Source: Medical Disability Advisor
| Length of disability depends on the underlying condition. |
Source: Medical Disability Advisor
| Most individuals will have no work restrictions or accommodations while being treated for constipation. However, restriction to light or sedentary work for 4 to 6 weeks may be required when an individual returns to the job after recovery from surgery. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual fit the criteria for constipation?
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What is the underlying cause of constipation?
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Does individual have an underlying medical condition that may complicate treatment or impact recovery?
Regarding treatment:
- If there is an underlying cause for the constipation, such as low thyroid levels or colon cancer, was the primary disease treated appropriately? Is treatment for the underlying disorder effective? Will the individual require surgery to correct the underlying disorder?
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Is the individual compliant with modification of dietary fiber and fluid intake?
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Does individual exercise routinely?
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If individual is taking laxatives, stool softeners, or medication to improve gastrointestinal muscle function, has he or she become dependent on these drugs to have a bowel movement? How can individual be effectively weaned off medication?
Regarding prognosis:
- Has constipation resolved or become less frequent?
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Has individual been compliant with treatment regimen? If not, what can be done to enhance compliance?
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Has underlying condition responded to treatment?
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If constipation was due to bowel cancer, was a colostomy required? Will it be temporary or permanent?
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Have complications occurred as a result of the underlying disease or condition that caused the constipation? Are complications responding to treatment?
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Source: Medical Disability Advisor
| Cited "Constipation." National Digestive Diseases Information Clearinghouse. National Institute of Diabetes and Digestive and Kidney Diseases. 20 Sep. 2004 <http://digestive.niddk.nih.gov/ddiseases/pubs/constipation/index.htm>. |
Source: Medical Disability Advisor