1. SAURABH WANI
PGDPM
GARWARE COLLEGE

3. DEFINE CONSTIPATION
• Constipation is associated with
symptoms in which patients
complains off very hard stools and
finds difficulty in defecation as he
needs to strain during defecation

4. CAUSES OF CONSTIPATION
SIMPLE
CONSTIPATION
• INADEQUATE FIBRE INTAKE
• INADEQUATE FLUIDS INTAKE
• LACK OF PHYSICAL ACTIVITY
• IGNORING TO DEFECATE
SECONDARY CONSTIPATION
• CAUSED BECAUSE OF DRUGS
• ANORECTAL DISORDERS
• ASSOCIATED WITH DIABETIS
MELLITUS

5. ANAL FISSURES HEMORRHOIDS

6. DIAGNOSIS OF CONSTIPATION
• CAREFULL CLINICAL HISTORY OF PATIENT IS TAKEN
• PHYSICAL EXAMINATION ROUTINE BLOOD,URINE
AND STOOL TEST
• OTHER DIAGNOSTIC TEST FOR DIAGNOSIS OF
CONSTIPATION INCLUDES SIGMOIDOSCOPY AND
COLONOSCOPY

7. • Sigmoidoscopy is medical examination of
large intestine from the rectum through the
last part of colon
• Colonoscopy is looking inside the colon and
used to evaluate symptoms like constipation
• PROCTOSCOPY procedure is essentially a
medical examination of the anal cavity or
rectum with the help of a special metal or
plastic scope that is known as a proctoscope

8. ENEMA IN CONSTIPATION
• Enema introduces liquids through a tube
inserted into the bowel. Enemas are
used to treat severe constipation and to
introduce fluids in patients who can't
receive them intravenously, as well as to
administer certain drugs in liquid
suspension. Done correctly, an enema is
safe, effective and a natural alternative
to laxatives

9. MANAGEMENT OF CONSTIPATION
• GENERAL MEASURES
• DIET
• LAXATIVES

10. GENERAL MEASURES
{1} ERADICATION OF ANY CAUSES LIKE DRUGS
{2} DOING MORE PHYSICAL ACTIVITIES
{3} ANY CALL TO STOOL MUST BE PROMPTLY
ANSWERED
{4} ALLOW SUFFICIENT TIME FOR DEFECATION
{5} ADEQUATE FIBRE INTAKE
{6} ADEQUATE FLUID INTAKE {1.5LITRE/DAY}

11. DIET
IN CASES OF CONSTIPATION IT IS
ADVISABLE TO TAKE DIET HAVING HIGH
CONTENT OF FIBRE
FIBRE IS PART OF PLANT MATERIAL WHICH
HELPS IN PROPER DIGESTION
WOMEN – 25grams/day
MEN – 38grams/day

12. LAXATIVES
• LAXATIVES ARE DRUGS WHICH PROMOTE
DEFECATION
• DEPENDING ON MECHANISM OF ACTION
LAXATIVES ARE CLASSIFIED AS
{1} BULK-FORMING LAXATIVES
{2} STIMULANT LAXATIVES
{3} OSMOTIC LAXATIVES
{4} EMOLLIENT LAXATIVES

13. BULK FORMING LAXATIVES
E.g.isphagula , agar
Bulk forming laxatives add mass to feces and
stimulate peristalsis and are useful in patients
with small and hard stools these laxatives
are to be taken with sufficient quantity of
water

14. Stimulant Laxatives
E g Sodium picosulphate, bisacodyl and senna
Stimulant laxatives act directly on large
intestine and do not act on small intestine except
[Senna and bisacodyl] these laxatives if taken
before going to bed produces entire bowel
movement till morning

15. Osmotic Laxatives
E g Milk of magnesia, Lactulose
When osmotic laxatives like milk of magnesia are
taken orally they are not absorbed and retained in
gastrointestinal tract. These exert an osmotic effect
basically they draw water from the cells in to the
intestinal lumen because of this bulk of intestine is
increased as result it facilitates clearing of bowel
tract.

16. Emollient laxatives
E g LIQUID PARAFFIN
Emollient laxatives basically softening agents
which helps in softening of hard stools
LIQUID PARAFFIN coats feces in colonic lumen
as a result there is decrease in water
reabsorption these leads to increase in bulk of
stool and softens stool significantly

17. DIFFERENT BRANDS AVAILABLE
LAXATIVES
• CREMAFFIN [ABBOTT]
• CREMAFFIN PLUS [ABBOTT]
• DUPHALAC [ABBOTT]
 SMUTH [ARISTO]
 AGAROL [PFIZER]
 DULCOLAX [GERMAN REMEDIES]
 CREMALAX [ABBOTT]
FIBRES
• NATUROLAX [MSD]
• CREMADIET [ABBOTT]
• CREMADIET DUO [ABBOTT]
• LACTIFIBER [SUN]
• LAXITOL [MACLOEDS]
• SOFTOVAC [LUPIN]

18. PHENOLPTHALEIN CONSTIPATION
Phenolphthalein has been used over
a century as a laxative but now it is
removed from over the counter
laxatives because of concerns of
carcinogenicity

19. EPIDEMIOLOGY OF
CONSTIPATION
• Constipation occurs in 2% to 20% of the population. It is more
common in women, the elderly and children. The reasons it occurs
more frequently in the elderly is felt to be due to an increasing
number of health problems as humans age and decreased physical
activity.
• 12% of the population worldwide reports having constipation.
• Chronic constipation accounts for 3% of all visits annually to pediatric
outpatient clinics.
• Constipation-related healthcare costs total $6.9 billion in the US
annually.
• More than four million Americans have frequent constipation,
accounting for 2.5 million physician visits a year.
• Around $725 million is spent on laxative products each year in
America.