Constipation Remedies

A systematic and detailed inquiry is extremely important, with particular attention to the onset of constipation (i.e., the precipitating event, if any). The history should also include the stool frequency and consistency, the degree of straining, the sensation of complete or incomplete evacuation, and the need for digital disimpaction of stool. A history of repeatedly ignoring the ''call to stool'' may contribute to constipation.

Dietary history should include the amount of fiber and fluid consumed and the frequency and time of eating and constipation remedies. Obstetric, surgical, and drug histories are useful, and reports of back trauma or neurological problems may provide significant clues. About 10% to 30% of patients with chronic constipation have a history of sexual abuse. In the elderly, fecal incontinence may be a presenting symptom of stool impaction and overflow.

Physical examination -- Abdominal examination may reveal a palpable colon with presence of stool, particularly in the left lower quadrant, but normal findings on examination are not uncommon. It is important to exclude gastrointestinal masses. Perianal inspection may reveal skin excoriation, skin tags, fissure in ano, or hemorrhoids. A careful rectal examination should be performed to feel for the presence of a mass or of stool. Resting and squeeze sphincter tone should also be noted. The patient should be asked to bear down as if to defecate. During this maneuver, relaxation of anal tone together with perinea descent should be perceived. The absence of anal relaxation and/or inadequate perinea descent suggests obstructive defecation.

Diagnostic procedures -- The first step is to exclude underlying pathologic or metabolic disturbances. An organic lesion can be excluded on the basis of a complete blood cell count, biochemical profile, thyroid function tests, calcium- and glucose-level estimation, stool examination for ova and parasites and occult blood, and flexible sigmoidoscopy. If no obvious pathologic condition is found, a therapeutic trial of a high-fiber diet with bran or psyllium supplements is appropriate. If dietary measures are unsuccessful, second-line investigations should be undertaken.

Colonic transit time can be assessed by one of several available methods. The simplest test consists of administering a single Sitzmarks capsule (Konsyl Pharmaceuticals, Fort Worth, Texas) containing 24 radiopaque markers and obtaining a flat-plate film of the abdomen 5 days after administration.

The presence of five or more markers on the film suggests slow transit or sluggish propulsion of stool through the colon12 Patients with obstructive defecation may also have delayed transit on this test. However, unlike patients with slow-transit constipation, who have markers distributed throughout the colon, patients with obstructive defecation usually have more markers in the rectosigmoid segment