Internal Medicine

0521779407-C03 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:54

394 Conjunctival Tumors Constipation and Fecal Impaction

complications and prognosis

n/a

Constipation and Fecal Impaction........................

GEORGE TRIADAFILOPOULOS, MD

history & physical

History

■Constipation: lack of urge for defecation; infrequent and hard stools;

difficult and painful defecation with straining; <3 bowel movements

per week

■Common predisposing factors: low fiber diet, sedentary lifestyle,

old age, previous gynecologic or pelvic surgery, diabetes mellitus,

hypothyroidism, depression, chronic pharmacologic therapy with

psychotropics, calcium channel blockers, aluminum or calcium

antacids, opiates, or anticholinergics, irritable bowel syndrome,

diverticulosis, chronic neurological disease, and anorectal dysmotil-

ity

■Severe idiopathic chronic constipation: predominantly a disease of

women

Signs & Symptoms

■Acute constipation (with or without fecal impaction): nausea, vom-

iting, abdominal distension and lack of stool evacuation; passage of

flatus may or may not be present

■Physical exam not generally helpful, except for rectal examination:

fissures or hemorrhoids, abnormal contraction of the puborectalis

and external anal sphincter muscles

tests

Basic Tests

■CBC, routine chemistries, stool for occult blood, thyroid function

tests are important to evaluate metabolic or endocrine causes; plain

abdominal film of the abdomen can detect significant stool retention

and megacolon

Specific Diagnostic Tests

■Colonic transit study: passage of swallowed radiopaque markers

through the colon monitored by abdominal radiograph on day 5 after

ingestion distinguishes several subtypes of chronic constipation: