0521779407-C03 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:54
396 Constipation and Fecal Impactionshould initially be disimpacted and the colon evacuated effectively
by drinking a balanced electrolyte solution containing polyethylene
glycol.Treatment Options
■Constipation is treated medically with any of the following, used
alone or in combination: 1) Stimulant laxatives; 2) Saline cathartics,
and hyperosmolar cathartics or osmolar cathartics; 3) Mineral oil; 4)
Bulk forming agents; 5) Polyethylene glycol; or 6) Stool softeners.
■Some patients with severe constipation have been treated success-
fully with misoprostol, which enhances colonic contractility
■Enemas or glycerine suppositories may be administered if there is
no success with oral therapy, to prevent fecal impaction
■Behavioral therapy may be effective in patients with neurogenic con-
stipation, dementia, or those with physical impairments
■Subtotal colectomy with ileorectal anastomosis can dramatically
ameliorate incapacitating constipation in patients with colonic
inertia
■Surgical repair of a rectocele and/or rectal intussusception may not
alleviate constipation unless improved rectal evacuation when pres-
sure is placed on the posterior wall of the vagina during defecation
is evident
■Surgery is the treatment of choice for Hirschsprung’s diseasefollow-up
During Treatment
■Increasing fiber may cause gaseousness and bloating over the period
of the first 4–6 weeks; increase fluid intake (6–8 glasses per day)Routine
■Bowel retraining is useful as it enhances the efficiency of the gastro-
colic reflex leading to postprandial defecationcomplications and prognosis
Complications
■Abuse of laxatives: melanosis coli.
■In elderly and sedentary adults with severe constipation: fecal
impaction with acute or subacute intestinal obstruction may occur
■Acute colonic pseudo-obstruction (Ogilvie’s syndrome): urgent
medical or endoscopic decompression