Constipation functional

There are two different mechanisms behind ordinary causes of constipation, functional and outlet obstructions. Functional constipation is caused by the slower movement of the colon, peristalsis, which comes with old age, often in combination with less physical activity and less intake of fibre containing food. Outlet obstruction is a result of incapacity to empty the rectum from faeces often due to too large masses of stool blocking the anus. It can also be caused by anal stricture from haemorrhoids or scar tissue caused by fissures. 

Irritable bowel syndrome (DBS) is an exceedingly common condition in all societies, characterized by abdominal discomfort or pain in association with altered bowel habit or incomplete stool evacuation, bloating and constipation or diarrhoea, easily go undetected and do not show up with common tests such as blood tests or x-rays. The estimated prevalence in the community is about 10%. Irritable bowel syndrome and its variants, collectively called functional gastrointestinal disorders, constitute 40-50% of all the patients seen by gastroenterologists in Western countries. 

During the ongoing assessment, the nurse checks vital signs and assesses bowel functioning because an adverse reaction to these drugp is constipation. Constipation may become serious if not treated. 

Normal-transit constipation (includes idiopathic or functional disorders)... 

Functional constipation (constipation occurring in the absence of a demonstrated pathologic condition) involves the presence of at least two of the following symptoms straining, lumpy or hard stools, sensation of incomplete evacuation, sensation of anorectal obstruction or blockage, need for manual maneuvers to facilitate defecation and/or, infrequent (fewer than three) bowel movements per week. 

Thyroid function tests abnormal thyroid hormone levels may suggest hypo- or hyperthyroidism, either of which may be associated with constipation. 

In patients with constipation, the principal goals are to (1) identify and treat secondary causes, (2) relieve symptoms, and (3) restore normal bowel function. 

Brandt L, Schoenfeld P, Prather C, et al. American College of Gastroenterology Functional Gastrointestinal Disorders Task Force. An evidence based approach to the management of chronic constipation in North America. Am J Gastroenterol 2005 100 S1-S21. 

The important adverse effects of the various antidepressants are often a function of their underlying pharmacologic profiles7,8 (Table 35-3). TCAs cause problematic sedative, anticholinergic, and cardiovascular adverse effects owing to their interaction with dirty receptors. While these adverse effects generally are considered to be common and bothersome, they can be quite serious in certain cases. For example, constipation in its... 

In the periphery, 5-HT4 receptor mRNA is found in vascular smooth muscle. Newly developed drugs that activate 5-HT4 receptors are of interest for their potential in treating cardiac arrhythmia. The 5-HT4 receptor is also located on neurons of the alimentary tract, for example the myenteric plexus of the ileum, and on smooth muscle cells and secretory cells of the gastrointestinal tract, where they evoke secretions and the peristaltic reflex. 5-HT4 receptor agonists (e.g. cisapride, prucalopride, tegaserod) are used therapeutically in the treatment of constipation-predominant irritable bowel syndrome and in functional motility disorders of the upper gastrointestinal tract. 

Amiodarone Tremor, ataxia, pareslfresia, insomnia, corneal microdeposits, optic neuropathy/neuritis, nausea, vomiting, anorexia, constipation, TdP (<1%), bradycardia or AV block (IV and oral use), pulmonary fibrosis, liver function test abnormalities, hepatitis, hypothyroidism, hyperthyroidism, photosensitivity, bluegray skin discoloration, hypotension (IV use), phlebitis (IV use)... 

A major goal for treatment of constipation is prevention of constipation by alteration of lifestyle (particularly diet) to prevent further episodes of constipation. For acute constipation, the goal is to relieve symptoms and restore normal bowel function. 

Sorbitol, a monosaccharide, has been recommended as a primary agent in the treatment of functional constipation in cognitively intact patients. It is as effective as lactulose and much less expensive. 

The adverse effects of antiandrogens are gynecomastia, hot flushes, GI disturbances, liver function test abnormalities, and breast tenderness. GI disturbances consist of diarrhea for flutamide and bicalutamide and nausea or constipation for nilutamide. Flutamide is also associated with methemoglobinemia, whereas nilutamide causes visual disturbances (impaired dark adaptation), alcohol intolerance, and interstitial pneumonitis. 

FGIDs present with variable combinations of chronic or recurring GI symptoms not explained by overt biochemical or structural abnormalities and encompass conditions like functional dyspepsia (FD), irritable bowel syndrome (IBS) and chronic idiopathic constipation [1], A variety of mechanisms that could explain the etiology of FGIDs are currently under investigation and include, but are not limited to altered GI motility, visceral hypersensitivity and post-infectious abnormalities [2],... 

Anti M, Pignataro G, Armuzzi A, Valenti A, Iascone E, Marmo R, Lamazza A, Pretaroli AR, Pace V, Leo F, Castelli A, Gasbar-rini G. Water supplementation enhances the effect of high fiber diet on stool frequency and laxative consumption in adult patients with functional constipation. Hepatogastroenterology 1998 45 727-732. 

In the second paragraph, the thyroid gland function is mentioned as slowing down—one effort on the part of the body to protect itself According to the second paragraph, dehydration contributes to constipation. 

Despite limited success with amitriptyline in some anorexia patients, using this class of antidepressants can be problematic in AN patients and therefore cannot be routinely recommended. TCAs slow gastrointestinal function and can therefore worsen the constipation and bloating that commonly plague AN patients during refeeding. In addition, TCAs can increase the likelihood of seizure or cardiac arrhythmia in patients already at risk due to electrolyte disturbances. Moreover, they are often lethal after overdose. 

When treating insomnia without depression, doxepin and amitriptyline (both tricyclic antidepressants) can be administered in low doses (25-100 mg) at bedtime. These antidepressants, however, do have troublesome anticholinergic side effects (dry mouth, constipation, blurred vision, dizziness) and adverse effects on the heart, and they can be lethal if taken in overdose. Because of their effect on heart function, these antidepressants should be avoided in patients with heart problems and administered cautiously, if at all, to those who are already receiving one of any number of newer antidepressants that inhibit the metabolism of the TCAs. 

Etidronate Convulsions, constipation, nausea, stomatitis, abnormal hepatic function, hypomagnesemia, hypophosphatemia, dyspnea, taste perversion, fever, fluid overload. 

Ora/-Adverse reactions requiring discontinuation include Pulmonary infiltrates or fibrosis paroxysmal ventricular tachycardia CHF elevation of liver enzymes visual disturbances solar dermatitis blue discoloration of skin hyperthyroidism hypothyroidism. Adverse reactions occurring in at least 3% of patients include CFIF Gl complaints (nausea, vomiting, constipation, anorexia) dermatologic reactions (photosensitivity, solar dermatitis) neurologic problems (malaise, fatigue, tremor/abnormal involuntary movements, lack of coordination, abnormal gait/ataxia, dizziness, paresthesias) abnormal liver function tests. 

---