TAILIEUCHUNG - Chapter 040. Diarrhea and Constipation (Part 17)

Constipation: Treatment After the cause of constipation is characterized, a treatment decision can be made. Slow-transit constipation requires aggressive medical or surgical treatment; anismus or pelvic floor dysfunction usually responds to biofeedback management (Fig. 40-4). However, only ~60% of patients with severe constipation are found to have such a physiologic disorder (half with colonic transit delay and half with evacuation disorder). Patients with spinal cord injuries or other neurologic disorders require a dedicated bowel regime that often includes rectal stimulation, enema therapy, and carefully timed laxative therapy. Patients with slow-transit constipation are treated with bulk, osmotic, prokinetic, secretory, and stimulant. | Chapter 040. Diarrhea and Constipation Part 17 Constipation Treatment After the cause of constipation is characterized a treatment decision can be made. Slow-transit constipation requires aggressive medical or surgical treatment anismus or pelvic floor dysfunction usually responds to biofeedback management Fig. 40-4 . However only 60 of patients with severe constipation are found to have such a physiologic disorder half with colonic transit delay and half with evacuation disorder . Patients with spinal cord injuries or other neurologic disorders require a dedicated bowel regime that often includes rectal stimulation enema therapy and carefully timed laxative therapy. Patients with slow-transit constipation are treated with bulk osmotic prokinetic secretory and stimulant laxatives including fiber psyllium milk of magnesia lactulose polyethylene glycol colonic lavage solution lubiprostone and bisacodyl. Newer treatment aimed at enhancing motility and secretion may have application in circumstances such as constipation-predominant IBS in females or severe constipation. If a 3- to 6-month trial of medical therapy fails and patients continue to have documented slow-transit constipation unassociated with obstructed defecation the patients should be considered for laparoscopic colectomy with ileorectostomy however this should not be undertaken if there is continued evidence of an evacuation disorder or a generalized GI dysmotility. Referral to a specialized center for further tests of colonic motor function is warranted. The decision to resort to surgery is facilitated in the presence of megacolon and megarectum. The complications after surgery include small-bowel obstruction 11 and fecal soiling particularly at night during the first postoperative year. Frequency of defecation is 3-8 per day during the first year dropping to 1-3 per day from the second year after surgery. Patients who have a combined evacuation and transit motility disorder should pursue pelvic floor .

• Y học thường thức
• Diarrhea and Constipation
• bệnh học và điều trị
• bài giảng bệnh học
• tài liệu học ngành y
• Harrisons Internal Medicine
• Chronic Constipation
• Indigestion
• Autogenetic Poisons
• Diarrhea
• Piles
• medical books
• pharmacology
• epidemiologic
• Obstetrics
• anatomy
• Preventing Morbidity
• Multidisciplinary Care