notes by dr Claudio
Italiano
One of the most frequent problems that the gastroenterologist must encounter, especially from the women is the problem of constipation, as a variety of irritable bowel syndrome. These are women suffering from internal conflicts. They suffer because of their partner and family problems, exasperated by the psychological defense of their "look", by the way of being and doing, who have had a difficult childhood, and have not acquired the " adult objects ", which are introverted and fought by emotional states, stress, depression, who live pressed by haste, feed badly, make fiber-free diets, for fear of the swollen belly.
Let's see in brief what are the causes that determine constipation, which
meanwhile we can frame between functional causes, where, that is, the segmenting
movements are responsible for slowed intestinal transit, to the detriment of the
motor activity of the colon, ie the propulsive. We are also talking about the
new women managers, always impeccable, in their career that repress their
impulse to defecation because it is unbecoming for a lady to go to the toilet
during a meeting. In other cases we talk about the simple employeds who have learned
to serve the client and to block his physiological functions.
- Low-slag diet, for example in patients who eat fast-food, with chips and
hamburgers.
- Foods producing scibalous masses, ie goat feces (eg cheese, etc.)
- Atony of the musculature of the colon, for example in the diabetic with
dysautonomia (cfr neuropathy), hypercalcemia, hypopotassemia, porphyria,
phaeochromocytoma,
- Dysynetic forms, for example in women, psychogenic, irritable bowel syndrome.
- Neurological disorders: autonomic neuropathy, amyloidosis, diabetes,
paraneoplastic diseases, Chagas disease, neurofibromatosis, ganglioneuromatosis,
Hirschprung disease and variants, lumbar discopathy, dorsal tabe, multiple
sclerosis, Parkinson's disease, stroke, brain neoplasms
- Forms related to the habit of life, haste, sedentary life, stress
- Post-diarrheal (see Diarrhea - pathophysiology)
- Post-smoking
- Iatrogena (use of densifying drugs (mucilage), opiate-derived drugs,
loperamide, anticholinergics
-Obstruction, megacolon, stenotic lesions: neoplasms, diverticulitis,
inflammatory stenosis, ischemia, volvulus, endometriosis
-Appendicitis, diverticulitis
- Masses that compress, (postoperative synechia, uterine fibroids, dermoid cysts,
etc.)
- anal fissures
- Disorders of the anorectal region and of the colon
- Hemorrhoids
- Stenosing tumors (cancer)
- Systemic diseases (m.autoimmune)
The international congress held in Rome establishes the symptoms necessary to
talk about constipation. To talk about functional constipation, a patient must
have the following symptoms:
effort in at least 25% of defecations
- lumpy or hard stools in at least 25% of defecations
- feeling of incomplete evacuation in at least 25% of defecations
- sensation of obstruction / ano-rectal blockage in at least 25% of defecations
- manual facilitation maneuvers in at least 25% of defecations (eg digital
defecation, pelvic floor support) with less than 3 bowel movements per week
- fluid defecations are rarely present without the help of laxatives
- insufficient criteria for IBS