Constipation

(Focus on Diabetes
and co-
medications causing
constipation)
Overview
Introduction

Epidemiology

Risk factors and pathophysiology

Constipation in diabetes and due to co-

medications

Diagnosis & Management of constipation

Summary
Introduction
Constipation is chronic problem in many
patients all over the world

Most people are affected at some time in their life

Can be severe & chronic

Has a significant, even debilitating, effect on

quality of life

J Am Board Fam Med 2011;24(4): 436-451,

Definition of constipation

According to the
patients
According to
physicians - hard stools, a feeling of
incomplete evacuation,
Infrequent bowel
abdominal discomfort,
movements, typically
bloating, and distention,
fewer than 3/week
excessive straining, blood
in stool etc.

J Am Board Fam Med 2011;24(4): 436-451,

 Epidemiology
Symptoms of constipation are extremely
common

2-27% of world population affected

In India, prevalence is about 15%

At least 65% of patients suffering from

constipation do not seek immediate medical
advice, instead use multiple home
remedies/Ayurvedic preparations

J Am Board Fam Med 2011;24(4): 436-451,

American Gastroenterological Association Medical Position Statement on Constipation. GASTROENTEROLOGY 2013;144:211217,
A SPECIAL 2012 WDHD SUPPLEMENT - WGO Foundation
Risk Situations, Group & Factors of
Constipation

Infants and children, People over the age of 55

Limited mobility & inadequate diet (fluid or fiber)
Medications (polypharmacy), especially in the
elderly
Known comorbidities
Recent abdominal or perianal/pelvic surgery
Terminal care patients
Travel
History of chronic constipation

American Gastroenterological Association Medical Position Statement on Constipation. GASTROENTEROLOGY 2013;144:211217

Constipation Based on
pathophysiology

Primary
Secondary
(idiopathic)

American Gastroenterological Association Medical Position Statement on Constipation. GASTROENTEROLOGY 2013;144:211217

Primary (functional)
constipation
Based on colonic transit time:
Normal
transit Most common
Frequently
overlaps with
constipatio IBS-C
n
Slow transit Reduced
Common in
constipatio phasic colonic
women
motility
n
Poor
Considerable
Pelvic floor coordination of
pelvic floor
overlap
dysfunction between STC
and anorectal
& NTC
muscles

American Gastroenterological Association Medical Position Statement on Constipation. GASTROENTEROLOGY 2013;144:211217

Secondary constipation

American Gastroenterological Association Medical Position Statement on Constipation. GASTROENTEROLOGY 2013;144:211217

Constipation in diabetes
One of the most common complications of
diabetes.

Up to 44 percent of patients with diabetes

reported symptoms of constipation or increased
use of laxatives.

Neuronal dysfunction in the large bowel, along

with impairment of the gastrocolic reflex,
results in constipation.

Am Fam Physician.2008Jun15;77(12):1697-1702.
Constipation in Diabetes
It is important to rule out other causes of
constipation such as hypothyroidism or
medications. A thorough history and physical
examination, including a rectal examination,
should be performed.

Symptomatic management includes good

hydration, regular physical activity, and
increased fiber intake. osmotic laxatives
may be needed in more severe cases.
Co-medications causing
constipation
Various commonly used medications may cause
constipation

Risk depends on dose and duration of therapy

as well as GI comorbidity
Medications causing
constipation
Detailed history taking plays an important role
to identify the cause of constipation

Replacing the offending drug with better

alternative often helps, but may not always
possible.

Symptomatic treatment with appropriate

laxative is the right choice in these cases.
Diagnosis of Constipation
History
- duration of complaint
- patients definition of constipation
- Posture during defecation
- Defecation frequency, stool consistency
- Concurrent medications
- Comorbidities
- Use of supplements or laxatives
- Lifestyle enquiry regarding the level of fluid intake,
dietary
fiber consumption, and daily exercise.

American Gastroenterological Association Medical Position Statement on Constipation. GASTROENTEROLOGY 2013;144:211217

Management of
constipation
Both non-pharmacological and pharmacological
approaches are equally important

Finding out cause of constipation by through

history taking is very critical.

Worsening of constipation can be prevented if

secondary causes are addressed adequately and
eliminated.

Symptomatic management is done by using

appropriate laxatives.

Lwc liu. chronic constipation: current treatment options. Can J gastroenterol 2011;25(suppl B):22B-28B
Management Pyramid for Patients
with Chronic Constipation

Lwc liu. chronic constipation: current treatment options. Can J gastroenterol 2011;25(suppl B):22B-28B
Laxatives
Offers symptomatic treatment

Stefan Muller-Lissner. Expert Opin. Drug Metab. Toxicol. (2013) 9(4):391-401

Fiber Supplements
 Mineral Oil (Emollients)

Lissner SM. Pharmacokinetic and pharmacodynamic considerations for the current chronic constipation treatmentsExpert Opin. Drug Metab. Toxicol.
 Osmotic Laxatives

Lissner SM. Pharmacokinetic and pharmacodynamic considerations for the current chronic constipation treatmentsExpert Opin. Drug Metab. Toxicol.
 Irritant or stimulant
laxatives

Lissner SM. Pharmacokinetic and pharmacodynamic considerations for the current chronic constipation treatmentsExpert Opin. Drug Metab. Toxicol.
Summary