Constipation diagnostics: fibrocolonoscopy, coprogram

Constipation is a difficult and rare bowel movement, a hard stool consistency and a feeling of incomplete emptying of the rectum.

Many people mistakenly believe that daily bowel movement is necessary, and complain of stool retention in the case of more rare bowel movements. Others are concerned about the appearance (size, shape, color) or stool consistency. Sometimes the main complaint is dissatisfaction with the act of defecation. Stool retention can be the cause of many complaints (abdominal pain, nausea, fatigue, anorexia), which are actually signs of underlying pathology (eg, irritable bowel syndrome, depression). Patients should not assume that all symptoms will disappear with daily bowel movements.

Because of these problems, many people abuse laxatives, suppositories and enemas. This can lead to somatic changes, including atony of the colon (a symptom of a “water pipe” with characteristic smoothing or lack of wrinkles detected during irrigoscopy and resembling ulcerative colitis) and colon melanosis (deposits of brown pigment in the mucous membrane detected during endoscopy and in biopsies) preparations of the large intestine).

Patients with obsessive states often feel the need to daily rid the body of "dirty" waste. Depression can result from a lack of daily bowel movement. The condition may progress, while depression helps reduce the frequency of bowel movements, and its absence aggravates depression. Such patients often spend a lot of time and effort on the toilet or become chronic users of laxatives.

Anamnesis

A history should be collected regarding the frequency, consistency, and color of the stool throughout life, including the use of laxatives or enemas. Some patients deny stool retention in history, but if they are asked specific questions, they are recognized in a 15–20 minute defecation procedure. An attempt should be made to determine the cause of metabolic and neurological disorders. It is necessary to find out the use of prescribed or over-the-counter medicines.

Chronic stool retention with frequent use of laxatives suggests colonic atony. Chronic stool retention without sensations of urging to defecate implies neurological impairment. Chronic stool retention, alternating with diarrhea and associated intermittent abdominal pain, suggests irritable bowel syndrome. The first time delayed stool that persists for several weeks or develops periodically with increasing frequency and severity suggests a colon tumor or other causes of partial obstruction. A decrease in stool volume implies an obstructive lesion of the distal colon or irritable bowel syndrome.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Physical examination

A general examination reveals manifestations of systemic disease, including fever and cachexia. Tension of the anterior abdominal wall, abdominal distention and tympanitis indicate mechanical obstruction. Abdominal mass lesions are diagnosed by palpation, rectal examination allows to estimate the sphincter tone; sensitivity; the presence of cracks, strictures, blood and voluminous formations (including coprostasis).

[10], [11]

Study

Stool retention in identified etiology (medication, trauma, prolonged bed rest) does not require further investigation and is subject to symptomatic therapy. Patients with signs of intestinal obstruction require radiography of the abdominal cavity in a horizontal and vertical position and, if indicated, in CT. Sigmoscopy and colonoscopy, as well as laboratory tests (complete blood count, fasting hormone levels and fasting blood glucose, electrolytes and Ca) should be performed for most patients with unclear etiology.

Further examination is usually necessary in patients with an unspecified cause or failure of symptomatic therapy. If the patient’s primary complaints relate to rare bowel movements, the passage time through the large intestine should be measured using a radiopaque passage. If the primary complaints are related to the need for strong straining during bowel movements, anorectal manometry is most appropriate.

[12], [13], [14], [15], [16], [17], [18], [19], [20]

Anamnesis

A history of frequency, consistency, stool color throughout life, including the use of laxatives or enemas should be collected. Some patients deny a history of stool, but if they are asked specific questions, are recognized in the 15-20 minute procedure for defecation. You should try to determine the cause of metabolic and neurological disorders. It is necessary to find out the use of prescription or over-the-counter medicines.

Chronic chair delay with frequent use of laxatives suggests colonic atony. Chronic chair delay without sensations of urge to defecate suggests neurological disorders. Chronic chair delay, alternating with diarrhea and associated intermittent abdominal pain, suggests irritable bowel syndrome. The first delay in the stool, which persists for several weeks, or develops periodically with increasing frequency and severity, involves colon swelling or other causes of partial obstruction. A decrease in the stool volume suggests an obstructive lesion of the distal colon or irritable bowel syndrome.

Physical examination

General examination reveals manifestations of a systemic disease, including fever and cachexia. The tension of the anterior abdominal wall, abdominal distension and tympanitis indicate mechanical obstruction. Volumetric abdominal cavity formations are diagnosed by palpation, rectal examination allows to assess the tone of the sphincter; sensitivity; presence of a crack, stricture, blood and volumetric formations (including coprostasis).

Study

Stool retention with the revealed etiology (medication, trauma, prolonged bed rest) does not require further research and is subject to symptomatic therapy. Patients with signs of intestinal obstruction need radiography of the abdominal cavity in a horizontal and vertical position and, according to indications, in CT. For most patients with unclear etiology, sigmoidoscopy and colonoscopy should be performed, as well as a laboratory examination (general blood test, thyroid stimulating hormone levels and fasting blood glucose, electrolytes and Ca).

Further examination is usually necessary in patients with an unidentified cause or ineffectiveness of symptomatic therapy. If the patient's initial complaints relate to a rare bowel movement, the passage time for the large intestine should be measured using an X-ray contrast passage. If primary complaints are associated with the need for severe straining during defecation, anorectal manometry is most appropriate.