Digital rectal examination should be done, among others, to determine the size and condition of the rectum and the amount and consistency of stool.
Digital rectal can provide information about:
- Rectal tone.
- Sphincter tone and strength.
- Pubo-rectal muscle strength and pelvic floor muscles.
- Is there a mass pile of feces ?
- Is there another mass (eg haemorrhoids) ?
- Is there blood ?
- Are there injury in the anus ?
Laboratory tests associated with efforts to detect risk factors cause constipation, such as blood glucose, thyroid hormone levels, electrolytes, anemia associated with bleeding from the rectum, and so on. Other procedures such as anoscopy done routinely recommended in all patients with constipation to find there any fissures, ulcers, haemorrhoids and malignancy.
Abdominal plain radiography should be performed in patients with constipation, especially the occurrence of acute. This examination can detect there a fecal impaction and hard fecal masses that can cause blockage and perforation of the colon. If there were an estimated colonic obstruction, can be followed by barium enema to ensure a place and nature of the obstruction. Intensive examination is done selectively after 3-6 months of treatment of constipation is less successful and performed only at centers managing certain constipation.
Many kinds of drugs that are marketed for constipation, stimulating efforts to provide symptomatic treatment. Meanwhile, when possible, treatment should be directed at the cause of constipation. Long-term use of laxatives that are primarily stimulates intestinal peristalsis, should be limited. Treatment strategy is divided into:
1. Non-pharmacological treatment
Exercise colon: colon train is a suggested form of exercise behavior in patients with otherwise unexplained constipation. Patients are encouraged to hold a regular time each day to take advantage of large bowel movement. The recommended time is 5-10 minutes after eating, so it can take advantage of the gastro-colonic reflex to defecate. It is expected that this habit can cause sufferers to respond to the signs and induce bowel movements, and do not resist or postpone the urge to defecate.
Diet: The role of diet is important for constipation, especially in the elderly group. Epidemiological data indicate that a diet containing plenty of fiber reduces the incidence of constipation and various other gastrointestinal diseases, such as colorectal cancer and diverticular. Fiber increases stool weight and mass and shorten transit time in the gut. To support the benefits of fiber, adequate fluid intake is expected around 6-8 glasses a day, if there are no contraindications for fluid intake.
Sports: Pretty in activities or mobility and exercise help overcome constipation, walk or jog conducted in accordance with the age and ability of the patient, will invigorate the circulation and to strengthen the abdominal muscles of the abdominal wall, especially in patients with atony on the abdominal muscles .
2 Pharmacologic Treatment
If less successful behavior modification, pharmacological therapy is added, and is usually used class of laxative drugs. There are 4 types of laxative drug classes:
Enlarge and soften the stool mass.
Soften and lubricate the stool, this medicine works by lowering the surface tension of the stool, making it easier for water absorption.
Osmotic classes that are not absorbed, so it is quite safe to use, for example in patients with renal failure.
Stimulates peristalsis, thereby increasing the motility of the colon. This group is widely used. It should be noted that this class of laxatives can be used for long-term, can result in plexus mesentericus damage and colonic dysmotility.
When encountered severe chronic constipation and can not be solved by means of the above, surgery may be needed. Pasa generally, if not found a blockage due to the presence of a mass or volvulus, surgery was not performed.