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Clinical Problems of Constipation Y. Nao 1,2 , Y. Murakami 2 , A. Machii 2 , M. Sato 2 1Insitute of Gastroenterology, Tokyo Women's Medical College 2Dept. of Int. Med., Tokyo Metropolitan Toshima Hospital pp.1267-1276
Published Date 1971/9/25
DOI https://doi.org/10.11477/mf.1403111569
  • Abstract
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1) Definition of constipation

 When there is either no defecation for more than three or four days or the stool is of insufficient amount even if defecation occurs daily, it is then called constipation. When associated further with pain and requiring medical management, the above mentioned symptoms can be regarded as constipation.

2) Originating mechanism

 Three phases are observed in defecation. Firstly, the stool enters the rectum from the sigmoid initiated by gastro-colonic reflex and its stimulus is conveyed to the spinal center, producing an urge to defecate. In the second place, through the urge the abdominal pressure is heightened and the contents of the colon are pushed downward, and by the contraction of the rectum they are propelled further. Thirdly, the stool is evacuated through the relaxation of the external sphincter. Any disturbance in this defecative mechanism causes constipation.

3) Causes of constipation

 Broadly they can be classified into passage disturbances of the bowel contents, abnormal morphology and disturbed function of the large intestine and clifficulty in defecation.

4) Classification

 The authors have divided constipation as follows: -

 1. Functional constipation

  a) transient simple constipation

  b) habitual constipation

   (1) atonic constipation

   (2) spastic constipation

   (3) rectum type functional constipation

 2. Organic constipation

  a) constipation due to passage hindrance of the bowel

  b) constipation through abnormal morphology of the colon.

5) Symptoms

 Transient constipation, also called environmental constipation, occurs following change in diet or mode of living. Most of spastic constipation belong to constipation type in the irritable colon syndrome and, as is different from atonic type, is often accompanied with abdominal pain. Many patients with spastic constipation tend to be nervous and complain of symptoms belonging to autonomic ataxia.

6) Differential diagnosis

 History taking, associated symptoms, examination of the stool, x-ray and endoscopic studies of the colon are very important factors in the discrimination between functional and organic constipations. Sometimes further diagnostic adjuncts may become necessary, such as character study, examination of the autonomic nervous system, and study in blood electrolytes, especially in kalium level.


Copyright © 1971, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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