Apr

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Obstipation

10-04-2011

Obstipation is the failure to pass fecal matters or gas, practically a chronic constipation.  It is a state where the intestines are never fully emptied and would eventually lead to obstruction.

There is no definite diagnostic exam for obstipation. Identification of the condition is frequently made based on the patient’s medical history and the presenting signs and symptoms.

A person who is chronically constipated would feel bloated most of the time which could lead to anorexia and abdominal discomfort or tenderness. If not treated as soon as possible, it can develop into more serious problems. If the bowel is not emptied, toxins would accumulate which could lead to infection, inflammation and a foul breath or body odor. Prolonged inflammation may interrupt the blood supply to the intestines which could lead to intestinal collapse or cramps, peritonitis, fever, body malaise and tachycardia. Intestinal distention may arise which would affect the intestinal peristaltic movement and secretory function.  The intestines would also lose their ability to absorb water and nutrients. Other physical symptoms would arise such as dehydration, nausea and vomiting.

Constipation is the condition wherein an individual has three or less bowel movements in one week; lacks a regular bowel movement. The stool is dry and hard to eliminate making the person strain during bowel movement. Individuals who are constipated sometimes feel pain during the process of elimination.

Obstipation, on the other hand, is a severe, persistent constipation that may be due to intestinal obstruction.

Chronic constipation can be caused by several factors such as:

  • Low fiber diet (regular fiber diet is an intake of 20 to 35 grams of fiber per day and a very high fiber diet contains 50 to 60 grams of fiber per day)
  • Decreased water intake
  • Intestinal obstruction
  • Fecal impaction
  • Anal fissure
  • Adhesions in the peritoneum
  • Fecalith
  • Gallstone ileus
  • Hypokalemia
  • Hypothyroidism
  • Functional constipation
  • Colonic stricture
  • Intestinal atresia
  • Intussusception – the intestines fold into itself which causes obstruction

Although there is no definite diagnostic exam, obstipation can be seen through abdominal CT scans or x-rays, barium enema, upper GI series, sigmoidoscopy or colonoscopy.

The main aspect for the treatment of chronic constipation is changing the diet. Food high in fiber (linseed, corn grain, bran, and psyllium) and increased free fluids intake to at least three liters per day should be encouraged. Free fluids are those that do not need to undergo metabolic processing such as water, herbal teas and vegetable broth. Fruit juices, coffee, alcohol and milk are not included. The free fluids should be taken in between meals and not in the course of the meal.

Exercise is promoted to help increase the circulation of the oxygen to the intestine and improve peristalsis. Consuming walnuts daily would help constipated individuals as these would act as laxatives. Bitters (found in artichoke, chicory and radicchio) help stimulate bowel functions through the activation of the gallbladder and liver; and would result to forceful peristalsis and eventually defecation.

Medical therapy would involve the use of laxatives such as lactulose (hyperosmotic laxative) or bisacodyl (stimulant laxative). Enemas, aluminum magnesium, irritant cathartics and emollient suppositories may also be used to promote evacuation of fecal matter.

If severe dehydration is present, the need for intravenous fluids would be necessary to help restore the fluid and electrolyte balance. Presence of severe pain would be an indication to use antispasmodics or narcotic analgesics. However, this should be given for a short period only.

Severe obstruction would require colonoscopy or laparoscopic surgery.

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