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CONDITION/DISORDER SYNONYMS

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  • Obstructed defecation

  • Pelvic floor dyssynergia

  • Paradoxical puborectalis syndrome

  • Anismus

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ICD-9-CM CODES

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  • 564 Constipation

  • 564.02 Outlet obstruction constipation

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ICD-10-CM CODES

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  • K59 Constipation

  • K59.02 Outlet obstruction constipation

  • R32 Unspecified urinary incontinence

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PREFERRED PRACTICE PATTERN

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  • As of June, 2014, the APTA Guide to Physical Therapist Practice does not include practice patterns for organ system pathology; therefore, the associated or secondary musculoskeletal, cardiovascular/pulmonary, or potential neuromuscular patterns would be indicated.

  • 4C: Impaired Muscle Performance1

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PATIENT PRESENTATION

A 40-year-old mother of three reports difficulty passing bowel movements (BMs). Symptoms have gradually worsened over the past 5 years since the birth of her third child. During that vaginal delivery, she suffered a fourth degree perineal tear which extended into the anal sphincter and rectal mucosa. She is now having BMs once every 3 to 4 days, as compared to daily just a few years ago. She reports that she has to “splint” her perineum with her hand, in order to evacuate her bowels.

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KEY FEATURES

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Description
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  • Difficulty passing feces

  • Obstructed defecation is also known as anismus, sphincter dyssynergia, nonrelaxing puborectalis

    • Pelvic floor muscles (PFMs) and external anal sphincter inappropriately contract instead of relaxing during defecation

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General Considerations
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  • Constipation is a symptom, and is not a disease

  • Constipation is the most common digestive complaint

  • The chief cause of constipation is inadequate alimentary fiber content

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FIGURE 36-1

Abdominal radiograph of an 83-year-old man with Parkinson disease and long-standing symptoms of continuous fecal leakage. As his caregiver at home, his wife was changing his clothing up to six times a day. The rectosigmoid colon is completely impacted, and the dilated bowel loop implies obstruction. He was briefly hospitalized for disimpaction with enemas and laxatives, resulting in complete resolution of incontinence. He and his wife were educated in regular use of laxatives and suppositories, as well as in lifestyle measures. (From Halter JB, Ouslander J, Tinetti M, Studenski S, High K, Asthana S. Hazzard’s Geriatric Medicine and Gerontology. 6th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Graphic Jump Location
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Demographics2
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  • In the United States, estimates are between 2% and 34%

    • 16.7% (1 in 6 people)

    • 6% of children

    • 80% of nursing home residents

    • In children: More common in males than females

    • In adults: More common in females than males

    • Very common during pregnancy and postpartum

    • In elders: Equally as common in males and females

    • More common in non-Whites than Whites

  • More than three million prescriptions per year for laxatives; over $725 million on over-the-counter laxatives

  • In patients with constipation, 15% to 38% have obstructed defecation3

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CLINICAL FINDINGS

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