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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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  • 564.0 Constipation

  • 564.02 Outlet dysfunction constipation

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ICD-10-CM Codes

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  • K59.0 Constipation

  • K59.02 Outlet dysfunction constipation

  • R32 Unspecified urinary incontinence

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Preferred Practice Patterns

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  • As of May 2013, the APTA's 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

  • Pattern 4C: impaired muscle performance1

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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, and non-relaxing puborectalis

    • Pelvic floor muscles 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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Demographics2

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  • In the U.S., estimates are between 2% to 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 3 million prescriptions per year for laxatives; over $725 million spent on over-the-counter laxatives

  • 15% to 38% of patients with constipation have obstructed defecation3

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Clinical Findings

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Signs and Symptoms4,5

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  • ROME-III criteria for constipation: in a patient who does not take laxatives or have IBS (Irritable Bowel Syndrome), patient has at least two of the following in any 12 weeks of the last 6 months

    • Straining more than 25% of BMs (bowel movements)

    • Fewer than three BMs/week

    • Sensation of incomplete evacuation/anorectal blockage more than 25% of BMs

    • Lumpy or hard stool in more than 25% of BMs

    • The necessity of digital manipulation to facilitate evacuation more than 25% of BM

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Functional Implications

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  • Headache

  • Decreased energy

  • Bad breath

  • Difficulty concentrating

  • Decreased appetite

  • Coating on the tongue

  • Abdominal bloating

  • Gas/flatulence

  • Skin problems

  • Depression

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Possible Contributing Causes

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  • Underactive, overactive, or non-functioning pelvic floor muscles

  • Medications: multiple medicines can cause constipation

  • Hormonal fluctuations: pregnancy, lactation, menopause

  • Neurological conditions: Parkinson's disease, multiple sclerosis

  • Diabetes mellitus

  • Scleroderma

  • Anorexia nervosa

  • Thyroid disease

  • Hyperparathyroidism

  • Hysterectomy

  • Dietary: inadequate fiber, fluid, weight loss

  • Poor defecation patterns, ignoring urge to defecate

  • Travel: change in food, time zones, stress

  • Change in routine: exercise, sleep, new job

  • Admission to hospital or nursing home

  • Decreased activity, bed rest

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Differential Diagnosis

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  • Hirschsprung's disease: aganglionosis

  • Colorectal neoplasm

  • Colorectal stricture, scarring

  • Diverticular ...

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