Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Obstructed defecationPelvic floor dyssynergiaParadoxical puborectalis syndromeAnismus ++ 564.0 Constipation564.02 Outlet dysfunction constipation ++ K59.0 ConstipationK59.02 Outlet dysfunction constipationR32 Unspecified urinary incontinence ++ 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 indicatedPattern 4C: impaired muscle performance1 +++ Description ++ Difficulty passing fecesObstructed defecation is also known as anismus, sphincter dyssynergia, and non-relaxing puborectalisPelvic floor muscles and external anal sphincter inappropriately contract instead of relaxing during defecation +++ General Considerations ++ Constipation is a symptom and is not a diseaseConstipation is the most common digestive complaintThe chief cause of constipation is inadequate alimentary fiber content +++ Demographics2 ++ In the U.S., estimates are between 2% to 34%16.7% (1 in 6 people)6% of children80% of nursing home residentsIn children: more common in males than femalesIn adults: more common in females than malesVery common during pregnancy and postpartumIn elders, equally as common in males and femalesMore common in non-whites than whitesMore than 3 million prescriptions per year for laxatives; over $725 million spent on over-the-counter laxatives15% to 38% of patients with constipation have obstructed defecation3 +++ Signs and Symptoms4,5 ++ 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 monthsStraining more than 25% of BMs (bowel movements)Fewer than three BMs/weekSensation of incomplete evacuation/anorectal blockage more than 25% of BMsLumpy or hard stool in more than 25% of BMsThe necessity of digital manipulation to facilitate evacuation more than 25% of BM +++ Functional Implications ++ HeadacheDecreased energyBad breathDifficulty concentratingDecreased appetiteCoating on the tongueAbdominal bloatingGas/flatulenceSkin problemsDepression +++ Possible Contributing Causes ++ Underactive, overactive, or non-functioning pelvic floor musclesMedications: multiple medicines can cause constipationHormonal fluctuations: pregnancy, lactation, menopauseNeurological conditions: Parkinson’s disease, multiple sclerosisDiabetes mellitusSclerodermaAnorexia nervosaThyroid diseaseHyperparathyroidismHysterectomyDietary: inadequate fiber, fluid, weight lossPoor defecation patterns, ignoring urge to defecateTravel: change in food, time zones, stressChange in routine: exercise, sleep, new jobAdmission to hospital or nursing homeDecreased activity, bed rest +++ Differential Diagnosis ++ Hirschsprung’s disease: aganglionosisColorectal neoplasmColorectal stricture, scarringDiverticular diseaseIrritable bowel syndromeAnorectal fissure, hemorrhoids, episiotomy scarPelvic organ prolapse; cystocele, rectocele, descended perineumRectal prolapseReferred pain from the gutAbdominal pain or tenderness; constant or intermittent, ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth