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 select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process 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 Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.