**Diagnosis "التشخيص"
-definition:-
Passage of stool < 3times per week or hard stool difficult to pass
-معدل التبرز الطبيعي يختلف من شخص لآخر لكنه يتراوح ما بين مرتين يوميا إلى ثلاث مرات اسبوعيا وبعض الأشخاص أقل من ذلك لكن متعودين على هذا الوضع وبالتالي لا تعتبر الحالة تعاني من إمساك إلا إذا لاحظ الشخص نفسه قلة عدد مرات التبرز بالنسبة لطبيعته الشخصية.
"يجب فحص الحالة لإستبعاد انسداد معوي " intestinal obstruction" قبل بدء أي علاج.
-most common practical causes of constipation "أشهر أسباب حالات الإمساك"
1-low fiber diet "نظام الاكل لا يحتوي على ألياف".
2-immobility"عدم الحركة كما في كبار السن ".
3-hypothyrodism قلة نشاط الغدة الدرقية وبالتالي لازم أسال المريض هل بينام كتير عن المعدل الطبيعي؟؟؟.
وبالتالي لازم يعمل تحاليل TSH,T3,T4
4- hypercalcemia "ولازم يعمل تحليل serum Ca".
5-drugs "لازم أسال هل بياخد علاج لحالة".
*anti depressant-calcium tab-iron tan "
6-colo-rectal cancer.
7-irritable bowel syndrome"التهاب القولون العصبي".
**treatment
1-instructions
- تناول الأكل الذي يحتوي على كمية كبيرة من الالياف ( الخس-والطماطم-فاصوليا- برتقال-يوسفي-خوخ).
-شرب كمية كبيرة من المياه.
-شرب كوب من اللبن الرايب يوميا "يعطي نتائج جيدة".
-دخول الحمام في ميعاد ثابت لمدة ربع -نصف ساعة يوميا يفضل بعد الإفطار حتى يعتاد الجسم على حركة الأمعاء في ميعاد يومي ثابت "behavioral therapy"
2-bulking agent
أقراص تعمل على زيادة حجم البراز مما يسهل من عملية مروره ويفضل استعماله مع شرب كميات كبيرة من الماء.
Bran tab قرصين قبل الأفطارمع كوب ماء كبير
3- laxatives الملينات
a-bulk laxative
"تعمل في خلال 1-3أيام لذلك تستخدم في الوقاية من الإمساك والإمساك المزمن تعتمد على إمتصاص الماء وزيادة حجم البراز وحركة الأمعاء .
Ex:agiolax pack
Contain plantago&ispaguls
توضع محتويات الكيس في الفم ثم يتم شربها مع كوب ماء مرة واحدة قبل النوم .
B-osmotic laxatives
يعمل في خلال 1-3أيام ويستخدم عادة في حالات الإمساك المزمن .
Ex:lactulose syp
"يمكن شربه مضافا على ماء أو عصير أو لبن -آمن للإستخدام أثناء الحمل - يمكن إستخدامه لفترة طويلة بدون مشاكل -يستخدم في مريض الكبد لعمل حقنة شرجية في حالات الغيبوبة الكبدية حيث يضاف 2-4 معالق الى محلول ملح ويتم عمل حقنة شرجية -لا يفضل إستخدامه في مرضى السكر".
C-saline laxatives
الحقنة الشرجية تعمل في خلال 30 دقيقة والأكياس تعمل في خلال 5 ساعات مفعولها سريع لذلك تستخدم في الامساك الحاد
****لا تستخدم في مرضى القلب والضغط والكلى والأطفال.
D-stimulant laxatives
الأقراص مفعولها بطئ لذا تستخدم في الإمساك المزمن.
Ex:-sennalax tab
Contain senna
"قرصين قبل النوم أو مرتين يوميا بحد أقصى 4أقراص مرتين يوميا".
E-stool softeners
Glycerin adult /pediatric supp.
لبوسة عند االلزوم "آمن في الحمل والأطفال".
**Constipation:-
-Constipation is most often defined as having a bowel movement less than 3 times per week.
- It is often associated with hard stools or problems passing stools.
-You may have pain while passing stools or may be unable to have a bowel movement after straining or pushing.
**Considerations
-Normal bowel movements are different for each person.
- Some people do not have a bowel movement every day.
-Also, some healthy people always have very soft stools.
- Other have firm stools, but are able to pass them without problems.
-When you do not have frequent bowel movements, or it takes a lot of effort to pass stool, you have constipation.
- Passing large, wide, or hard stools may tear the anus, especially in children.
-This can cause bleeding and may lead to an anal fissure.
**Causes
-Constipation is most often caused by:
●Low-fiber diet
●Lack of physical activity
●Not drinking enough water
●Delay in going to the bathroom when you have the urge to move your bowels
●Stress and travel can also contribute to constipation or other changes in bowel habits.
-Other causes of constipation may include:
●Colon cancer
●Diseases of the bowel, such as irritable bowel syndrome
●Mental health disorders
●Nervous system disorders
●Pregnancy
●Underactive thyroid
●Use of certain medications
●Constipation in children often occurs if they hold their bowel movements.
This may happen when the child is not ready for toilet training or is afraid of it.
**Home Care
-Lifestyle changes can help you avoid constipation. These changes can also be used to treat it.
**Things you can do include:
-Drink plenty of fluids each day (drink at least 8 glasses of water every day).
-Eat a lot of high fiber-foods.
-Exercise regularly.
-Use the toilet when you feel the urge.
Do not wait.
**For infants with constipation:
-Over 2 months old: Try 2 to 4 ounces of fruit juice (grape, pear, apple, cherry, or prune) twice a day.
-Over 4 months old: If the baby has started to eat solid foods, try baby foods with high-fiber content such as peas, beans, apricots, prunes, peaches, pears, plums, and spinach twice a day.
-Regular exercise may also help establish regular bowel movements.
-If you are confined to a wheelchair or bed, change position often.
-Also do abdominal exercises and leg raises. A physical therapist can recommend exercises that you can do.
-Stool softeners (such as those containing docusate sodium) may help.
-Bulk laxatives such as psyllium may help add fluid and bulk to the stool.
-Suppositories or gentle laxatives, such as milk of magnesia liquid, may help you have regular bowel movements.
-Enemas or stimulant laxatives should only be used in severe cases.
-These methods should be used only if fiber, fluids, and stool softeners do not provide enough relief.
***Do NOT give laxatives or enemas to children without first asking your doctor.
-When to Contact a Medical Professional
-Call your doctor right away if you have sudden constipation with abdominal cramps and you cannot pass gas or stool. Do NOT take any laxatives.
-Also call your doctor if you have:
-Been using laxatives for several weeks or self care is not working
-Blood in your stool
-Constipation alternating with diarrhea
-Rectal pain
-Sharp or severe abdominal pain, especially if you also have bloating
-Thin, pencil-like stools
-Unexplained weight loss
-Call your child's doctor right away if:
-An infant (except those who are only breastfed) goes 3 days without a stool and is vomiting or irritable
-Also call your child's doctor if:
-An infant younger than 2 months is constipated
-Non-breastfeeding infants go 3 days without having a bowel movement (call immediately if there is vomiting or irritability)
-A child is holding back bowel movements to resist toilet training
-What to Expect at Your Office Visit
**Your doctor will perform a physical exam. You will be asked questions such as:
*How long have you had constipation?
*How many days do you go between two bowel movements?
*Is constipation worse when you are stressed?
*What is the color, shape, and consistency of your stools? Is there bleeding?
*Do you have any abdominal pain?
*What surgeries or injuries have you had?
*What medicines do you take?
*Do you drink coffee or alcohol? Do you smoke?
*Do you have other symptoms?
*The following tests may help find the cause of constipation:
***Anorectal manometry (pressure measurements of the anus and rectum)
-Barium enema
-Complete blood count (CBC)
-Colonoscopy
-Proctosigmoidoscopy (an examination of the lower bowel)
-Stool studies
-Upper GI series
-X-rays of the abdomen
-Alternative Names
-Irregularity of bowels; Lack of regular bowel movements
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