질병의 병태생리학 Constipation 변비 2014년 11월 11일 소화기내과 홍 경 섭

Q. What is constipation ?

Female, 46 years Constipation for 20 years “Hard, compacted stool like a chest nut” “Bowel movement once a week” “Straining during bowel movements” Difficulties in passing stool out of the anus

Q. Why is my stool so hard ?

Functions of GI tract Digestion (소화) Absorption (흡수) Motility (운동) Secretion (분비) 그림 참고용

Stool consistency is dependent on water content !!

Colonic transit time 장 통과 시간 Longer (peristalsis dec.) ---------------- shorter (inc. peristalsis inc.) Shortened colonic transit Too short to absorb water and nutrients  Loose stool Stimulation of bowel peristalsis Laxative ex) Aloe(containing senna)

Q. Is my constipation due to slow colonic transit ? Hard and lumpy stool means slow colonic transit in some patients, but others…

Pelvic Floor Dysfunction; PFD = Dyssynergic Defecation; DD

Q. How can my constipation be managed ?

Diet control ? Constipation !! Decreased food intake  small stool volume  constipation 뭐가 있어야 밀지… Nothing to pass… What food ? Dietary fiber !!

Dietary fiber rich foods Whole grains 현미 보리 Legumes 콩 Sea weeds 미역 Fruits 사과 등 Vegetables 당근 오이 Others 고구마 감자 (결국 야채, 과일, 풀)

Q. I am trying to have lots of vegetable and fruits, so my fiber intake seems not short to recommended daily acquirement !!

Dietary fiber 20g ? 토마토 1개(2.0g) 10개 딸기 10개(3.8g) 50~60개 사과 1개(1.0g) 20개 귤 1개(0.2g) 100개 느타리버섯(0.6g) 33접시 배추김치(0.4g) 50접시 시금치나물(0.5g) 40접시 콩나물(0.4g) 50접시

Q. I will try to have more food. Is there any medication for me ?

Physiology Colonic Motility

High Amplitude Propagated Contractions; HAPCs

Q. I have been taking laxatives regularly as your prescription Q. I have been taking laxatives regularly as your prescription. But, still I have difficulties in passing stools !!

Q. I underwent hysterectomy due to uterine myoma Q. I underwent hysterectomy due to uterine myoma. Since then, my constipation have been aggravated !!

Behavioral tx: Biofeedback

Approach to Constipation Most patients with constipation are diagnosed as functional or motility disease. Rule out organic lesion !!! Alarm symptoms or signs ‘Red flag sign’ Weight loss, bloody stool, anemia Night symptoms Persistent changes in bowel habit Onset >50 years old

Take Home Messages Constipation Normal Transit / Slow Transit / Dyssynergic defecation (= functional evacuation disorder) Overlap is common, especially STC/DD Mass movement ‘HAPC’ and 5-HT are important factors in colonic motility Increase food intake, then laxatives !!!

Thank you for attention !! kshong1@empas.com Feel free to email me, especially English-speaking student ^^;;