1. GIT

2. Conistipation:

3. Being constipation means your bowel movements are difficult or happen less often than normal. Almost everyone has it at some point in life, and it's usually not serious.
The normal length of time between bowel movements varies widely from person to person.  

4. Some people have bowel movements three times a day
Some people have bowel movements three times a day. Others have them only once or twice a week.
Going longer than three or more days without one is usually too long.
After three days, the stool or feces become harder and difficult to pass.

5. Symptoms:
1-Few bowel movements
2-Trouble (straining)
3-Hard or small stools
4- abdominal pain
5-Swollen abdomen
6-Vomiting

6. 1-Conventional therapy THIS INCLUDE
TYPES OF THERAPY :
1-Conventional therapy THIS INCLUDE
A- Dietary advice,
B- Toilet training,
C- Drug- laxatives
in combination with
D- Behavioural therapy
If fail
2-Surgery

7. ADVICE TO
1-Eat a well-balanced diet with plenty of fiber. Good sources of fiber are fruits, vegetables.
2-Drink large amount of water and other fluids
3-Avoid caffeine BS It leads to dehydrating.
4-Avoid milk . because dairy products may cause constipating.
5-Exercise regularly.

8. Drug used in treatment of constipation :
Purgative, laxative and evacuant are synonymous, there are medicines that promote defecation: including
1-stool bulking agent.
2-faecal softeners.
3-osmotic laxative
4-stimulant laxative
5-others: include

9. A-chlorid channel activator: increases chloride and fluid secretion into the intestines, resulting in relief of constipation like (lubiprostone) B-Opiod receptor antagonist (methylnaltrexon) C-5HT4 agonist (tegaserode)

10. D- PROBIOTICS E- Vitamins

11. 1-stool bulking agent: including dietary fibers
They occur in form of non-starch poly- saccaride (NSP) in the cell wall and supporting structures of vegetables and fruits. They are indigestable fibers increasing the volume and decrease the viscosity of intestinal contents to produce a soft bulking stool, the patient should take a large quantities of water preparation.
These include Bran , methyl cellulose, psyllium

12. 2-faecal softener (Emollients)
The softening properties of these agent are useful in management of anal fissure and hemorrhoid. Ex.:
a-Docusate sodium: soften feces by lowering the surface tension of fluid in the bowel, this allow more water to remain in the faeces and also have little bowel stimulant effect.

13. b-Liquid paraffin
It is a chemically inert mineral oil and it is not digested , it promotes the passage of softer faeces.
3-Osmotic laxatives
These increase the bulk and decrease the :viscosity of intestinal content
a-inorganic salts; this return water in the intestinal lumen or it gives as hypertonic solution that draw water from the body. Like MgOH and Mg sulphate.

14. B-Lactulose: synthetic disaccharide, taken orally, un affected by small intestine disaccaridase, used in hepatic encephalopathy
C-Manitol; these agent frequently used to clear the colon for diagnostic procedure or surgery by enema.
D-sorbitol
E-PEG

15. polyethylene glycol(PEG) : effective and well-tolerated treatment choice for pediatric constipation, especially as an adjunct to education and behavioral training. (children with constipation who have failed or are intolerant of other pharmacotherapies).
It does not cause cramps and flatulence.

16. 4-stimulant laxative; these drugs increase intestinal motility by various mechanisms, they may cause abdominal cramps, should used with caution in pregnancy and never used if intestinal obstruction is suspected
a-Bisacodyl(Diphenylmethane drevitives)
stimulates sensory endings in the colon by direct action from the lumen, ;it is effective orally in 6-10 hr and as suppositories in 1 hr.
b-Glycerol and sodium picosulphate

17. c-Anthraquinone group include:
Senna , danthron, cascara, rhubarb, aloes
Senna: widly used to empty the bowel for diagnostic procedure.
Danthron: carcinogenic, used in combination with softeners

18. Serotonin plays a key role in mediating peristalsis and stimulating intestinal secretion via 5-HT4 receptors in the gut wall. Tegaserod, a selective 5-HT4 agonist stimulates intestinal secretion and inhibits visceral afferent responses has proven effective in the treatment of chronic constipation in adults 

19. Probiotics
PROBIOTICS are living microorganisms that when taken by mouth, benefit your health by improving the balance of bacteria in the body. Play an important role in regulating digestive system and can help support body natural wellness.

20. Vitamins
Vitamins play role in treatment of constipation including Vitamin C Vitamin B5 Vitamin B9

21. Abuse of laxatives: may occur in an illness or in pregnancy or in an individual who think that daily bowel motion is essential for health.
Cessation of use of laxative may follow by few days constipation while sufficient material collects to restore the normal state.
This may mislead the patient that constipation return again and start treatment again.

22. Excessive use of laxatives, especially in old patient, may lead to sever water and electrolyte depletion and malabsorption.

23. THANK YOU