Gastrointestinal Disorders Chapter 27. Diarrhea Constipation Constipation Difficult or infrequent passage of feces, hardness of stool, or a feeling of incomplete evacuation. Symptoms Fecal impaction, which may cause or develop from constipation, is particularly common in the bedridden elderly and after barium has been given by mouth or enema. The patient has rectal pain and tenesmus and makes repeated but futile attempts to defecate. The patient may have cramps and may pass watery mucus or fecal material around the impacted mass, mimicking diarrhea.
Rectal examination discloses a firm, sometimes rocklike, but often rubbery, putty-like mass.
Acute constipation occurs when a change in bowel habits produces infrequent stools or hard stools that are difficult to pass. Strong laxatives should be avoided in these circumstances. When a change of bowel habit persists for weeks or occurs intermittently with increasing frequency or severity, colonic tumors and other causes of partial obstruction should be suspected. A reduced stool size suggests an obstructive lesion in the distal colon. The common functional causes of chronic constipation hamper normal bowel movements because the storage, transport, and evacuation mechanisms of the colon are deranged.