Constipation 변비 2013 년 3 월 24 일 서울의대 내과학교실, 서울대학교병원 홍 경 섭 질병의 병태생리학
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 ?
Digestion ( 소화 ) Absorption ( 흡수 ) Motility ( 운동 ) Secretion ( 분비 ) Functions of GI tract
Stool consistency is dependent on water composition !!
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…
Q. How can my constipation be managed ?
Decreased food intake small stool volume constipation Diet control ? 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 1 개 (2.0g) 10 개 딸기 10 개 (3.8g) 50~60 개 귤 1 개 (0.2g) 100 개 사과 1 개 (1.0g) 20 개 배추김치 (0.4g) 50 접시 콩나물 (0.4g) 50 접시 느타리버섯 (0.6g) 33 접시 시금치나물 (0.5g) 40 접시
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. But, still I have difficulties in passing stools !!
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 / Pelvic Floor Dyssynergia (=evacuation disorder) Overlap is common, especially STC/PFD –Mass movement ‘HAPC’ and 5-HT are important factors in colonic motility Increase food intake, then laxatives
Thank you for attention !! Please feel free to me, especially English-speaking student ^^;;