1. Constipation 변비 2013 년 3 월 24 일 서울의대 내과학교실, 서울대학교병원 홍 경 섭 질병의 병태생리학

2. Q. What is constipation ?

4. 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

5. Q. Why is my stool so hard ?

6. Digestion ( 소화 ) Absorption ( 흡수 ) Motility ( 운동 ) Secretion ( 분비 ) Functions of GI tract

7. Stool consistency is dependent on water composition !!

8. 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)

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

13. Q. How can my constipation be managed ?

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

15. 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 )

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

17. 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

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

21. Physiology Colonic Motility

22. High Amplitude Propagated Contractions; HAPCs

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

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

37. Behavioral tx: Biofeedback

38. 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

40. 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

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