They were participating in a seminar organized by Heart Care Foundation of India and eMedinewS at Constitution Club of India as part of 19th MTNL Perfect Health Mela celebrations. Over 200 doctors participated in the seminar which was supported by Win Medicare.
The doctors said that any abdominal pain associated with diarrhea should suspect one of inflammatory bowel disease but if the same appears for the first time in the elderly, one must conduct colonoscopy to rule out cancer of gut.Constipation should not be treated with laxatives as they may be habit forming. Isabgol, triphala and poly ethylene glycol are the commonest medicines used to treat constipation. Isabgol is a bulk laxative. Presence of rectal bleeding, constipation and diarrhea, unexplained abdominal pain should warrant one to undergo colonoscopy.
Facts about chronic constipation
1. Constipation is the most common digestive complaint in the general population, and is associated with substantial economic costs
2. Infrequently, constipation is the first manifestation of metabolic (diabetes mellitus, hypothyroidism, hypercalcemia, heavy metal intoxication), neurologic, or obstructive intestinal disease; more often, it occurs as a side effect of commonly used drug
3. Constipation has been defined as a stool frequency of less than three per week
4. An international working committee recommended diagnostic criteria (Rome III) for functional constipation. The diagnosis should be based upon the presence of the following for at least three months (with symptom onset at least six months prior to diagnosis).
a. Must include two or more of the following:
· Straining during at least 25 percent of defecations
· Lumpy or hard stools in at least 25 percent of defecations
· Sensation of incomplete evacuation for at least 25 percent of defecations
· Sensation of anorectal obstruction/blockage for at least 25 percent of defecations
· Manual maneuvers to facilitate at least 25 percent of defecations (eg, digital evacuation, support of the pelvic floor)
· Fewer than three defecations per week
b. Loose stools are rarely present without the use of laxatives
c. There are insufficient criteria for IBS.
5. It often responds to dietary changes and various laxatives.
6. Idiopathic constipation is associated with normal or slow colonic transit, functional defecation disorder, or both.
7. Management of normal and slow transit chronic constipation includes patient education, behavior modification, dietary change, bulk forming laxatives, and the use of non-bulk forming laxatives or enemas
8. Initial management of idiopathic constipation involve dietary fiber and bulk forming laxatives such as psyllium ormethylcellulose, together with adequate fluids
9. For patients who do not tolerate bulk forming laxatives or respond poorly to fiber one should start with osmotic laxative
10. Other options include stool softeners or stimulant laxatives (bisacodyl, senna, and sodium picosulfate).
11. Management of severe constipation and functional defecation disorder may involve suppositories, biofeedback, botulinum toxin injections into the puborectalis muscle, or subtotal colectomy under specific circumstances.
12. Various pharmacologic therapies (lubiprostone, misoprostol, colchicine) have been used to treat severe constipation with limited success.
13. In patients over the age of 70 years warm water enemas rather than sodium phosphate enemas be used for the treatment of constipation
14. The use of sodium phosphate enemas in older adults has been associated with complications including hypotension and volume depletion, hyperphosphatemia, hypo- or hyperkalemia, metabolic acidosis, severe hypocalcemia, renal failure, and EKG changes (prolonged QT interval).
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