Constipation Part 1 PowerPoint PDF

constipation DR/Manal Eldamery Lecturer of Physical Therapy constipation and identify its different types. 2. Understanding: Students will be able to explain the pathophysiology of constipation, including colonic motility and pelvic floor dysfunction. 3. Applying: Students will be able to apply ph...

constipation DR/Manal Eldamery Lecturer of Physical Therapy constipation and identify its different types. 2. Understanding: Students will be able to explain the pathophysiology of constipation, including colonic motility and pelvic floor dysfunction. 3. Applying: Students will be able to apply physical therapy interventions such as pelvic floor muscle exercises to treat constipation. 4. Analyzing: Students will be able to analyze the causes of constipation related to diet, medication, and lifestyle. 5. Evaluating: Students will be able to evaluate different treatment methods for constipation, such as biofeedback and abdominal massage, and determine their effectiveness based on patient response. 6. Creating: Students will be able to develop a comprehensive physical therapy plan for patients with chronic constipation, integrating techniques such as breathing exercises, dietary recommendations, and strength training.  Gastrointestinal (GI) disorders conditions that affect the digestive system, which includes the esophagus, stomach, intestines, liver, pancreas, and gallbladder. These disorders can impact how food is digested, nutrients are absorbed, and waste is eliminated from the body  Irritable Bowel Syndrome (IBS): A functional disorder that causes symptoms like abdominal pain, bloating, constipation, and diarrhea.  Gastroesophageal Reflux Disease (GERD): A chronic condition where stomach acid flows back into the esophagus, causing heartburn and potential damage to the esophagus lining.  Constipation: Difficulty in passing stools or infrequent bowel movements, often due to slow movement of waste through the digestive system. constipation Part I Introduction 1. Definition 2. Types 3. Causes 4. Clinical Picture 5. Symptoms 6-Pathophysiology  Constipation 1. Definition Constipation is a symptom, not a disease, characterized by a reduction in the frequency of defecation (less than 3 times per week). It is often associated with slow movement of the large intestine. Incidence: Constipation is significantly increased with age, making it a common problem in 20% of women and 15.8% of men in the elderly 2. Types Functional Constipation:  This is the most common type, where no underlying medical condition is found. Slow-Transit Constipation:  This occurs when there is a delay in the movement of stool through the colon, leading to infrequent bowel movements. Outlet Obstruction:  This type occurs when there is a blockage in the rectum or anus, making it difficult to pass stool. It may be caused by conditions like rectal prolapse or anal fissures. 3. Causes Dietary Factors: Low fiber intake, insufficient water consumption, and excessive consumption of processed foods can contribute to constipation. Dehydration: Not drinking enough fluids can lead to harder stools that are difficult to pass. Lack of Physical Activity: Sedentary lifestyles can slow down intestinal motility. Medications: Certain medications, such as opioids, antacids containing aluminum, and some antidepressants, can cause constipation as a side effect. Medical Conditions: o Conditions such as hypothyroidism, diabetes, Parkinson’s disease, and irritable bowel syndrome (IBS) can contribute to constipation.  4. Clinical Picture Abdominal Discomfort: Patients may experience cramping or pain in the abdominal area. Bloating: A feeling of fullness or swelling in the abdomen. Hard Stools: Stools that are hard and difficult to pass, often requiring straining. 5. Symptoms completely emptied after a bowel movement. Infrequent Bowel Movements: Fewer than three bowel movements per week. Straining: Difficulty or discomfort during bowel movements. Feeling of Incomplete Evacuation: A sensation that the bowel has not been Pain During Bowel Movements: Discomfort or pain may occur while passing stool 6. Pathophysiology A. Colonic Motility: o The colon is responsible for absorbing water and electrolytes from indigestible food matter and forming stool. Dysfunctional motility can lead to constipation. B. Pelvic Floor Dysfunction: o Effective bowel movements require coordination between the abdominal muscles, pelvic floor muscles, and anal sphincters. Any disruption can lead to difficulty in stool passage. C. Neurogenic Factors: Neurological dysfunction plays a significant role in the pathophysiology of constipation. Here's a breakdown of the key mechanisms involved: 1. Impaired Intestinal Motility: * Nerve damage: Conditions such as Parkinson's disease, multiple sclerosis, spinal cord injury, and stroke can damage the nerves that control intestinal muscle contractions (peristalsis). This leads to a decrease in muscle activity, slowing down the movement of stool through the colon. * Autonomic nervous system dysfunction: The autonomic nervous system regulates involuntary bodily functions, including intestinal motility. If the autonomic nervous system is impaired, it can disrupt the coordinated contractions necessary for normal bowel movements. 2. Pelvic Floor Dysfunction: * Nerve damage: Nerve damage in the pelvic floor region can affect the coordination of the muscles involved in defecation. This can lead to excessive tension in the pelvic floor muscles, making it difficult to push out stool. * Sensory impairment: If the nerves that provide sensation to the rectum are damaged, a person may not be able to accurately perceive the urge to defecate, leading to delayed or infrequent bowel movements. 3. Medication-Induced Constipation: * Central nervous system effects: Some medications, such as antidepressants and antipsychotics, can affect the central nervous system in a way that slows down intestinal motility. Part II ASSESSMENT 1. Medical History Review 2. Postural and Breathing Assessment 3. Pelvic Floor Muscle Assessment 4. Abdominal and Core Muscle Evaluation 5. Mobility and Activity Level 6. Toileting Habits and Environment 7. Biofeedback Physical therapy assessment for constipation 1. Medical History Review Detailed history of constipation, including frequency, stool consistency, and any straining during bowel movements. Questions about hydration, diet, medications, and lifestyle factors that might impact bowel habits. 2. Postural and Breathing Assessment Evaluation of the individual's posture, particularly in relation to how they sit on the toilet. Assessment of diaphragmatic breathing, which plays a role in abdominal and pelvic pressure regulation. 3. Pelvic Floor Muscle Assessment Internal or external examination of the pelvic floor muscles to check for tightness, weakness, or inappropriate muscle coordination (dyssynergia). The therapist may use biofeedback devices to assess muscle function or teach proper coordination for bowel movements. Physical therapy assessment for constipation 4. Abdominal and Core Muscle Evaluation Assessment of the strength and function of the abdominal muscles, which contribute to effective defecation. Checking for abdominal tension or pain, which could affect bowel movements. 5. Mobility and Activity Level Evaluation of overall mobility and activity levels, as physical activity can influence bowel regularity. Gait assessment and functional movements to identify any biomechanical issues contributing to constipation. Physical therapy assessment for constipation 6. Toileting Habits and Environment Discussion of bathroom habits, including time spent on the toilet and body positioning (e.g., use of a footstool for proper alignment). Recommendations for ergonomic positioning on the toilet to facilitate bowel movements. 7. Biofeedback Biofeedback training may be incorporated to help patients learn how to properly relax and contract pelvic floor muscles during bowel movements Part III CONSTIPATION MANAGEMENT 1. Pelvic Floor Muscle Training 2. Abdominal Massage 3. Breathing Exercises 4. Proper Toileting Posture 5. Diet and Hydration Recommendation 6. Electrical Stimulation 7. Regular aerobic exercise can help stimulate bowel activity 8. Electromyography (EMG) Biofeedback 9. Acupuncture 10.Progressive Muscle Relaxation 11.Behavioral Therapy 12. Medications 13.Surgical options  1. Pelvic Floor Muscle Training Pelvic floor dysfunction can contribute to constipation. Strengthening and coordinating these muscles helps in A physical facilitating bowel movements therapy A- Kegel Exercises: program for Focus on relaxing and contracting the pelvic floor muscles. constipation How to perform: While sitting or lying down, tighten the pelvic muscles (as if trying to stop urination) for 5 seconds, then relax for 5 seconds. Repeat 10-15 times. Gradually increase to holding for 10 seconds  Benefits of Kegel Exercises Improved Bladder Control: Helps prevent urinary incontinence. Enhanced Bowel Control: Can aid in managing bowel function. Support for Pelvic Organs: Strengthens the pelvic floor to support organs like the bladder and uterus B.Bridge Exercise Description: This exercise strengthens the pelvic floor and glutes. C. Squats Description: Squats strengthen the pelvic D. Side-Lying Leg Lifts Description: This exercise targets the pelvic floor and hip abductors E. Pelvic Tilts Description: Pelvic tilts improve core stability and strengthen the pelvic floor floor and lower body F. Leg Raises: Goal: Strengthens the abdominal muscles, which can help improve bowel movements. 2. Abdominal *Frictional:* Pressure applied according to Massage *Massage Techniques patient tolerance using knuckles over gluteus Maximus. *Shaking and Vibration:*. *Effleurage:* Pressing Vibration to relax muscles against the underlying over the colon in the surface. same direction. *Tapotement Benefits of abdominal massage Helps stimulate bowel movement by promoting colonic motility. · Reduces bloating and discomfort by relieving gas. · Supports regular bowel movements when done regularly..Helps stimulate bowel movement by encouraging colonic motility Perform for 5-10 minutes daily, especially before or after meals.  3. Deep abdominal breathing helps activate Breathing the diaphragm and Exercises encourages bowel movements. Helps calm the nervous system and improve bowel movements by stimulating the abdominal area. 4. Proper Using the correct posture on the toilet can make bowel movToileting Toileting Techniques Posture · When to perform: Train yourself to go when you feel the urge, ideally 30 minutes after meals, to take advantage of the body’s natural bowel reflexes. · Breathing during defecation: Avoid holding your breath when trying to pass stool. Practice "abdominal bracing" by gently pushing out while exhaling.  5. Diet and Hydration Recommendation 1. Increase Fiber Intake A high-fiber diet is essential for preventing and treating constipation. Fiber adds bulk to the stool and helps it move through the digestive tract. There are two types of fiber: Soluble Fiber: Dissolves in water and forms a gel-like substance, which can help soften stools. It can be found in: Nuts Fruits such as apples, oranges, and pears Seeds Insoluble Fiber: Does not dissolve in water and helps add bulk to the stool, promoting movement through the intestines. It can be found in: o Whole grains (brown rice, whole wheat bread, and pasta) o Vegetables (carrots, celery, and leafy greens) o Wheat bran Recommended  6. Electrical Stimulation 1. Nerve Stimulation: TENS stimulates the nerves in the abdominal area, which can help regulate the autonomic nervous system and promote peristalsis (the wave-like movements of the intestines that move stool through the digestive system). 2. Muscle Activation: TENS can activate muscles in the abdomen and pelvic floor, encouraging better muscle coordination that assists in the defecation process. 3. Pain Reduction: oIt can also reduce discomfort or pain associated with constipation by interrupting pain signals sent to the brain, helping to relieve bloating or cramping often linked with constipation Application of TENS for Constipation  Benefits of Non-invasive: TENS provides a drug-free, TENS for non-invasive treatment for constipation, Constipation making it a safe option for many patients. · Pain Relief: It can relieve abdominal pain, discomfort, or bloating associated with constipation. · Improved Bowel Movement: By stimulating the nerves and muscles in the abdominal and pelvic areas, it may promote more regular bowel movements. · Suitable for Various Ages: TENS can be adapted for use in both adults and children with functional constipation.  7. Regular aerobic exercise can help stimulate bowel activity Recommend 30 minutes of moderate-intensity activities like walking, cycling, or swimming at least 5 days per week. 1. Aerobic Exercises Walking: o Duration: 30-60 minutes per day. exercises CYCLING: O DURATION: SWIMMING: O DURATION: 20-30 MINUTES. 30-45 MINUTES. 2. Strengthening Exercises Strength training helps improve overall muscle tone, including those involved in bowel movements. Squats: o Sets/Reps: 3 sets of 10-15 reps. o Technique: Stand with feet shoulder-width apart, lower your body as if sitting back into a chair, keeping your weight on your heels.  Lunges: o Sets/Reps: 3 sets of 10-12 reps per leg. o Technique: Step forward with one leg, lowering your hips until both knees are bent at a 90-degree angle. Push back to the starting position. Abdominal Exercises: Plank: Hold for 20-30 seconds, 3 time o Bicycle Crunches: 3 sets of 15-20 reps. Lie on your back, bring knees to a tabletop position, and alternate touching your elbow to the opposite knee.  3. Flexibility and Stretching Exercises These promote relaxation and help improve digestion. Cat-Cow Stretch Sets/Reps: 10-15 repetitions. o Technique: Start on all fours. Inhale, arching your back (cow position), then exhale, rounding your spine (cat position). Child’s Pose: Duration: Hold for 30 seconds to 1 minute. o Technique: Kneel and sit back on your heels, then stretch your arms forward and lower your torso to the ground. Torso Twist Sets/Reps: 10-15 repetitions per side. o Technique: Sit or stand, rotate your torso to one side while keeping your hips stable, then switch to the other side.  8. Electromyography (EMG) Biofeedback is a therapeutic technique used in physical therapy to help patients improve muscle control by providing real-time feedback on muscle activity  How EMG Biofeedback Works for Constipation Identify incorrect muscle use: The system shows if the muscles are not relaxing properly during bowel movements. Improve muscle coordination: With visual or auditory feedback, patients can practice controlling these muscles. Develop better defecation habits: Over time, patients learn to relax the pelvic floor muscles at the right time, making bowel movements easier.  Benefits of EMG Biofeedback for Constipation Real-Time Monitoring: The patient can see how well they’re controlling their muscles, making it easier to correct improper techniques. Targeted Training: It focuses on the specific muscles responsible for defecation, making it more effective than general exercises. Non-Invasive and Safe: EMG biofeedback is non-invasive and doesn’t involve medication or surgery. It helps treat constipation conservatively. Long-Term Improvement: By training the muscles and improving coordination, patients can experience long-lasting relief from constipation.  9. Acupuncture Is a traditional Chinese medicine practice that involves inserting thin needles into specific points on the body. It has been used for various health issues, including constipation  1-Regulation of Gut Motility: o Acupuncture may enhance intestinal motility by stimulating the nervous system and promoting the release of neurotransmitters that facilitate bowel movements. o Certain acupuncture points are believed to influence the gastrointestinal tract, improving peristalsis (the wave-like muscle contractions that move food through the digestive system). 2. Relaxation of the Abdominal Muscles: Mechanisms o Acupuncture can help reduce tension in the abdominal and pelvic floor muscles, allowing for easier passage of stool. of Action o It may also alleviate any stress-related muscle tightness that can contribute to constipation. 3. Hormonal Regulation: o Acupuncture has been shown to influence the release of hormones and chemicals in the body that can affect digestion and bowel function. o It can enhance the secretion of gastrointestinal hormones that promote digestion and bowel motility. 4. Pain Relief: o By alleviating pain or discomfort associated with constipation, acupuncture can help patients feel more relaxed and willing to respond to their body's natural urges to defecate. 5 Improved Bowel Frequency: o Research indicates that acupuncture can increase the frequency of bowel movements in patients with chronic constipation, leading to improved overall bowel function. 6 Reduction in Symptoms: o Acupuncture has been associated with a decrease in symptoms such as abdominal pain, bloating, and the sensation of incomplete evacuation, which are common in patients with constipation  Specific Points: *Acupuncture Points:* Common acupuncture points used for treating constipation include:  Stomach 36 (ST36): Located below the knee, this point is believed to enhance digestive function. Large Intestine 4 (LI4): Located on the hand, this point is known to relieve pain and promote bowel movement Spleen 6 (SP6): Located above the ankle, this point is thought to regulate gastrointestinal function.  10. Progressive Muscle Relaxation Goal: Helps the individual improve control over pelvic floor muscles by gradually relaxing them. How to perform: o Sit or lie in a comfortable position. o Begin by tightening the pelvic muscles (as if trying to stop urination) and hold for 5 seconds. o Then fully relax the muscles for 10 seconds. Repeat this process 10-15 times daily, focusing on improving relaxation  11. Behavioral Therapy Toilet Training: Establishing a regular schedule for bowel movements can help train the body to respond to the urge to defecate. Timed Toileting: Encourage bowel movements after meals when the gastrocolic reflex is strongest, typically 30 minutes after eating.  12. Medications When dietary and lifestyle changes are insuffici Laxatives: o Bulk-forming Laxatives (e.g., psyllium, methylcellulose): Increase stool bulk and promote regular bowel movements. o Osmotic Laxatives (e.g., polyethylene glycol, lactulose): Draw water into the intestines to soften stool and facilitate passage ent, medications may be prescribed  13. Surgical Options In severe or refractory cases of constipation where conservative treatments fail, surgical options may be considered: Surgical Removal of Part of the Colon: In cases of structural abnormalities or severe colonic dysfunction, a colectomy may be necessary. Colostomy: In rare cases, a colostomy may be performed to bypass the affected portion of the colon  *Complications of Constipation · Rectal Hemorrhoids. ·Anal fissure. prolapse. · Cardiac and · Urinary · Fecal cardiovascular retention. incontinence. dysfunction. Review Case Study 1: Functional Constipation in an Elderly Patient Background: Mrs. A, a 72-year-old woman, reports experiencing difficulty with bowel movements for the past six months. She has fewer than three bowel movements per week and often strains during defecation. She describes her stools as hard and pellet-like. Mrs. A feels abdominal discomfort and bloating but denies any significant abdominal pain. She has a sedentary lifestyle, a low-fiber diet, and drinks minimal water daily. Medical History: No significant underlying conditions like diabetes or hypothyroidism Takes calcium supplements for osteoporosis No recent surgeries or significant changes in medication Physical Therapy Assessment: Posture is normal, but she sits for extended periods during the day Breathing assessment reveals shallow breathing with minimal diaphragmatic engagement Pelvic floor muscle examination shows mild weakness but no major dysfunction She reports no regular exercise routine Discussion Questions: 1.What are the potential causes of Mrs. A's constipation based on her history? 2.What physical therapy interventions would you recommend to improve her symptoms? 3.How would you modify her lifestyle to improve bowel movements (diet, hydration, activity)? 4.Would you consider any biofeedback or abdominal massage techniques in this case? Why or why not?