Young women with a sluggish bowel

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Our ancestors who were by no means fools regarded a daily bowel action as necessary. While the efforts made to procure this caused various harm, the lack of concern in these enlightened times also gives rise to some problems.

Neither frequency nor quantity defines constipation and in the absence of disturbance to the patient these should be carefully left alone.

However, some people, of whom all or most are female, complain of episodic abdominal discomfort, nausea and on examination have a full and often tender descending colon with gurgling and increased bowel sounds.

Management

In the visibly healthy person, dietary enquiry and advice may be all that is required. If the problem persists then first exclude significant conditions (Hypothyroidism, obscure tropical diseases (absent in those who have not travelled), congenital atony such as Hirschsprung's) by means of enquiry and sufficient blood tests to be persuasive. Consider and hopefully dismiss psychological factors - a history of childhood sexual abuse is said to be more common but this is not diagnostic of it. Rectal examination may hint at this, as well as ruling out painful anal conditions.

Initially clearing the bowel should produce an improvement. This only works if the patient takes the same view of the conditition's cause as the doctor. Once the colon is no longer palpably full, encouragement to eat more fibre and drink more water, with occasional use of aperients should maintain it.

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Constipation and Fainting: Gut Dysautonomia?
One patient had been "constipated", by which was meant infrequency, for years, essentially her whole life. She developed slight dyspepsia and a tendency to faint, suddenly and with no other apparent cause. Helicobacter eradication and Cisapride controlled both, but was then withdrawn. The hypothesis that stimulation of the Vagus nerve was producing reflex bradycardia was tested with a minimal dose of an Atropine-like drug, propantheline. This cured her tendency to faint, and as an unlooked-for by-effect increased her bowel activity to approximately daily.


References

[on constipation]

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