Constipation pathophysiology

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Constipation Microchapters

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Constipation from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

About 1.5 liter fluid enters the colon from small intestine every day. Colon only excrete out 200-400 mL stool. The defecation process consist of three important stages, include filling of the rectum, sensation of rectum fullness, and relaxation of pelvic floor muscles in a coordinated fashion. Primary constipation is caused by anorectal and colonic problems, while secondary constipation is caused by organic and metabolic diseases or medications. Diseases that disturb the nervous system may lead to constipation, such as diabetes mellitus, autonomic neuropathy, Chagas' disease, and Hirschsprung's disease. Chronic use of the laxative may lead to melanosis coli, which is identified by hyperpigmentation and brownish discoloration of colonic mucosa. The primary histopathological finding in melanosis coli is brown granular pigment in lamina propria.

Pathophysiology

Colonic Function

Defecation

Pathogenesis

Primary constipation

Secondary constipation

Group Drug Alternatives
Antihypertensives Clonidine
Calcium channel blockers
Ganglionic blockers
Antidepressants Tricyclic antidepressants
Cation-containing drugs Oral iron supplementation
Aluminum-containing drugs Sucralfate
Antacids
Analgesics Opiates
Cannabinoids
Anti-Parkinson
Antiepileptic
Antipsychotic
Antihistamines
  • Replaced with other groups
Antispasmodics
Vinca alkaloids

Genetics

  • Genetic studies have shown the role of genetics in childhood constipation by various mechanisms.
  • Genes involved in the pathogenesis of childhood constipation and related diseases are as following:[24]
Group Gene OMIM/Chromosome Syndrome Other manifestations
Autonomic nervous system GFAP 203450/17q21 Alexander disease
LMNB1 169500/5q23 Cavitating leukodystrophy – autonomic failure
PHOX2B 209880/4p12 Congenital central hypoventilation syndrome
HSN2 201300/12p13 Hereditary sensory and autonomic neuropathy type II and III
IKBKAP 223900/9q31
MECP2 300005/Xq28 MECP2 duplication
SCN9A 167400/2q24 Paroxysmal extreme pain disorder
TCF4 610954/18q21 Pitt-Hopkins syndrome
NRXN1 610954/2p16.3
Innervation ATRX 301040/Xq13 Alpha-thalassemia mental retardation syndrome
RET 162300/10q11 MEN2B
ZEB2 235730/2q22 Mowat-Wilson syndrome
HPSE2 236730/10q24 Ochoa syndrome
Muscular COL4A5 308940/Xq22 Alport syndrome with diffuse leiomyomatosis
COL4A6
PTRF-CAVIN 613327/17q21 Congenital generalized lipodystrophy, type 4
DES 601419/2q35 Desmin-related myopathy
SCN4A 170500/17q23 Hyperkalemic periodic paralysis (HYPP)
  • Episodic flaccid generalized muscle weakness
ZNF9 160900/3q21 Myotonic dystrophy
DMPK 602668/19q13
SMN1 253300/5q12 Spinal muscular atrophy
AXPC1 609033/1q31 Posterior column ataxia with retinitis pigmentosa
CBP 180849/16p13 Rubinstein-Taybi syndrome
EP300 180849/22q13
HUWE1 300706/Xp11 Turner mental retardation syndrome
UPF3B 300676/Xq25 X-linked syndromic mental retardation -14
Electrolyte disturbance SLC12A3 263800/16q13 Gitelman syndrome
SLC6A8 300036/Xq28 Creatinine transporter defect
CASR 239200/3q21 Hyperparathyroidismneonatal familial
AVPR2 304800/Xq28 Nephrogenic diabetes insipidus
SPINK5 256500/5q32 Netherton syndrome
Malformation HLXB9 176450/7q36 Currarino syndrome
MED12 305450/Xq13 FG syndrome
FLNA 305450/Xq28
SIX3 157170/2p21 Holoprosencephaly
VANGL1 600145/1p13 Sacral defect with anterior meningocele

Associated Conditions

Associated conditions with constipation are included:

Gross Pathology

  • On gross pathology, there is no finding related to constipation.

Microscopic Pathology

Melanosis coli with brown granular pigments, By Ed Uthman from Houston, TX, USA - Uploaded by CFCF, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=30104213
Melanosis coli, By myself (Alex_brollo) - Slide files from Hospital of Monfalcone (Italy), CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=1221399
Melanosis coli in laxative abusing patient, By Ed Uthman from Houston, TX, USA - Melanosis coliUploaded by CFCF, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=30104214

References

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