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No rule for frequency of normal bowel movements The general range is from 3 times a day to 3 times a week. A bowel movement should be soft and easy to pass, though some people may have harder or softer stools than others.

There is usually a time of day when bowel movements are more likely to occur The urge to defecate is often strongest in the morning Laxatives Food

y Frequency of occurrence y Texture y Sudden change in the colour y Consistency of stool y Shape of stool

y Excessive and frequent evacuation of watery faeces. usually indicating gastrointestinal distress or disorder. y Loose watery stool y condition of having three or more loose or liquid bowel movements per day .

. dry stools that are painful or difficult to pass. but an adult who has not had a bowel movement in three days or a child who has not had a bowel movement in four days is considered constipated.y Constipation is an acute or chronic condition in which bowel movements occur less often than usual or consist of hard. y Bowel habits vary.



y Nervous system of GIT y Lies along the GIT y Plexuses: y Myenteric plexus (Auerbach s) y Between inner circular and outer longitudinal muscle y For GI muscle movement y Submucosal plexus (Meissner s) y In the submucosa y For GI secretion & local blood flow .

y Extrinsic control by: y Parasympathetic NS y Sympathetic NS y Sensory fibers travel through: Luminal epithelium and gut wall Prevertebral ganglia of spinal cord Enteric plexuses Spinal cord & brain stem .

y Parasympathetic stimulation increase activity of GIT y Cranial and sacral division y To first half of large intestine y Sacral parasympathetics y Through pelvic nerve y To distal half of large intestine y Sympathetic stimulation y Inhibit activity of GIT y Have opposite effects of parasympathetic stimulation .

y Integrated entirely within the gut wall y GI secretion y Peristalsis y Mixing contraction y Local inhibitory effects y Gut prevertebral sympathetic ganglia y Eg: gastrocolic reflex y Gut spinal cord / brain stem y Defecation reflex GIT GIT .


Move food forward through the GIT Also known as myenteric reflex Food enters lumen Distention of intestinal tract Stimulate afferent enteric neuron Relaxation of smooth muscle below the bolus Activate inhibitory motor neuron Activate excitatory motor neuron (Ach) Food move forward through GIT Peristalsis Contraction of smooth muscle above the bolus .

local intermittent constrictive contractions occur every few centimeters in the gut wall y Chopping and shearing contents . the peristaltic contraction causes most mixing Sphincter blocks intestinal contents + Peristalsis = Mixing of contents y In other times.y Keep intestinal contents thoroughly mixed y Differ in different parts of the body y In some areas.

rectum . rectal pressure Stretch receptors detect Ignore Desire to defecate Afferent signals (myenteric plexus) Relieve Constipation Peristaltic wave thru descending & sigmoid colon.y Initiated by intrinsic reflex Rectum stores feces Rectal wall distention.

Peristaltic wave thru descending & sigmoid colon. rectum Feces move towards anus Peristaltic wave reaches anus External anal sphincter consciously relax Inhibitory signals (myenteric plexus) Internal anal sphincter relax Pass stool .


y constipation that does not have a physical (anatomical) or physiological cause y Bowel is healthy but not working properly y When colon absorbs too much water or y Slow stool movement in colon y Due to slow muscle contraction hard stool y Common causes y Not enough fiber and liquid in diet y Medications y Ignoring urge to defecate .

etc.) y Volvulus y Large intestine: y Neoplasms y Hernias y Transverse colonic volvulus y . swallowed objects.y Due to colonic obstruction y Caused by: y Small intestine: Hernia y Foreign bodies (gallstone.

y Flow of abnormal stool with increased frequency y Acute: <2 weeks y Chronic: >4 weeks y Persistent: 2-4 weeks y Types: y Secretory y Osmotic y Exudative y Inflammatory y Dysentery .

channels prolonged opening Affects ENS Uncontrolled water secretion water secretion Diarrhea Independent stimulus of secretion .y Secretion of water > absorption y Due to certain bacterial infections y Eg: cholera by Vibrio cholerae Activates adenylyl cyclase intracell cAMP (crypt enterocytes) Cholera toxin Cl.

y When ingested poorly absorbable substrate y Eg: sorbitol cannot be absorbed into the body draws water from body into the bowel y Malabsorption .deficiencies of enzyme to process disaccharides y Eg: Lactose intolerance Lactose is consumed deficiency of lactase Lactose remains in lumen Passes large intestine Lactose osmotically active (holds water in lumen) No lactase Excessive gas production Fermented by colonic bacteria Diarrhea .

y No detectable organic causes y A functional disorder y Subgroups : y With diarrhea (common in male) y With constipation (common in female) y Mixed bowel habit .

Investigation .

which normally makes up 60-85% of fecal matter y acute.y an increased frequency or decreased /consistency of bowel movements y increase in stool weight due to excess water. y chronic. which continues for longer than 23 weeks . lasts one-two weeks.

y Associated with any injury y to GI track Fever Nausea Vomiting Abdominal pain No. of bowel movements can vary up to 20 or more per day .

y Diarrhea needs to be distinguished from four other - conditions Incontinence of stool Rectal Urgency Incomplete evacuation Bowel movements immediately after eating a meal .

Examination of a small amount of stool .Measurement of blood pressure (supine & lying down) .Usage of Antibiotics .y Acute diarrhoea .

Sugar Malabsorption hydrogen breath test .Fat Malabsorption Fat in 72 hour stool .X-rays of the intestines (upper GI/barium enema) .Celiac disease blood test/biopsy of SI .y Chronic Diarrhoea .Endoscopy ( EGD) .

Codeine phosphate .Bismuth Compounds .Antibiotics .y Medication .Bile acid sequestrants .Anti motility agent .Zinc .

< 3x a week y Difficulty during defecation y Sensation of incomplete bowel evacuation .y Change in the bowel habit or defecatory behaviour .Resolved with relieve of constipation y Infrequent bowel movement .

Ray y Barium Enema .y Medical History y Physical Examination y Blood test y Abdominal X.

y Dietary fiber (bulk-forming laxatives) y Emollient laxatives (stool softeners) y Hyperosmolar laxatives y Saline laxatives y Stimulant laxatives y Enemas .