Constipation is one of the most common gastrointestinal complaints in the general population. It is associated with a diminished quality of life and increased psychological stress. Although the prevalence varies widely, the rate for chronic constipation is 15 to 20% based on epidemiologic surveys in North America. There are many causes of constipation, and its definition is imprecise and variable. Diagnosis and appropriate management are therefore difficult but extremely important. This chapter primarily focuses on the diagnosis and management of constipation as it relates to adult females. Although it is not known why more women than men experience constipation, it is possible that hormone levels, which influence the digestive system, likely contribute. Pregnancy-related constipation is also common because of both hormonal changes and pelvic floor dysfunction after pregnancy. Women also tend to experience constipation prior to menstruation. In these cases, it is most likely that fluids that would normally soften stools in the colon are retained in other parts of the body. The female anatomy may also be a factor as functional outlet obstruction can occur after changes to the pelvic floor anatomy (such as after pregnancy). Figures illustrate the Bristol Stool Chart, rectal prolapse, protrusion of the posterior vaginal wall consistent with rectocele, enterocele with vaginal prolapsed, and enterocele with bladder prolapse. Videos show rectal prolapsed, rectocele, cystocele, descended perineum, and repaired perineum. Tables list causes of functional constipation, drugs associated with constipation, diagnostic criteria for functional constipation, and Rome criteria of irritable bowel syndrome.
This review contains 5 figures, 6 tables, and 99 references.
Episiotomy: the biomechanical impact of multiple small incisions during a normal vaginal delivery