Anatomy and physiology

Constipation : The anatomy and physiology

Basic knowledge of anatomy and physiology of the lower gastrointestinal tract is important to understand constipation. The picture shows the basic gross anatomy of the large intestine ( colon ). 0. Terminal Ileum 1. Appendix 2. Caecum 3. Ascending colon 4. Transverse colon 5. Descending colon 6. Sigmoid colon 7. Rectum 8. Anal canal

y y y y y y y y y

Ingested food is digested by the stomach and the small intestine. After absorption of nutrients by the small intestine, the waste products and undigested particles are moved through the large intestine by propulsive movements. The main propulsive movements that occur in the colon are known as mass movements. These motions allow the colonic contents to move towards the rectum. These movements occur in 1 to 3 episodes within a day, usually lasting about 10 to 30 minutes at a time.

Colonic transit time

The time taken for the passage of materials through the colon is called colonic transit time. The average colonic transit time for the Westerners is 60 hours, for a rural Asian or African on a high fibre diet is 30 hours.

Formation of feces
As the contents pass through the colon it is dehydrated, mixed with bacteria and mucus, and formed into feces. Normal feces contain roughly 75% water and 25% solids. The bulk of fecal solids are bacteria and undigested organic matter and fiber. The characteristic brown color of feces is due to stercobilin and urobinin, both of which are produced by bacterial degradation of bilirubin. Fecal odor results from gases produced by bacterial metabolism. Constipation Can be due to slow transit or obstruction in the passage.

Human gastrointestinal tract

.

Human gastrointestinal tract (Digestive System)

Stomach colon rectum diagram

The human gastrointestinal tract refers to the stomach and intestine, and sometimes to all the structures from the mouth to the anus. (The "digestive system" is a broader term that includes other structures, including the accessory organs of digestion). In an adult male human, the gastrointestinal (GI) tract is 5 metres (20 ft) long in a live subject, or up to 9 metres (30 ft) without the effect of muscle tone, and consists of the upper and lower GI tracts. The tract may also be divided into foregut, midgut, and hindgut, reflecting theembryological origin of each segment of the tract.

The GI tract always releases hormones to help regulate the digestion process. These hormones, including gastrin, secretin, cholecystokinin, and grehlin, are mediated through either intracrine or autocrine mechanisms, indicating that the cells releasing these hormones are conserved structures throughout evolution.

Constipation is a symptom with many causes. These causes are of two types: obstructed defecation and colonic slow transit (or hypomobility). About 50% of patients evaluated for constipation at tertiary referral hospitals have obstructed defecation.[3] This type of constipation has mechanical and functional causes. Causes of colonic slow transit constipation include diet,hormones, side effects of medications, and heavy metal toxicity. Treatments include changes in dietary habits, laxatives, enemas, biofeedback, and surgery. Because constipation is a symptom, not a disease, effective treatment of constipation may require first determining the cause.    infrequent bowel movements (typically three times or fewer per week) difficulty during defecation (straining during more than 25% of bowel movements or a subjective sensation of hard stools), or the sensation of incomplete bowel evacuation.

Constipation is an abnormal condition in which there is an infrequent and difficult passage of hard and dry feces or stools. Constipation can happen by itself or can be a symptom of a wide variety of mild to serious diseases, disorders and conditions. .

Pregnancy symptoms differ from woman to woman and pregnancy to pregnancy; however, one of the most significant pregnancy symptoms is a delayed or missed menstrual cycle. Understanding the signs and symptoms of pregnancy is important because each symptom may be related to something other than pregnancy. Some women experience signs or symptoms of pregnancy within a week of conception. For other women, pregnancy symptoms may develop over a few weeks or may not be present at all.

Implantation Bleeding:
Implantation bleeding can be one of the earliest pregnancy symptoms. About 6-12 days after conception, the embryo implants itself into the uterine wall. Some women will experience spotting as well as some cramping. Other Explanations: Actual menstruation, altered menstruation, changes in birth control pill, infection, or abrasion from intercourse.

Delay/Difference in Menstruation:
A delayed or missed period is the most common pregnancy symptom leading a woman to test for pregnancy. When you become pregnant, your next period should be missed. Many women can bleed while they are pregnant, but typically the bleeding will be shorter or lighter than a normal period. Other Explanations: Excessive weight gain/loss, fatigue, hormonal problems, tension, stress, ceasing to take the birth control pill, illness or breastfeeding.

Swollen/Tender Breasts:
Swollen or tender breasts is a pregnancy symptom which may begin as early as 1-2 weeks after conception. Women may notice changes in their breasts; they may be tender to the touch, sore, or swollen. Other Explanations: Hormonal imbalance, birth control pills, impending menstruation (PMS) can also cause your breasts to be swollen or tender.

Fatigue/Tiredness:
Feeling fatigued or more tired is a pregnancy symptom which can also start as early as the first week after conception. Other Explanations: Stress, exhaustion, depression, common cold or flu, or other illnesses can also leave you feeling tired or fatigued.

Headaches:
The sudden rise of hormones in your body can cause you to have headaches early in pregnancy. Other Explanations: Dehydration, caffeine withdrawal, impending menstruation, eye strain, or other ailments can be the source of frequent or chronic headaches.

Pregnancy is the fertilization and development of one or more offspring, known as an embryo orfetus, in

a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets.

Childbirth usually occurs about 38 weeks after conception; in women who have a menstrual cycle length

of four weeks, this is approximately 40 weeks from the start of the last normal menstrual period (LNMP).

Human pregnancy is the most studied of all mammalian pregnancies.One scientific term for the state of

pregnancy is gravidity (adjective "gravid"), latin for heavy and a pregnant female is sometimes referred

to as a gravida.

[1]

Similarly, the term parity (abbreviated as para) is used for the number of previous

successful live births. Medically, a woman who has never been pregnant is referred to as a nulligravida,

a woman who is (or has been only) pregnant for the first time as a primigravida,[2] and a woman in

subsequent pregnancies as amultigravida or multiparous.[1][3][4] Hence, during a second pregnancy a

woman would be described as gravida 2, para 1 and upon live delivery as gravida 2, para 2. An in-

progress pregnancy, as well as abortions, miscarriages, or stillbirths account for parity values being less

than the gravida number. In the case of twins, triplets etc., gravida number and parity value are increased

by one only. Women who have never carried a pregnancy achieving more than 20 weeks of gestation age

are referred to as nulliparous.[5]

The term embryo is used to describe the developing offspring during the first 8 weeks following

conception, and subsequently the term fetus is used henceforth until birth.[6][7]

In many societies medical or legal definitions, human pregnancy is somewhat arbitrarily divided into three

trimester periods, as a means to simplify reference to the different stages of prenatal development. The

first trimester carries the highest risk of miscarriage (natural death of embryo or fetus). During the second

trimester, the development of the fetus can be more easily monitored and diagnosed. The beginning of

the third trimester often approximates the point ofviability, or the ability of the fetus to survive, with or

without medical help, outside of the uterus.