Constipation: Causes

Pathogenesis (development of disease)

The pathogenesis of constipation is diverse. The following components may occur:

  • Disruption of intrinsic (“internal”) motility (movement of the bowel).
  • Lack of luminal factors, such as stretching, chemical and tactile stimuli.
  • Lack of extrinsic innervation (functional supply of nerve tissue to the organ, i.e., nerve cells; cross-sectional lesions).
  • Defecation disorders (disorders of defecation).
  • Medication
  • Hormones (very rare!, e.g., in the case of a pheochromocytoma).

Primary constipation usually occurs when the colon transit time (transit time through the intestine) is prolonged. This occurs due to a decreased number of contraction waves. The cause is then usually a disorder in the nervous system of the intestine. In addition to this form of constipation, many other different causes (secondary constipation – see below) can be considered. Note: In childhood, 3% of patients in a general pediatric practice and up to 25% in a pediatric gastroenterology consultation have stool problems. However, in 90-95% of affected children, no organic cause is found.

Etiology (Causes)

Biographic causes

  • Genetic burden
    • Genetic diseases
      • Cystic fibrosis (ZF) – genetic disease with autosomal recessive inheritance, characterized by the production of secretions in various organs to be tamed.
      • Neurofibromatosis – genetic disease with autosomal dominant inheritance; belongs to the phakomatoses (diseases of the skin and nervous system); three genetically different forms are distinguished:
        • Neurofibromatosis type 1 (von Recklinghausen’s disease) – patients develop multiple neurofibromas (nerve tumors) during puberty, which often occur in the skin but also occur in the nervous system, orbita (eye socket), gastrointestinal tract (gastrointestinal tract), and retroperitoneum (space located behind the peritoneum on the back toward the spine); Typical is the appearance of café-au-lait spots (light brown macules) and multiple benign (benign) neoplasms
        • [Neurofibromatosis type 2 – characteristic is the presence of bilateral (bilateral) acoustic neuroma (vestibular schwannoma) and multiple meningiomas (meningeal tumors).
        • Schwannomatosis – hereditary tumor syndrome]
      • Hirschsprung’s disease (MH; synonym: megacolon congenitum) – genetic disease with both autosomal recessive inheritance and sporadic occurrence; disease, which in most cases is the last third of the colon (sigmoid and rectum) of the large intestine affected; belongs to the group of aganglionoses; lack of ganglion cells (“aganglionosis”) in the area of the submucosal plexus or myentericus (Auerbach’s plexus) leads to hyperplasia of the upstream nerve cells, resulting in increased acetylcholine release. The permanent stimulation of the ring muscles thus leads to a permanent contraction of the affected section of the intestine.MH is relatively common at 1: 3,000 – 1: 5,000 births, boys are affected up to four times more often than girls. [paradoxical diarrhea (diarrhea); diarrhea alternating with constipation.]
      • Porphyria or acute intermittent porphyria (AIP); genetic disease with autosomal dominant inheritance; patients with this disease have a 50 percent reduction in the activity of the enzyme porphobilinogen deaminase (PBG-D), which is sufficient for porphyrin synthesis. Triggers of a porphyria attack, which can last a few days but also months, are infections, drugs or alcohol.The clinical picture, of these attacks presents as acute abdomen or neurological deficits, which can take a lethal course. The leading symptoms of acute porphyria are intermittent (occasionally or chronically) neurological and psychiatric disturbances. Autonomic neuropathy is often in the foreground, causing abdominal colic (acute abdomen), nausea (nausea), vomiting or constipation, as well as tachycardia (heartbeat too fast: > 100 beats per minute) and labile hypertension (high blood pressure).
  • Age – increasing age

Behavioral causes

  • Nutrition
  • Drug use
    • Opiates or opioids (alfentanil, apomorphine, buprenorphine, codeine, dihydrocodeine, fentanyl, hydromorphone, loperamide, morphine, methadone, nalbuphine, naloxone, naltrexone, oxycodone, pentazocine, pethidine, piritramide, remifentanil, sufentanil, tapentadol, tilidine, tramadol)
  • Physical activity
    • Physical inactivity
    • Long bed rest
  • Psycho-social situation
    • Psychological stress
  • Overweight (BMI ≥ 25; obesity).

Disease-related causes

Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99).

  • See under “Biographic Causes/Genetic Disorders.”
  • Spina bifida

Endocrine, nutritional and metabolic diseases (E00-E90).

  • Amyloidosis – extracellular (“outside the cell”) deposits of amyloids (degradation-resistant proteins) that can lead to cardiomyopathy (heart muscle disease), neuropathy (peripheral nervous system disease), and hepatomegaly (liver enlargement), among other conditions.
  • Conn syndrome (primary hyperaldosteronism, PH).
  • Diabetes mellitus
  • Hashimoto’s thyroiditis – autoimmune disease leading to chronic thyroiditis.
  • Hyperparathyroidism (parathyroid hyperfunction).
  • Hypothyroidism (hypothyroidism)
  • Rickets – refers to a disorder of bone metabolism in children, which leads to marked demineralization of bone and skeletal changes due to retardation of bone growth. In adults with completed bone growth, the symptomatology is called osteomalacia.

Cardiovascular system (I00-I99).

Infectious and parasitic diseases (A00-B99).

  • Chagas disease – South American infectious disease caused by unicellular parasites.
  • Helminthiasis – diseases caused by parasitic worms.
  • Syphilis (lues) – venereal disease
  • Typhoid abdominalis – infectious disease caused by the serovar Typhi of the bacterial species Salmonella enterica.

Liver, gallbladder and bile ducts – pancreas (pancreas) (K70-K77; K80-K87).

  • Biliary colic
  • Pancreatitis (inflammation of the pancreas)

Mouth, esophagus (esophagus), stomach, and intestines (K00-K67; K90-K93).

  • Anal fissure – tears in the mucosa of the anus (anus).
  • Anal stenosis (anal stricture)
  • Anal stricture – narrowing of the anus
  • Anorectal voiding disorders such as:
    • Intussusception (synonym: intussusception) – invagination of a portion of the bowel into itself or a neighboring organ.
    • Pelvic floor depression
    • Enterocele – hernia of the intestine that protrudes into the vagina.
    • Reflector-induced defecation disorders.
    • Rectocele – outpouching of the anterior wall of the rectum into the vagina.
  • Abdominal wall hernia (hernia of the intestine).
  • Intestinal ischemia – circulatory disorders of the intestine.
  • Intestinal tuberculosis [paradoxical diarrhea; diarrhea alternating with constipation/constipation]
  • Diverticulitis – inflammation of the wall of the diverticulum.
  • Diverticulosis – change in the colon in the form of small protrusions of the intestinal wall (diverticula).
  • Dysbiosis – disease process triggered by a qualitatively and / or quantitatively deviating from the norm bacterial flora in the intestine.
  • Functional constipation (In 90-95% of children with constipation, no organic cause is found).
  • Hemorrhoids
  • Ileus (intestinal obstruction)
  • Colonic transit disorder – prolonged retention of stool in the colon.
  • Periproctitic abscess – encapsulated purulent inflammation in the area of the anal canal.
  • Peritonitis (inflammation of the peritoneum)
  • Irritable bowel syndrome (irritable colon)
  • Rectocele – is a protrusion of the anterior wall of the rectum into the vagina due to weakness of the wall layers between the rectum and the vagina.
  • Rectal prolapse (rectal prolapse), also known as anal prolapse.

Musculoskeletal system and connective tissue (M00-M99).

  • Muscle diseases, unspecified
  • Myopathies (muscle diseases):
    • Atrophic desmosis coli
    • Degenerative fibrosis
    • Enteric leiomyositis, amphophilic inclusion bodies.
    • Myofilament loss
  • Progressive systemic sclerosis – severe generalized disease that manifests in many organs.

Neoplasms – tumor diseases (C00-D48).

  • Familial adenomatous polyposis (FAP; synonym: Familial polyposis) – is an autosomal dominant inherited disorder. This leads to the occurrence of a large number (> 100 to thousands) of colorectal adenomas (polyps). The probability of malignant (malignant) degeneration is almost 100% (on average from the age of 40). [paradoxical diarrhea/diarrhea; diarrhea alternating with constipation/constipation.]
  • Colon carcinoma (colon cancer) [paradoxical diarrhea/diarrhea; diarrhea alternating with constipation/constipation]
  • Colonic polyps – tissue protrusions into the cavity of the colon.
  • Neuroblastoma – malignant neoplasm of the autonomic nervous system.
  • Ovarian carcinoma (ovarian cancer)
  • Peritoneal carcinomatosis – extensive infestation of the peritoneum (peritoneum) with malignant tumor cells.
  • Pheochromocytoma – usually benign tumor that originates predominantly from the adrenal gland and can lead to hypertension crises.
  • Rectal carcinoma (rectal cancer).
  • Tumors in the central nervous system

Psyche – nervous system (F00-F99; G00-G99)

  • Anxiety
  • Dementia
  • Depression
  • Diabetic polyneuropathy – damage to multiple nerves (polyneuropathy) that occurs as a complication of existing diabetes mellitus.
  • Drug abuse
  • Eating disorders
  • Guillain-Barré polyneuritis (synonyms: acute inflammatory demyelinating polyneuropathy; chronic inflammatory demyelinating polyneuropathy; idiopathic polyradiculoneuritis; Landry-Guillain-Barré-Strohl syndrome,) – idiopathic polyneuritis (inflammatory disease of multiple nerves) of spinal nerve roots and peripheral nerves.
  • Parkinson’s disease
  • Multiple sclerosis (MS) – chronic inflammatory demyelinating disease of the central nervous system (CNS) that can cause paralysis and spasticity.
  • Neuropathies (diseases of the peripheral nervous system):
    • Degenerative neuropathy
    • Enteric ganglionitis
    • Hypoganglionosis of the myenteric plexus
    • Intestinal neuronal dysplasia

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99).

  • Uremia (occurrence of urinary substances in the blood above normal levels).

Genitourinary system (kidneys, urinary tract – reproductive organs) (N00-N99).

  • Adnexitis
  • Descensus (lowering of the pelvic floor)
  • Genital prolapse – partial or complete prolapse of the vagina (descensus vaginae) and / or uterus (descensus uteri) from the pubic cleft (rima pudendi).
  • Nephrolithiasis (kidney stones).
  • Renal colic
  • Premenstrual syndrome (PMS) – occurs in women about four to fourteen days before their next period and involves a complex picture of different symptoms and complaints

Injuries, poisonings, and other consequences of external causes (S00-T98).

  • Pseudoallergy (pseudoallergic/nonimmunologic reaction).
  • Stricture (high-grade narrowing) of the intestine after surgery/radiatio (radiation therapy).
  • Spinal cord injury – spinal cord transection, lesion of autonomic nerve plexuses (pelvic surgery).

Laboratory diagnoses – laboratory parameters considered independent risk factors.

  • Hypercalcemia (excess calcium).
  • Hypokalemia (potassium deficiency)

Medication

Environmental pollution – intoxication (poisoning).

  • Lead

Other causes

  • Change of location (travel obstipation)
  • Pregnancy (3rd trimester/third trimester).
  • Cycle (2nd half of the cycle)