Digestive System

Kamran
 OVERVIEW OF DIGESTIVE SYSTEM
• The Digestive System Consists of ;
• Long hollow muscular tube or
canal or tract called gastrointestinal
tract (GIT):
– it is about 9 meters (30 ft) long
• Accessory glands: include:
• Salivary glands
• Liver and gall bladder
• Pancreas
GIT Animation
GIT consists of;
– Oral cavity or mouth
– Pharynx
– Esophagus
– Stomach
– Small intestine
– Large intestine
– Rectum
– Anus
 Sphincters of GIT
• The intestinal tract is
functionally divided into
segments, by means of muscle
rings known as sphincters ,
that restrict the flow of
intestinal contents to optimize
digestion and absorption
• These sphincters include the
upper and lower esophageal
sphincters, the pylorus that
retards emptying of the
stomach, the ileocecal valve
that retains colonic contents
(including large numbers of
bacteria) in the large intestine,
and the inner and outer anal
sphincters
 Function of GIT
• The alimentary tract provides the body with a continual
supply of water, electrolytes, vitamins, and nutrients,
which requires the following:
• (1) movement of food through the alimentary tract;
• (2) secretion of digestive juices and digestion of the food;
• (3) absorption of water, various electrolytes, vitamins, and
digestive products;
• (4) circulation of blood through the gastrointestinal organs
to carry away the absorbed substances; and
• (5) control of all these functions by local, nervous, and
hormonal systems.
Structure of GIT Wall
• The GIT wall is composed of four layers, each having
different tissues and functions
• From the inside out , they are called: mucosa,
submucosa, muscularis and serosa
• MUCOSA:
• The mucosa is made up of three layers:
– Lining the lumen of GI tract is a single layer of epithelial
cells representing the barrier that nutrients must traverse
to enter the body; this layer is responsible for most
digestive, absorptive and secretory process
– Below the epithelium is a layer of loose connective tissue
known as the lamina propria
– The lamina propria in turn is surrounded by a loose layer
General Anatomy of GI Wall
• The mucosae (singular: mucosa) are highly
specialized in each part of the GIT in order to deal
with different digestive tract conditions
• The most variation is seen in the epithelial tissue
layer of the mucosa
– Esophagus:
• The mucosa of the esophagus consists of
nonkeratinized stratified squamous epithelium
• Near the stomach, the mucosa of the esophagus
also contains mucous glands
– Stomach:
• The stomach wall is lined internally with mucosa
formed from simple columnar epithelium
• The mucosa is turned into large folds, called rugae
when stomach is empty and depressions called
gastric pits
• The epithelia at different points in pits is thrown
deep into mucosa to form gastric glands which deal
with gastric secretions
– Small Intestine:
• Throughout the small intestine, the epithelium
(particularly the ileum) is folded up into fingerlike
projections called villi (0.5–1 mm) to maximizes the
surface area available for nutrient absorption
• The villi contains blood vessels & lacteals (lymph
vessel)
• In intestine, between the villi are infoldings known
as crypts
• The epithelial layer of the small intestinal mucosa
consists of simple columnar epithelium that
contains many types of cells
• Absorptive cells of the epithelium contain enzymes
that digest food and possess microvilli which are
projections of the apical (free) membrane of the
absorptive cells; means greater surface area for
absorption
• Also present in the epithelium are goblet cells,
which secrete mucus
VILLI & CRYPT
• Cells lining the crypts form the intestinal glands, or
crypts of Lieberkühn and secrete intestinal juice
• The intestinal glands also contain paneth cells and
enteroendocrine cells
• Paneth cells secrete lysozyme, a bactericidal enzyme,
and are capable of phagocytosis; may have a role in
regulating the microbial population in the small
intestine
• Three types of enteroendocrine cells are found in the
intestinal glands of the small intestine:
• S cells, CCK cells, and K cells, which secrete the
hormones secretin, cholecystokinin (CCK), and
glucose-dependent insulinotropic peptide (GIP)
• Stem cells that give rise to both crypt and villus
epithelial cells reside toward the base of the crypts
and are responsible for completely renewing the
epithelium every few days or so
• Daughter cells formed in the crypts from stem cells
then migrate out onto the villi, where they are
eventually shed and lost in the stool
• The lamina propria of the small intestinal mucosa
contains areolar connective tissue and mucosa-
associated lymphoid tissue (MALT)
• The microvilli in the apical cells are endowed with a
dense glycocalyx (the brush border) that probably
protects the cells to some extent from the effects of
• Some digestive enzymes are actually part of the
brush border, being membrane-bound proteins;
these so-called “brush border hydrolases” perform
the final steps of digestion for specific nutrients.
• Large Intestine:
• Since major function of large intestine is to absorb
water; the epithelium contains mostly absorptive
and goblet cells similar to small intestine
Intestinal Structure
• SUBMUCOSA:
• The submucosa lies under the mucosa and consists
of dense irregular layer of connective tissue with
large blood vessels, lymphatics and nerves
• It is relatively thick and supports mucosa
• It holds the glands and a nerve plexuses called
Meissner’s plexus
• The absorbed elements that pass through the
mucosa are picked up by the blood vessels of
submucosa
• MUSCULARIS:
• Around the sub-mucosa is the muscularis externa or
muscularis propria consisting of two rings or layers of
smooth muscles; an inner one oriented
circumferentially and outer one longitudinally to the
axis of the gut (the circular and longitudinal muscle
layers, respectively)
• Between the two muscle layers is the layers of nerve
plexus called myenteric or Auerbach’s plexus
– Esophagus:
• The muscularis of the superior third of the
esophagus is skeletal muscle, the intermediate third
is skeletal and smooth muscle, and the inferior third
• At each end of the esophagus, the muscularis
becomes slightly more prominent and forms two
sphincters—the upper esophageal sphincter (UES),
which consists of skeletal muscle, and the lower
esophageal (cardiac) sphincter (LES), which consists
of smooth muscle and is near the heart
• The UES regulates the movement of food from the
pharynx into the esophagus; the LES regulates the
movement of food from the esophagus into the
stomach; both prevent backflow of food
– Stomach:
• The stomach has a third layer, the inner oblique
layer which helps churn the chyme in the stomach
 – Large Intestine:
• To match the needs of large intestine, in the layer of
muscularis, portions of the longitudinal muscles are thickened,
forming three conspicuous bands called the teniae coli (teniae
= flat bands) that run most of the length of the large intestine
• The teniae coli are separated by portions of the wall with less
or no longitudinal muscle
• Tonic contractions of the bands gather the colon into a series
of pouches called haustra (HAWS-tra = shaped like pouches;
singular is haustrum), which give the colon a puckered
appearance
• A single layer of circular smooth muscle lies between teniae
coli
• In the colon , the muscularis externa is much thicker because
the feces are large and heavy, requiring more force to push
along
• SEROSA:
• The outermost layer covering the wall of GIT is serosa
which separates GI tract from other organs in the
abdominal cavity
• It is composed of a secretory epithelial layer and an
underneath connective tissue layer
• The epithelial layer known as mesothelium, consists of
avascular flat nucleated cells (simple squamous
epithelium) that produce the lubricating serous fluid
• The serous fluid has a consistency similar to thin mucus
and provides lubrication to reduce friction
• The superficial layer of the esophagus is known as the
adventitia which attaches the esophagus to
surrounding structures
THE MUSCULATURE OF THE DIGESTIVE TRACT

• The smooth muscles of the digestive tract are

generally organized in distinct layers.
• Two important muscle layers for motility in the
lower esophagus and small and large intestine are
the longitudinal and circular layers
• The two layers form the intestinal muscularis
externa
• The stomach has an additional obliquely oriented
muscle layer
 GI Smooth Muscle Functions as a Syncytium
• The individual smooth muscle fibers in the GI tract
are 200 to 500 μm in length and 2 to 10 μm in
diameter, and they are arranged in bundles of as
many as 1000 parallel fibers
• In the longitudinal muscle layer, the bundles extend
longitudinally down the intestinal tract; in the
circular muscle layer, they extend around the gut
• Within each bundle, the muscle fibers are electrically
connected with one another through large numbers
of gap junctions that allow low-resistance
movement of ions from one muscle cell to the next
and help to travel electrical signals more readily in
• Each bundle of smooth muscle fibers is partly separated
from the next by loose connective tissue
• However, the muscle bundles fuse with one another at
many points, thus, representing a branching latticework of
smooth muscle bundles
• This makes the muscle layer a syncytium, i.e., when an
action potential is elicited anywhere within the muscle
mass, it generally travels in all directions in the muscle
• The distance that it travels depends on the excitability of
the muscle; sometimes it stops after only a few mm, and at
other times it travels many cm or even the entire length
and breadth of the intestinal tract
• A few connections also exist between the longitudinal and
circular muscle layers, excitation of one of these layers
often excites the other as well
 GI Smooth Muscle:
Circular Muscle and
Longitudinal Circular Muscle
Longitudinal Muscle
Muscle • Thick Muscle Coat
• Thin Muscle Coat • Contraction increases
• Contraction shortens intestine length &
intestine length & decreases radius
expands radius • Innervated by excitatory
• Innervated & & inhibitory motor
activated by neurons
excitatory motor • Activated by myogenic
neurons pacemaker & excitatory
• Few gap junctions to motor neurons
adjacent fibers • Many gap junctions to
• Extracellular Ca2+ adjacent fibers
influx important in • Intracellular Ca2+
excitation- release important in
excitation-contraction
 THE ENTERIC NERVOUS SYSTEM (ENS)
• The ENS lies entirely in the wall of the gut, beginning in
the esophagus and extending all the way to the anus as
two layers of nerve plexus
• This highly developed ENS is especially important in
controlling GI movements and secretion
• These two nerve plexus are intrinsic to GIT:
– the myenteric plexus (Auerbach‘s plexus),
between the outer longitudinal and middle circular muscle
layers, and
– the submucous plexus (Meissner‘s plexus), between the
middle circular layer and the mucosa
• Collectively, these neurons constitute the enteric
• The system contains about 100 million sensory
neurons, inter-neurons, and motor neurons in
humans more than the entire spinal cord; so
referred as “little brain”
• The myenteric plexus innervates the longitudinal
and circular smooth muscle layers and is concerned
primarily with motor control,
• The submucous plexus innervates the glandular
epithelium, intestinal endocrine cells, and
submucosal blood vessels and is primarily involved
in the control of intestinal secretion.
 EXTRINSIC INNERVATION
• The ENS in intestine receives a dual extrinsic
innervation from the ANS, with
– parasympathetic cholinergic activity generally increasing
the activity of intestinal smooth muscle; and
– sympathetic noradrenergic activity generally decreasing
it while causing sphincters to contract
• The preganglionic parasympathetic fibers consist of
about 2000 vagal efferents and other efferents in
the sacral nerves and generally end on cholinergic
nerve cells of the myenteric and submucous
plexuses
• The sympathetic fibers are postganglionic, but many
of them end on postganglionic cholinergic neurons,
where they inhibit Ach secretion by activating α2
presynaptic receptors via NE release
• Other sympathetic fibers appear to end directly on
intestinal smooth muscle cells
• Still other fibers innervate blood vessels, where
they produce vasoconstriction
• Besides, the intestinal blood vessels seems to have
intrinsic innervation too by fibers of the ENS
• VIP and NO are among the mediators in the intrinsic
innervation
 Integration of sympathetic, parasympathetic and
enteric nervous system

Effector system
of GI innervat ion:

( modified from B&L)

 Oral/or Buccal Cavity
• The digestive tract begins with the oral cavity
• The oral cavity includes the mouth, teeth, tongue,
and salivary glands
• The buccal cavity is composed of two separate
regions; the vestibule-the area between the cheeks,
teeth and lips, and the oral cavity proper which is
mostly filled with the tongue
• It is lined by oral mucosa consisting of non-keratinized
stratified squamous epithelium
• The oral cavity proper is formed by the cheeks, hard
and soft palates, and tongue
• The palate is a wall or septum that separates the
oral cavity from the nasal cavity, and forms the roof
of the mouth
• The anterior portion of the palate called hard
palate is made up of the maxillae and palatine
bones
• The posterior portion of the palate is called soft
palate; it is an arch-shaped muscular partition
between the oropharynx and nasopharynx
• The posterior margin of the soft palate supports the
uvula- a dangling fingerlike muscular structure that
helps prevent food from entering the pharynx
• During swallowing, the soft palate and uvula are
drawn superiorly, closing off the nasopharynx and
preventing swallowed foods and liquids from
entering the nasal cavity
• At the posterior border of the soft palate, the oral
cavity opens into the oropharynx
• The functions of the oral cavity include:
– Sensory analysis of material before swallowing
– Mechanical processing through the actions of the teeth,
tongue and palatal surfaces
– Lubrication by mixing with mucus and salivary gland
secretions; and
– Limited digestion of carbohydrates and lipids
 Pharynx
• The pharynx is an anatomical funnel-shaped space present at
the posterior portion of the buccal cavity
• It serve as a common passageway for solid food, liquids and air
• The pharynx is composed of skeletal muscle and lined by
mucous membrane; there are 3 parts of pharynx:
– Nasopharynx
– Oropharynx
– Laryngopharynx
• Food normally passes through the oropharynx and
laryngopharynx on its way to esophagus
• Both of the later 2 parts have a stratified squamous epithelium
similar to oral cavity
• The muscular contractions of these areas help propel food into
the esophagus and then into the stomach
 Esophagus
• The esophagus is a collapsible hollow muscular
tube, about 25 cm (10 in.) long and a diameter of
about 2 cm(0.8 in.)
• The esophagus begins at the inferior end of the
laryngopharynx in the neck and descends through
the thoracic cavity posterior to trachea
• Passing along the mediastinum anterior to the
vertebral column, it pierces the diaphragm through
an opening called the esophageal hiatus
• The esophagus then empties into the stomach
• Sometimes, part of the stomach protrudes above
the diaphragm through the esophageal hiatus; this
condition is termed a hiatus hernia
• The esophagus secretes mucus and transports food
into the stomach
 Deglutition or Swallowing
• The movement of food from the mouth into the
stomach is achieved by the act of swallowing
• It is a complex process that can be initiated
voluntarily but proceeds automatically once it begins
• On eating and drinking, swallowing is a conscious
effort; it is also controlled at the subconscious level
• For example, swallowing occurs at regular intervals as
saliva collects at back of the mouth; each day we
swallow approximately 2400 times
• Deglutition is facilitated by the secretion of saliva and
mucus and involves the mouth, pharynx, and
esophagus
• Swallowing occurs in three stages:
– (1) the voluntary stage, in which the bolus is passed into
the oropharynx; also called buccal phase
– (2) the pharyngeal stage, the involuntary passage of the
bolus through the pharynx into the esophagus; and
– (3) the esophageal stage, the involuntary passage of the
bolus through the esophagus into the stomach
• In the buccal phase, the bolus is forced to the back of
the oral cavity and into the oropharynx by the
movement of the tongue upward and backward
against the palate
• With the passage of the bolus into the oropharynx,
the involuntary pharyngeal phase of swallowing
begins in which the bolus stimulates receptors in the
• The impulses are send to the deglutition center in
the medulla oblongata and lower pons of the brain
stem
• The returning impulses cause the soft palate and
uvula to move upward to close off the nasopharynx,
which prevents swallowed foods and liquids from
entering the nasal cavity
• In addition, the epiglottis closes off the opening to
the larynx, which prevents the bolus from entering
the rest of the respiratory tract; during this period,
the respiratory centers are inhibited and breathing
stops
• The bolus moves through the oropharynx and the
• The esophageal stage of swallowing begins once the
bolus enters the esophagus
• During this phase, peristalsis, a progression of
coordinated contractions and relaxations of the
circular and longitudinal layers of the muscularis,
pushes the bolus onward
• The approach of bolus to the LES triggers its opening
and then the bolus continues into the stomach
• Mucus secreted by esophageal glands lubricates the
bolus and reduces friction
• The passage of solid or semisolid food from the
mouth to the stomach takes 4 to 8 seconds; very soft
foods and liquids pass through in about 1 second
 Stomach
• The stomach performs 4 functions:
– Storage of ingested food
– Mechanical breakdown of ingested food
– Disruption of chemical bonds in food material through
the action of acid and enzymes
– Production of intrinsic factor, a glycoproteins, needed for
absorption of Vitamin B12 in intestine
• The food enters the stomach as a bolus but exit into
the intestine as a viscous, highly acidic, soupy
mixture of partially ingested food called chyme
• The stomach has the shape of an expanded j
• The stomach has four main regions: the cardia,
fundus, body, and pyloric part
– The cardia is the smallest part (within 3 cm of the
junction between stomach and the esophagus) that
surrounds the opening of the esophagus into the
stomach
– The rounded portion superior to and to the left of the
cardia is the fundus; It contacts the inferior, posterior
surface of the diaphram
– Inferior to the fundus is the large central portion of the
stomach, the body; it functions as a mixing tank for
ingested food and secretion produced in the stomach
 – The Pylorus forms the sharp curve of the J and is
divisible in 3 regions—the pyloric antrum, connects to
the body of the stomach; the pyloric canal leads to the
third region; the pylorus which in turn connects to the
duodenum via a smooth muscle sphincter called the
pyloric sphincter (valve)
• The concave medial border of the stomach is called
the lesser curvature; the convex lateral border is
called the greater curvature
• Mechanical Digestion in the Stomach
• Several minutes after food enters the stomach,
waves of peristalsis pass over the stomach every 15
to 25 seconds
• Most waves begin at the body of the stomach and
intensify as they reach the antrum
• Each peristaltic wave moves gastric contents from
the body of the stomach down into the antrum, a
process known as propulsion
• The pyloric sphincter normally remains almost, but
not completely, closed
• Because most food particles in the stomach initially
are too large to fit through the narrow pyloric
sphincter, they are forced back into the body of the
stomach, a process referred to as retropulsion
• Another round of propulsion then occurs, moving the
food particles back down into the antrum
• If the food particles are still too large to pass through
the pyloric sphincter, retropulsion occurs
• This cycle of propulsion and retropulsion results in
mixing of gastric contents with gastric acid to form a
soupy chyme
• Once the food particles in chyme are small enough,
they can pass through the pyloric sphincter, a
phenomenon known as gastric emptying
• Gastric emptying is a slow process: only about 3 mL of
chyme moves through the pyloric sphincter at a time
• Gastric transit time for food is 2—4 hours
 Small Intestine
• Most digestion and absorption of nutrients occur in the
small intestine
• For this reason, Its structure is specially adapted for these
functions
• Its length alone provides a large surface area for digestion
and absorption, and that area is further increased by
circular folds, villi, and microvill
• The small intestine begins at the pyloric sphincter of the
stomach and opens into the large intestine through
ileocecal valve
• It averages 2.5 cm (1 in.) in diameter; its length is about 3
m (10 ft ) in a living person and about 6.5 m (21 ft ) in a
cadaver due to the loss of smooth muscle tone after death
• The small intestine is divided into three regions:
– Duodenum, the shortest region, about 25 cm (10 in.)
– The jejunum is the next portion and is about 1 m (3 ft )
– The final and longest region of the small intestine, the
ileum, measures about 2 m (6 ft ) and joins the large
intestine through ileocecal valve
• Functions of the Small Intestine:
• Segmentations mix chyme with digestive juices and
bring food into contact with mucosa for absorption;
peristalsis propels chyme through small intestine
• Completes digestion of carbohydrates, proteins, and
lipids; begins and completes digestion of nucleic acids
• Absorbs about 90% of nutrients and water that pass
through digestive system
 Chemical Digestion in Small Intestine
• Chyme entering the small intestine from the stomach contains
partially digested carbohydrates, proteins, and lipids
• The completion of the digestion of carbohydrates, proteins, and
lipids is a collective effort of pancreatic juice, bile, and intestinal
juice in the small intestine
• The absorptive cells of the small intestine synthesize several
digestive enzymes, called brush-border enzymes, and insert them
in the plasma membrane of the microvilli
• Thus, some enzymatic digestion also occurs at the surface of the
absorptive cells that line the villi
• Among the brush-border enzymes are four carbohydrate-digesting
enzymes called α-dextrinase, maltase, sucrase, and lactase;
proteindigesting enzymes called peptidases (aminopeptidase and
dipeptidase); and two types of nucleotide-digesting enzymes,
nucleosidases and phosphatases
Absorption in Intestine
 Large Intestine
• The large intestine is the terminal portion of the GIT
• The medical specialty that deals with the diagnosis and
treatment of disorders of the rectum and anus is called
proctology
• Functions of the Large Intestine
• 1. Haustral churning, peristalsis, and mass peristalsis
drive contents of colon into rectum
• 2. Bacteria in large intestine convert proteins to amino
acids, break down amino acids, and produce some B
vitamins and vitamin K
• 3. Absorption of some water, ions, and vitamins
• 4. Formation of feces
 Anatomy of Large Intestine
• The large intestine, which is about 1.5 m (5 ft) long and
6.5 cm (2.5 in.) in diameter in living humans and it extends
from the ileum to the anus
• Structurally, it is divided into four major regions, the
cecum, colon, rectum, and anal canal
• The opening from the ileum into the large intestine is
guarded by a fold of mucous membrane called the
ileocecal sphincter (valve), which allows materials from
the small intestine to pass into the large intestine
• Hanging inferior to the ileocecal valve is the cecum, a
small pouch about 6 cm (2.4 in.) long
• Attached to the cecum is a twisted coiled tube, measuring
about 8 cm (3 in.) in length, called the appendix
• The cecum continues as a long tube called the colon
which is divided into ascending, transverse, descending,
and sigmoid portions
• The rectum is about 15 cm (6 in.) in length and is
connected to the anal canal
• The last part of large intestine is called the anal canal
• The mucous membrane of the anal canal is arranged in
longitudinal folds called anal columns that contain a
network of arteries and veins
• The opening of the anal canal to the exterior, called the
anus, is guarded by an internal anal sphincter of smooth
muscle (involuntary) and an external anal sphincter of
skeletal muscle (voluntary)
• Normally these sphincters keep the anus closed except
 Mechanical Digestion
• The passage of chyme from the ileum into the cecum
is regulated by the action of the ileocecal sphincter
• Normally, the valve remains partially closed so that
the passage of chyme into the cecum usually occurs
slowly
• Immediately after a meal, a gastroileal reflex
intensifies peristalsis in the ileum and forces any
chyme into the cecum
• The hormone gastrin also relaxes the sphincter
• Whenever the cecum is distended, the degree of
contraction of the ileocecal sphincter intensifies
• One movement characteristic of the large intestine is
• In this process, the haustra remain relaxed and
become distended while they fill up
• When the distension reaches a certain point, the
walls contract and squeeze the contents into the
next haustrum
• Peristalsis also occurs, although at a slower rate (3–
12 contractions per minute) than in more proximal
portions of the tract
• A final type of movement is mass peristalsis, a
strong peristaltic wave that begins at about the
middle of the transverse colon and quickly drives
the contents of the colon into the rectum
• Because food in the stomach initiates this
gastrocolic reflex in the colon, mass peristalsis
usually takes place three or four times a day, during
or immediately after a meal
Chemical Digestion
• The final stage of digestion occurs in the colon
through the activity of bacteria that inhabit the
lumen
• Mucus is secreted by the glands of the large
intestine, but no enzymes are secreted
• Chyme is subjected to the action of bacteria, which
ferment any remaining carbohydrates and release
hydrogen, carbon dioxide, and methane gases
• These gases contribute to flatus (gas) in the colon,
termed flatulence when it is excessive
• Bacteria also convert any remaining proteins to
amino acids and break down the amino acids into
simpler substances: indole, skatole, H2S, and fatty
acids
• Some indole & skatole eliminated gives specific odor
to the feces
• Bacteria also decompose bilirubin to simpler
pigments, including stercobilin, which gives feces
their brown color
• Bacterial products that are absorbed in the colon
include several vitamins needed for normal
 Defecation
• Mass peristaltic movements push fecal material
from the sigmoid colon into the rectum
• The resulting distension of the rectal wall stimulates
stretch receptors, which initiates a defecation reflex
that results in defecation, the elimination of feces
from the rectum through the anus
• The amount of bowel movements that a person has
over a given period of time depends on various
factors such as diet, health, and stress
• The normal range of bowel activity varies from two
or three bowel movements per day to three or four
bowel movements per week
• Diarrhea is an increase in the frequency, volume, and
fluid content of the feces caused by increased motility
of and decreased absorption by the intestines
• When chyme passes too quickly through the small
intestine and feces pass too quickly through the large
intestine, there is not enough time for absorption
• Frequent diarrhea can result in dehydration and
electrolyte imbalances
• Excessive motility may be caused by lactose
intolerance, stress, and microbes that irritate the
gastrointestinal mucosa
• Constipation refers to infrequent or difficult
defecation caused by decreased motility of the
intestines
• Because the feces remain in the colon for prolonged
periods, excessive water absorption occurs, and the
feces become dry and hard
• Constipation may be caused by poor habits
(delaying defecation), spasms of the colon,
insufficient fiber in the diet, inadequate fluid intake,
lack of exercise, emotional stress, and certain drugs
• A common treatment is a mild laxative, such as milk
of magnesia, which induces defecation
• However, laxative are habit forming and adding
fiber to the diet, increasing the amount of exercise,
and increasing fluid intake are safer ways of
controlling this common problem