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PubMed1999

[Pathophysiology of chronic constipation and new therapy recommendation].

Three causes of constipation are known: Chagas' disease, congenital megacolon (Hirschsprung's disease) and continent obstipation. Those diseases are rare, they can be treated successfully by drugs, surgery or psychotherapy. More common is the idiopathic chronic constipation, observed manly in females. A frequent cause is the laxative abuse for many years. The possible etiologic factors are discussed. Based on the fact, that constipation never occurs in patients with a colostomy, reasons for the development of chronic idiopathic constipation are presumed in a disturbance in the distal colon and the anorectum. A possible explanation for the malfunction of defecation could be a different calibre between the usually tight pelvic colon and the wide rectum. In contrast to the apolar structure of the large bowel, the rectum shows a polar fibrous configuration. An additional disorder in the feedback mechanism between continence and defecation could impede the bowel passage. Because of these observations and thoughts, we performed a deep resection of the rectum in 18 patients instead of resecting the dilated and elongated colon. All patients operated that way experienced a major improvement of their bowel function. Postoperatively the bowel movements were regular and normal.

Adult↗
PubMed1999

[Dietary and medicamentous therapy of chronic constipation].

Therapy of constipation is complex. It is mainly based on general rules and treatment with dietary fibers. If drugs are necessary they should be applied according to the type of constipation as evidenced by the results of special diagnostic procedures. Some patients may improve with psychotherapeutic procedures. Surgical treatment should be the last choice. The aim of therapy is to relieve the patient from his symptoms and achieve a habit of regular defecation, if possible with only a small amount of laxatives--or better without the application of drugs. Most often a highly individualized therapy is necessary. Many patients consult their doctor only when they have already a grave problem. Therapy then becomes difficult. Information on bowel movements and on how to prevent constipation by the way of living, therefore, should be widely spread in the general population in order to minimize constipation as a medical problem.

Cathartics↗
PubMedDate not supplied

Outcome in children under 5 years of age with constipation: a prospective follow-up study.

Constipation in the pre-school child is common and causes considerable distress to children and their parents. There is a lack of information regarding prognosis in this group of patients although some are clearly at risk of developing long-term difficulties with defaecation. We have previously reported characteristics of children under 5 years of age referred to hospital over a one-year period with idiopathic constipation. We now report outcome data after 18 months of follow-up in 41 of the original cohort of 42 children. We have also summarised what we regard as good practice in managing constipation in this age group. Eighteen months after initial outpatient assessment, the symptoms of constipation were reported to have resolved in 36 (88%), although seven of these were still needing regular laxative treatment. It was our subjective impression that the five children who apparently did not improve came from families that had a greater degree of psychosocial problems and where compliance with treatment was suspect. This study shows that with simple treatment measures and ongoing support, an optimistic prognosis can be given to families from the outset. The minority of pre-school children who do not improve may benefit from a more intensive psychological approach to management.

Child, Preschool↗
PubMed2000

[Diagnosis and therapy of chronic constipation].

Chronic constipation is a frequent disorder, which results from a disturbed colonic passage and/or an impaired evacuation of the rectum. Secondary forms of constipation due to systemic disorders or medications are frequent. Therapy of constipation is complex and should be planned according to the type of constipation. Therapy includes general rules, dietary fibers and, when necessary, the controlled treatment with medications. Functional obstructions in the rectum may require a surgical therapy or specialized forms of treatment like biofeedback.

Cathartics↗
PubMed2001

Severe juvenile chronic constipation.

Constipation in the paediatric population is common and encompasses a spectrum of organic and functional pathology which differ from that of the adult population. Recently an expert group published a comprehensive system of classification of childhood functional gastrointestinal disorders that may have useful clinical application. We present the case of an adolescent schoolgirl with severe constipation with extreme anorectal, urological and neurological sequelae who displayed inappropriate behavioral response to her condition. The patient appeared inappropriately unmotivated and undisturbed by the severity of her constipation. This abnormal psychological habituation and adaptation to an abnormal bowel habit perpetuated the constipation. In addition, we examined the role of recent advances in anorectal investigation techniques and treatment in the context of the recent guidelines issued by the American Gastroenterological Association

Adolescent↗
PubMed2001

[Multidimensional appraisal in patients suffering from chronic idiopathic constipation].

A multidimensional appraisal of the patient suffering from chronic idiopatic constipation is used in this study. 16 consecutive patients affected by chronic idiopatic constipation defined by Rome criteria were enrolled. The following assessments were performed: radiological study of colorectal transit time using radiopaque markers, anorectal manometry, proctography, psychiatric appraisal, with the somministration of The Minnesota Multiphasic Personality Inventory 2, Hamilton Rating Scales for Depression, Hamilton Rating Scales for Anxiety, Toronto Alexithymia Scales, quality of life appraisal, by means of Short Form 36. The present study must be considered a pilot-study, lead on a limited champion of 16 cases; the reported data express therefore tendencies. Chronic idiopatic constipation appears to be a disturbance with a strong impact on the patient's quality of life. The study moreover confirms the hypothesis of a multifactorial genesis for chronic idiopatic constipation, in which psychopathological aspects (anxiety, depression and alessitimia in particular) and personality traits play a fundamental role, as much as the physiopathological alterations. Colorectal transit time study and anorectal manometry confirm to be valid instruments for the evaluation of physiopathological characteristics, useful for a classification of patients, particularly with respect to the presence of a normal or slowed colorectal transit and to the relief of pelvic floor dysfunctions. The differences between subgroups based on physiopathological characteristics, with respect to quality of the life and personality traits, expressed as tendency, need a confirm form studies lead on larger champions.

Adolescent↗
PubMed2001

The prevalence of faecal incontinence and constipation in a general New Zealand population; a postal survey.

AIMS: To determine the prevalence of constipation and faecal incontinence in the community. METHODS: A 20-question multi-field postal questionnaire was sent to 1500 adults (over 18 years) randomly selected from the electoral roll in the Canterbury region. Questions detailed frequency of bowel function, time spent at the toilet, incidence and severity of faecal incontinence, constipation, and the effect of disordered bowel function. RESULTS: Of 1500 questionnaires, 717 (48%) were returned (male: female 388:329). The median age was 46 years (range 18-70). 24 (4%) had self-reported gastrointestinal disease. There was a median frequency of seven bowel motions per week (BM/wk) (range 1 to 70) with 89% having between two motions a day and one every two days. Faecal incontinence affected lifestyle in 58 (8.1%). Incontinence of solid stool at least once a month occurred in 70 (9.8%), of liquid stool in 91 (12.7%), of gas in 459 (64%), while 12 (2%) regularly wore a pad. Those with self-reported gastrointestinal disease had a significantly higher (p<0.05) bowel motion frequency (17 vs 7 BM/wk) and median faecal incontinence score (2.5 vs 0). Laxatives were used by 4.9% of the population, while 26.2% increased fibre to avoid constipation. CONCLUSIONS: The normal frequency of bowel motions (+/- 2SD) was 2-17 per week. Faecal incontinence affecting life style affected 8.1%, while constipation requiring regular laxative use affected 4.9% of people. There is acceptance in the community that a moderate degree of bowel dysfunction is normal. Stool frequency and faecal incontinence scores can be used to predict those most likely to have organic gastrointestinal disease.

Adolescent↗
PubMed2002

[Incidence of constipation after recent vascular hemiplegia: a prospective cohort of 152 patients].

Constipation is a major problem for institutionalized patients. This prospective study was performed on a population of 152 in-patients of a stroke rehabilitation center. Constipation was defined as less than three stools weekly or the use of laxative medication. Constipation occurred in sixty percent of the patients. The incidence of constipation was not related to age or sex but was strongly related to functional status of patients assessed by Barthel Index (p<0.003). The influence of both brain lesion or reduce activity is evaluated.

Cohort Studies↗
PubMedDate not supplied

[Success of antegrade enemas in children with functional constipation].

AIM: To assess the benefit of antegrade enemas via cecostomy in children with functional constipation unresponsive to medical treatment. METHODS: A retrospective chart review identified 19 children (12 male, age 10.4 +/- 4.3 yrs) who from 1998-2001 underwent placement of a cecostomy for administration of antegrade enemas. All children were neurologically normal, suffered from functional constipation; all had a history of using multiple medications, having daily soiling, and 65% had prior hospitalizations due to fecal impaction. Sixteen of 19 children had undergone colonic manometry which ruled out colonic inertia. One of 3 irrigation solutions: polyethylene glycol (65%), saline and glycerin solution mix (10%) and phosphate enema (25%) administered through the cecostomy everyday in 14 children or every other day in 5 children. We used a questionnaire to interview caregivers, a mean of 21.1 +/- 24.9 mo after cecostomy placement. RESULTS: In all patients antegrade enemas led to significant improvement of: bowel movements/wk (7.4 vs. 1.4, p < 0.001), soiling accidents/wk (1.1 vs. 6.1, p < 0.001), emotional health score (3.8 vs. 1.8, p < 0.001), overall health score (3.7 vs. 1.8, p < 0.001), number of medications for constipation (0.8 vs. 4.2, p < 0.001), number of missed school days/mo (1.3 vs. 10.5, p < 0.001), and number of physician office visits/yr (7.7 vs. 24.1, p < 0.002). Eight patients have been able to discontinue the use of the antegrade enemas within a mean of 19.9 +/- 14.2 mo after beginning treatment. CONCLUSION: Antegrade enemas are an alternative effective way for treating severe cases of functional constipation unresponsive to medical management.

Cecostomy↗
PubMedDate not supplied

[Dietary fiber intake in women with constipation].

The objective of this study was to investigate the food pattern of women with constipation. It was carried out a 24 h recall and a food frequency survey in 31 constipated women and compared the results with a control of 31 women without constipation. Their mean daily crude fiber intake were no statistical different (2.33 +/- 1.4 vs 2.17 +/- 0.9 g/day), but the usual intake of fruits and vegetables of the constipated ones were irregular. These results call the attention for the influence of the kind and schedule of the food rich fiber intake on the intestinal habit.

Adolescent↗
PubMed2003

[The assessment of the influence of IgE-mediated food allergy on colonic transit time in children with chronic constipation].

The aim of the study was a comparative analysis of patients with chronic constipation and coexisting food allergy in relation to patients with functional chronic constipation without food allergy. 325 children with chronic constipation aged 0.6-17.1 years (mean 8.0 +/- 4.3) were included into the study. The IgE-mediated food allergy was diagnosed in 179 children. Results of anthropometric measurements, rectoscopies, abdominal ultrasonographies, evaluations of colonic transit time and anorectal manometric examinations, together with clinical symptoms, were analysed and compared. The results were subjected to statistical analysis. There were no significant differences in clinical presentation, anthropometric measurements, rectoscopic, ultrasonographic, manometric and histopathological findings between both groups. In the food allergy group the total and segmental colonic transit time more frequently was prolonged, manifested usually as colonic inertia (p < 0.001). Food allergy can be clinically manifested as a chronic constipation. IgE-mediated food allergy may significantly prolong colonic transit in affected patients.

Adolescent↗
PubMed2004

New and emerging treatment options for chronic constipation.

Chronic constipation remains a therapeutic challenge for today's physicians. Traditional approaches include use of fiber, osmotic laxatives, stimulant laxatives, prokinetic agents, biofeedback training, and surgery. These often are tried sequentially and episodically and have little evidence of long-term efficacy. Patients often report inadequate relief of symptoms. There is room for improvement, therefore, in the therapy of chronic constipation. Future advances largely will be based on insights into the enteric nervous system (ENS), the structure and function of which is being revealed in great detail. Manipulating the ENS pharmacologically offers the opportunity to reprogram this key control system to improve bowel function. For example, interneurons in the ENS display 5-HT4 receptors, activation of which enhances the peristaltic reflex. Prokinetic agents that stimulate those receptors, such as tegaserod and prucalopride, have demonstrated efficacy as investigational agents for the treatment of chronic constipation in large studies. Less well studied investigational drugs with presumed activity in the ENS include opiate antagonists and the nerve growth factor neurotrophin-3. Both of these types of agents have been shown to be effective in small groups of patients with constipation. Another approach under development is to stimulate colonic fluid secretion by opening chloride channels in the epithelium pharmacologically. Existing non-pharmacological treatments that can be improved include biofeedback training for pelvic floor dysfunction and surgery. Future developments include investigation of electrical stimulation of the colon and use of stem cells to repopulate degenerated populations of neurons, interstitial cells of Cajal, or smooth muscle cells.

Biofeedback, Psychology↗
PubMed2004

Protective effect of vilva juice on glycoconjugate levels in experimentally induced constipation in rats.

Efficacy of vilva, a polyherbal formulation was evaluated in morphine induced constipated rats. Vilva juice, at a dose of 1.5 ml/100 g body wt was given orally for a period of 7 days. Morphine sulfate was injected to induce constipation on 8th day, 45 min before the experiments. Protein bound glycoconjungates were estimated in intestinal tissue. Altered levels of glycoconjugates were maintained at near normalcy when pretreated with vilva juice in morphine induced rats. Histological changes were observed in the colon tissue. The damage to crypts of Liberkunn in constipated rats were found to be reduced in vilva pretreated rats. Vilva, thus, offered significant protection against morphine induced constipation by way of augmenting mucus secretion.

Animals↗
PubMed2004

[Chronic constipations in elderly people].

Chronic constipations in elderly people proved to be an important medical and social problem due to their high prevalence and serious complications caused by the very disease and administration of stimulating laxatives. They include as follows: anorectic incontinence, large intestine obstruction, stercoral ulcers, laxative dependence and bowels toxic affection (Cathartic colon). Morphological and physiological prerequisites of chronic constipation and anorectic incontinence occurrence are examined in this review. Drugs and tactics for monitoring constipations depending on their severity, dominance of transit and evacuation disturbances, occurrence of anorectic incontinence are described. Characteristics of laxatives and intestinal motility regulators, range of side effects as well as experience of their application in elderly patients with functional constipations and irritable bowel syndrome are presented.

Aged↗
PubMed2004

May chronic childhood constipation cause oxidative stress and potential free radical damage to children?

OBJECTIVE: To investigate whether chronic childhood constipation (CCC) may cause oxidative stress and potential free radical damage to children, and to explore the mechanisms by which CCC may cause oxidative stress and potential free radical damage to chronic constipation patients (CCPs). METHODS: Sixty CCPs and sixty healthy child volunteers (HCVs) whose ages, gender and others were matched for the CCPs were enrolled in a randomized controlled study, in which levels of vitamin C (VC) and vitamin E (VE) in plasma as well as activities of superoxide dismutase (SOD) and catalase (CAT) in erythrocytes were determined by spectrophotometric analytical methods. RESULTS: Compared with average values of the above biochemical parameters in the HCVs group, the average values of VC and VE in plasma as well as those of SOD and CAT in erythrocytes in the CCPs group were significantly decreased (P < 0.0001). Linear regression and bivariate correlation analysis showed that with prolonged course of the CCPs, the levels of VC and VE in plasma as well as the activities of SOD and CAT in erythrocytes in the CCPs were decreased gradually (P < 0.0001). CONCLUSION: The findings in the present study suggest that chronic childhood constipation causes oxidative stress and potential free radical damage to children with chronic constipation.

Adolescent↗
PubMed1992

[Colonic transit time (segmental and total) in healthy subjects and patients with chronic idiopathic constipation].

BACKGROUND: The efficacy of the treatment of patients with chronic idiopathic constipation not responding to normal therapeutic measures depends on correct functional diagnosis. The study of the segmentary and total colonic transit time with radioopaque markers is the most economic technique in everyday clinic ambience for functionally evaluating these patients. METHODS: Segmental and total colonic transit time was calculated with the use of radioopaque markers in 23 healthy subjects (12 men and 11 women) and in 13 women with severe idiopathic constipation. Twenty markers were administered daily for three consecutive days and simple x-rays of the abdomen were made on the fourth, seventh and in some cases on the tenth day. In addition, the symptomatology of 9 patients was collected by means of a 30 day diary. RESULTS: The maximum values of transit time (mean + 2SD) obtained in the healthy subjects were 17, 25, 26, and 49 hours for the right colon, left colon, rectosigmoid and the whole colon, respectively. The time of left colon transit was significantly lower in the women. The transit time in constipated patients permitted the differentiation of three functional patients: a) slowing of the right and left colon possibly associated to rectosigmoid slowing in 5 patients; b) isolated slowing in the left colon in 4 patients and c) isolated rectosigmoid slowing in 4 patients. Group a) was characterized by long total colonic transit times while these were normal in 2 patients of group b) and in one patient of group c). No differences were seen in the symptomatology of the groups. CONCLUSIONS: The calculation of segmentary and total colonic transit time with radioopaque markers is a simple technique which permits the detection of different subgroups of patients with chronic idiopathic constipation refractory to normal treatment. The exact typification of the functional anomaly is an important basis for the individualization of treatment.

Adult↗
PubMed2005

Prevalence and ramifications of chronic constipation.

Constipation is a common condition, affecting 2% to 27% of North Americans. Arriving at true prevalence rates is complicated, because consensus definitions are lacking. Constipation has daily implications for those affected, and, although only one-third of affected persons seek care, it is associated with high socioeconomic costs. Traditional interventions, such as fiber and laxatives, are often recommended, but high-quality evidence of their efficacy is lacking and patient dissatisfaction is common. Improved understanding of the pathophysiology of constipation has resulted in the development and approval of a new agent for the treatment of patients with chronic idiopathic constipation.

Chronic Disease↗
PubMed2006

[Characteristics of anorectal motility spectrum and preliminary approach to treatment of functional constipation in children].

OBJECTIVE: To investigate the characteristics of anorectal motility spectrum in children with functional constipation in comparison with healthy children and determine the efficacy of treatment measures based on the results of anorectal manometry. METHODS: Anorectal manometric indexes were detected by the multi-functional manometry in eight patients with functional constipation aged (11.4 +/- 4.8) yrs and ten healthy children aged (10.5 +/- 3.5) yrs from May 2004 to June 2005. The patients received combined treatment including probiotics (Bifid. triple viable), prebiotics (Lactulose) and regular defecation according to the results of anorectal manometry in patients with functional constipation. The efficacy of these conservative measures were estimated during the course of treatment. RESULTS: No statistical differences were found in the indexes of effective length of anal sphincter, maximal systolic pressure and the duration of more than 50% of maximal systolic pressure between two groups. But minimal sensitivity and maximal tolerated volume between the two groups were significantly different. Seven of eight patients got better with the conservative treatment. CONCLUSION: Abnormal features exit in the anorectal motility spectrum of the children with functional constipation. The clinical efficacy of the conservative treatment measures based on the results of anorectal manometry is significantly good.

Adolescent↗