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PubMed1991

Hereditary internal anal sphincter myopathy causing proctalgia fugax and constipation. A newly identified condition.

A newly identified myopathy of the internal anal sphincter is described. In the affected family, at least one member from each of five generations had severe proctalgia fugax; onset was usually in the third to fifth decades of life. Three members of the family have been studied in detail. Each had severe pain intermittently during the day and hourly during the night. Constipation was an associated symptom, in particular difficulty with rectal evacuation. Clinically the internal anal sphincter was thickened and of decreased compliance. The maximum anal canal pressure was usually increased with marked ultraslow wave activity. Anal endosonography confirmed a grossly thickened internal anal sphincter. Two patients were treated by internal anal sphincter strip myectomy; one showed marked improvement and one was relieved of the constipation but had only slight improvement of the pain. The hypertrophied muscle in two of the patients showed unique myopathic changes, consisting of vacuolar changes with periodic acid-Schiff-positive polyglycosan bodies in the smooth muscle fibers and increased endomysial fibrosis. In vitro organ-bath studies showed insensitivity of the muscle to noradrenaline, isoprenaline, carbachol, dimethylpiperazinium, and electrical-field stimulation. Immunohistochemical studies for substance P, calcitonin gene-related peptide, galanin, neuropeptide Y, and vasoactive intestinal peptide showed staining in a similar distribution to that in control tissue. A specific autosomal-dominant inherited myopathy of the internal anal sphincter that causes anal pain and constipation has been identified and characterized.

Adult↗
PubMed1991

Scintigraphic measurement of regional gut transit in idiopathic constipation.

In this study, total gut transit and regional colonic transit in patients with idiopathic constipation were measured scintigraphically. Eight patients with severe constipation were studied, none of whom had evidence of abnormal function of the pelvic floor. 99mTc-radiolabeled Amberlite resin particles (average diameter, 1 mm; Sigma Chemical Co., St. Louis, MO) with a mixed meal were used to assess gastric emptying and small bowel transit; similar particles labeled with 111In were ingested in a coated capsule that dispersed in the ileocecal region. These were used to quantify colonic transit. Five healthy volunteers were also studied. Two patients showed delayed gastric emptying and two had slow small bowel transit. Seven of the eight patients had slow colonic transit. In five, delay affected the whole colon ("pancolonic inertia"); in two, transit in the ascending and transverse colon was normal, but solids moved through the left colon slowly. Mean colonic transit was also measured using radiopaque markers; this technique identified the patients with slow transit, as shown by measurements of overall colonic transit by simultaneous scintigraphy. However, estimated transit through the ascending and transverse colons was considerably shorter by the radiopaque marker technique. In conclusion, idiopathic constipation is characterized by either exaggerated reservoir functions of the ascending and transverse colons and/or impairment of propulsive function in the descending colon. Particle size may influence the result of regional colonic transit tests. Transit delays in other parts of the gut suggest that, in some patients, the condition may be a more generalized motor dysfunction.

Adult↗
PubMed2004

Adolescent constipation: evaluation and management.

It is important for physicians who deal with adolescents to become familiar with the multiple facets of the symptom of constipation. Constipation is not a life-threatening problem; however, affected patients may suffer a great deal of angst and have their lives disrupted, especially when it is left untreated. A thorough history and physical examination will uncover the majority of predisposing problems that may contribute to constipation. Most adolescents are adequately treated by appropriate behavioral and lifestyle changes and pharmacologic interventions. Failure of treatment despite good compliance requires reconsideration of the differential diagnosis, further evaluation, and possible referral to the subspecialist.

Adolescent↗
PubMed2007

Resolution of symptoms of chronic constipation in an 8-year-old male after chiropractic treatment.

OBJECTIVE: This case report describes the history, treatment, and proposed explanation of a positive outcome in a patient with chronic constipation. CLINICAL FEATURES: An 8-year-old boy presented with chronic constipation. His mother reported that this had been a problem since the child's birth. Allopathic treatment consisting of laxatives, high fluid intake, and high fiber intake had not been effective to date. INTERVENTION AND OUTCOME: The patient was examined and it was determined that he had a sacral chiropractic subluxation complex. Manipulation of the sacral area using diversified adjusting procedures was performed. External massage of the abdomen starting in the right lower quadrant and following the course of the large intestine in a clockwise direction was also applied. The patient reported an immediate dramatic improvement in bowel function after the first treatment. Treatment was continued for a 4-week period (2 visits per week) and then discontinued when the patient (confirmed by his mother) reported consistent normal bowel function. A follow-up call made 13 years after treatment revealed continuing normal bowel function. CONCLUSION: This case suggests that chiropractic care may be helpful in some cases of chronic constipation.

Child↗
PubMed2004

Lymphoid nodular hyperplasia and cow's milk hypersensitivity in children with chronic constipation.

OBJECTIVE: To investigate the incidence of cow's milk allergy as evidenced by milk challenge and the findings of endoscopic and immunohistochemical examinations in children with chronic and refractory constipation. STUDY DESIGN: Thirty-five study subjects (mean age, 8.3 +/- 3.3 years; range, 3-15 years; 17 girls) and 15 control subjects (mean age, 11.7 +/- 3.2 years; range, 2-15 years; 9 girls) were studied by colonoscopy and a 4-week cow's milk elimination and challenge. RESULTS: Lymphoid nodular hyperplasia was the most prominent endoscopic finding in half of the subjects (46%), mostly occurring patchily in the transverse colon. Histologic findings other than lymphoid accumulation and mildly increased density of eosinophils were few. During the milk elimination and with supportive medication, 83% of subjects remitted. Constipation and/or other gastrointestinal or skin symptoms relapsed only in one third (34%) during the cow's milk challenge, these having significantly higher densities of intraepithelial gammadelta + T cells ( P <.001) in the biopsy samples of the terminal ileum as compared with the control subjects. CONCLUSIONS: We were able to find formal evidence for the presence of cow's milk allergy in children with chronic constipation.

Adolescent↗
PubMed2005

Ineffectiveness of Lactobacillus GG as an adjunct to lactulose for the treatment of constipation in children: a double-blind, placebo-controlled randomized trial.

OBJECTIVE: To determine if Lactobacillus GG (LGG) is an effective adjunct to lactulose for treating constipation in children. STUDY DESIGN: Eighty-four children (2-16 years of age) with constipation (<3 spontaneous bowel movements [BMs] per week for at least 12 weeks) were enrolled in a double-blind, randomized placebo-controlled trial in which they received 1 mL/kg/day of 70% lactulose plus 10 9 colony-forming units (CFU) of LGG (experimental group, n = 43) or a placebo (control group, n = 41) orally twice daily for 12 weeks. The primary outcome measure was treatment success, and analyses were performed on an intention-to-treat basis. RESULTS: Treatment success, defined as >or=3 spontaneous BMs per week with no fecal soiling, was similar in the control and experimental groups at 12 weeks (28/41 [68%] vs 31/43 [72%], respectively; P = .7) and at 24 weeks (27/41 [65%] vs 27/42 [64%], respectively; P = 1.0]. Groups also did not differ in their mean number of spontaneous BMs per week or episodes of fecal soiling per week at 4, 8, and 12 weeks. Adverse events and overall tolerance did not differ between groups. CONCLUSION: LGG, as dosed in this study, was not an effective adjunct to lactulose in treating constipation in children.

Adolescent↗
PubMed2005

Use of pelvic ultrasound in the diagnosis of megarectum in children with constipation.

PURPOSE: It has not been possible so far to differentiate slow transit constipation from functional fecal retention because the existing medical literature lacks data on rectal dimensions for healthy children or children with chronic idiopathic constipation (CIC). We, for the first time, describe the use of pelvic ultrasound (US) to achieve this. METHODS: A pelvic US was carried out on 82 children with a full or partially full bladder and with no history of bowel problems and on 95 children with CIC. The rectal crescent seen behind the bladder was measured. All children also had documentation of their age, weight, and height. RESULTS: The median age, weight, and height for the healthy children were comparable with those of the children with CIC. The median rectal crescent size in children with constipation was 3.4 cm (range, 2.10-7.0; IQR, 1.0), as compared with 2.4 cm (range, 1.3-4.2; IQR, 0.72) in the healthy children, and this difference is statistically significant on multiple regressions of log for rectal diameter, adjusted for height, weight, and age (P value< .001). CONCLUSION: Pelvic US is a quick child-friendly investigation, which can be used to document the presence of megarectum. It should be the first line investigation for all the children with CIC.

Adolescent↗
PubMedDate not supplied

Fiber intake, constipation, and overweight among adolescents living in Sao Paulo City.

OBJECTIVE: This study evaluated the dietary fiber intake of adolescents in the metropolitan area of Sao Paulo city and any association between low dietary fiber intake with constipation and overweight. METHODS: In total, 716 adolescents were included within the study, of whom 314 attended private school and 402 attended public school. Evaluation of fiber intake was based on a 24-h daily intake record and a frequency questionnaire. Data concerning bowel movements and height and weight measurements were also taken. RESULTS: Fiber consumption, below that recommended ("age + 5"), was found in 61.8% and 41.4% (P = 0.000) of girls attending private and public schools, respectively, and in 44.1% and 25.6% of boys (P = 0.001). Adolescents who did not eat beans on more than 4 d/wk presented a higher risk of fiber intake below that recommended (age + 5; P < 0.05), with odds ratios ranging from 10.4 to 14.2 according gender and private or public schooling. Dietary fiber intake below that recommended was associated with a greater risk (P < 0.05) toward overweight in students attending public schooling (odds ratios 2.84 and 2.95 for males and females, respectively). Low dietary fiber intake was not associated with constipation. CONCLUSION: Intake of beans more than four times per week is associated with the appropriate level of fiber intake. Dietary fiber intake below the recommendation was not associated with constipation but was associated with being overweight among those students attending public schooling.

Adolescent↗
PubMed2001

Outcome of the antegrade colonic enema procedure in children with chronic constipation.

BACKGROUND: Chronic constipation and fecal incontinence in children related to pelvic trauma, congenital anomalies, or malignancy will eventually lead to significant social and psychologic stress. Maximal medical treatment (daily enemas and laxatives) can also be difficult to maintain in many children. METHODS: At our children's hospital, 11 children with chronic constipation or fecal incontinence or both underwent the antegrade colonic enema (ACE) procedure. The operation involved constructing a conduit into the cecum using either the appendix (n = 8) or a "pseudo-appendix" created from a cecal flap (n = 3). We report our surgical results. RESULTS: Mean child age was 9.6 (5 to 18) years. With a mean follow-up of 14 (6 to 24) months, 10 of the children (91%) had significant improvement and 7 children (64%) are completely clean with no soiling and controlled bowel movements after irrigation. CONCLUSIONS: Regular colonic lavage after the ACE procedure allows children with chronic constipation and fecal incontinence to regain normal bowel habits and a markedly improved lifestyle. This procedure should be considered before colostomy in children and adults for the treatment of fecal incontinence from a variety of causes.

Adolescent↗
PubMed2001

Investigation of the effects of YM-31636, a novel 5-HT3 receptor agonist, on defecation in normal and constipated ferrets.

We examined the effects of YM-31636 (2-(1H-imidazol-4-ylmethyl)-8H-indeno[1,2-d]thiazole monofumarate), a newly synthesized 5-HT(3) receptor agonist, on defecation in normal and constipated ferrets, and evaluated it as an agent against constipation. YM-31636 facilitated defecation without inducing diarrhea or emetic episodes. This effect occurred within 1 h after oral administration, mostly within 30 min, whereas sodium picosulfate, a widely used laxative, tended to increase the frequency of defecation for several hours with much lower peak incidence than that of YM-31636, and induced diarrhea. UK14304 (brimonidine), an alpha2 receptor agonist, and morphine reduced the frequency of defecation and YM-31636 restored it. These effects of YM-31636 were antagonized by ramosetron, a 5-HT(3) receptor antagonist. These results suggest that YM-31636 could be promising in the treatment of constipation. Because of an early and reliable onset of action compared with sodium picosulfate, YM-31636 could make it easier to control the time of defecation.

Animals↗
PubMed2002

Metamizol potentiates morphine antinociception but not constipation after chronic treatment.

This work evaluates the antinociceptive and constipating effects of the combination of 3.2 mg/kg s.c. morphine with 177.8 mg/kg s.c. metamizol in acutely and chronically treated (once a day for 12 days) rats. On the 13th day, antinociceptive effects were assessed using a model of inflammatory nociception, pain-induced functional impairment model, and the charcoal meal test was used to evaluate the intestinal transit. Simultaneous administration of morphine with metamizol resulted in a markedly antinociceptive potentiation and an increasing of the duration of action after a single (298+/-7 vs. 139+/-36 units area (ua); P<0.001) and repeated administration (280+/-17 vs. 131+/-22 ua; P<0.001). Antinociceptive effect of morphine was reduced in chronically treated rats (39+/-10 vs. 18+/-5 au) while the combination-induced antinociception was remained similar as an acute treatment (298+/-7 vs. 280+/-17 au). Acute antinociceptive effects of the combination were partially prevented by 3.2 mg/kg naloxone s.c. (P<0.05), suggesting the partial involvement of the opioidergic system in the synergism observed. In independent groups, morphine inhibited the intestinal transit in 48+/-4% and 38+/-4% after acute and chronic treatment, respectively, suggesting that tolerance did not develop to the constipating effects. The combination inhibited intestinal transit similar to that produced by morphine regardless of the time of treatment, suggesting that metamizol did not potentiate morphine-induced constipation. These findings show a significant interaction between morphine and metamizol in chronically treated rats, suggesting that this combination could be useful for the treatment of chronic pain.

Analgesics↗
PubMed2000

Tegaserod accelerates orocecal transit in patients with constipation-predominant irritable bowel syndrome.

BACKGROUND & AIMS: This study evaluated the effects of a partial 5-hydroxytryptamine (5-HT)(4) agonist, tegaserod, on gastric small bowel and colonic transit in constipation-predominant irritable bowel syndrome (IBS). METHODS: After a 1 week run-in period, 24 patients with constipation-predominant IBS were randomized to 1 week of tegaserod, 2 mg twice daily, or placebo treatment. Scintigraphic gastric emptying, small bowel transit, and colonic transit were determined before administration of study drug and after 1 week on the medication. Colonic transit was also measured using radiopaque markers and a single radiograph on day 5. RESULTS: Gastric emptying was unaltered by tegaserod. Proximal colonic filling at 6 hours, a measure of orocecal transit, was accelerated by tegaserod (70.4% +/- 1.3% [mean +/- SEM] vs. placebo, 46.4 +/- 1.9; P = 0.015). Proximal colonic emptying half-time and geometric center at 48 hours were also accelerated by tegaserod compared with baseline, but not compared with placebo. Mean colonic transit time was similar in both groups at baseline and after drug administration (tegaserod, 59.5 +/- 2.1 hours; placebo, 62.1 +/- 2.1 hours). CONCLUSIONS: Tegaserod accelerates orocecal transit, tends to accelerate colonic transit, and deserves further study in patients with constipation-predominant IBS.

Adult↗
PubMed2003

Constipation and the preached trio: diet, fluid intake, exercise.

A survey of 90 older community-dwelling people's constipation experience is reported in part. The focus is the participants' efforts to use diet, fluid intake and exercise as preventive strategies. Most feel that they have been preached to in this regard. However, constraints may prevent full adherence to the trio and although some have gained from diet adjustment, the majority is disillusioned about these strategies. Nurses should be aware that scientific and medical literature is discussing evidence that dietary fibre intake preventing constipation is not proven, that fluid intake does not necessarily determine stool bulk or speed colon transit time, and that there is no proven link between exercise levels and chronic constipation.

Aged↗
PubMed1982

The successful management of chronic constipation in infants and children.

During a 3 yr period, 77 patients with functional constipation and 34 patients with constipation related to organic lesions of the anorectal area were managed with a strict regimen employing the long-term use of daily enemas. Seventy-four percent of the patients with functional constipation had excellent results and the rest had good results. In children with associated anorectal anomalies, 52% had excellent results, 35% had good results and only 13% had a poor result. A detailed flow chart of the workup and treatment regimen is presented.

Adolescent↗
PubMed1984

Mid-anal sphincteric malformation, cause of constipation in anterior perineal anus.

Constipation characterized by straining at defecation has been reported in association with an anteriorly located, but otherwise "normal' anus, however its cause is not known. In this communication the pathogenesis of constipation has been discussed on the basis of clinical features and intraoperative findings seen in seven children with this syndrome. The primary cause of constipation lies in the congenital malformation of the mid-portion of the external sphincter and weakness of the corresponding segment of the anal canal.

Anal Canal↗
PubMed1987

Long-term management of chronic constipation in children.

A retrospective clinical study was conducted to determine the success of a strict regimen employing the prolonged use of daily enemas in 203 children with chronic constipation. This study confirmed that the use of long-term daily enemas did eliminate constipation as well as the primary complaint of fecal soiling. The majority of children treated had an excellent to good result (85.8%) over an extended period of time. Patients with a past medical history of imperforate anus or Hirschsprung's disease required longer treatment periods (32.6 and 20.1 months, respectively) than children with other medical problems (rectal prolapse, rectal stricture, malrotation, spina bifida, mental retardation, psychological; 13 months) or patients with functional constipation (5.9 months).

Adolescent↗
PubMed1988

Sphincteromyectomy and sphincteroplasty in chronic constipation with megarectum.

An operative procedure for patients with chronic constipation with megarectum and its results is presented. Eleven cases of idiopathic chronic constipation showing megarectum on barium enema underwent this operation. Bowel habits of operated patients were evaluated at 1 to 5 years after the operation. Complete cure was obtained in eight cases. Three cases were improved but needed occasional suppositories. This procedure, sphincteromyectomy and sphincteroplasty, may be an operation of choice for chronic constipation with megarectum, when nonoperative methods fail.

Adolescent↗