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PubMed2001

Antegrade continence enemas in the treatment of slow-transit constipation.

BACKGROUND/PURPOSE: Children with anorectal dysfunction can now be treated by antegrade continence enema (ACE), as described Malone et al. Those with idiopathic constipation, however, are not thought to be suitable for this treatment. Over 150 children attend the authors' department with proven slow transit constipation (mostly proven on nuclear transit/X-ray study), and the authors reviewed the outcome in the 40 of these who have had the ACE procedure. Families completed a questionnaire and attended interview with an independent assessor. METHODS: Of the 40 patients, 32 patients were assessed. Follow-up ranged from 3 to 54 months (median, 18 months) and age ranged from 5 to 17 years (median age, 10 years). Three of 32 stomas were no longer in use. Frequency of soiling was reduced significantly in 20 patients, and a further 6 patients were clean (P <.01). Abdominal pains were relieved significantly (P <.05), and appetite and mood improved. RESULTS: Stomal complications were frequent, (stenosis in 16 of 29, mucus leak in 20 of 29, fecal leak 3 of 29, catheter-related pain in 20 of 29). Slow evacuation (12 of 29) and pain with enema (17 of 20) also were common. CONCLUSION: Malone appendicostomy does improve the well being of patients with slow transit constipation, but the advantages are less dramatic than in children with normal motility.

Adolescent↗
PubMed1980

Rectoanal pressures and rectal compliance in constipated infants and children.

Anorectal manometry with perfused side opening catheter was carried out in 86 normal infants and children, 9 infants with Hirschsprung's disease, and 10 children with idiopathic chronic constipation. Studies on pressure volume curve of the rectum and rectal compliance were carried out in 37 normal infants and children, 4 infants with Hirschsprung's disease, and 10 children with idiopathic chronic constipation. Decreased basal rhythmic contraction of the anal canal, absent recto-anal reflex, steep elevation of pressure volume curve of the rectum, and low rectal compliance were characteristic of infants with Hirschsprung's disease. Resting pressure profile of the anorectum, recto-anal reflex, pressure volume curve of the rectum, and rectal compliance were normal in chronically constipated children without megarectum, whereas remarkably high rectal compliance was characteristic of those with megarectum.

Anal Canal↗
PubMed1998

Intolerance of cow's milk and chronic constipation in children.

BACKGROUND: Chronic diarrhea is the most common gastrointestinal symptom of intolerance of cow's milk among children. On the basis of a prior open study, we hypothesized that intolerance of cow's milk can also cause severe perianal lesions with pain on defecation and consequent constipation in young children. METHODS: We performed a double-blind, crossover study comparing cow's milk with soy milk in 65 children (age range, 11 to 72 months) with chronic constipation (defined as having one bowel movement every 3 to 15 days). All had been referred to a pediatric gastroenterology clinic and had previously been treated with laxatives without success; 49 had anal fissures and perianal erythema or edema. After 15 days of observation, the patients received cow's milk or soy milk for two weeks. After a one-week washout period, the feedings were reversed. A response was defined as eight or more bowel movements during a treatment period. RESULTS: Forty-four of the 65 children (68 percent) had a response while receiving soy milk. Anal fissures and pain with defecation resolved. None of the children who received cow's milk had a response. In all 44 children with a response, the response was confirmed with a double-blind challenge with cow's milk. Children with a response had a higher frequency of coexistent rhinitis, dermatitis, or bronchospasm than those with no response (11 of 44 children vs. 1 of 21, P=0.05); they were also more likely to have anal fissures and erythema or edema at base line (40 of 44 vs. 9 of 21, P<0.001), evidence of inflammation of the rectal mucosa on biopsy (26 of 44 vs. 5 of 21, P=0.008), and signs of hypersensitivity, such as specific IgE antibodies to cow's-milk antigens (31 of 44 vs. 4 of 21, P<0.001). CONCLUSIONS: In young children, chronic constipation can be a manifestation of intolerance of cow's milk.

Animals↗
PubMed2001

Efficacy and optimal dose of daily polyethylene glycol 3350 for treatment of constipation and encopresis in children.

OBJECTIVE: To determine efficacy, safety, and optimal dose of a laxative, polyethylene glycol (PEG) 3350, in children with chronic constipation. STUDY DESIGN: Children with chronic constipation (n = 24) were treated with PEG for 8 weeks at an initial dose of 1 g/kg/d. The dose was adjusted every 3 days as required to achieve 2 soft stools per day. A diary was kept to monitor dose, stool frequency and consistency, soiling, and other symptoms. Stool consistency was rated from 1 (hard) to 5 (watery). Subjects were examined for fecal retention. The Student t test and the Fisher exact test were used for data analysis. RESULTS: All 20 children who completed the study found PEG to be palatable and were satisfied with the treatment. There were no significant adverse effects. Weekly stool frequency increased from 2.3 +/- 0.4 to 16.9 +/- 1.6 (P <.0001) during treatment and stool consistency from 1.2 +/- 0.1 to 3.3 +/- 0.1 (P <.0001). In 9 children with soiling, weekly soiling events declined from 10.0 +/- 2.4 to 1.3 +/- 0.7 (P =.003). The mean effective dose was 0.84 g/kg/d (range, 0.27-1.42 g/kg/d). CONCLUSION: Daily administration of PEG at a mean dose of 0.8 g/kg is an effective, safe, and palatable treatment for constipation.

Cathartics↗
PubMed1988

Treatment of constipation in the elderly.

About $250 million a year are spent on laxatives in the United States, attributable in large portion to the elderly. However, before laxative therapy is started in these patients, adequate exercise, ample fluids, and a high-fiber diet should be recommended. If these measures are unsuccessful and underlying disease is excluded, laxative use may be considered. Selection of the most appropriate cathartic for the clinical situation is vital. Bulk-forming laxatives and lactulose are favored. Dietary and drug intake should be discussed with the patient and constipating items eliminated when possible. Enema therapy may be necessary to retrain or evacuate an atonic, constipated colon. The mnemonic, right, summarizes the major points in treating constipation.

Aged↗
PubMed1990

Chronic constipation in adults. How far should evaluation and treatment go?

In all patients who present with constipation, a history should be taken and physical examination and proctosigmoidoscopy performed. Structural evaluation of the entire colon by barium enema should be considered when constipation is of recent onset, is severe, or does not resolve with simple measures. A colonic transit study should also be considered in the latter two situations. Anorectal manometry, defecography, and electromyography are helpful in patients with diagnosed or suspected outlet delay. Treatment is most often empirical. Simple, helpful measures include education, dietary fiber supplementation, adequate fluid intake, and regular physical activity. When laxatives are necessary, they should be used sparingly. Pelvic floor retraining may be helpful in the management of patients with outlet delay. Select patients with intractable constipation may benefit from surgery, although results are variable.

Cathartics↗
PubMed2002

Efficacy and tolerability of prucalopride in patients with constipation due to spinal cord injury.

BACKGROUND: Chronic constipation (CC) often occurs after spinal cord injury (SCI). Prucalopride is a novel, highly selective, specific serotonin4 receptor agonist with enterokinetic properties. We evaluate the tolerability and pilot efficacy of prucalopride in the treatment of CC due to SCL. METHODS: Double-blind, placebo-controlled, pilot, phase 11, dose-escalation study. After 4 weeks' run in, patients received prucalopride 1 mg (n = 8) or placebo (n = 4); 11 new patients were randomized to prucalopride 2 mg (n = 8) or placebo (n = 3) once daily for 4 weeks. Patients recorded bowel function (diary) and assessed constipation severity and treatment efficacy (visual analogue scale (VAS) 0-100 mm). Colonic transit times were determined. RESULTS: Compared with run in. mean changes in constipation severity (VAS) increased with placebo, but decreased with prucalopride 1 and 2 mg. The VAS score for treatment efficacy showed a clear dose response (medians 4, 52 and 73 for placebo, 1 and 2 mg, respectively). Diary data showed an improvement in average weekly frequency of all bowel movements over 4 weeks within the 2 mg group (median 0.6; 95% CI 0.2; 1.2). There was a significant reduction in median colonic transit time with 2 mg (n = 4; -38.5 h (95% CI -80; -5)). Four patients (2 mg) reported moderate/severe abdominal pain, and two of these discontinued treatment. There were no clinically relevant effects on any of the safety parameters. CONCLUSION: This pilot study indicates that prucalopride can play an important role in the management of patients with CC due to SCI.

Adolescent↗
PubMed2004

Peptide YY release after colectomy in slow transit constipation.

BACKGROUND: The gut hormone peptide YY is abundant in the colonic mucosa. Circulating PYY inhibits gastrointestinal motility and decreases food intake. The aim was to determine whether colectomy decreases PYY release in patients with slow transit constipation. METHODS: Plasma PYY concentrations were measured in 10 patients with slow transit constipation before and 3-24 months after total abdominal colectomy with ileorectal anastomosis, and in 8 healthy controls. A liquid meal was infused intraduodenally to stimulate PYY release. RESULTS: Postprandial PYY significantly (P < 0.05) increased from a basal value of 15.6 +/- 1.8 pM to a peak of 71.2 +/- 11.6 pM after colectomy. Basal and postprandial plasma PYY concentrations were not significantly different from the results before surgery. Fasting, but not postprandial, plasma peptide YY after colectomy was significantly higher than that in healthy volunteers, 10.9 +/- 0.9 pM. CONCLUSION: Despite removal of a major source of PYY-secreting cells, colectomy with ileorectal anastomosis does not induce major impairment of PYY release in slow transit constipation.

Adult↗
PubMed1998

The symptomatic effect of cisapride in patients with irritable bowel syndrome and constipation.

BACKGROUND: Cisapride improves symptoms in patients with idiopathic constipation. This trial compares the effect of cisapride with that of placebo in patients with irritable bowel syndrome (IBS) and constipation. METHODS: Seventy patients were randomized to 12 weeks' treatment with 5 mg cisapride three times daily or placebo in a double-blind trial. The dose could be doubled after 4 weeks in patients without satisfactory improvement. The patients scored their symptoms on a 100-mm visual analogue scale (VAS) (0 = best, 100 = worst), and the investigators evaluated the symptomatic effect. RESULTS: The dose was doubled in 17 and 23 patients in the cisapride and placebo groups, respectively, after 4 weeks. The patients' mean VAS score for global evaluation of IBS symptoms in the cisapride and placebo groups was 73 and 71 mm, respectively, at the start of treatment and 47 and 41 mm at the end. The difference between cisapride and placebo at the end was 6 mm in favour of placebo (95% confidence interval (CI), -6, 18) (NS). The investigators evaluated the effect as good or excellent in 39.2% and 58.8% in the cisapride and placebo groups, respectively. The difference in favour of placebo was 19.5% (95% CI, -5, 44) (NS). Nor were any statistically significant differences seen between cisapride and placebo in the other effect factors. CONCLUSIONS: The trial seems to exclude a clinically significant effect of 15-30 mg cisapride daily in patients with IBS and constipation during a 12-week treatment period.

Adolescent↗
PubMed2004

Children with constipation: what happens to them when they grow up?

Constipation and soiling are common complaints in childhood and often cause distress to the children and their parents. The treatment for these symptoms is oral and sometimes rectal laxatives or behavioural therapy. Until now, there have been few randomized controlled trials to evaluate the efficacy of the different treatment regimens. Moreover, there is a lack of information regarding what happens to these children with constipation when they grow up. A recent long-term follow-up study in The Netherlands showed that 30% of the children followed beyond puberty continued to have severe complaints of constipation such as a low defecation frequency and soiling. Long-lasting support and the development of improved therapeutic regimens are necessary to treat these difficult patients more effectively.

Child↗
PubMed1995

Cisapride for constipation in spinal cord injured patients: a preliminary report.

Chronic constipation in patients with spinal cord injury (SCI) has significant impact on quality of life. To measure baseline clinical functioning, colonic transit time and anorectal manometry and the effect of cisapride on these clinical and physiological parameters, we studied 12 SCI patients. Patients initially received baseline clinical scoring, measurement of colonic transit time and anorectal manometry. Patients then received cisapride 20 mg orally three times each day. After one and three months of cisapride therapy, all measurements were repeated. The mean duration cisapride treatment was 5.2 months. Six of 12 (50 percent) reported that symptoms of constipation improved. No patient had worsening of symptoms. Prior to cisapride treatment, 23 percent of patients passed colonic transit markers by day five and 57 percent by day seven; baseline anal manometry revealed variable resting and squeeze pressures. After treatment, 33 percent of patients passed their colonic transit markers by day five and 71 percent by day seven. Six of 12 (50 percent) demonstrated a 10 percent or more increase in resting anal canal pressures. We conclude that about 50 percent of SCI patients have subjective improvement in constipation after cisapride therapy. Cisapride appears to improve both colonic and anorectal function.

Cisapride↗
PubMed2000

Constipation after hysterectomy: fact or fiction?

Hysterectomy is responsible for numerous postoperative complications largely urological, but sometimes of sexual or colorectal function. The latter involve modifications of bowel function resulting in constipation as a result of delayed transit, infrequent evacuations and greater difficulty in expelling faeces. We have reviewed the topic, and consider the various hypotheses whereby these modifications may result from hormonal alterations, iatrogenic causes, or variations in recto-bladder sensitivity. Any of these could justify the modifications in bowel function detected in these patients. The studies carried out so far provide no clear information about the type of constipation that develops after hysterectomy, as we lack prospective studies that compare bowel function before and after operations. Nor is it clear whether we are dealing with constipation as a result of delayed transit or obstructed defaecation, nor which pathogenetic mechanisms are involved. In view of the large number of hysterectomies that are done, sometimes prophylactically, controlled prospective studies are warranted to address these issues more fully.

Constipation↗
PubMed1997

Effects of inulin and lactose on fecal microflora, microbial activity, and bowel habit in elderly constipated persons.

Constipation is an ailment encountered often in elderly people. A study was initiated to test the effects of lactose or inulin on the bowel habits of constipated elderly patients and to correlate these effects with several variables measured in feces such as microflora composition, concentration of lactate and short-chain fatty acids (SCFAs), pH, and the activities of beta-glucosidase and beta-glucuronidase, Groups of 15 and 10 patients received lactose and inulin, respectively, for a period of 19 d. The dose, 20 g/d from days 1 to 8, was gradually increased to 40 g/d from days 9 to 11 and was kept at this dose from days 12 to 19. There was considerable interindividual variations with this kind of dietary intervention. Inulin increased bifidobacteria significantly from 7.9 to 9.2 log10/g dry feces, but decreased enterococci in number and enterobacteria in frequency. In individuals consuming lactose, a noticeable increase in fecal counts of enterococci and a decrease in lactobacilli and clostridia was detected. Total bacterial counts remained unchanged. No changes in the concentrations of fecal SCFAs and lactate were observed. SCFAs showed a slight trend toward higher molar ratios of acetate to butyrate in response to the intake of lactose or inulin. The fecal pH and the beta-glucosidase and beta-glucuronidase activities were not influenced by sugar intake. Inulin showed a better laxative effect than lactose and reduced functional constipation with only mild discomfort.

Aged↗
PubMed1989

Understanding idiopathic chronic constipation: an understated problem.

Constipation is a common problem and is frequently taken for granted by both the lay and medical populations. Although sometimes easily resolved it can prove to be a lifelong, debilitating problem, both medically and sociologically. Most frustrating is the category of idiopathic chronic constipation, a problem without identifiable etiology and diagnosed by exclusion. This paper takes an in-depth view of chronic and more specifically, idiopathic chronic constipation, discussing etiology, diagnosis and treatment. Two case histories are presented illustrating opposite ends of the spectrum in terms of severity. The objective of this paper is to enhance the reader's knowledge about a "common" problem and to increase the future appreciation for patients experiencing this alteration in bowel functioning.

Adult↗
PubMed1990

Constipation in the long-term care facility.

In the long-term care facility, constipation is a problem of clinical significance. An awareness of the types and specific causes of constipation, such as underlying medical conditions and side effects of medication, can facilitate management of these patients. Problems unique to long-term care patients also need to be addressed. This review emphasizes that constipation in these patients needs to be addressed individually and that regular inservice education can optimize nursing care.

Constipation↗
PubMedDate not supplied

Teenage constipation: a case study.

Constipation is a problem of significant magnitude. It can have a devastating impact on a patient's personal life. There are many causes of constipation. Among them are dietary factors such as decreased fiber and low fluid intake, decreased activity, lack of privacy for defecation, pharmacologic agents, physiologic problems such as bowel obstruction or metabolic disorders, and psychosocial distress. A young teenage boy is followed through a series of emergency room visits, office visits, and a hospitalization related to his experiences with constipation. A bowel program was identified and instituted with successful outcomes.

Adolescent↗
PubMedDate not supplied

Biofeedback: its role in the treatment of chronic constipation.

Constipation accounts for more than 2.5 million physician visits a year. Treatment of constipation has been a long-standing and costly problem. Affecting approximately 4.5 million Americans, predominantly women and the elderly, constipation can be persistent and difficult to manage. With the great number of laxative products available, more than $350 to $400 million is spent on over-the-counter laxatives each year. In addition to a complete history and physical examination, tests of anorectal function are useful in the assessment of defecation disorders. Approximately 50% of patients exhibit uncoordinated or dyssynergic defecation patterns. Biofeedback therapy may improve the symptoms of these patients. Biofeedback therapy is labor-intensive, expensive, and available only at a few centers. Although the concept of dyssynergic defecation has existed for only a few years, its therapy, based on neuromuscular conditioning, is gaining recognition. The biofeedback program from one Midwestern tertiary care center is described. Although much still needs to be learned regarding the etiology and pathophysiology of dyssynergic defecation, its management with biofeedback is shown to be efficacious and may prove to be the treatment of choice for patients with this dysfunction of the pelvic floor.

Biofeedback, Psychology↗
PubMed1985

Anorectal motility and rectal sensitivity in chronic idiopathic constipation: effect of high-fiber diet.

The rectoanal inhibitory reflex and rectal sensitivity were evaluated in 13 patients with idiopathic chronic constipation and in 13 control subjects. A double balloon probe was used to stimulate and record the rectoanal inhibitory reflex and rectal sensitivity. The results showed a linear relationship between relaxation amplitude and the logarithm of rectal distending volume, and between relaxation duration and the logarithm of rectal distending volume, with a significant reduction of relaxation amplitude in the patient group. The rectal sensitivity thresholds were significantly increased in patients compared with controls. In 10 additional patients with chronic constipation, motility and sensitivity parameters were evaluated before and after 28 days of high-fiber diet. After diet, the values of relaxation amplitude were significantly increased, returning within normal range, but sensitivity parameters did not change. In conclusion, it appears that in adult chronic idiopathic constipation, anorectal motility and rectal sensitivity are altered, and that only motor abnormalities are corrected by a high-fiber diet.

Adolescent↗