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PubMed2005

Are diet and constipation related in children?

Constipation is a common complaint in childhood, and the etiology of many healthcare referrals. Despite literature documenting the high frequency of this problem, there is little research directly relating the food consumed and the eventual stool consistency. There is literature suggesting the importance of adequate fiber intake in children to maintain soft stools. Other dietary modifications actually have not been shown to be helpful or are not based on actual clinical studies. The presence of dietary allergies may also contribute to etiology of constipation. More studies to provide further linkages between diet and constipation are clearly needed.

Child↗
PubMed1978

Management of constipation in terminally ill patients.

This small study was carried out to assess the effectiveness of lactulose syrup (Duphalac) in the management of constipation in forty-six patients with terminal illnesses. The daily dose of lactulose was titrated to meet the individual patients requirements and was found to be in the region of 20 to 30 mls twice daily, despite the almost universal administration of opiates as analgesics. The study lasted 21 days in each patient capable of completing the assessment. Constipation was relieved within a an average of 3 to 4 days, and of the 512 days observed, there were 203 days in which a bowel movement occurred. Of these motions 71% were recorded as easy to move, rather than hard (21%) of loose (8%). Faecal incontinence and nausea attributable to lactulose treatment were extremely rare. Therefore, lactulose appeared to be a useful treatment for constipation in the terminally ill patient.

Adult↗
PubMed1992

Lactulose in the management of constipation: a current review.

OBJECTIVE: To review the current published clinical studies evaluating the clinical efficacy and safety of lactulose compared with other laxatives or placebo. Adverse effects associated with lactulose are also reported. DATA SOURCES: Information was retrieved by searching the MEDLINE and EMBASE databases for clinical trials, abstracts, conference proceedings, and review articles dealing with lactulose. STUDY SELECTION: Emphasis was placed on clinical trials where lactulose was compared with other laxatives or placebo in patient populations where the diagnosis of constipation was reasonably established. DATA EXTRACTION: The methodology and results from clinical studies were evaluated. Assessment of the studies was made based on diagnosis of constipation, prior management of patients, follow-up of patients, dosage, and adverse effects. DATA SYNTHESIS: Clinical trials in geriatric patients, terminally ill patients, children, and normal and constipated subjects were reviewed. In most instances, lactulose was compared with a placebo, without incorporating the current education on dietary techniques for improving defecation. CONCLUSIONS: Generally, clinical trials have demonstrated a beneficial response compared with placebo, although sometimes that response has been only marginally better, from a clinical point of view.

Adolescent↗
PubMed2001

Hemostasis in children with dysbacteriosis in chronic constipation.

The purpose of the study was to investigate hemostasis in children with dysbacteriosis disturbance in chronic constipation. The disturbance of factors in the inner mechanism of blood coagulation (VII, IX, XI, XII) in compensated chronic constipation was defined based on the reduction in colon bacillus levels. We observed hypocoagulation caused by the reduced activity of the prothrombin complex factors, disaggregate thrombocytopathy, and endotheliosis with fibrinolysis inhibition in subcompensated chronic colostasis with continuous reduction of colon bacillus levels and pathogenic microflora appearance. In decompensated colostasis there was an increase in pathogenic microorganisms and a continuous reduction of colon bacillus levels. In hemostasis there was a factor deficiency in inner (XII, XI, IX, VIII) and outer (II, V, VII, X) blood coagulation mechanisms. Fibrinolysis inhibition, endotheliosis development with thrombocyte aggregation, and microthrombosis formation were determined. Thus, in children with chronic constipation, there was a marked reduction in the amount of colon bacillus, which led to the reproduction of pathogenic bacteria. We also observed chronometric hypocoagulation with the inner (XII, XI, IX, VIII) and outer (II, V, VII, X) mechanisms of blood coagulation, at the base of which there is the deficiency of vitamin K-dependent factors (II, VII, IX, X) and a slightly marked disturbance in the final stage of coagulation. In thrombocyte vascular hemostasis, thrombocytopathy was observed with increased adenosine-5-diphosphate aggregation and the inhibition of the inner mechanism with fibrinolysis and endotheliosis.

Adolescent↗
PubMed2000

Constipation and the use of laxatives: a comparison between transdermal fentanyl and oral morphine.

Constipation and the use of laxatives were investigated in patients with chronic cancer pain treated with oral morphine and transdermal fentanyl in an open sequential trial. Forty-six patients were treated with slow-release morphine 30-1000 mg/day for 6 days and 39 of these patients were switched to transdermal fentanyl 0.6-9.6 mg/day with a conversion ratio of 100:1. Median fentanyl doses increased from 1.2 to 3.0 mg/day throughout the 30-day transdermal treatment period. Twenty-three patients completed the study. Two patients died from the basic disease while treated with transdermal fentanyl, 12 patients were excluded for various reasons, and not enough data for evaluation were available for two patients. Mean pain intensity decreased slightly after conversion although the number of patients with breakthrough pain or requiring immediate-release morphine as a rescue medication was higher with transdermal fentanyl. The number of patients with bowel movements did not change after the opioid switch but the number of patients taking laxatives was reduced significantly from 78-87% of the patients per treatment day (morphine) to 22-48% (fentanyl). Lactulose was used mainly and was reduced most drastically, but other laxatives were also used less frequently. In this study transdermal fentanyl was associated with a significantly lower use of laxatives compared to oral morphine. The difference in the degree of constipation between the two analgesic regimens should be confirmed in a randomized double-blind study that takes into account both constipation and use of laxatives.

Administration, Cutaneous↗
PubMed2003

Factors influencing constipation in advanced cancer patients: a prospective study of opioid dose, dantron dose and physical functioning.

The relationship between opioid dose, dantron dose, bowel function and physical functioning (measured with the modified Barthel Index) was determined in a sample of 50 inpatients with advanced cancer. Data were collected prospectively from chart review and patient interviews one week after admission to allow for protocol-driven management of constipation to be established. Bowel scores were significantly reduced in 35 patients treated with opioids compared with 15 patients not treated with opioids. Within the opioid group, however, there was no relationship between opioid dose, bowel score, dantron dose or Barthel Index. Higher doses of dantron were associated with better physical functioning (but not opioid dose) suggesting that for any given dose of opioid, fitter patients were treated with larger doses of laxatives. Factors other than opioid dose and physical functioning may be more important in contributing to constipation in this group of patients. Less potent opioid drugs, such as codeine, are just as likely to cause constipation as more potent opioids.

Activities of Daily Living↗
PubMed2002

Effect of dietary fiber on morphine-induced constipation in rats.

Morphine is used to alleviate chronic cancer pain. However, constipation is a major adverse effect that often detracts from the patient's quality of life. In this study, we investigated the effectiveness of dietary fiber on morphine-induced constipation. Rats were fed on a normal diet or one containing either 10% or 20% apple fiber for two weeks before morphine was administered. In the control diet group, the fecal number and dry weight were decreased by treating with morphine in a dose-dependent manner. Moreover, the motility of the small and large intestines was reduced. The fecal number and weight were increased and the colon motility was promoted by dietary fiber, regardless of whether morphine was being administered. The dietary fiber increased the concentration of short-chain fatty acids (SCFAs) in the cecum. These results suggest that dietary fiber has a preventative effect on morphine-induced constipation by increasing SCFAs in the cecum, and thereby promoting colon motility in rats.

Animals↗
PubMedDate not supplied

Constipation services for children: the role of health visitor teams.

Constipation among children is a prevalent condition, yet poorly understood. There is little empirical evidence for 'best possible' configurations of services. This article presents a survey of Walsall health visitor team members (HVTMs) which aimed to identify the types of advice and care provided to young children with constipation, pathways to care and ideas for service improvement. Most HVTM consultations were parent-initiated. Few GPs referred children to HVTMs. HVTMs most commonly provided advice about fluids and diet -- only one prescribed medication. HVTMs identified the need for early intervention, consistent information for parents and a clear pathway for all health professionals to follow. Currently, a team from the local primary and hospital NHS trusts is developing an integrated care pathway for paediatric constipation. Success of such pathways depends on their adoption by GPs and hospital-based health professionals, and on evidence of efficacy arising from their evaluation.

Aftercare↗
PubMed2006

A randomized, prospective, comparison study of polyethylene glycol 3350 without electrolytes and milk of magnesia for children with constipation and fecal incontinence.

OBJECTIVE: Our aim was to compare 2 laxatives, namely, polyethylene glycol 3350 without electrolytes and milk of magnesia, evaluating the efficacy, safety, acceptance, and 1-year outcomes. METHODS: Seventy-nine children with chronic constipation and fecal incontinence were assigned randomly to receive polyethylene glycol or milk of magnesia and were treated for 12 months in tertiary care pediatric clinics. Children were counted as improved or recovered depending on resolution of constipation, fecal incontinence, and abdominal pain after 1, 3, 6, and 12 months. An intent-to-treat analysis was used. Safety was assessed with evaluation of clinical adverse effects and blood tests. RESULTS: Thirty-nine children were assigned randomly to receive polyethylene glycol and 40 to receive milk of magnesia. At each follow-up visit, significant improvement was seen in both groups, with significant increases in the frequency of bowel movements, decreases in the frequency of incontinence episodes, and resolution of abdominal pain. Compliance rates were 95% for polyethylene glycol and 65% for milk of magnesia. After 12 months, 62% of polyethylene glycol-treated children and 43% of milk of magnesia-treated children exhibited improvement, and 33% of polyethylene glycol-treated children and 23% of milk of magnesia-treated children had recovered. Polyethylene glycol and milk of magnesia did not cause clinically significant side effects or blood abnormalities, except that 1 child was allergic to polyethylene glycol. CONCLUSIONS: In this randomized study, polyethylene glycol and milk of magnesia were equally effective in the long-term treatment of children with constipation and fecal incontinence. Polyethylene glycol was safe for the long-term treatment of these children and was better accepted by the children than milk of magnesia.

Abdominal Pain↗
PubMed2003

Dietary fiber, energy intake and nutritional status during the treatment of children with chronic constipation.

The present prospective study was carried out to determine dietary fiber and energy intake and nutritional status of children during the treatment of chronic constipation. Twenty-five patients aged 2 to 12 years with chronic constipation were submitted to clinical evaluation, assessment of dietary patterns, and anthropometry before and after 45 and 90 days of treatment. The treatment of chronic constipation included rectal disimpaction, ingestion of mineral oil and diet therapy. The standardized diet prescribed consisted of regular food without a fiber supplement and met the nutrient requirements according to the recommended daily allowance. The fiber content was 9.0 to 11.9 g for patients aged less than 6 years and 12.0 to 18.0 g for patients older than 6 years. Sixteen patients completed the 90-day follow-up and all presented clinical improvement. The anthropometric variables did not change, except midarm circumference and triceps skinfold thickness which were significantly increased. Statistically significant increases were also found in percent calorie intake adequacy in terms of recommended daily allowance (55.5 to 76.5% on day 45 and to 68.5% on day 90; P = 0.047). Percent adequacy of minimum recommended daily intake of dietary fiber (age + 5 g) increased during treatment (from 46.8 to 52.8% on day 45 and to 56.3% on day 90; P = 0.009). Food and dietary fiber intake and triceps skinfold thickness increased during follow-up. We conclude that the therapeutic program provided a good clinical outcome.

Body Composition↗
PubMed2003

Use of erythromycin for the treatment of severe chronic constipation in children.

The efficacy of erythromycin was assessed in the treatment of 14 children aged 4 to 13 years with refractory chronic constipation, and presenting megarectum and fecal impaction. A double-blind, placebo- controlled, crossover study was conducted at the Pediatric Gastroenterology Outpatient Clinic of the University Hospital. The patients were randomized to receive placebo for 4 weeks followed by erythromycin estolate, 20 mg kg-1 day-1, divided into four oral doses for another 4 weeks, or vice versa. Patient outcome was assessed according to a clinical score from 12 (most severe clinical condition) to 0 (complete recovery). At enrollment in the study and on the occasion of follow-up medical visits at two-week intervals, patient score and laxative requirements were recorded. During the first 30 days, the mean SD clinical score for the erythromycin group (N = 6) decreased from 8.2+/-2.3 to 2.2+/-1.0 while the score for the placebo group (N = 8) decreased from 7.8+/-2.1 to 2.9+/-2.8. During the second crossover phase, the score for patients on erythromycin ranged from 2.9+/-2.8 to 2.4+/-2.1 and the score for the patients on placebo worsened from 2.2+/-1.0 to 4.3+/-2.3. There was a significant improvement in score when patients were on erythromycin (P < 0.01). Mean laxative requirement was lower when patients ingested erythromycin (P < 0.05). No erythromycin-related side effects occurred. Erythromycin was useful in this group of severely constipated children. A larger trial is needed to fully ascertain the prokinetic efficacy of this drug as an adjunct in the treatment of severe constipation in children.

Adolescent↗
PubMedDate not supplied

[Intestinal constipation in patients with intracranial tumors].

The effort that occurs during the Valsalva maneuver provokes a raise in intracranial pressure and may decompensate patients with increased intracranial pressure. The aims of this study were to evaluate the incidence of intestinal constipation in the preoperative period of patients with intracranial tumors and establish a relationship between constipation and intracranial pressure decompensation. This study was performed at the neurosurgery unit of Hospital São Paulo, from August to October 2003, evaluating 37 patients. Preoperative time varied from 2 to 34 days (mean 12 days). During this period, 6 (16.2%) patients underwent constipation; all of them received dietary fiber and lactulose, 2 (33.3%) needed enema administration. All patients performed the Valsalva maneuver during defecation and none of them developed intracranial hypertension decompensation.

Adult↗
PubMed1986

Motilin in chronic idiopathic constipation.

The plasma motilin levels were studied in seven patients with severe long-standing idiopathic constipation before and after a fat-rich test meal. The results were compared with those of a control group consisting of 10 apparently healthy persons with normal bowel function. The constipated patients had reduced basal motilin levels and a reduced motilin release after the test meal. Motilin is known to stimulate intestinal motility by inducing interdigestive descending contractions in the stomach and small intestine. A defective motilin release may therefore play a part in the pathogenesis of idiopathic constipation.

Adult↗
PubMed1992

Idiopathic constipation: any movement?

Severe constipation now attracts considerable research interest. As a consequence, there have been recent advances in most aspects of this disorder. The epidemiology of this condition is now better appreciated, and subgroups of patients with different epidemiologies, symptom complexes, aetiologies, and treatments can now be distinguished. Radioisotopes enable detailed transit studies to be obtained of the entire gastrointestinal tract. Careful psychologic evaluation is an essential part of the evaluation. In young women with severe idiopathic constipation there is a decrease in propulsive mass movements, and specific colonic neurotransmitter abnormalities have been identified. Biofeedback therapy is an effective treatment for many of these patients. The variable results of surgery are now also clearly defined. Patients with chronic idiopathic intestinal pseudoobstruction can be categorized on the basis of their pathologic findings; detailed tissue studies may be required. The recognition that severe constipation encompasses various different conditions is leading to a more precise understanding of pathogenesis and treatment.

Constipation↗
PubMed1995

Treatment of internal rectal intussusception in patients with chronic constipation.

BACKGROUND: The significance of internal rectal intussusception (rectal invagination) in chronic constipation dominated by symptoms of obstructed defecation is not fully clarified. METHODS: Seventeen consecutive patients with chronic constipation and a history of obstructed defecation with internal rectal intussusception demonstrated by defecography were treated by perineal rectopexy. RESULTS: Of 15 patients followed up for more than 2 years defecography showed total disappearance of the intussusception in 12. Five of these claimed substantial improvement (42%; 17-72%). Three of four patients with concomitant anal incontinence became fully or partly continent after the rectopexy. CONCLUSION: In some patients with chronic constipation, dominated by symptoms of obstructed defecation, rectal invagination may be an aggravating factor. The study indicates that rectal invagination does not seem to be the cause but rather a consequence of the obstructed defecation. In selected patients, including those with concomitant faecal incontinence, surgical treatment of the intussusception by a minor procedure may be indicated.

Constipation↗
PubMed1998

Colonic neuroendocrine peptide levels in patients with chronic idiopathic slow transit constipation.

The motility disorders in patients with slow-transit constipation have been attributed to a disturbance in the peptidergic innervation of the colonic enteric nervous system. The nature of this disturbance is, however, controversial. In the present study 7 patients with long-standing severe slow- transit constipation were included, and normal tissues from the colon of 6 patients, which had undergone colonectomy because of polyp, chronic diverticulitis, prolapsis and volvulus were used as controls. The concentrations of several neuroendocrine peptides were measured in tissue extracts by radioimmuno-assays. The level of pancreatic polypeptide was high in 2 patients and low in one patient. Peptide YY level was high in 3 patients and low in one patient, and that of neuropeptide Y was high in 4 patients. Somatostatin and vasoactive intestinal polypeptide levels were high in 3 patients and substance P concentration was low in 3 patients. Neurotensin level was high in one patient and low in another patient. Galanin concentration was low in 2 patients and high in one patient. Gastrin-releasing peptide level was high in one patient and that of enkephalin was high in 2 patients. All patients had altered concentrations of several neuroendocrine peptides except one, who had only a low level of galanin. It is concluded that patients with slow-transit constipation have disturbed neuroendocrine peptides in common, though the nature of this disturbance varies between patients and in most patients several neuroendocrine peptides were affected. This may explain the controversial results obtained in previous studies.

Adult↗
PubMed2006

Constipation as a reversible cause of ventriculoperitoneal shunt failure. Report of two cases.

Ventriculoperitoneal (VP) shunt failure is a common problem encountered by pediatric neurosurgeons. The majority of such failures are due to obstruction of the device. Conditions in which intraabdominal pressure is chronically elevated, such as pregnancy, have been associated with shunt failure. Chronic constipation may also result in abnormally elevated intraabdominal pressure and may be an underrecognized cause of distal VP shunt failure. The authors describe the cases of two children who presented with clinical and imaging evidence of VP shunt failure and who were also severely constipated. Treatment of their constipation resulted in both clinical and imaging-documented resolution of their shunt failure.

Child, Preschool↗
PubMed2005

Effect of xylooligosaccharide intake on severe constipation in pregnant women.

Xylooligosaccharides (XOS) are mainly composed of two or three xylose units with beta-1,4 linkages. They are obtained by hemicellulose hydrolysis, which is relatively abundant in the cell walls of grains. XOS increases the number of intestinal Bifidobacterium in humans, and maintains the fecal water content within the normal range. To examine the effect of XOS intake on severe constipation in pregnancy, which is predominant in the third trimester, thirty constipated pregnant women were treated with 4.2 g XOS daily for 4 wk. During the study, the clinical efficacy was assessed using a daily diary. The subjects indicated the number of stools and the clinical symptom scores. Twenty-nine subjects completed the study. The mean number of stools was 1.1 +/- 0.4 in the pre-treatment week, and increased in weeks 1-4 of XOS administration to 5.3 +/- 2.1, 5.9 +/- 2.5, 6.2 +/- 2.2 and 6.7 +/- 1.9, respectively. At the end of the study, 27 subjects could defecate spontaneously. The occurrence of very loose or very hard stools decreased and the stool consistency normalized. The stool color changed from dark to yellowish brown. No side effects were observed. XOS intake was highly effective for the reduction of severe constipation in pregnant women without adverse effects.

Constipation↗