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PubMed2005

Manometric assessment of idiopathic megarectum in constipated children.

AIM: Chronic constipation is a frequent finding in children. In this age range, the concomitant occurrence of megarectum is not uncommon. However, the definition of megarectum is variable, and a few data exist for Italy. We studied anorectal manometric variables and sensation in a group of constipated children with megarectum defined by radiologic criteria. Data from this group were compared with those obtained in a similar group of children with recurrent abdominal pain. METHODS: Anorectal testing was carried out in both groups by standard manometric technique and rectal balloon expulsion test. RESULTS: Megarectum patients displayed discrete abnormalities of anorectal variables and sensation with respect to controls. In particular, the pelvic floor function appeared to be impaired in most patients. CONCLUSION: Constipated children with megarectum have abnormal anorectal function and sensation. These findings may be helpful for a better understanding of the pathophysiological basis of this condition.

Case-Control Studies↗
PubMed2006

Colonic exclusion and combined therapy for refractory constipation.

AIM: To investigate the therapeutic effectiveness of colonic exclusion and combined therapy for refractory constipation. METHODS: Thirty-two patients with refractory constipation were randomly divided into treatment group (n = 14) and control group (n = 18). Fourteen patients in treatment group underwent colonic exclusion and end-to-side colorectal anastomosis. Eighteen patients in control group received subtotal colectomy and end-to-end colorectal anastomosis. The therapeutic effects of the operations were assessed by comparing the surgical time, incision length, volume of blood losses, hospital stay, recovery rate and complication incidence. All patients received long-term follow-up. RESULTS: All operations were successful and patients recovered fully after the operations. In comparison of treatment group and control group, the surgical time (h), incision length (cm), volume of blood losses (mL), hospital stay (d) were 87 +/- 16 min vs 194 +/- 23 min (t = 9.85), 10.4 +/- 0.5 cm vs 21.2 +/- 1.8 cm (t = 14.26), 79.5 +/- 31.3 mL vs 286.3 +/- 49.2 mL (t = 17.24), and 11.8 +/- 2.4 d vs 18.6 +/- 2.6 d (t = 6.91), respectively (P < 0.001 for all). The recovery rate and complication incidence were 85.7% vs 88.9% (P = 0.14 > 0.05), 21.4% vs 33.3% (P = 0.73 > 0.05), respectively. CONCLUSION: Colonic exclusion has better therapeutic efficacy on refractory constipation. It has many advantages such as shorter surgical time, smaller incision, fewer blood losses and shorter hospital stay.

Adult↗
PubMed1999

How to deal with chronic constipation. A stepwise method of establishing and treating the source of the problem.

Chronic constipation is a common medical complaint encountered often in a primary care setting. Most patients can be treated successfully with simple measures, including education, bowel habit training, increased fluid and fiber intake, and use of laxatives. Chronic constipation is usually considered idiopathic, but secondary causes should be excluded. In about 1% of patients with severe, intractable constipation, further diagnostic testing (e.g., endoscopy, colonic transit study) is needed. Patients with colonic inertia can be treated with judicious use of laxatives, but surgery may be necessary in a few cases. Patients with outlet inertia should be referred for biofeedback treatment.

Anus Diseases↗
PubMed1996

Cisapride in chronic idiopathic constipation: clinical response and effect on colonic transit time.

OBJECTIVES: To evaluate the effect of cisapride on the total and segmental colonic transit times (CTT's) and on the clinical symptoms in patients with chronic idiopathic constipation, and to elucidate whether the correction of the CTT parallels the symptomatic improvement. METHODS: An open prospective trial of cisapride, 10 mg t.i.d. orally for 8 weeks, was done in 25 adult patients (M: F6: 19) with chronic idiopathic constipation of 1 year or longer duration. CTT was measured at baseline and after 8 weeks of cisapride therapy. Frequency, consistency and difficulty in passage of bowel movements were evaluated at baseline and after 2, 4 and 8 weeks of cisapride therapy. RESULTS: 19 cases continued to participate until the end of 4 weeks of therapy and 15 cases completed the entire 8 weeks' trial. No serious side effect was experienced during the study period. Total and right segmental CTT's shortened with 8 weeks of cisapride treatment. Defecation frequency increased and difficulty in stool passage improved with 2 to 8 weeks of treatment. Stool consistency had a tendency toward normal after 8 weeks of treatment (p = 0.06). The global response was excellent in 7 cases (46.7%), good in 5 (33.3%) and poor in 3 (20.0%). If all dropped-out cases were assumed to be poor responders, the good or excellent responders after 8 weeks of cisapride might be 48.0% of all recruited patients. The response to cisapride could not be predicted by the various clinical parameters of the patients. CONCLUSION: Cisapride is an effective drug in at least half of the patients with chronic idiopathic constipation.

Adult↗
PubMed1998

Evaluation and treatment of constipation and fecal impaction in adults.

Constipation is a common complaint that physicians encounter. Understanding the patient's definition of constipation and focusing the history and physical examination provide clues to the underlying cause. Initially, an empiric treatment trial is recommended. For patients with warning symptoms or those in whom treatment fails, a limited diagnostic work-up is suggested. Tests of physiologic function are reserved for patients whose condition is refractory to therapy. Fecal impaction can be considered extreme constipation. The pathophysiologic features of fecal impaction are discussed, and recommendations are provided for treatment and prevention.

Adult↗
PubMed2000

Anorectal dysfunction in constipated women with anorexia nervosa.

OBJECTIVE: To evaluate anorectal and colonic function in a group of patients with anorexia nervosa complaining of chronic constipation. PATIENTS AND METHODS: Twelve women (age range, 19-29 years) meeting the criteria for anorexia nervosa and complaining of chronic constipation were recruited for the study. A group of 12 healthy women served as controls. Colonic transit time was measured by a radiopaque marker technique. Anorectal manometry and a test of rectal sensation were carried out with use of standard techniques to measure pelvic floor dysfunction. A subgroup of 8 patients was retested after an adequate refeeding program was completed. RESULTS: Eight (66.7%) of 12 patients with anorexia nervosa had slow colonic transit times, while 5 (41.7%) had pelvic floor dysfunction. Colonic transit time normalized in the 8 patients who completed the 4-week refeeding program. However, pelvic floor dysfunction did not normalize in these patients. CONCLUSIONS: Patients with anorexia nervosa who complain of constipation have anorectal motor abnormalities. Delayed colonic transit time is probably due to abnormal eating behavior.

Adult↗
PubMed2001

Patient satisfaction after biofeedback for constipation and pelvic floor dyssynergia.

BACKGROUND: Patients referred for chronic constipation frequently report symptoms of straining, feeling of incomplete evacuation, or the need to facilitate defecation digitally (dyschezia). When such patients show manometric evidence of inappropriate contraction or failure to relax the pelvic floor muscles during attempts to defecate, they are diagnosed as having pelvic floor dyssynergia (Rome I). AIMS: To evaluate long-term satisfaction of patients with pelvic floor dyssynergia after biofeedback. PATIENTS: Forty-one consecutive patients referred for chronic constipation at an outpatient gastrointestinal unit and diagnosed as having pelvic floor dyssynergia who completed a full course of biofeedback. METHODS: Data have been collected using a standardised questionnaire. A questionnaire survey of patients' satisfaction rate and requirement of aperients was undertaken. RESULTS: Mean age and symptom duration were respectively 41 and 20 years. Half of patients reported fewer than 3 bowel motions per week. Patients were treated with a mean of 5 biofeedback sessions. At the end of the therapy pelvic floor dyssynergia was alleviated in 85% of patients and 49% were able to stop all aperients. Satisfaction was maintained at follow-up telephone interviews undertaken after a mean period of 2 years, as biofeedback was helpful for 79% of patients and 47% still abstained from intake of aperients. CONCLUSIONS: Satisfaction after biofeedback is high for patients referred for chronic constipation and diagnosed with pelvic floor dyssynergia. Biofeedback improves symptoms related to dyschezia and reduces use of aperients.

Adult↗
PubMedDate not supplied

The nurse's role in managing constipation.

Constipation is a problem that affects patients in many care settings. Although recommendations are made for specific groups of patients with constipation, such as older patients and children, there is less information available for general adult patients. Angela Day discusses the need for clinical audit to ensure that nurses are using the most effective options for managing and preventing constipation, and examines the treatment options currently available.

Acute Disease↗
PubMed2003

Reflexology in the management of encopresis and chronic constipation.

Encopresis or faecal incontinence in children is an extremely distressing condition that is usually secondary to chronic constipation/stool withholding. Traditional management with enemas may add to the child's distress. This study investigated the efficacy of treating patients with encopresis and chronic constipation with reflexology. An observational study was carried out of 50 children between three and 14 years of age who had a diagnosis of encopresis/chronic constipation. The children received six sessions of 30-minutes of reflexology to their feet. With the help of their parents they completed questionnaires on bowel motions and soiling patterns before, during and after the treatment. A further questionnaire was completed by parents pre and post treatment on their attitude towards reflexology. Forty-eight of the children completed the sessions. The number of bowel motions increased and the incidence of soiling decreased. Parents were keen to try the reflexology and were satisfied with the effect of reflexology on their child's condition. It appears that reflexology has been an effective method of treating encopresis and constipation over a six-week period in this cohort of patients.

Adolescent↗
PubMed2006

User satisfaction with a constipation service: a comparative audit.

Chronic constipation in children affects their quality of life and can have far reaching consequences, causing low self-esteem in children and family conflict (McGinley 2001). A review of outcomes following the establishment of a new constipation service showed significant improvements in outcomes and in the level of support provided to families. To obtain a more in depth picture of effectiveness, quantitative findings were supplemented with the views of 16 children and families who use the service. Families generally understood the condition and were attempting to make lifestyle changes. They appreciated the education and support offered by the service: for many it was the first time that they had been given effective treatment for what was often a long term problem. Although the existing service is effective, further development could help prevent constipation, improve early intervention and prevent the need for secondary referrals.

Aftercare↗
PubMed1999

[Treatment of anal incontinence and constipation with transanal irrigation].

The Enema Continence Catheter (ECC) consists of a rectal catheter with an inflatable balloon. The balloon keeps the catheter in the rectum, while enemas are administered. Results from 25 adult patients and 12 children treated with the ECC were evaluated by telephone interviews or by information drawn from patient records. The ECC reduced the frequency of incontinence episodes in four of nine (44%) adult patients suffering from faecal incontinence due to spinal cord lesions, myelomeningocele, complicated anal sphincter lesions or anorectal surgery and irradiation therapy. Among 16 adult patients suffering from constipation or obstructed defecation, the ECC reduced symptoms in three (19%). Furthermore, the ECC procedure reduced symptoms in 10 of 11 (91%) children with colorectal dysfunction, mainly due to spina bifida. In conclusion, the ECC can reduce symptoms in most children suffering from faecal incontinence or constipation, and in some adults with faecal incontinence. However, the method is less effective among adults with constipation or obstructed defecation.

Adolescent↗
PubMed1999

[Disorders of intestinal innervation as a possible cause for chronic constipation].

The gastrointestinal tract contains the largest amount of nerve cells apart from the central nervous system constituting together with glial cells the enteric nervous system (ENS). The morphology of the ENS is characterized by intramurally located ganglionated and non-ganglionated plexus of different structure. The diversity of neurotransmitters synthesized by the different nerve cell types as well as the complex neuronal circuits establish the basis for the mediation of a coordinated intestinal motility. Subsequently abnormalities of the ENS may cause severe constipation. The most acknowledged intestinal innervation disorder represents aganglionosis (Hirschsprung's disease) characterized by the absence of intramural nerve cells and the hypertrophy of nerve fiber bundles within the affected intestinal segment. Non-aganglionic intestinal innervation disorders include intestinal neuronal dysplasia (IND), hypoganglionosis and heterotopic ganglia. The pathogenesis of intestinal neuronal malformations is mainly attributed to development disorders of the ENS, in part caused by genetic defects. Furthermore, the ENS can sustain damage during the postnatal period by ischemic, inflammatory, autoimmunological processes or neurotoxic agents. The histopathological diagnosis of intestinal innervation disorders is achieved by enzyme- and immunohistochemical methods. The examination of the ENS can be carried out on mucosal, deep submucosal or full-thickness biopsies using serial transverse sections as well as on intestinal whole-mount preparations allowing a three-dimensional demonstration and assessment of the intramural plexus. Structural abnormalities of the myenteric and submucosal plexus and an abnormal content of neurotransmitters have been considered to be responsible for primary chronic constipation. However, until now no unified pathophysiological concept has been established due to the partly contradictory findings. Therefore, an important goal in patients with chronic constipation should be a detailed quantitative and qualitative assessment of the underlying neurohistopathology. The correlation of these data with functional parameters of intestinal motility may represent an useful tool for the differential diagnostic and therapeutic considerations.

Chronic Disease↗
PubMed1999

Chronic neurogenic lesions of the external anal sphincter and abdomino-perineal dyssynergia in chronic constipation.

BACKGROUND: Neuropathy of the pudendal nerves which may be found in constipated patients has been considered the result of pelvic floor descent due to the repetitive acts of straining at stool. However, the relationship between abdominopelvic dyssynergia, which may lead to repetitive acts of straining and neurophysiopathologic alterations of the pelvic floor has not yet been fully elucidated. AIM: Of this study was to assess the relationship between neurophysiologic alterations of the external anal sphincter, patterns of altered evacuation and defaecographic pelvic floor physiology in 32 patients with chronic idiopathic constipation. RESULTS: At electromyography partial muscle denervation, identified as chronic neurogenic lesions of the external anal sphincter, were found in 19% and dyssynergia (co-contraction of external anal sphincter and abdominal muscles) in 34% of the investigated subjects. Patients with different electromyography patterns did not differ as far as concerns symptoms of altered evacuation, bowel frequency, use of digital manoeuvres, age, and duration of symptoms. The presence of neurophysiologic alterations was significantly associated with altered defaecographic findings: reduced ano-rectal angle at rest in chronic neurogenic lesions and abdomino-pelvic dyssynergia (p < 0.01); excessive pelvic floor descent in the presence of chronic neurogenic lesions (p < 0.05). CONCLUSIONS: In chronically constipated patients symptoms of altered defaecation do not appear to be related to abdomino-pelvic dyssynergia and/or chronic neurogenic lesion of the external anal sphincter and do not show any association with defaecographic alterations. These results suggest that straining at evacuation can be induced by additional factors other than abdomino-pelvic dyssynergia and chronic neurogenic lesions and that these two alterations have different pathogenetic mechanisms.

Abdominal Muscles↗
PubMed1999

What's the 'best buy' for treatment of constipation? Results of a systematic review of the efficacy and comparative efficacy of laxatives in the elderly.

Constipation is a common cause of general practice consultations in elderly people, and laxative use is common among this group of patients. However, there appears to be little evidence to guide laxative treatment in this population. This paper reports the results of a systematic review of randomized controlled trials of the efficacy of laxatives in the treatment of constipation in the elderly. While the results of the review suggest that laxatives can improve bowel movement frequency, stool consistency, and symptoms of constipation, with a few exceptions, the relevant trials have serious methodological shortcomings. However, the review finds little evidence of marked differences in effectiveness between laxatives and, in particular, there appears to be no evidence to support the current National Health Service (NHS) trend towards prescribing the more expensive stimulant laxatives. This is an area where good quality trial evidence is now needed.

Aged↗
PubMed2000

[Treatment of constipation and different laxative requirements in palliative medicine].

The significance of constipation with its variety of possible complications is often underestimated in the context of the tumour patient's complaints although difficulties in stool management are more common in patients with advanced cancer than in those with other terminal diseases. Without treatment constipated patients will suffer from nausea and emesesis and will possibly develop small bowel paralysis. About half of all patients admitted to specialist palliative care units report constipation, but about 75% of the patients will require laxatives. Unlike for pain, no generally accepted and widely disseminated management guidelines are available. Effective prophylaxis and cause-based therapy do improve the alimentary condition and can help to prevent the transition to ileus situations. Effective symptom management presupposes exact knowledge of the pharmacokinetics.

Cathartics↗
PubMedDate not supplied

Development of a protocol to prevent opioid-induced constipation in patients with cancer: a research utilization project.

Opioids are the major class of analgesics used in the management of moderate to severe cancer pain, and constipation is a common side effect of opioid administration. While monitoring for quality-assurance, nurses found that 95% of patients interviewed on a 28-bed oncology unit of a Midwestern hospital reported constipation as the major side effect of their opioid regimen for pain control. Through the efforts of a nursing research utilization committee, a protocol to prevent opioid-induced constipation in patients with cancer was developed and implemented.

Algorithms↗
PubMed1999

Surgical aspects of chronic constipation in children.

Chronic constipation accounts for 3% of paediatric visits. These patients can be broadly classified into three groups: (a) medical group (60-70%), (b) surgical group (20-25%), (c) refractory constipation group (5-10%). The first two groups can be managed by dietary adjustments and surgery respectively. The recognition and management of refractory constipation is a slower process and needs close scrutiny and perseverance before a definite therapeutic option could be decided.

Adolescent↗
PubMed1975

Differential measurement of small and large bowel transit times in constipation and diarrhoea: A new approach.

Differential measurements of small and large bowel transit times were performed in 13 subjects iwth a radiotelemetering pressure-sensitive capsule incorporating less than 10mugCi of 51-Cr. Six patients had constipation. The other seven patients had diarrhoea due to the irritable bowel syndrome (3), following vagotomy and pyloroplasty (3), or due to laxative abuse (1). This new method enables the gastric, small intestinal, and colonic transit times to be measured differentially in the same subject. The capsule can be localized in the gut lumen by reference to the characteristic pressure pattern and in relation to bony landmarks by the radioactive marker as frequently as desired without recourse to radiographs. The results show that gastric emptying and small intestinal transit did not differ in constipation and diarrhoea. By contrast the mean colonic transit was significantly faster (P smaller than 0.01) in diarrhoea whatever the cause (17.5 plus or minus 4.1 hours) than in constipation (118 plus or minus 4.1 hours).

Adult↗