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PubMed2005

[Clinical observation on moving cupping therapy combined with moxibustion for treatment of senile habitual constipation].

OBJECTIVE: To explore an effective method for treatment of senile habitual constipation. METHODS: Sixty-four cases were randomly divided into a treatment group treated with moving cupping at Hechelu plus Shenque (CV 8) Bazhenxue moxibustion, and a control group with oral administration of Tab phenolphthaleinum, 32 cases in each group. Improvement of constipation in the patients were observed and compared. RESULTS: The short-term (14 days) clinical cured-markedly effective rate was 84.4% in the treatment group, which was significantly better than 59.4% of the control group (P < 0.05), and there was a significant difference between the two groups in the long-term (2 months) therapeutic effect (P < 0. 01). CONCLUSION: Moving cupping at the Hechelu combined with Shenque (CV 8) Bazhenxue moxibustion is an effective method for senile habitual constipation.

Acupuncture Points↗
PubMed1992

Psychological evaluation of patients with severe idiopathic constipation: which instrument to use.

We prospectively evaluated 38 patients with chronic severe idiopathic constipation who failed to respond to conventional therapy. Colonic transit studies, the Hopkins Symptom Checklist (SCL-90-R), and the Minnesota Multiphasic Personality Inventory (MMPI) were completed. Colonic transit studies identified 23 patients with slow transit and 15 with normal transit. Patients with normal transit constipation scored higher than those with slow transit on every scale of both the SCL-90-R and MMPI, but the SCL-90-R appeared to detect greater differences between the two groups. We conclude that the SCL-90-R is the preferred psychological instrument to evaluate patients with chronic severe constipation who fail to respond to conventional therapy. It provides information similar to the MMPI with which to measure behavioral profiles of patients in an office setting, and it can be completed and scored more rapidly.

Adult↗
PubMed2006

[Nausea, vomiting and constipation in palliative care].

Nausea/vomiting and constipation are frequent symptoms among patients with advanced disease and short survival expectancy. The aim of this paper is to present the aetiology, diagnostic work-up, prophylaxis and treatment of these symptoms in palliative patients, based on a literature review and clinical experience. Nausea/vomiting is not a diagnosis, but symptoms with multiple causes. There is no universally applicable treatment approach. General guidelines for good treatment are: 1) impeccable assessment and work-up, 2) choice of treatment according to underlying causes and involved mechanisms, 3) pharmacological treatment applied jointly with non-pharmacological measures, 4) thorough follow-up and readjustment of treatment. During work-up, or if underlying causes can not be identified, metoclopramide, alternatively haloperidol, is the first drug of choice. Oral administration should be avoided until vomiting is controlled. Adequate hydration is important. The same general guidelines are applicable to handle constipation. However, prophylactic measures are also essential, focusing on risk factors (fluid intake, activity and toilet accommodations). Stool softening laxatives should be administered, (polyethylene glycol or lactulose), and if needed, combined with a bowel stimulant (bisacodyl or sodium picosulphate). Opioid use is among the most common causes of constipation and prescription of opioids should always be accompanied by prescription of laxatives. Exceptions are diarrhoea, ileostomy and dying patients.

Antiemetics↗
PubMed2005

[Usefulness of biofeedback treatment in children with chronic functional constipation].

BACKGROUND: About 2/3 of constipated children present anal-rectal dyssynergy (ARD) with paradoxical contraction of the external anal sphincter (EAS) during defecation. AIM: The aim of our study was to answer the question whether additional treatment with biofeedback training (BF) is more effective than traditional treatment. MATERIALS, METHODS: We assessed chronically constipated children who fulfilled the criteria of ARD: recto-sigmoid transit time in Hinton's test with radio-paque markers at least 28.8 h, paradoxical EAS contraction during defecation trials (anorectal manometry). The study included 22 constipated children (16 boys and 6 girls), aged 5 to 14 years (mean 8.1 +/- SD 2.8). Children were randomly divided in two groups. In group I at the start of the study children had four day-by-day sessions of BF training based on the anorectal manometry and the surface EMG. Children from group II received only traditional treatment. The follow-up was 6 months. Improvement was estimated based on manometric data, number and quality of stools. RESULTS: In the group I after one month, more manometric parameters, significantly improved as compared to the II group. During the observation period the number of stools increased and their quality improved in both groups. There was no statistically significant difference between the groups in terms of the above mentioned symptoms. CONCLUSIONS: Treatment with BF can improve rectal sensation and particularly defecation dynamics, faster than the traditional method. There is no significant effect of additional BF treatment on such objective symptoms as the number and quality of stools.

Adolescent↗
PubMed1991

Chronic idiopathic constipation: the importance of transit time studies.

Chronic idiopathic constipation includes a very heterogeneous group of alterations which cannot be correctly defined only by their clinical appearance and require an examination of the colonic transit time. This test is performed by using a specific number of radiopaque markers and a fixed number of X-ray observations. By means of transit time study, we can classify the constipated patients into 4 groups: a) patients with stasis in the right colon (17-53% of cases) which implies an alteration of propulsive forces or absence of mass movements and segmentary motor activity; b) stasis in the left colon (13-27% of cases) which could be due to a "reflux" of colonic contents or to a hyperactive sigmoid; c) rectosigmoid stasis (20-33% of cases) which is secondary to a megarectum. Internal anal sphincter (IAS) and/or external anal sphincter (EAS) function failure and d) normal transit time (greater than 40 of cases) which is commonly due to psychological problems or to a low-fiber-content diet. We can conclude that transit time study is not necessary in mild constipation, but it is advised for those patients who do not respond to standard medical therapy or when surgery is being contemplated.

Anal Canal↗
PubMed1991

Therapeutic proposals for the treatment of idiopathic constipation.

The objectives to be achieved by a medical therapy of constipation are: 1) to protect the patient from excessive use of dangerous drugs (laxatives), 2) to help the patient to understand what is a "normal" intestinal function, 3) to reduce or eliminate pain and 4) to avoid complications. The first step consists in general measures (reduced stress, regular meals and physical exercise) and some modifications in diet habits (greater than 1.5 1 of water a day, vegetables, fruits, whole wheat bread). The pharmacological therapy is based on drugs which act in different ways: a) some contain unabsorbable substances (i.e. cellulose, emicellulose) that increase the volume of the stools: b) unabsorbable sugars (i.e. lactulose, lactose) or salts (Mg-sulphate, citrate and Na-sulphate) that provoke an osmotic effect and stimulate the colonic motility; c) suppositories that stimulate the defecation reflex; d) drugs able to stimulate colonic secretion and propulsive motility (i.e. anthraquinones, oral bisacodyl, phenolphthalein, castor oil, prokinetics). There are many conditions in which medical therapy fails its objective: in these cases it is important to exclude other causes of constipation (i.e. drug-related constipation, endocrine disorders, metabolic diseases, systemic illnesses or lesion of the enteric plexus) in order to obtain an improvement of this symptom.

Cathartics↗
PubMedDate not supplied

[Constipation. Proposal for a new classification and therapy].

The Authors propose a new classification for constipation according to which 84 patients were selected (63 females, 21 males) for a functional rehabilitation programme. Patients were subjected to a diagnostic protocol involving the performance of a number of instrumental tests. Degree and symptomatology of constipation were established by taking the clinical history of the patient. The rehabilitation protocol involved the simultaneous performance of physiokinesitherapy, electrostimulation and biofeedback of the pelvic floor. Patients underwent 3 weekly sessions, each lasting 60 minutes, over a series of 15 consecutive sessions, followed by a series of 6 consecutive sessions every three months. One-year results showed that 77 patients (92%) reported achieving regular intestinal activity with at least one evacuation a day and at intervals of no more than 3 days, and with a modification of faecal consistency and discontinuation of laxatives and/or cathartics. The other 7 patients (8%) continued using laxatives at a minimal dosage but had an improved evacuation rate and faecal consistency. The results show that many patients with constipations can undergo rehabilitation procedures with encouraging and remarkable therapeutic success.

Adolescent↗
PubMed2006

[Clinical observation on acupuncture combined with microorganism pharmaceutical preparations for treatment of irritable bowel syndrome of constipation type].

OBJECTIVE: To explore the best program for treatment of irritable bowel syndrome (IBS) of constipation type. METHODS: Ninety-five cases of IBS were randomly divided into 3 groups. Group A (n = 30) were treated by acupuncture combined with microorganism pharmaceutical preparations, group B (n = 35) by oral administration of medicine for loosening the bowel to relieve constipation plus microorganism pharmaceutical preparations, and group C (n = 30) by simple acupuncture. RESULTS: The total effective rates were 90.0%, 77.2% and 66.7%, in the group A, B and C, respectively, with a very significant differences as the group A compared with those in the groups B, C (P < 0.01), and with no significant difference as the group B compared with that of the group C (P > 0. 05). The intestinal available bacteria, bilidobacteria and lactobacillus, increased and enteric bacilli decreased in varying degrees in the 3 groups. CONCLUSION: Acupuncture combined with microorganism pharmaceutical preparations has a better therapeutic effect on irritable bowel syndrome of constipation type.

Acupuncture Therapy↗
PubMedDate not supplied

[Detrusor pseudohyperactivity syndrome in children with constipation].

THE AIM OF THE STUDY: was the evaluation of dependencies occurring between constipation and observed nocturia, pressing tenesmus and daytime urinary incontinence. MATERIAL AND METHODS: the studies were conducted in 51 children aged between 3 and 17 years including 25 girls and 26 boys hospitalized in the Clinical Department because of nocturia, pressing tenesmus and daytime urinary incontinence. In all children a complex diagnostic work up of the urinary system and the lower segment of alimentary tract was performed. Results of the examinations were compared to the control group. RESULTS: analysis of the results of the conducted examinations indicates that the overblown rectal ampulla, through the pressure exerted on the urinary bladder, seemingly decreases its volume causing the occurrence of pressing tenesmus, nocturia and daytime urinary incontinence. This process leads to the formation of detrusor hyperactivity syndrome characterized by: chronic constipation, increase of miction frequency and simultaneous decrease of volume of each portion of urine, nocturia and/or daytime urinary incontinence. CONCLUSIONS: chronic constipation disturbs the functional-morphological equilibrium between the end segment of alimentary tract and the urinary bladder. By influencing the process of filling and accumulation of urine in the bladder they lead to the formation of detrusor hyperactivity syndrome.

Adolescent↗
PubMedDate not supplied

[Manometry and defecography in constipated patients with dyschezia].

BACKGROUND: Constipation is one of the most frequent disorders in Gastroenterology. Radiologic and physiologic studies are essential to the diagnosis and treatment of constipated patients. OBJECTIVE: We aimed to assess the usefulness of manometry and defecography in constipated patients with suspect of dyssynergic defecation. METHODS: Dyschesic patients referred for anorectal testing, all patients underwent anorectal manometry and defecography. RESULTS: Fifty eight patients consecutive patients referred from 1998 to 2003. According to manometric findings patients were classified in patients without dyssynergia (group I, n = 16) and patients with dyssynergia (group II, n = 42). Group I patients had intussusception (75%), abnormal rectal emptying (56%), rectocele > 2.5 cm (56%), perineal descending (50%) and inadequate opening of the anal canal (38%). Group II patients had inadequate opening of the anal canal (69%), rectocele < 2.5 cm (55%), perineal descending (17%), intussusception (45%) and abnormal rectal emptying (55%). Group I had a higher frequency of perineal descending (p = 0.01) and intussusception (p = 0.044). Group II had a higher frequency of inadequate opening of the anal canal (p = 0.03), and not for inadequate opening of the anorectal angle. CONCLUSIONS: Defecography showed disorders in group I that may contribute to symptomatology, and in group II the inadequate opening of the anal canal suggests the participation of different parts of the external anal sphincter other than puborectalis in the genesis of dyssynergia.

Adult↗
PubMed2006

Efficacy of multidisciplinary approach in treatment of constipation: a pilot study.

OBJECTIVE: To evaluate a multidisciplinary Hong Kong treatment programme for patients with constipation. DESIGN: Pilot study. SETTING: A joint collaboration among the departments of surgery, physiotherapy, and dietetics in a regional hospital in Hong Kong. PATIENTS: Thirty-one constipated patients with normal colonic transit and pelvic floor dyssynergia. INTERVENTION: Multidisciplinary treatment including dietary modification, bowel habit adjustment, and physiotherapy. MAIN OUTCOME MEASURES: Anorectal manometry, fibre intake, subjective improvement, bowel frequency, Bristol score, and straining time and effort. RESULTS: Significant improvement was found in mean fibre intake, straining time and effort, but not in anal manometric results. A total of 78% of patients demonstrated more than 50% improvement in subjective symptoms, whereas 70% of the patients enjoyed objective improvement in pelvic floor dyssynergia documented by electromyography and anal pressure during a push effort. CONCLUSION: The multidisciplinary rehabilitative programme for constipated patients significantly improved symptoms. Electromyography and anal pressure during a push effort are useful tools for objective assessment of the treatment effect.

Constipation↗
PubMedDate not supplied

Action of glucomannans on complaints in patients affected with chronic constipation: a multicentric clinical evaluation.

Chronic constipation is a very frequent disease in western countries but fibres can often solve the problem. In the present study, authors tested the efficacy and the acceptability of glucomannans, hydrophylic carbohydrates with a high degree of viscosity, in 93 patients affected with chronic constipation. The multicentric, open and non-controlled study was divided into an initial phase (treatment with 1g of glucomannans t.i.d. for 1 month) and a maintenance phase (1g b.i.d. for one month). We evaluated both objective parameters (number of days per week with bowel movements and number of enemas) and abdominal symptoms. After one month all assessed parameters showed a statistically significant improvement lasting through the second month. Glucomannans were well accepted and devoid of relevant side-effects. In conclusion, considering their efficacy and tolerability, they can be proposed as an ideal therapeutic tool in the management of chronic constipation symptoms.

Adult↗
PubMed1991

Prolonged manometric investigation of the colon in research on chronic constipation.

We studied the whole colonic motility for 24 hours in controls and in constipated patients. In the patient group we found a significant reduction in the colonic mass movements (6.1 +/- 0.9 vs 2.6 +/- 0.7 controls vs patients, respectively). The constipated patients showed a reduction of the colonic motor activity after the ingestion of a standard meal. Moreover, they showed, compared with controls, a significant reduction of postprandial mass movements. On the other hand we were not able to find the so-called rectal motor complex described by others. In conclusion, we believe that prolonged colonic manometry would become an important step when evaluating the pathophysiology of constipated patients, particularly of those not responding to standard treatment.

Colon↗
PubMed1991

Alteration of recto-anal motility in chronic idiopathic constipation.

We studied anorectal function in 10 controls and 13 constipated patients (chronic idiopathic constipation, outlet obstruction and inertia coli). We did not find any difference among the 3 groups as regards the internal anal sphincter (IAS) basal tone, the recto-anal inhibitory reflex (RAIR) and the maximal voluntary contraction, whereas some significant differences were observed in the sensitivity threshold. In fact, we observed that all patient groups required larger volumes in order to perceive the minimum sensation. Moreover, the patients with distal obstruction showed higher threshold for a permanent defecation stimulus. The reduction of rectal sensitivity in these patients was confirmed by the infusion of 1500 cc of saline solution. On the basis of our experience constipated patients are characterized by both normal IAS tone, RAIR appearance, squeezing capacity, and lower rectal sensitivity.

Adult↗
PubMedDate not supplied

[Evaluation and use of polyethylene glycol in constipated patients].

We evaluated the efficiency of polyethylene glycol at low dosage for the treatment of chronic constipation. A prospective, randomized, double blind study was performed in 34 patients (32 female, 2 male) with the following inclusion criteria: age between 20-60 years, history of more than 5 years of constipation and no lower endoscopic findings of infections or malignancies. The solution was administered in a fasting state at the rate of 0.5 liters daily during 8 days. Patients were divided in 2 groups. Group 1 received placebo during the first week and PEG during the 2nd. week. Group 2 received PEG solution during the first week and placebo during the 2nd. A mean of 5.53 bowel movements was observed after placebo and 12.13 after PEG in group 1 (p < 0.005). A mean of 13.56 bowel movements were observed in group 2 after PEG and 7.73 after placebo (p < 0.001). Decreased consistency of the stools was seen after PEG in both groups (p < 0.001). According to our findings, low doses of PEG were useful and safe in the treatment of constipation, with few side effects.

Adult↗
PubMed1991

[Surgical therapy of chronic constipation].

Results of the surgical treatment for conservative intractable constipation in 70 adult patients are reviewed. 49 patients with severe symptoms have been treated by partial colectomy as sigmoid colectomy (n = 23) or left hemicolectomy (n = 26). 33 patients underwent colectomy with cecorectal anastomosis (n = 25) or ileorectal anastomosis (n = 8). Out of these patients with colectomy seven had undergone previous segmental colonic resection or internal sphincterotomy. Of those patients with cecorectal anastomosis who were dissatisfied, three underwent ileorectal anastomosis. Overall, a mortality rate of 3.3% and morbidity rate of 22.5 resp. 54.5% for partial and total colectomy were observed. The most frequent occurring complication after colectomy was small bowel obstruction in 30% requiring laparotomy in 40%. Of 45 patients who underwent partial colectomy, 34 (75%) had normal bowel function or were markedly improved. In 28 of 32 patients (87.5%) treated by colectomy a successful result has been achieved. The operation of sigmoid colectomy or left hemicolectomy may be recommended as a treatment for constipation only in patients with less severe symptoms or patients with recurrent sigmoid volvulus. For those patients with severe constipation, at present, colectomy with ileorectal anastomosis seems to be the surgical procedure that offers the greatest probability of improvement. However, the significant morbidity claimed the need for a careful patient selection.

Adolescent↗
PubMed1990

[Preliminary experiences of the University of Parma study group on "The diagnosis and treatment of chronic constipation"].

The authors present a report of their study on a group of patients affected by serious chronic constipation undergoing multidisciplinary evaluation by a radiologist, a neurologist and, if necessary, also a psychiatrist. From June 1989 to October 1990, 40 patients were examined using anal manometry, intestinal transit time, proctogram and electromyography of the pelvic floor. The examinations carried out by the different specialists led to the following results: 10 patients were found to be affected by slowed transit due to right colon constipation; in 16 cases, spastic pelvic floor syndrome (S.P.F.S.) was diagnosed; 5 subjects showed a rectocele which in 3 was associated with S.P.F.S.; 3 patients presented with an anterior rectal prolapse; in 6 cases the diagnosis was perineal descent syndrome, associated in 3 cases with S.P.F.S.; the remaining 6 subjects manifested a diminished ampullary sensitivity. This experience reveals the complexity of the alterations that, alone or in association, cause chronic idiopathic constipation. The authors' conclusion is that a correct diagnostic approach requires close collaboration between various specialists, who, by careful examination of different aspects of the colo-recto-anal region, arrive at an accurate physiopathological diagnosis leading to the most suitable therapy.

Adolescent↗
PubMed1990

Colonic lavage solution (polyethylene glycol electrolyte lavage solution) as a treatment for chronic constipation: a double-blind, placebo-controlled study.

The purpose of this study was to demonstrate that polyethylene glycol electrolyte lavage solution (PEG-ELS), a colonic lavage solution presently used for gut cleansing in preparation for colonic procedures, can be an effective agent in the treatment of chronic constipation. Thirty-two patients with chronic constipation completed a controlled, double-blind, randomized, cross-over study. Each patient was given two containers, marked A and B, one containing PEG-ELS and the other a placebo. They drank a specified amount (8 or 16 oz) of solution A for five consecutive days. Daily number of bowel movements and stool consistency were recorded. Group I (patients 1-16) drank 8 oz of solution per day; group II (patients 17-32) drank 16 oz of solution per day. Mean stool frequency and mean stool consistency were calculated per 5-day testing period for each treatment group (8 oz placebo, 8 oz PEG-ELS, 16 oz placebo, 16 oz PEG-ELS). Two-factor analysis of variance results confirmed that PEG-ELS was superior to placebo with regard to mean stool frequency (7.75 +/- 4.55 vs. 4.88 +/- 2.62, p less than 0.01) and mean stool consistency (2.56 +/- 1.17 vs. 1.91 +/- 0.94, p less than 0.05). Furthermore, PEG-ELS 16 oz per day was superior to all other groups with regard to the measured variables. Side effects from the PEG-ELS were infrequent and tolerable. Our results indicate that PEG-ELS may be an effective alternative therapy in the treatment of chronic constipation. The proper dosage is probably between 8 and 16 oz per day.

Administration, Oral↗