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PubMedDate not supplied

[Surgical treatment of chronic idiopathic constipation].

We review current experience with surgical treatment of severe constipation due to primary inertia of the colon. Over the last 10 years, we have operated 18 patients (14 females and 4 males) with severe constipation. The surgical procedure was either nearly total colonectomy with ascending colon/rectum anastomosis (8 cases) or total colonectomy with ileorectal anastomosis (9 cases). In one patient, coloproctectomy was performed with an ileoanal anastomosi. Indications for surgery were based on results of barium emena and functional evaluation of defecation. Results were satisfactory in all patients. In several patients however, we noted that the motility of other levels of the digestive tract was also impaired. Colonectomy was introduced as a treatment for chronic constipation nearly a century ago and although very few indications have been retained in the recent this procedure has now become an acceptable surgical approach in a limited number of well-though-out cases.

Adult↗
PubMed1994

Constipation and spina bifida occulta: is there an association?

Spina bifida occulta (SBO) is an abnormality in the posterior arch formation, most commonly found at the level of the S1 vertebra. It has recently been implicated in the aetiology of urinary voiding problems. We have therefore investigated its incidence in female patients with constipation due to outlet obstruction (anismus) and slow colonic transit. The plain abdominal radiographs of 52 females with constipation, and 48 age-matched controls were reviewed by one radiologist, looking for both the incidence of SBO and the incidence of abnormally high posterior sacral arc opening (S3 and above) in each group. Seventeen (32.6%) patients compared to 11 (22.9%) control subjects had SBO (chi 2 1.183, P = 0.4). Fourteen (26.9%) patients compared to six (12.4%) control subjects had an abnormally high posterior sacral arc opening (chi 2 2.406, P = 0.2). Three of seven patients (42.6%) with anismus were found to have SBO. Of 19 patients with slow colonic transit five (26.2%) had SBO and of seven patients with a mixed picture, three (42.6%) had SBO. There was no significant difference in the incidence of SBO in any of these three patient subgroups when compared to the control group. These results suggest that there is no association between spina bifida occulta and constipation.

Adult↗
PubMed1995

Hirschsprung's disease: a cause of chronic constipation in children.

Constipation is common in neonates and children. Most constipation is benign and easily treated. Hirschsprung's disease is an unusual, but well-recognized cause of chronic constipation. An example of the group of disorders known as dysganglionoses, Hirschsprung's disease is characterized by an absence of the intramural ganglionic cells at the submucosal and myenteric levels of the intestine. The course of the disease is variable, with five distinct patterns of varying severity. Without treatment, mortality approaches 50 percent by one year of age, but early diagnosis and intervention are associated with a favorable outcome. The treatment is surgical, and several approaches are currently used.

Adult↗
PubMed1995

Managing constipation using a research-based protocol.

Constipation, a common health problem particularly for elderly and hospitalized patients, can cause abdominal pain, discomfort, gas, headaches, nausea, anorexia, a bad taste in the mouth, and potentially adds to functional loss and length of stay. As part of a quality improvement initiative, a research-based interdisciplinary protocol was developed to prevent constipation in hospitalized immobile vascular surgery patients. Using a combination of dietary fiber, increased fluid, and hygiene measures over a 3-year period, incidence of constipation was reduced from 59% to about 9%. The incidence of impaction was eliminated and requests for laxatives and enemas were reduced from 59% to about 8%.

Clinical Nursing Research↗
PubMed1994

[Chronic constipation--what to do?].

Chronic constipation implicates heterogeneous disturbances of colonic transit and defecation which require both, careful medical evaluation and therapy. While the modes of action and side effects of laxatives are known for years, the understanding of dysfunctions underlying chronic constipation appears to be related to the understanding of subtle and new investigative techniques. This and the former extent of laxative prescriptions may explain why (based on an 'ex cathedra' decision by the governmental and insurance companies) the prescription of laxatives among primary care practitioners (in Germany) is not acknowledged as medical therapy. How to continue? First: two steps back, reestablishing understanding of constipation as a disease, including subtle diagnosis and differential diagnosis; then; two steps ahead, towards specific therapy, being aware that the available drugs are effective and require prescription by an experienced physician.

Cathartics↗
PubMedDate not supplied

Evaluation and treatment of constipation.

Constipation is a symptom that usually reflects the existence of associated diseases. The clinical history, physical examination, and barium enema or colonoscopy should permit the diagnosis of extracolonic and structural colonic causes of constipation. A comprehensive evaluation of colonic transit and pelvic floor function in patients with functional constipation should categorize the underlying pathophysiologic mechanism, and optimize the selection of candidates for surgical operations and their results.

Aged↗
PubMedDate not supplied

Chronic constipation: a cause of recurrent urinary tract infections.

In this study children hospitalized for chronic constipation were investigated for urinary tract problems. The study group consisted of 180 children, 62 girls and 118 boys, suffering from recurrent urinary tract infections. In a number of the patients, radiological and ultrasonographic examinations revealed various urinary tract anomalies. When patient presents with a problem of the urinary tract, it is necessary to consider constipation as a possible cause. In many cases the treatment of chronic constipation may be the most important remedy for pyuria, bacteriuria and enuresis.

Adolescent↗
PubMed1993

Body acupuncture: effect on colonic function in chronic constipation.

Acupuncture has been claimed to be an efficacious treatment for chronic constipation, though there are no studies to prove this. We therefore investigated the effect of body acupuncture on stool frequency and colonic transit time of radiopaque markers in 8 constipated patients (58 +/- 6 years, 3 female; vigorous straining necessary to open bowels without the use of laxatives for more than one year, total colonic marker transit > 60 h) in a control period and during a three weeks treatment period with six sessions. Acupuncture was performed as body acupuncture with electric needles (10 Hz, current titrated to individual threshold, 25 min each session) on acupuncture points Di4 [He Gu], Ma25 [Tian Shu], Le3 [Yuan], and B125 [Da Chang Yu]). Two patients dropped out during acupuncture because symptoms of constipation worsened. In the other 6 patients, stool frequencies and colonic transit times were not significantly different during control and acupuncture period (0.38 +/- 0.09 vs. 0.40 +/- 0.14 defecations per day +/- s.e.m., 95% confidence interval for the difference control minus acupuncture [-0.34; 0.30], and 97 +/- 17 vs. 108 +/- 24h, 95% Cl [-50; 27]). Segmental transit times for right and left hemicolon, and rectosigmoid colon did not differ significantly either. In conclusion, acupuncture as performed in this study does not influence objective parameters of colonic function to a clinically relevant degree.

Acupuncture Points↗
PubMed1993

[Surgically treatable chronic constipative defecation disorders. Indications, diagnosis and therapy].

Paediatric surgeons are engaged in different causes of chronic constipation. Aganglionosis usually needs surgical therapy, but in dysganglionosis a distinct differentiation is necessary between patients sufficiently treated by conservative methods and others requiring surgery. Sometimes the operation seems to be an "ultima ratio" in these patients. Otherwise surgery can be necessary early in enterocolitis, ileus or toxic megacolon. In the spectrum of anal malformations constipation may be a primary symptom (anal ectopia, anal stenosis, low anal atresia with anocutaneous fistula) or appears as a post-operative complication (intermediate or high anal atresia). In secondary megacolon, surgery is performed to remove the result of therapeutic negation over many years. The operation may be the supposition to follow up with conservative treatment. In the management of constipated patients an exact diagnostic clarification has a central position. This especially includes anorectal manometry, x-ray examination with contrast medium application and defaecography and as last rectal biopsy.

Anal Canal↗
PubMed1994

Management of chronic constipation in infants and toddlers.

Infants and toddlers with constipation usually have a history of infrequent, hard and painful bowel movements, often accompanied by screaming and stool-holding maneuvers. Encopresis, the intermittent and involuntary passage of formed-to-liquid feces, is common. Although constipation most often has a functional cause, the history and physical examination should rule out anatomic, endocrinologic, metabolic or neurologic causes. Hirschsprung's disease--aganglionic megacolon--is a congenital cause of severe constipation that occurs in one of every 5,000 births. Treatment consists of fecal disimpaction, laxatives to prevent future impaction, promotion of regular bowel habits and, finally, toilet training. Parents should be reassured that although this disorder is not life-threatening, several months to years of supportive intervention may be required for effective treatment.

Child, Preschool↗
PubMed1993

[Test of colonic transit for the diagnosis of constipation].

This study consists of the design of the experimental markers for the colonic transit and the application of clinical examination. The markers were displayed distinctly in the transit test. The study of clinical application showed that colonic transit test is of diagnostic value in screening patients with constipation. The index of transit test, an authoritatively significant target, is an important value for the differential diagnosis of patients with constipation. We conclude that multiple physiological examinations are the key to the successful operation and strict indications are necessary for the surgical treatment of constipation.

Adult↗
PubMed1993

[Constipation in childhood; evaluation of a diagnostic-therapeutic protocol].

In 87 children with constipation an assessment was made of the causes, and of the effect of treatment. Two subdivisions were made, one by age (< 3 years and > or = 3 years) and the second into 'own' or 'referred' patients. For the 59 own children a diagnostic-therapeutic protocol was used, the three-phase protocol. For children over 3 years (n = 29) this policy consists in the first phase of anamnesis, physical examination, diet and oral and/or rectal laxatives. In the second phase, toilet training is administered in combination with diet and oral laxatives. The third phase comprises continuation of the diet and tapering off of the laxatives. If no improvement is seen, supplementary examination is carried out. In the group of own patients younger than 3 years, supplementary examination is already carried out during the first phase. Functional constipation was diagnosed in 69% and 98%, respectively, of the 36 patients under 3 years and the 51 over 3 years. Hirschsprung's disease was diagnosed in 14% and 2%, respectively. In the children > or = 3 years with functional constipation the three-phase policy was successful in 86% with a mean duration of the treatment of 9.5 months. The efficiency of diagnostic examination of children over 3 years appears to be low, justifying the proposed three-phase policy. In children under 3 years, on the other hand, limited laboratory examination is necessary during the first phase. Examination for the presence of Hirschsprung's disease, by means of rectal biopsy or anorectal manometry is indicated if the treatment during the first phase is unsuccessful.

Cathartics↗
PubMed1977

[Surgical therapy of severe chronic constipation].

Primary chronic constipation is an ailment of modern civilisation. Severe forms can seldom be treated satisfactorily by conservative methods, and in these cases surgical intervention must be considered. This consists of subtotal colectomy with ileosigmoidostomy. Partial resection and hemicolectomy do not afford the desired result. A report is presented on 28 patients who had subtotal colectomy for chronic constipation during the period 1959 to 1976. Immediate and long-term results have proved to be surprisingly good. Unsatisfactory conditions are to be expected in patients with strong complementary psychoneurotic symptoms. Preoperative investigations must be carried out with precision, morphological changes accurately identified and treated by differentiated surgical methods. The indication for colectomy in cases of chronic constipation must be strictly established, if possible in collaboration with a gastroenterologist.

Adult↗
PubMed1996

Manometric evaluation of constipation--Part I.

Tests of anorectal function have evolved into clinically useful investigations, and they should no longer be regarded as esoteric tools. This transformation has led to major advances in understanding, diagnosis, and treatment of defecation disorders, such as constipation. Because constipation is a heterogeneous condition, it cannot be assessed by a single test. Judicious use of anorectal manometry, colon transit study, a test of simulated defecation, and defecography may provide invaluable pathophysiological information. Undoubtedly, examination of rectal and anal pressure activity, rectal sensation, rectoanal reflexes, and the functional morphology of the defecation unit provides more information than any other test of gastrointestinal motor function; however, there is no uniform criteria for defining manometric abnormalities. There is also an urgent need for establishing international standards for manometric techniques and for diagnosis. Nevertheless, knowledge and experience have paved the way for innovative diagnostic techniques and therapeutic approaches for patients with constipation.

Anal Canal↗
PubMed1996

[Surgical therapy of chronic constipation in pediatric age].

The authors report their experience in the treatment of the chronic constipation in paediatric age. During the last 3 years (1991-1994), 230 children presenting chronic constipation have been studied at the Strumental Gastroenterologic Department of Children Hospital Bambino Gesù; 19 of them (8%), 10 male and 9 female, were studied with anorectal manometry, defecography and Intestinal Transit test. All the patients had a overtone (high squeeze) of the anal sphincter and the medical treatment was unsuccessful. They underwent sphincteromyectomy by posterior approach. In 17 patients it has been obtained a notable improvement of the symptomatology with regularization of the evacuations. The simplicity of the surgical technique, the absence of complications and the obtained results confirm the validity of sphinteromyectomy in the therapy of the chronic constipation in paediatric age. Interoperating anorectal manometry proved to be essential both in modulating sphincteromyectomy and in its eventual complications.

Adolescent↗
PubMed1996

[The relationship between intake of dietary fiber and chronic constipation in children].

OBJECTIVE: Evaluation of the feeding patterns of children with chronic constipation, in particular dietary fibres, energy and fluid intake and their influence on colonic transit time. In addition, the effect of dietary recommendations regarding fibres was assessed. DESIGN: Prospective randomized study. SETTING: Department of Paediatric Gastroenterology and Nutrition, Academic Medical Centre, Amsterdam, the Netherlands. METHOD: Children with at least 2 months of complaints related to constipation were enrolled and both dietary intake and colonic transit time were evaluated. After dietary and laxative treatment, in some combined with biofeedback training, and a follow-up of 6 months, a randomized sample were again evaluated regarding their transit times and dietary patterns. RESULTS: In 73 consecutive children mean fibre intake was the same as in healthy controls, although energy and fluid intake were lower. Colonic transit time was increased compared with healthy controls and no relationship was established between fibre intake and transit time. At 6 months no significant increase in mean fibre intake was observed and no relationship was found between either transit time and change in fibre intake or cure and change in fibre intake. In the cured patients no increase of their mean fibre intake could be observed. CONCLUSION: The amount of dietary fibres played no pathogenic part in chronic constipation. Dietary advice did not change the mean fibre content of the diet. In addition, changes in fibre intake had no effect on colonic transit time or cure.

Child↗
PubMed1996

Constipation: common-sense care of the older patient.

Constipation is a common complaint in older patients. Contributing factors are impaired general health, use of medications, and decreased mobility and physical activity. Diet has an indeterminate effect. Many patients become gradually more constipated with age and self-treat with over-the-counter laxatives. Investigation is warranted if defecation is associated with pain or bloating and/or represents a recent change in bowel habit. Although constipation is usually just an annoyance, it can have more serious consequences, such as impaction and ulceration. A combination of bowel training, dietary management, and regular exercise is the first phase of treatment. Bulk laxatives are second-line treatment, followed by other laxatives if needed.

Aged↗
PubMed1977

[Studies of the results of the surgical treatment of severe forms of constipation in 5 patients].

A small percent of the population in our country suffer chronic constipation, manifested in various degrees. To surgical treatment are subjected patients with severe decompensated forms of constipation, resulting in a general state deterioration, when the systematic conservative treatment failed to give an effect. In five patients, ileosigmoanastomosis below Balli sphincter was performed thus interrupting the pasage through the large intestine. All cases, followed for a period of one to three years, reported regular daily defecation. The results from the carried out control clinical, laboratory, X-ray, endoscopic and microbiological investigations are reported. The author's opinion is that the surgical treatment must be given consideration in thoroughly examined and selected patients with severe forms of chronic constipation.

Acute Disease↗