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PubMed2003

Constipation caused by functional outlet obstruction.

Functional constipation is a very common problem in Western societies. Functional outlet obstruction, part of the spectrum of functional constipation, is suspected when patients present with select symptoms. Diagnosis is commonly made with anorectal manometry, electromyography, and rectal evacuation tests. Abnormal test patterns include poor relaxation and contraction of the anal sphincter in response to attempted defecation and difficult rectal evacuation. Several treatment approaches have been tested in these patients. Biofeedback training is considered the most specific therapeutic modality, and it is particularly attractive because of its safety. This review provides an assessment of the diagnostic tests for functional outlet obstruction and summarizes current options for therapy.

Anal Canal↗
PubMed2006

Diagnostic testing in patients with chronic constipation.

During the past few years, significant developments have taken place in the understanding and diagnosis of defecation disorders. Several innovative manometric, neurophysiologic, and radiologic techniques have been discovered, which have improved the accuracy of identifying the neuromuscular and pathophysiologic mechanisms of chronic constipation. Such approaches have led to improved management of these patients. In this review, we summarize and highlight recent advances in the utility of diagnostic testing of chronic constipation.

Chronic Disease↗
PubMed1983

Role of subtotal colectomy in the treatment of incapacitating constipation.

Nine patients from a community surgical practice have been presented who underwent subtotal colectomy with ileal lower sigmoid anastomosis for the treatment of chronic incapacitating idiopathic constipation. Emphasis was placed on carefully selecting patients for this procedure. The results in this small series have been promising. Long-term follow-up is necessary to determine whether the patients will continue to do well. A review of the literature regarding the surgical treatment of constipation has indicated that subtotal colectomy is the most successful form of treatment in select patients. More studies are needed, specifically in the area of radiopaque markers and anorectal manometry, to determine whether or to what extent these procedures can help select patients who might benefit from this procedure.

Adult↗
PubMed1987

Efficacy of antibody NF2F11 staining in the investigation of severe long-standing constipation. A preliminary report.

A retrospective study of 7 adult patients (6 with severe, long-standing constipation and 1 with chronic idiopathic intestinal pseudoobstruction) was carried out to test the diagnostic potential of the antineurofilament monoclonal antibody NF2F11. In 4 of the cases of constipation and in the 1 case of pseudoobstruction, paraffin sections of resected colon revealed an anomaly in that the axon bundles of both plexus systems remained unstained. This picture differed from that found in the control population. The results are discussed in relation to previous studies of congenital neurogenic abnormalities of the digestive tract in children.

Adult↗
PubMed1990

Na+-dependent bile acid transport in the ileum: the balance between diarrhea and constipation.

Ileal Na+-dependent bile acid transport was quantified in vitro as the uptake of 3H-taurocholate into brush-border membrane vesicles. Vesicles were prepared from ileal biopsies of 158 patients placed in 10 diagnostic categories. Active bile acid transport (expressed as picomoles taurocholate uptake per milligram brush-border membrane protein per 15 s, median and interquartile ranges indicated) did not differ significantly in 6 categories: irritable bowel syndrome (71, 35-97; n = 21), colon polyps (42, 30-89; n = 29), colitis (62, 33-91; n = 31), postvagotomy or postcholecystectomy (69, 37-97; n = 11), diarrhea without increased bile acid loss (58, 48-85; n = 12), and lack of gastrointestinal pathology (74, 45-103; n = 22). A decreased active bile acid transport was found in 3 categories: ileal disease (4, 1-36; n = 11), partial ileal resection (5, 1-35; n = 5), and constipation (41, 22-50; n = 8). Bile acid transport was increased in patients with bile acid-losing diarrhea with endoscopically and histologically normal ilea (111, 94-135; n = 8). These findings indicate that a low fecal bile acid loss, presumed to be present in constipated patients, is associated with a low Na+-dependent ileal bile acid transport and a high bile acid loss is associated with a high active bile acid transport. Ileal bile acid transport might be regulated by the availability of bile acids to the ileal enterocytes.

Bile Acids and Salts↗
PubMed1993

Chronic constipation in children.

The evaluation of chronic constipation with or without encopresis must begin with a careful history. The intervals between bowel movements and the size and consistency of stools deposited into the toilet should be noted. Encopresis may be manifested as dirtying the underwear. The physical examination should include a rectal and neurological examination. No specific organic cause can be found in the majority of children. One or several anorectal physiological abnormalities have been found by us and others in 95% of children with idiopathic constipation. These abnormalities include impaired rectal and sigmoid sensation and decreased rectal contractility during rectal distention. The external anal sphincter and pelvic floor muscles may be abnormally contracted during straining for defecation, and the child may be unable to defecate a rectal balloon. Most patients will benefit from a program designed to clear stools, to prevent further impaction, and promote regular bowel habits. Fifty percent of patients will be cured after 1 year and 65%-70% after 2 years.

Child↗
PubMed1984

Bremazocine induces antinociception, but prevents opioid-induced constipation and catatonia in rats and precipitates withdrawal in morphine-dependent rats.

Some in vivo agonist and antagonist properties of the putative k-compound bremazocine were characterized in rats. Bremazocine, at doses from 0.015-32 mg/kg i.p., delayed nociceptive reaction on a 55 degrees C hot-plate with a dose-response curve not readily fitting a single straight line; this effect was antagonized by high doses of naloxone. In the same rats bremazocine did not delay the intestinal transit of a charcoal meal fed 5 min earlier and prevented morphine-induced constipation. This antagonism appeared to be opioid-specific and competitive, with apparent pA2 value 8.56. Catatonia induced by etorphine (0.004 mg/kg s.c.) and constipation induced by etorphine (0.004 mg/kg s.c.) and D-Ala2-D-Leu5-enkephalin (0.1 mg/kg i.p.) were completely antagonized by bremazocine (0.03-8 mg/kg i.p.). Antinociception induced by morphine (10 mg/kg i.v.) and etorphine (0.004 mg/kg s.c.) was only partly prevented. Naloxone (1 mg/kg) and bremazocine (0.015-1 mg/kg i.p.) precipitated a withdrawal syndrome, evaluated as jumping frequency, in rats rendered dependent to morphine. These data suggest the involvement of more than one opioid receptor population in bremazocine action in vivo.

Analgesics↗
PubMed1996

A Gi2alpha antisense oligonucleotide differentiates morphine antinociception, constipation and acute dependence in mice.

In the same mice in which the intracerebroventricular (i.c.v.) administration of antisense oligodeoxyribonucleotide (oligo) directed against the Gi2alpha (but not Gi1alpha, Gi3alpha or G(s)alpha) G-protein subunits attenuated i.c.v. morphine-induced antinociception in the tail-flick test, none of the oligos altered naloxone-precipitated jumping (acute dependence). Likewise, none of the oligos significantly altered morphine-induced constipation. Hence, i.c.v. morphine-induced antinociception might be preferentially mediated via transduction pathway(s) different from constipation or acute dependence, offering novel opportunities for drug discovery.

Analgesics, Opioid↗
PubMed1986

Constipation associated with vesicoureteral reflux.

Seventeen children who had vesicoureteral reflux underwent urodynamic and rectal manometric studies. All had uninhibited bladder contractions. All had rectal dilatation confirming the presence of constipation by rectal balloon manometry. The recurrent association of constipation with ureteral reflux suggests the possibility of a nonfortuitous association.

Child↗
PubMed1991

Effect of RU-38486 on dexamethasone reversal of morphine-induced constipation in mice.

1. Morphine and dexamethasone significantly reduce gastrointestinal transit in mice. The degree of reduction was greater for morphine. 2. Dexamethasone pretreatment was found, however, to antagonize morphine-induced constipation. 3. Cycloheximide does not modify the dexamethasone effects. 4. RU-38486 reverses both the inhibitory action of dexamethasone on gastrointestinal transit and its reducing effect on morphine-induced constipation. 5. These results suggest that dexamethasone might act through binding to receptors not linked to DNA-responsive elements.

Animals↗
PubMed1985

Constipation: a cause of enuresis, urinary tract infection and vesico-ureteral reflux in children.

The observation that constipation alone may induce uninhibited bladder contractions in children and is associated with recurrent urinary tract infection in childhood suggests an etiologic association. Rectal distension due to faecal retention in chronic functional constipation causes bladder distortion and may cause stimulation of detrusor stretch receptors resulting in detrusor peroneal dyssynergism. Distortion of the trigonal area may result in failure of ureteral valve competence and allow for vesico-ureteric reflux.

Constipation↗
PubMed1992

Unrecognized constipation in patients with advanced cancer: a recipe for therapeutic disaster.

Morphine-induced constipation can lead to therapeutic disasters by several mechanisms. It can be readily prevented by administration of appropriate laxatives, but the importance of this simple intervention is often overlooked. Problems resulting from uncontrolled constipation include not only fecal impaction and spurious diarrhea, but also pseudoobstruction of bowel causing abdominal pain, nausea and vomiting, and serious interference with drug administration and absorption. Cancer pain may also be exacerbated. All of these contribute unnecessarily to morbidity and costs of health care. A case that exemplifies many of these problems is presented and discussed.

Aged↗
PubMed1996

A volunteer model for the comparison of laxatives in opioid-related constipation.

Loperamide was used to provide a source of opioid-induced constipation in healthy volunteers. Each volunteer took a sequence of three dose levels of loperamide. One of three laxatives was used to counterbalance the effect of loperamide and restore bowel function to what the individual considered normal at each stage before the dose of loperamide was increased. Lactulose, senna, and codanthrusate were selected as examples of a softening, a stimulant, and a combination laxative, respectively. Outcome measures were the doses of laxative used, stool form and frequency, ease of defecation, a rating scale of subjective bowel function, and the occurrence of adverse effects. Each laxative was taken by ten volunteers, and all proved capable of maintaining normal bowel function. A combination of stimulant and softening laxatives was most likely to maintain normal bowel function at the lowest dose and least adverse effects. The mean final dose of lactulose was excessive for use in ill patients. Senna was associated with significantly more adverse effects than the other laxatives, mainly abdominal pain (P < 0.001). This model of constipation may provide a standardized means of assaying the clinical effectiveness of oral laxatives.

Adolescent↗
PubMed1995

[Re-education in biofeedback: role in terminal constipation in children].

BACKGROUND: Chronic constipation with or without encopresis is often associated with abnormal defecation dynamics evidenced by manometric study and possibly manageable with biofeedback treatment. PATIENTS AND METHODS: Twenty-six children more than 5 years of age suffering from constipation with or without encopresis for at least 6 months were treated with biofeedback plus lactulose; 15 of them were also given psychiatric attention. Pressure recordings from the internal and external sphincters in response to transient balloon distension of the rectum were obtained in all patients as did the recto-anal inhibitory reflex and the rectal sensitivity. RESULTS: Sixteen patients were considered as definitely cured or improved with this management; two others had relapses 6-12 months later and five were not improved; the three remaining patients were lost for follow-up. CONCLUSION: As already reported, biofeedback treatment represents an interesting role in management of such children.

Adolescent↗
PubMed1988

Diarrhoea and constipation.

Drug-induced constipation is mostly caused by changes in gut motility, whilst diarrhoea is more frequently caused by an increase in intestinal fluid secretion. In both instances the drug has to reach the enteric nervous system or the enterocyte, either via the blood or from the lumen, in sufficient concentrations to affect the mediators that regulate motility and fluid transport. Diarrhoea and constipation are frequently mentioned as side-effects of drugs, and therapeutic agents for almost all organ systems have been implicated. However, both these side-effects are usually mild or moderate, and rarely necessitate interruption of drug treatment. An exception to this rule is the antibiotic-associated colitis seen in patients treated with antibiotics such as lincomycin or clindamycin; in principle almost all antibiotics may cause this severe and potentially life-threatening complication. Other rare forms of severe, drug-induced colitis and diarrhoea result from toxic or anaphylactic reactions against gold preparations, cytostatic agents and sulphonamides. Ischaemic colitis due to vascular complications has been described in some women taking oral contraceptives, and in patients treated with vasopressin or digitalis.

Constipation↗
PubMed2006

Constipation in the primary care setting: current concepts and misconceptions.

Constipation is prevalent in Western societies and is a common illness in clinical practice. A broader clinical definition, which encompasses difficult and infrequent defecation, has aligned medical concepts with that of patients and the general population. Unfortunately, there are widespread misconceptions concerning the origins and management of constipation within both the lay and medical communities that influence recommendations by health care practitioners. This review highlights and seeks to correct some of these misconceptions and provide treatment guidelines for the practicing physician.

Cathartics↗
PubMed2005

Constipation in paediatric oncology.

Constipation is a common problem encountered by many children during treatment for childhood cancer. It can be distressing and impact on the quality of life for the child. However, the advice and information they and their families receive can vary enormously. The clinical practice group (a subgroup of the paediatric oncology nurses forum (PONF)) decided to examine the management of constipation throughout the paediatric oncology units in the UK. This paper presents the findings and the subsequent action taken and highlights the need for further work.

Cathartics↗
PubMed2004

Incidence of spinal cord lesions in patients with intractable constipation.

Abstract Spinal magnetic resonance imaging of children with intractable constipation was reviewed. Nine percent of patients had spinal cord abnormalities. Tethered cord was the most common lesion in 75% of patients. Magnetic resonance imaging is a useful tool to evaluate children with intractable constipation.

Child, Preschool↗