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PubMed2002

Effect of probiotics on constipation, fecal azoreductase activity and fecal mucin content in the elderly.

BACKGROUND: Constipation is a common problem in elderly subjects, probiotics have been suggested to improve intestinal motility and reduce fecal enzyme activity. METHODS: Elderly subjects (n = 28) were enrolled in an open parallel study. The subjects were divided into 3 groups: 1 control group receiving juice; 1 group receiving juice supplemented with Lactobacillus reuteri, and 1 group receiving juice supplemented with Lactobacillus rhamnosus and Propionibacterium freudenreichii. During the first 3 weeks all subjects consumed unsupplemented juice. In the subsequent 4 weeks, the subjects received their designated juice. During the last 3 weeks, all subjects again received unsupplemented juice. From the subjects, defecation frequency, laxative use, fecal pH, mucin content and azoreductase activity were assessed during the last week of each period. RESULTS: The subjects receiving the L. rhamnosus/P. freudenreichii-supplemented juice exhibited a 24% increase in defecation frequency. However, no reduction in laxative use was observed. The fecal azoreductase activity was also significantly reduced in this group. No changes in fecal pH or mucin excretion were observed. CONCLUSION: Some relief from constipation may be observed with the combination of L. rhamnosus/P. freudenreichii. This probiotic combination also reduced fecal enzyme activity. The tested probiotics did not affect the mucosal barrier.

Aged↗
PubMed2006

Methemoglobinemia caused by the ingestion of courgette soup given in order to resolve constipation in two formula-fed infants.

Methemoglobinemia is not a rare condition arising from the exposure to hemoglobin-oxidizing agents such as nitrates-nitrites present in well water or vegetables. Infants < 3 months of age are more susceptible than adults because of lower amounts of a key enzyme, NADH-cytochrome b5 reductase, which converts methemoglobin back to hemoglobin. We report 2 infants, aged respectively 2 and 1 months, suffering from methemoglobinemia, fed with a formula that was reconstituted with a high concentration of courgette soup to resolve constipation. They developed a severe cyanosis with methemoglobinemia (respectively 30.4 and 27%) and were hospitalized and treated with methylene blue at 1%. After 12 h the syndrome was completely resolved. Home-prepared infant foods containing vegetables are potential causes of methemoglobinemia. It is important not to feed infants with vegetables having a high nitrate content (e.g., courgette, spinach, beets and green beans) to resolve constipation since, particularly in the first months of life, they may cause severe methemoglobinemia.

Constipation↗
PubMed1988

Intestinal transport in constipation and diarrhoea.

Approximatively 10 liters of fluid enter the gastrointestinal tract with food and endogenous secretions, and only less than 100 ml or 1% leave it with the faeces. Minor changes of this equilibrium in the intestinal transport may cause diarrhoea or constipation. Functions of small and large intestine differ markedly in transport of electrolytes and water. The relatively leaky epithelium of the small intestine allows for rapid equilibrium of osmolality in both directions while the tight epithelium of the colon preserves electrolytes and water once they have been absorbed. It may compensate secretory diarrhoea of the small intestine for instance caused by bacterial toxins to a certain degree unless it is overwhelmed leading to an overflow type of diarrhoea. On the other hand, small changes of net fluid transport in the colon in either direction will lead to diarrhoea or constipation since there is no compensating mechanism behind it. Mechanisms involved in the regulation of transintestinal electrolyte and water movements are the energy providing Na+,K+-ATPase, the mediators of membrane permeability and active Cl- secretion such as cAMP and Ca2+ and substances affecting the tight junctions. Various substances may affect one or more of these regulatory mechanisms. Laxatives are one of those.

Biological Transport, Active↗
PubMed1993

A comparison of Agiolax and lactulose in elderly patients with chronic constipation.

In a double-blind crossover study the efficacies of Agiolax, a combination of fibre and senna pod, and lactulose were compared in 77 long-stay elderly patients with chronic constipation. Mean daily bowel frequency, stool consistency and ease of evacuation were significantly greater with Agiolax than lactulose. The recommended dose was exceeded more frequently with lactulose than Agiolax (chi 2 = 8.38, p < 0.01). Adverse effects were not different for the 2 treatments. In long-stay elderly patients with chronic constipation Agiolax and lactulose were well tolerated, but Agiolax proved a more effective treatment.

Aged↗
PubMed1993

Safety and efficacy of a bulk laxative containing senna versus lactulose in the treatment of chronic constipation in geriatric patients.

Thirty geriatric long-stay patients aged 65-94 years (mean 81.8) participated in the trial the aim of which was to examine bulk laxative plus senna (Agiolax) in the treatment of chronic constipation using lactulose (Levolac) as a reference medicine. Bulk laxative plus senna (daily doses 14.8 g) produced more frequent (p < 0.05) bowel habits (4.5 vs. 2.2-1.9/week) than lactulose (daily doses 20.1 g). Both laxatives proved to be safe to use. Our study indicated bulk laxative plus senna to be more efficient in treating constipation in geriatric long-stay patients.

Aged↗
PubMed1982

Function of the internal anal sphincter and rectal sensitivity in idiopathic constipation.

Anal manometry was performed in 8 control individuals (group A) and in 13 patients with idiopathic constipation (group B), 6 of whom were grouped apart (group C) because of an elective delay of the intestinal transit in the rectum. The basal pressure of the internal anal sphincter, the rectal inflation volume necessary to elicit the rectoanal inhibitory reflex, and the duration of the reflex were not significantly different in the three groups, while the maximal amplitude of the reflex was significantly lower in group C at 10 and 100 cm3 of rectal distension. However, the amplitude of the sphincteric relaxation and the rectal inflation volumes were significantly correlated (p less than 0.001) in the three groups. The rectal sensitivity was lower in the patient groups and particularly in group C (p less than 0.05 vs. controls up to 50 cm3 of rectal distension). The results obtained do not support the 'outlet obstruction' hypothesis as a mechanism of idiopathic constipation and point out that rectal hyposensitivity seems to be the only abnormality in these patients, particularly in those with an elective delay of the transit in the rectum.

Adolescent↗
PubMed1991

A double-blind trial of a celandin, aloevera and psyllium laxative preparation in adult patients with constipation.

The aim of this study was to evaluate the effect of a novel laxative preparation, composed of celandin, aloevera and psyllium in patients with chronic constipation. Thirty-five men and women were randomized to receive capsules containing celandin-aloevera-psyllium, or placebo, in a double-blind trial lasting 28 days. Symptoms in the last 2 weeks of the treatment period were compared to those in the 14-day pre-trial basal period. In the celandin, aloevera and psyllium group, bowel movements became more frequent, the stools were softer and laxative dependence was reduced. In the placebo group, all these parameters were unchanged. Abdominal pain was not reduced in either group. The results of this study show that the preparation is an effective laxative in the treatment of constipation.

Adult↗
PubMed1991

Prolonged (24-hour) manometric recording of rectal contractile activity in patients with slow transient constipation.

A periodic motor activity, named the rectal motor complex, has been recently described in the healthy human rectum. We studied the rectal contractile activity for 24 h by a low compliance manometric system in a group of 10 women with slow transit constipation. Analysis of the 24-hour manometric recordings showed that these subjects: (1) had overall scarce rectal motility; (2) display few rectal motor complexes (average, 3.3 +/- 1.3/subject/24 h) which are irregularly distributed over time, and (3) respond weakly to ingestion of a standard meal (average duration of the motor response 19 +/- 6 min). The observations suggest that an underlying neuropathic process may be involved in the pathogenesis of the impaired rectal motility in patients with slow transit constipation.

Adult↗
PubMed1987

Relevance of constipation to enuresis, urinary tract infection and reflux. A review.

Little attention has been afforded the relevance of constipation to urinary symptoms. Problems of definition and measurement have contributed to this problem. A review of the literature suggests that rectal dilatation may influence the function of the urinary tract leading to urinary tract infection and enuresis. Our studies indicate that constipation may, by causing uninhibited bladder contractions, cause urinary tract infection, enuresis and vesicoureteral reflux.

Child↗
PubMed2004

Treatment of constipation and fecal incontinence in stroke patients: randomized controlled trial.

BACKGROUND AND PURPOSE: Despite its high prevalence in stroke survivors, there is little clinical research on bowel dysfunction in this population. This is the first randomized controlled trial to evaluate treatment of constipation and fecal incontinence in stroke survivors. METHODS: Stroke patients with constipation or fecal incontinence were identified by screening questionnaire (122 community, 24 stroke rehabilitation inpatients) and randomized to intervention or routine care (73 per group). The intervention consisted of a 1-off structured nurse assessment (history and rectal examination), leading to targeted patient/carer education with booklet and provision of diagnostic summary and treatment recommendations (after consultation with geriatrician) to patient's general practitioner (GP)+/-ward physician. RESULTS: Percentage of bowel movements (BMs) per week graded as "normal" by participants in a prospective 1-week stool diary was significantly higher in intervention versus control patients at 6 months (72% versus 55%; P=0.027), as was mean number of BMs per week (5.2 versus 3.6; P=0.005). There was no significant reduction in fecal incontinence, although numbers were small. At 12 months, intervention patients were more likely to be modifying their diets (odds ratio [OR], 3.1 [1.2 to 8.0]) and fluid intake (OR, 4.2 [1.4 to 12.2]) to control their bowels and to have visited their GP for their bowel problem (OR, 5.0 [1.4 to 17.5]). GP prescribing of laxatives and suppositories was significantly influenced at 12 months. CONCLUSIONS: A single clinical/educational nurse intervention in stroke patients effectively improved symptoms of bowel dysfunction up to 6 months later, changed bowel-modifying lifestyle behaviors up to 12 months later, and influenced patient-GP interaction and physician prescribing patterns.

Aged↗
PubMed2002

Comparison of polyethylene glycol 3350 and lactulose for treatment of chronic constipation in children.

Polyethylene glycol (PEG) 3350 and lactulose were compared in an unblinded, randomized, crossover design for treatment of constipation in 37 children aged 2 to 16 years. Subjects received lactulose (1.3 g/kg/d divided twice daily up to 20 g) or PEG 3350 (10 g/m2/day) for 2 weeks. PEG 3350 significantly decreased the total colonic transit time compared to lactulose (47.6+/-2.7 vs 55.3+/-2.4 hours, mean +/- SE, PEG 3350 vs lactulose, respectively, p = 0.038). The stool frequency, form, and the ease of passage were similar for each laxative. Polyethylene glycol 3350 is an effective laxative for the treatment of chronic constipation in children.

Adolescent↗
PubMed1991

No-enema therapy for idiopathic constipation and encopresis.

Idiopathic constipation and encopresis of childhood are thought to occur when children volitionally withhold stool. Withholding may be prompted by social pressures or by episodes of painful defecation. Repetitive withholding may result in colonic dilatation and colorectal dysfunction. Therapy involves removal of impacted stool, stool softening, and behavioral therapy. The use of enemas in this therapy is widespread but may be counterproductive. A retrospective review of patients treated without enemas revealed 45 patients whose course could be followed for six months. Ninety-eight percent of these had successful initial cleanouts without enemas; 94% had continued success at six months. These results, comparable with other treatment programs, demonstrate that therapy without enemas is a reasonable alternative in the treatment of childhood constipation and encopresis.

Child↗
PubMed1995

Long-term follow-up of medically treated childhood constipation.

We describe the long-term (mean 6.8 years) follow-up of 43 children treated medically for chronic constipation and encopresis. Overall outcome was quite good. Thirty children (70%) were entirely asymptomatic at follow-up. Intermittent mild constipation persisted in 13 patients; only two required persistent but infrequent laxative therapy. Encopresis persisted in three of 17 children who initially reported this symptom, and was associated with significant behavioral problems.

Adolescent↗
PubMed2004

Constipation and soiling--outcome of treatment at one year.

AIM: To assess the outcome at one year of a cohort of patients referred to outpatient clinics with soiling. METHOD: Retrospective case note audit of 34 children referred to hospital outpatients over a four month period with soiling stated as the main problem in the referral letter. RESULTS: After one year, 29% of the 34 children studied were discharged to patient satisfaction, 38% defaulted from follow up, 24% were still attending outpatient clinics and 9% had been referred back to source. Coexisting pathologies, in particular enuresis and family stress, were found in several of the children. At the time of referral, 44% of new patients and 89% of re-referrals bad symptoms present for longer than 12 months. Only 18% of the children were receiving treatment at the time referral was made. CONCLUSION: Constipation is often undiagnosed until the problem is well established with soiling present, which makes treatment a long and often difficult process. It is necessary to consider the wider social and family issues when managing a child with constipation and soiling. Hospital based general medical and surgical outpatient clinics may not be the ideal setting in which to deal with these problems.

Adolescent↗
PubMed1984

Constipation: what does the patient mean?

Constipation is a very common complaint but, in the absence of a universally accepted definition, misunderstandings may result between doctor and patient. Two hundred and eighty-seven patients attending this hospital completed a questionnaire which attempted to establish what patients themselves mean by the term. Almost half considered constipation purely in terms of frequency of bowel action, without considering difficulty or pain on defaecation. Women were more likely to have infrequent bowel actions than men, and men more likely to consider such infrequency harmful. A quarter of respondents believed in the benefits of regular purgation, surprisingly with no difference in attitude between age groups, but men were much less likely to have heeded their own advice.

Adolescent↗
PubMed1996

An investigation of the ability of oral naloxone to correct opioid-related constipation in patients with advanced cancer.

A dose-ranging study of the use of oral naloxone in opioid-related constipation in patients with far-advanced cancer is reported. Naloxone doses were calculated as a percentage of the morphine dose each patient was receiving. Seventeen patients entered the first phase of the study, which had a randomised, double-blind design. Outcome measures were small bowel transit time (SBTT) measured by the lactulose/hydrogen breath test, pain scores and the occurrence of adverse events. One subject was excluded before receiving naloxone. No significant difference between placebo and naloxone occurred in the 14 remaining patients receiving total daily doses of naloxone 10% or less of the 24 h dose of morphine. Two further patients experienced a marked laxative effect with naloxone at 20% of the 24 h dose of morphine. In one of these, SBTT was available and was unchanged from placebo. The other declined to continue with SBTT measurement. Phase two of the study had an open design, in which laxative effects were determined clinically. Naloxone at a maximum dose level of 20% was given to seven patients, up to 40% to two patients and up to 80% to one patient. Four out of the seven patients in the 20% dose level group, and all of the remainder, experienced laxative effects. Two patients experienced symptoms of opioid withdrawal, one of whom also had return of pain. It is concluded that oral naloxone at a daily dose of 20% or more of the prevailing 24 h morphine dose is a potentially valuable therapy for opioid-related constipation. However, opioid withdrawal was observed and it is suggested that initial individual naloxone doses should not exceed 5 mg. Further research is needed into the oral absorption of naloxone, as well as further studies of clinical efficacy and dosing.

Administration, Oral↗
PubMed1983

Treatment of constipation with chenodeoxycholic acid.

The aim of this study was to investigate whether the cathartic effect of chenodeoxycholic acid (CDCA) could be helpful in the management of chronic constipation. Twenty cholesterol gall-stone patients with chronic constipation were randomly treated with either CDCA (750 mg/day in three divided doses at meals) or placebo for a period of 4 weeks. The administration of CDCA produced a significant increase of stool frequency and a decrease of stool consistency, while placebo was not effective in improving the bowel habit of the patients. As some patients complained of diarrhoea, and some had no modification of bowel frequency, further studies are needed to determine the most appropriate dose for each patient.

Adult↗
PubMed2001

The peculiar features of changing the hemostasis in children with chronic constipation.

Our purpose was to study the peculiarities of changing the hemostasis in children with chronic constipation. In the course of our investigation of hemostasis in children with chronic constipation, we found chronometric hypocoagulation with impairment of internal (XII, XI, IX, VIII) and external (II, V, VII, X) mechanisms of blood clotting, at the base of which is a deficit of vitamin K-dependent factors (II, VII, IX, X) and a slight impairment of the final stage of coagulation. In thrombocytovascular hemostasis, thrombocytopathy demonstrated increased adenosine-5-diphosphate aggregation and suppression of the internal route of fibrinolysis and endotheliosis. We must point out that all these changes lead to impairment of microcirculation in the form of thromboses, particularly in the submucous and mucous membrane vessels, which is confirmed by the morphologic findings. In the compensated form, chronometric hypocoagulation with a deficit of II, IX, and X factors is noted. In the subcompensated form, hypocoagulation increases, and the deficit of V and VII factors is in part the cause. Endotheliosis and the increase of the thrombogenesis dynamics are noted in the thrombocytovascular section. In the decompensated form, there is marked hypocoagulation. Low activity of antithrombin III leads to high content of fibrinmonomeasured complexes in combination with reduction of the thrombocytes quantity and to hypercoagulation. The present changes are confirmed by the morphologic research methods of studying the vascular channel of the large intestine wall, where organized thrombi and a marked plethora of neutrophil tissue infiltration are often revealed.

Adolescent↗