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PubMed1991

Constipation: physiopathology and classification.

Constipation is commonly defined on the basis of the number of bowel movements in a week (greater than 3 week) or on the stool weight (less than 35 g/day) and on their consistency and expulsion capacity. A pathophysiological classification of constipation subdivides the patients into 2 groups. The first includes those patients in which a propulsion defect is prevalent (inertia coli) and the second one comprehends those in which a predominant expulsion defect is found. This second group consists of patients with myogenic, neurogenic or mechanical disorders. Moreover, we can consider in this group those patients with irritable bowel syndrome (IBS) who show a reduction of rectal compliance and those who produce "inappropriate stools". Finally, in this group we can find those patients having the so-called faecal impaction, that is an abnormality of either sensitivity or stimulus to defecate frequently observed in the elderly and in children.

Adult↗
PubMed1991

Encopresis in children: a cyclical model of constipation and faecal retention.

Encopresis afflicts one in 100 children causing considerable stigma and parental concern. General practitioners are in a position to help in most cases but are often deterred by the psychoanalytical theories which have been developed to explain this problem. It is currently accepted that children with encopresis tend to retain stools. This leads to constipation, overstretching of sphincters and resultant faecal soiling. Physical and psychological perpetuating factors result in retention once again, thus completing a cycle of constipation and retention. Various precipitant and predisposing factors can maintain this cycle. Once physical causes have been excluded a simple behavioural approach can be adopted aimed at retraining the bowel. By using laxatives to prevent retention, gaining the child's confidence, cooperation and understanding and involving both the family and school, encopresis can be successfully managed in general practice.

Child, Preschool↗
PubMed1991

Non-surgical treatment for constipation in adults: the place of biofeedback.

The treatment of slow-transit constipation consists of dietary measures combined with a regime of laxatives and enemas. Surgery should only be considered when intractable constipation persists despite these measures. Results, however, are moderate. Functional outlet obstruction, the spastic pelvic floor syndrome, is caused by an abnormal use of a normal pelvic floor muscle. Procedures aiming at weakening pelvic floor function give no long-term good results and may lead to faecal incontinence. Biofeedback treatment, relearning normal muscle function by monitoring pelvic floor EMG and simulating defaecation, gives excellent results.

Anal Canal↗
PubMed1991

Severe, long-standing constipation in adults: indications for surgical treatment.

In recent years, new techniques for the investigation of colonic motility and defaecation mechanism have been developed. Based on the results of these studies it has been suggested that there might be an indication for a surgical approach to the distressing problem of constipation. Because this approach is still controversial, it seems to be appropriate to review the suggested indications for the use of surgery in the treatment of constipation and to discuss the results as reported in literature so far.

Adult↗
PubMedDate not supplied

[Study of colonic transit time with radiopaque markers in patients with chronic constipation].

We studied 30 young patients with idiopathic chronic constipation through the ingestion and colonic follow-up of 20 radiopaque markers, gotten from catheters of those used for intravenous lines. The number of markers were counted in each segment and total colon. Mean segmental and total colonic transit times were also calculated. There was a greater number of markers in each segment and total colon compared to 20 control subjects (p < 0.001). The mean colonic transit time was 61.4 hours (patients and 15.6 hours controls) (p < 0.001) occurring an important delay in the left colon and rectosigmoid (45.72 hours). So, in these patients there was predominantly a left colon dysfunction and the called outlet obstruction syndrome, likely related to their evacuatory habits. We do recommend this method as a valuable diagnostic tool for particularly observing the colonic progression and to offer a more rational assessment to the chronic constipated patient.

Adolescent↗
PubMed1991

An open, randomised, parallel group study of lactulose versus ispaghula in the treatment of chronic constipation in adults.

The efficacy, tolerance and acceptability of lactulose (Duphalac) and ispaghula (Fybogel Orange) were assessed in the treatment of chronic constipation in adults. In an open, prospectively randomised, parallel group study, 124 patients with a history of constipation for more than three weeks were treated with either 15 ml bd of lactulose (increasing to 60 ml daily if necessary) or one sachet bd of ispaghula. Over the four-week treatment period both treatments were shown to be effective, and numbers of concurrent effects were similar between the two groups. Differences were demonstrated with regard to acceptability in favour of lactulose.

Bicarbonates↗
PubMed1990

[The role of colorectal resection in severe constipation after promontory rectopexy].

Abdominal rectopexy to the promontory is an effective treatment for total rectal prolapse, internal procidentia and solitary ulcer. This paper is designed to stress the risk of severe constipation following rectopexy, a complication which required surgical resection in 5 cases. This raises the problems of the physiological mechanisms of this complication, the definition of a possible high risk population (young women, patients who were constipated preoperatively?), and an alternative to promontory rectopexy: sacral fixation of the rectum, associated sigmoidectomy, Delorme's operation?

Adult↗
PubMed1990

Constipation and fecal incontinence in the elderly.

The successful management of constipation and fecal incontinence in the elderly requires an understanding of colorectal function, careful delineation of the patient's complaint, and in selected patients, specialized studies of colonic and anorectal function. This article reviews (1) the prevalence and nature of lower bowel dysfunction in the elderly population: (2) colonic and anorectal physiologic changes that are associated with aging; (3) the causes, consequences, and approaches to the management of constipation in the elderly; and (4) the causes of fecal incontinence in this age group and the treatment available.

Age Factors↗
PubMed1990

Randomized controlled trial of Cassia alata Linn. for constipation.

Cassia alata Linn. is a medical plant. Its leaves have been claimed to be effective as a laxative. The studies done so far have shown no toxicity as a result of consuming Cassia alata Linn. leaves. The plant has been found to contain anthraquinones, presumed to be the active ingredient causing the laxative effect. The objective of the study was to test efficacy of Cassia alata Linn. leaves for treatment of constipation compared with a placebo and mist. alba in a multicenter randomized controlled trial carried out in one provincial and 5 community hospitals. Eighty adult patients admitted to 5 community hospitals and one provincial hospital with at least 72 hours of constipation were included in the study. Twenty-eight patients were in the placebo group, 28 in the mist. alba group, and 24 in Cassia alata Linn. group. Each patient was given 120 ml of fluid with caramel color, mist. alba, or Cassia alata Linn. infusion at bed time. Evaluation was performed after 24 hours whether the patient defecated or not. The characteristics of the patients among the three groups were not different. Eighteen per cent of patients in the placebo group passed stools within 24 hours, whereas, 86 and 83 per cent of patients in mist. alba and Cassia alata Linn. groups respectively, passed stools. The differences observed between placebo and mist. alba, placebo and Cassia alata Linn. were statistically highly significant, P less than 0.001 and clinically important. Minimal self-limited side effects, i.e., nausea, dyspepsia, abdominal pain and diarrhea were noted in 16-25 per cent of the patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

The plain abdominal radiograph in the assessment of constipation.

To investigate the value of the plain abdominal radiograph in the assessment of constipation we prospectively studied 30 patients (20 females, 10 males, mean age 48.6 years, range 21-76 years). These patients underwent the following tests: plain abdominal radiograph in supine position, measurement of stool weight (mean of 5 days) and whole gut transit time (20 radioopaque pellets, fluoroscopy of stools). All patients completed a questionnaire regarding their defaecation characteristics (a.o. average defaecation frequency and faecal consistency). The abdominal films were coded and independently scored for the degree of faecal stasis in ascending, transverse, descending colon and rectosigmoid by four gastroenterologists. To each of these parts of the colon a score of 1 (no faeces) to 4 (loaded with faeces) was assigned. The film scores given by the four observers were significantly correlated (p less than 0.001). Significant correlations were found between the radiograph scores and frequency of defaecation, faecal consistency and stool weight. The strength of these correlations were of the same order of magnitude as those between the other subjective and objective defaecation variables. The scores for the left colon (descending colon and rectosigmoid) showed a better correlation with the other defaecation parameters than the scores for the right colon. It is concluded that in the assessment of constipation a simple plain abdominal radiograph is as reliable as measurement of faecal weight or marker transit and can thus be advocated as the first procedure. When an abdominal radiograph is used for this purpose the stasis in the descending and sigmoid colon provides most information.

Adult↗
PubMed1990

Constipation.

The author outlines a safe diagnostic strategy for the symptom of chronic constipation, conforming to Australian Family Physician's series on common problems in general practice. The constipation is most commonly idiopathic, especially the simple form related to inadequate dietary fibre and bad habit. It is vital not to miss colonic or anorectal carcinoma. Important causes to consider include drugs (self administered or prescribed), hypothyroidism and depression.

Clinical Protocols↗
PubMed1989

Cisapride accelerates colonic transit in constipated patients with colonic inertia.

A double-blind cross-over trial of oral cisapride 10 mg before meals and placebo was performed to determine its effects on colonic transit in patients with severe idiopathic constipation. Nine patients with less than 3 spontaneous bowel movements/wk were studied. After passing a tube to the cecum, 50 muCi of 111In-DTPA were instilled into the cecum and followed for 48 h using colonic transit scintigraphy. In the group as a whole, cisapride had little effect on transit. The patients were then divided into two groups based on transit: functional rectosigmoid obstruction (FRSO) and colonic inertia (CI). In the CI group, cisapride accelerated the half emptying time of the cecum and ascending colon from 2.50 to 1.21 h (p less than 0.05). The progression of the geometric center was also faster after cisapride in CI. In FRSO, the geometric center was unchanged by cisapride except at 48 h. Cisapride thus has a prokinetic effect on colonic transit in patients with severe idiopathic constipation, colonic inertia subtype. It may be a useful agent in the treatment of this group of patients.

Adult↗
PubMed1987

[Therapy of constipation with wheat bran in infancy and early childhood].

In 22 infants and children aged 6 to 62 months (mean = 23 months) with severe constipation a commercially produced solid food containing 4.2 g wheat bran was used for 41 days. Acceptance was satisfactory, compatibility was reported to be good. In 86% of the children normal bowel movements appeared within 8.2 days of therapy. Blood levels of hemoglobin, calcium, phosphathase, alkaline phosphatase, iron, transferrin, total protein, cholesterol, and carotene were controlled in monthly intervals. Under wheat bran there was only a slight decrease of carotene concentrations by 13.5 mg/dl (p less than 0.05) and a minimal increase of alkaline phosphatase activity by 14.5 U/l (p less than 0.1). In 8 healthy infants aged 4.5-9 months (mean = 6.7 months) the bran preparation induced an increase of stool weight by 21.5% (p less than 0.05), whereas the frequency of bowel actions did not change. The results indicate that bran preparations may be used in severe constipation even in early childhood.

Child, Preschool↗
PubMedDate not supplied

[Constipation--a new approach].

Chronic idiopathic constipation is defined as the emission of less than 3 stools per week. Beside signs evoking a severe form (Hirschsprung's disease, idiopathic megacolon), a treatment with bran, at a dose of 20 grams per day, is instituted right away, which cures almost 60% of the patients (constipation secondary to dietetic errors). If this is not the case, the study of the colonic transit time of markers, anorectal manometry, defecation radiographs, enables to recognize various etiological forms (colonic inertia, irritable colon, anism, descending perineum, etc...) which require a specific treatment.

Anal Canal↗
PubMed1989

Patterns of colonic transit in chronic idiopathic constipation.

Rectosigmoid motility, anal manometry, and radiopaque marker studies have suggested the presence of several patterns of altered colonic transit in patients with chronic idiopathic constipation. Colonic transit scintigraphy was used to evaluate 23 constipated patients. After oral passage of a tube to the cecum, 50 microCi of 111In-diethylenetriaminepentaaceticacid (111In-DTPA) were instilled, and abdominal images were obtained for 48 h with a gamma camera. The 95% confidence limit for the geometric center in normals at 24 h was used as a criterion to differentiate patients with colonic inertia from those with functional rectosigmoid obstruction. In patients with functional rectosigmoid obstruction, colonic transit was essentially normal. In colonic inertia, transit was delayed in the cecum and ascending colon, hepatic flexure, and transverse colon. These two distinct patterns of colonic transit may have different pathogenetic and therapeutic implications.

Adult↗
PubMed1986

Pilot study of the efficacy of spent grain dietary fiber in the treatment of constipation.

Spent grain is the crude fiber obtained by decanting the fermented distillate of barley. The spent grain was processed to yield dietary fiber composed of: cellulose and hemicellulose 65.6% (by weight), lignin 5.2%, pectin 2.2%, protein 10.9% and lipid 8.0%. Biscuits and scones were prepared by 25% substitution of wheat flour by fiber, yielding 7 to 8 g fiber per biscuit/scone. Nineteen ambulatory patients with chronic, laxative-dependent constipation were treated in a pilot study for 4 weeks with 20 to 25 g fiber daily. Fifteen patients (79%) showed improvement in some or all of five factors, while four patients were largely unresponsive to fiber. Specific symptoms improved as follows: bowel movement frequency in 15 patients (79%), flatulence in 12 (63%), abdominal pain in 10 (53%), stool consistency in 8 (42%) and laxative dependence in 14 (74%). A 4-week post-treatment follow-up showed a return to prefiber status in 11 of 13 improved subjects. This preliminary study suggests a role for spent grain fiber in the treatment of constipated patients, and a comparative study with placebo and wheat fiber is now warranted.

Adult↗
PubMed1988

Subtotal colectomy for treatment of chronic constipation associated with idiopathic megacolon in cats: 38 cases (1979-1985).

Chronic constipation, nonresponsive to medical management and associated with idiopathic megacolon, was diagnosed in 38 cats from 1979 to 1985. All cats were treated by subtotal colectomy and enterocolostomy, in which the ileum or distal portion of the jejunum was joined to a 2- to 4-cm segment of distal portion of the colon preserved to accommodate an end-to-end anastomosis. After surgery, cats usually were depressed and anorectic, had tenesmus, and passed liquid tarry feces. In 37 cats 1 week to 3 months after surgery, character of the feces changed from diarrhea to soft semiformed or formed feces. One cat had severe diarrhea that was nonresponsive to diet change and pharmacologic treatment; the diarrhea resolved after 4.5 months. One cat developed a stricture of the enterocolostomy, which was relieved by 3 balloon catheter dilatations. All cats regained normal appetite, did not lose weight, and were not incontinent. Three cats had sporadic episodes of constipation and were easily treated. Results of histologic examination of the resected portion of colon in 23 cats were inconclusive.

Animals↗
PubMed1988

[The role of total colonic electromyography in children in case of chronic constipation. Preliminary study].

Since December 1987, the chirurgical pediatric team in Clermond-Ferrand performs total colonic electromyography in children. This examination is integrated into a diagnostic and therapeutic protocol for chronic constipation. We used an intraluminal probe supporting 10 groups of 3 ring electrodes. Inside the probe a lead pellet was placed opposite each electrode. The probe was inserted through the colon by colonoscopy into a starving child. The recording starts 24 hours later and is registered for 3 hours before and 3 hours after a meal. The aim of this work is to report the preliminary results of 6 electromyography in constipated children.

Adolescent↗