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PubMedDate not supplied

[Lactitol in chronic idiopathic constipation in children].

Fifty-one children affected by chronic idiopathic constipation (23 males, 28 females), ranging in age from 8 months to 16 years were enrolled in the study; 42 completed the trial. The patients were divided into two groups: Group A: 19 children treated with lactitol (250-400 mg/kg/day); Group B:23 patients treated with lactulose (500-750 mg/kg/day). Parents filled a questionnaire concerning clinical response to therapy for a period of 30 days. In 17 Group A children and in 17 Group B children orocecal transit time using H2 Breath Test with lactulose was performed. A statistically significant increase of week stool frequency was found after treatment both with lactitol or lactulose (p < 0.001). Nevertheless Group B patients complained abdominal pain (p < 0.005) and flatus (p < 0.001) more frequently. Other adverse reactions, such as vomiting and meteorism, were more frequent in Group B patients (n.s.). In addition patients treated with lactitol found that sugar as more palatable and had a better compliance to the therapy. Orocecal transit time did not show statistically significant differences after the therapy with both these sugars, indicating that the activity of lactulose and lactitol occurs in the colon and that small bowel functions are not affected by a previous therapy with these sugars. In conclusion, our study demonstrate that lactitol, because of the less number of side effects compared to lactulose, should be considered as an useful agent in the treatment of chronic idiopathic constipation in childhood.

Adolescent↗
PubMed1979

[Surgical management of incontinence in rectal constipation (author's transl)].

In rectal constipation chronic filling of the rectum with feces will cause continuous rectal dilatation, a permanent stimulus for defecation and finally rectal incontinence. Reduction of rectal volume and perfect continence may be achieved in these cases by surgical removal of part of the elongated colon; thus surgery may have its place as an alternative to medical treatment of this disease. Patients with rectal constipation do not have an aganglionic segment of the colon, as is the case in Hirschsprung's disease; the dilated part of the colon is characterized on the contrary by hypertrophic intestinal wall.

Adolescent↗
PubMed1994

Management of constipation and encopresis in infants and children.

Chronic functional constipation is common in childhood. Basic understanding of the defecation process is essential to formulate a rational diagnostic and therapeutic approach to pediatric patients with chronic constipation, with or without encopresis. Primary care physicians can perform a major preventive function by anticipatory guidance and early dietary intervention. Most patients referred to pediatric gastroenterologists can be effectively treated as outpatients with use of an approach consisting of colonic evacuation, stool softeners, dietary manipulations, bowel training, and behavioral management. Avoidance of painful (laxatives) and invasive (suppositories, enemas) modalities is an important part of successful management. Further evaluation, including manometric tests, are reserved for patients with a history or physical findings suggesting an underlying disorder predisposing the patient to difficulty with defecation. Biofeedback therapy is likely destined to play a role in the subgroup who respond poorly to traditional therapeutic methods.

Barium Sulfate↗
PubMed1994

[Treatment of chronic constipation with physiologic Escherichia coli bacteria. Results of a clinical study of the effectiveness and tolerance of microbiological therapy with the E. coli Nissle 1917 strain (Mutaflor)].

AIM: A randomized, double-blind clinical trial including a change-over of medication was carried out for 9 weeks to investigate the efficacy of an E. coli preparation. The study's main objective was to prove that patients of the verum group had 1.5 stools/week more than placebo patients after a therapeutic period of just 4 weeks. Stool consistency as well as efficacy and compatibility of the medication as judged by doctor and patient were additional criteria. PATIENTS AND METHOD: For a 7-day run-in phase 134 patients were recruited who had suffered from constipation for 18.8 years in average. In this initial phase 64 patients evacuated more than 2 stools per week and were excluded from the study. The remaining 70 patients entered the therapeutic phase being randomly distributed amongst verum and placebo medication. After 4 weeks of therapy patients who delivered 2 or less stools/week obtained the alternative medication (change-over). RESULTS: Within the 4th week of therapy the average number of stools per week from patients treated with the E. coli preparation (4.9) was already significantly higher than from placebo-treated patients (2.6; p < 0.001). At the end of the 8th week of therapy the number of stools/week rose to 6.0 for verum-treated patients, whereas for the placebo-treated control group a decrease in stool frequency was observed (1.9 stools/week). The results of change-over patients confirmed the data of the therapy weeks 1 to 4. CONCLUSION: The E. coli preparation proved to be successful in the therapy of the idiopathic chronic constipation almost free of side effects.

Adult↗
PubMed1994

Biofeedback treatment of constipation: a comparison of two methods.

OBJECTIVES: Our purpose in this study was to determine whether, with balloon feedback treatment, one can obtain results similar to those achieved with electromyographic (EMG) feedback treatment, in patients with a functional outlet obstruction (spastic pelvic floor syndrome). METHODS: In a randomized controlled study, 11 patients received EMG biofeedback and nine patients received balloon feedback. Treatment outcome was assessed by standard EMG during straining, constipation score, and a standard diary with details about complaints. RESULTS: Using change scores (posttreatment score minus pretreatment score), we found significantly greater positive changes for EMG feedback at posttreatment and at follow-up. When criteria for good clinical outcome were used, eight of 11 patients treated with EMG feedback appeared to be improved, against two of nine patients treated with balloon feedback. Type of feedback was the only difference between the groups. CONCLUSIONS: Alteration of the EMG pattern leads to lessening of complaints, which means that pelvic floor contraction during straining indeed is the cause of the constipation. The results suggest that EMG feedback is more effective than balloon feedback in treating spastic pelvic floor syndrome.

Adult↗
PubMed1994

Constipation as a side effect of opioids.

PURPOSE/OBJECTIVES: To describe the phenomenon of opioid-induced constipation and its treatment. DATA SOURCES: Published books and journal articles; commercial pharmacologic information. DATA SYNTHESIS: Patients receiving opioid analgesia are at risk for constipation and its complications. A number of pharmacologic and nonpharmacologic interventions are available to prevent and treat this problem. CONCLUSIONS: Discomfort from this opioid side effect can be particularly distressing to patients with cancer who already suffer from pain. Accurate assessment and individualized interventions are needed. IMPLICATIONS FOR NURSING PRACTICE: Collaboration with physicians to determine appropriate drug or nondrug interventions and patient and family education regarding the problem, preventive action, and appropriate treatment methods.

Cathartics↗
PubMed1994

Clinical evaluation and treatment of constipation.

Constipation is a symptom but can generally be defined as less than three bowel movements per week. The history and physical examination should be evaluated for stool size, frequency, and straining and discomfort on defecation. The influence of age, gender, and society should also be considered. The etiologies of constipation can be classified as 1. dietary; 2. drug induced; 3. metabolic; 4. neurologic; or 5. anatomic. If hard or small stools are part of the initial evaluation, then a dietary approach of increased dietary fiber intake can be used as a therapeutic trial. If it does not succeed or the history and physical evaluation indicate an etiology other than dietary, then barium-contrast enema, flexible sigmoidoscopy, colonoscopy, transit time, or anorectal manometry can be used selectively in further evaluation. Detailed methods of treatment are described, such as how to increase fiber intake by use of dietary history and recommendation of appropriate fiber, food, or supplement intake. Methods of using behavioral changes such as laxation and toilet-training programs are described. In selected situations pharmacologic therapy and, rarely, surgical intervention, can be useful.

Adult↗
PubMed1994

[Diagnostic strategy in constipation, including irritable bowel syndrome].

Constipation is not a disease but a symptom. Underlying causes include side effects of drugs, metabolic, endocrine, neurologic, psychiatric and intestinal diseases. Constipation is part of the so-called irritable bowel syndrome. The diagnosis is based on history, physical examination and a few laboratory tests. Second-line diagnostic procedures include endoscopy, colonic transit time and physiological investigations of the anorectum like anorectal manometry or defecography.

Adult↗
PubMed1993

[Calcium polycarbophil in clinical practice. The therapy of constipation].

The clinical efficacy of polycarbophil calcium was assessed in 57 patients of both sexes aged between 18 and 77 years old affected by chronic non-organic constipation. The multicentre study was performed using a single blind and cross-over protocol for 8 weeks, 4 with placebo and 4 with the drug (2 c.p.s 3 t.i.d). Thirteen patients failed to complete the study, 8 of them for reasons not related to the drug. In comparison to placebo, the drug caused a significant reduction in the consistency of stool and evacuatory force during the first week of stool therapy. Medical judgement was that efficacy was "very good" in 73% and "good" in 18%, whereas the drug was thought to be "non efficacious" in 9% of cases. The statistical analysis of data confirmed the efficacy of the drug. The hematochemical parameters evaluated before, during and after treatment only showed a slight increase in calcemia and calciuria which did not reach statistical significance. The therapeutic efficacy and lack of undesired effects confirm the value of polycarbophyl calcium in the treatment of chronic constipation.

Acrylic Resins↗
PubMed1993

[Constipation in childhood--from the pediatric viewpoint].

Chronic constipation is a common problem in paediatric practice. The majority of the toddlers can be successfully treated by conventional therapy. Young infants with constipation or older children with longstanding stool impaction with or without encopresis should be referred to a centre for further diagnostic and therapeutic management. Children with a paradoxical contraction of the external anal sphincter during attempted defecation on anorectal manometry profit form bio-feedback-training by learning a normal defecation pattern.

Biofeedback, Psychology↗
PubMed1994

The constipation quandary.

Constipation. It's uncomfortable, worrisome and, unhappily, a common problem in the elderly. In the largest study to date, for instance, 21 to 34 per cent of American women over 65 years reported experiencing it, as did nine to 20 per cent of the men. Elders are particularly at risk of becoming constipated because of age-related changes like weakening of the intestinal muscles, decreased peristalsis and altered activity. This risk is magnified in individuals with hypotonic colon function or central nervous system lesions, and in those who are immobilized and debilitated.

Aged↗
PubMed1993

[Irritable colon and constipation].

Irritable bowel syndrome is a very common clinical problem with a broad spectrum of severity. The management includes a combination of positive diagnosis of typical symptoms with limited investigations to exclude underlying structural or biochemical disorders. Therapeutic trials focus on the relief of predominant symptoms. Identification and modification of factors exacerbating symptoms, behavioural techniques and pharmacologic agents directed to the presumed gastrointestinal motor dysfunction are required. Psychological support by the physician is the most important part of treatment. Chronic constipation may be the predominant symptom of irritable bowel syndrome. Underlying organic disorders must be excluded by clinical examination and endoscopy. Severe chronic constipation requires further investigation of colonic motility and defecation. High fibre diet, osmotic laxatives and procinetic agents may lead to an improvement. In rare cases surgery may be indicated.

Chronic Disease↗
PubMed1994

Current approaches to the management of constipation.

Constipation in patients with advanced cancer results from reduced food intake and debility as well as medication, particularly opioid analgesics. Prophylactic measures are important, but most patients will require laxatives. History and examination should exclude the presence of intestinal obstruction, and if there is doubt, only a softening laxative should be used. In general, a combination of softening and stimulant laxatives is most likely to be successful with minimum adverse effects. Management of constipation is frequently poor, and considerable research effort is needed into both the more effective use of current treatments and the development of new therapies.

Cathartics↗
PubMedDate not supplied

[Chronic constipation. Use of cisapride].

We studied the effect of Cisapride (10 mg vo every 8 hours) on the characteristics of the evacuations, orocoecal transit time and motility trough rectoanal manometry in patients diagnosed with chronic constipation. The patients (N = 51) received placebo and/or drug in a controlled, randomized, double blind, crossed study during two treatment phases of 30 days each. The end of each phase was followed by a clinical evaluation, a rectoanal manometry and hydrogen breath test. Cisapride increased the rhythm of ecacuations (5.53 days +/- 3.11 vs 1.59 days +/- 1.15 p < 0.05) improved the frequency of evacuations and diminished the consistency of the feces (p < 0.05), shortened the orocoecal transit time (271.57 min +/- 9.87 vs 201.18 min +/- 29.30 p < 0.05) and improved the parameters of the rectoanal manometry readings such as the pressure of internal anal sphincter (58.14 mmHg 7.33 vs 53.90 mmHg 5.19 p < 0.05), and its relaxation percentage (73.41% +/- 15.30 vs 66.84% +/- 11.83 p < 0.05). Side effects associated with Cisapride were not significant. It is concluded that Cisapride improves intestinal motility in chronic constipation.

Adolescent↗
PubMedDate not supplied

[Use of polyethylene glycol in the treatment of puerperal constipation].

We evaluated the efficiency of polyethylene glycol at low dosage as a treatment for constipation in the puerperium. A prospective, open label and control study was performed in 225 puerpery patients. We observed a 94.7% of study group patients and a 10.7% of a control group patients had a evacuation in the first 48 hours, (p < 0.01). Decreased consistency of the stools was seen in the PEG group (74.3%). According to our findings, low doses of PEG were useful and safe as a treatment for constipation in the puerperium, without side effects.

Adult↗
PubMed1995

[Anorectal manometry in children with chronic functional constipation and encopresis].

We performed a rectal motility study in 39 children with encopresis and in 41 with chronic functional constipation. A three balloon system Schuster technic, was employed. Pressure changes were recorded. The "Inflation" reflex was absent in 23/39 children with Encopresis 59% and in 11/41. 26.8% with chronic functional constipation (p < 0.05).

Age Factors↗
PubMed1995

FG syndrome: the trias mental retardation, hypotonia and constipation reviewed.

FG syndrome: The trias mental retardation, hypotonia and constipation reviewed: A family with FG syndrome in two males and mild features in their mothers is reported. The data of the present family are compared with the 56 patients from the literature. At birth, affected individuals present with hypotonia and constipation and/or anal anomalies and joint hyperlaxity. Mental deficiency is the rule. Craniofacial dysmorphism is nonspecific. Macrocephaly may be present at birth or develop later in life. Features in older patients include joint contractures and a typical pleasant personality, sometimes with sudden aggressive outbursts. FG syndrome has a variable clinical presentation and clinical diagnosis is difficult, especially in sporadic patients. A thorough family examination with special attention to mild symptoms in female relatives is emphazised.

Abnormalities, Multiple↗
PubMed1996

The investigation of chronic constipation for surgical management.

AIMS: This study was conducted to ascertain the incidence of patients requiring surgery for intractible constipation. We also aimed to determine the anorectal physiology findings which influenced the surgery, and the outcome of surgical intervention. METHODS: A prospective study was done on 217 patients (34 men, 183 women; mean age 59 years [SD 17.7]) managed in a tertiary referral centre. Physiological tests consisting of transit marker studies, anal manometry, electromyography (EMG) and synchronised mano-myo-cinedefaecography (SMC), were then performed where appropriate. Surgical management was based on the results of these investigations. The mean follow-up was 19.6 months (SD 9.3). RESULTS: Eighteen patients (8.3 percent) underwent surgery: 2 for Hirschsprung's disease, 8 for colonic inertia (CI) and 8 for obstructed defaecation (OD). CI patients were younger than the OD patients (p = 0.03). Transit marker studies were abnormal but manometry was not different from the OD patients. The latter were identified on SMC to have rectoceles, sigmoidocele or rectal intussusception. The stool frequency significantly improved after surgery (before = 1.9 bowel motions a week [SD 0.9], after = 8.8 bowel motions a week [SD 1.2]; p = 0.003). There were no complications. CONCLUSIONS: A small but significant proportion of constipation patients require surgery. Good results are obtainable when surgery is directed by the findings of anorectal physiology investigations.

Adult↗