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PubMedDate not supplied

[Preliminary evaluation of the usefulness of passage time along the alimentary tract in the diagnosis of constipation in children].

In children with constipation the usefulness of passage time along the large bowel was assessed, limiting the number of performed rectal enemas. The preliminary results suggest that it is possible to answer the clinician's questions - whether the passage time is prolonged, and if so, to determine in what segment of the large bowel. This method may be treated as a screening test in the diagnosis of constipation in children.

Adolescent↗
PubMed1997

[Defecation problems: incontinence, constipation and impeded defecation; why and what can be done?].

Defaecation disorders may be subsumed in three categories: Inability to control motions = incontinence. Difficulty of evacuation = constipation [inertia coli, outlet obstruction]. Impeded defaecation: Rectocele, enterocele, intussusception. Etiology, examination and therapy are described in detail. Characteristic complaints of patients are listed and matched with probable diagnoses. Beside routine proctologic examination endosonography, estimation of transit time, endoscopy and defecography are discussed. The role of nutrition is stressed and emphasis layed on fibre and fluid intake. The advice, "take more fluid and fibres" does not help a lot, because no individual help is given. A time consuming nutrition and defaecation history has to be taken to establish nutritional support. This attention gives confidence to the patient and helps a great deal in the treatment. A checklist of the therapy of constipation and summarizing tables on different types of fibres are included. Additional conservative treatments are pelvic exercises and biofeedback training. Operative therapy is directed towards etiology of the disorder. Therefore many different methods exist and their diagnose related indication are discussed.

Anal Canal↗
PubMed1997

Outcome and predictors of success of biofeedback for constipation.

BACKGROUND: A study was undertaken to determine outcome and to identify predictors of success for biofeedback for constipation. METHODS: Patients who had at least one biofeedback session were evaluated whether or not they completed a treatment course. Parameters assessed included use of cathartics, number of spontaneous bowel movements per week, presence of rectal pain, number of biofeedback sessions and results of anorectal physiology. RESULTS: A total of 194 patients (59 male, 135 female) of median age 71 (range 11-96) years, including 30 with concomitant rectal pain, were treated. The median number of spontaneous bowel movements per week before treatment was 0. Some 35 per cent of patients had complete success (three or more spontaneous bowel movements per week with discontinuation of cathartics), 13 per cent had partial success (fewer than three spontaneous bowel movements per week with continued use of cathartics) and 51 per cent had no improvement. Neither patient age, sex nor duration of symptoms significantly affected outcome. Only 18 per cent of patients who had between two and four sessions had complete success, compared with 44 per cent of those who had five or more (P < 0.001). A total of 63 per cent of patients who completed the treatment protocol experienced complete success, compared with 25 per cent of those who self-discharged (P < 0.0001). CONCLUSIONS: This large study indicates that the success rate of biofeedback for patients with constipation is less than previously reported. However, the success rate improves significantly after five or more sessions and is significantly related to the patient's willingness to complete treatment.

Adolescent↗
PubMed1996

[Constipation after tilidine/naloxone and tramadol in comparison to codeine. A dose response study in human volunteers].

Tramadol, a mixed mu-opioid agonist and a monoamine-reuptake blocking analgesic, has been supposed to have little effect on propulsive gastrointestinal motility. However, this has not been specifically studied in man. Following institutional approval, 18 human volunteers were given 50 mg of tramadol, tilidine/naloxone, and codeine, respectively, in a double-blind randomised cross-over design. Additionally, 12 further volunteers were given 100 mg of each opioid in a double-blind, randomised fashion, followed by measurement of gastrocoecal transit time. Gastrointestinal transit time was measured using the lactulose H(2)-breath test. A threefold increase in end-expiratory hydrogen when compared to the control value was considered the end point of gastrocoecal transit. At the low dose (50 mg) the three opioids did not differ significantly with regard to their effect on gastrointestinal motility. Gastrocoecal transit time was 90.8 (+/- 10.1 SEM) min for tramadol, 100.6 (+/- 9.8 SEM) min for tilidine/naloxone, and 104.2 (+/- 8.7 SEM) min for codeine. Doubling the dose of each opioid resulted in an increase in mean gastrocoecal transit, namely 97.8 (+/- 11.2 SEM) min for tramadol, 129.2 (+/- 12.2 SEM) min for tilidine/naloxone and 135.9 (+/- 9.2 SEM) min for codeine. The increase in gastrocoecal transit time was significant (P < 0.01) for high doses of tilidine/naloxone and codeine in contrast to the effect of the low doses. This lesser constipation effect may be due to the reduced affinity of tramadol to the mu-opioid receptor. Sedation was significantly higher for codeine after 50 mg (P < 0.05) and 100 mg (P < 0.005) than for tilidine/naloxone and tramadol. Vertigo was significantly higher after 50 mg (P < 0.05) and 100 mg (P < 0.005) of tilidine/naloxone and codeine than after tramadol. Perspiration was significantly higher after tramadol 100 mg (P < 0.005) than after tilidine/naloxone and codeine. Sedation is considered a typical symptom of analgesics interacting with centrally located opioid receptor sites. The higher incidence of perspiration after tramadol suggests that monominergic pathways may be involved in thermoregulation. In conclusion, the opioids tilidine/naloxone and codeine at the doses used significantly prolong gastrointestinal transit time in the high-dose range. Since tramadol does not induce a dose-related increase in gastrocoecal transit time, it may be a useful analgesic in patients who are prone to developing constipation during high-dose opioid therapy.

Clinical Trial↗
PubMed1998

Idiopathic Constipation and Fecal Incontinence.

Patients with constipation or fecal incontinence have great potential for remediation. Both disorders warrant a thorough diagnostic evaluation to search for remediable causes, especially to identify defecation disorders. Constipation should be treated by relieving any impactions and then starting a course of fiber supplementation of at least 20 g per day. If not successful, other agents such as lactulose, polyethylene glycol solutions, or stimulants can be added. Biofeedback may be very helpful. If all else fails, several surgical procedures are available. Fecal incontinence should be treated by fiber supplements, encouragement of regularity, and enemas as needed. Kegel exercises and biofeedback are often helpful, but surgery may be needed and is most effective in recent onset or traumatically induced incontinence.

Journal Article↗
PubMed1998

Germinated barley foodstuff improves constipation induced by loperamide in rats.

The effects of germinated barley foodstuff (GBF) derived from the aleurone and scutellum fractions of germinated barley low-lignified hemicellulose were examined in Sprague-Dawley rats with constipation induced by loperamide by addition to the diet (2 mg/kg body weight). Bowel movements were higher in the GBF-fed rats than in the cellulose-fed rats used as a control. Fecal water content was also higher in the GBF-fed rats. The concentration of short chain fatty acids in cecal content, especially butyrate, was significantly higher in the GBF-fed rats than in the cellulose-fed rats. These findings suggested that GBF helps normalize defecation not only in diarrhea but also constipation.

Animals↗
PubMedDate not supplied

[ALTERNATIVES IN THE TREATMENT OF CHRONIC CONSTIPATION]

This article briefly reviews epidemiological, patophysiological and definition aspects of chronic constipation. Additionally, treatment of constipation regarding to general an specific measures, including several types of laxatives and presenting the alternative use of combined fiber and Senna, is discussed.

Journal Article↗
PubMed2005

Constipation heralding neuroborreliosis: an atypical tale of 2 patients.

This is a report of 2 patients with Lyme disease who initially presented with severe constipation, which progressed to ascending muscular weakness resembling acute idiopathic polyneuritis, with neuropsychiatric symptoms, severe urinary retention, and hyponatremia. These symptoms resolved following proper antibiotic therapy.

Aged↗
PubMed1987

Serum beta-carotene, retinol, and alpha-tocopherol levels during mineral oil therapy for constipation.

Twenty-five children with chronic constipation underwent serial monitoring of serum beta-carotene, retinol (vitamin A1), and alpha-tocopherol (vitamin E) levels during mineral oil therapy. Mineral oil was administered between meals. Patients were monitored for up to four months of therapy. Mean serum beta-carotene levels fell from 1.0 +/- 0.5 mumol/L (55.7 +/- 26.0 micrograms/dL) to 0.7 +/- 0.4 mumol/L (35.9 +/- 22.1 micrograms/dL) after the first month of mineral oil therapy and remained depressed throughout the remainder of the study. Serum alpha-tocopherol levels remained unchanged throughout the observation period. There was a modest increase in serum retinol levels during the study, especially after three months (from 1.48 +/- 0.84 mumol/L [42.3 +/- 24.1 micrograms/dL] to 2.22 +/- 0.77 mumol/L [63.5 +/- 22.1 micrograms/dL]). We conclude that while a short course of mineral oil can induce a reduction in the serum level of beta-carotene, the treatment has no adverse effect on serum levels of retinol and alpha-tocopherol.

Adolescent↗
PubMed1984

Chronic constipation. Manometric patterns and surgical considerations.

We studied 80 children who had severe chronic constipation that was refractory to dietary, medicinal, and psychiatric therapy by means of barium enemas, rectal biopsies, and manometry. Four patients had Hirschsprung's disease and three patients had segmental dilatation of the colon. The remaining 73 patients had radiologically dilated anorectums with inpaction. Only 49 patients underwent rectal wall biopsies. All of the specimens were positive for ganglion cells. Manometric study of the 73 patients showed 18 patients who had elevated internal sphincter pressures with good relaxation following balloon inflation (group A); 45 patients who had normal internal sphincter pressures but no relaxation following balloon inflation (similar to Hirschsprung's disease) (group B); and ten patients who had normal pressures with good relaxation. Twenty-five patients in groups A and B had internal sphincter myectomies. Eight patients resumed normal bowel movements, 11 patients required minimal medicinal help, and two patients' conditions did not improve. Postoperatively, there was a reduction to normal pressure levels in group A patients and relaxation of the internal sphincter in group B patients.

Adolescent↗
PubMed1998

Hypoxia and chest pain due to acute constipation: an underdiagnosed condition?

An obese, previously healthy, 10-year-old boy presented with acute respiratory distress, chest, and abdominal pain. He was hypoxic and dyspneic in the emergency room. The abdomen was distended and tender, and the rectum was full of hard stool. Following catharsis, he made a complete recovery with resolution of all clinical signs. A review of the literature reveals that acute constipation as a cause of hypoxia and respiratory distress has been recognized, but has rarely been reported. We believe that this is a common phenomenon but probably infrequently recognized.

Acute Disease↗
PubMed2001

Smooth muscle inclusion bodies in slow transit constipation.

Slow transit constipation (STC) is a disorder of intestinal motility of unknown aetiology. Myopathies, including those characterized by the finding of inclusion bodies, have been described in enteric disorders. Amphophilic inclusion bodies have been reported in the muscularis externa of the colon of STC patients. This study formally tested the hypothesis that these represent a primary muscle disorder, specific to STC. In a systematic, blinded, dual observer qualitative and quantitative analysis, colonic and ileal tissue from patients with STC (n=36) were compared with selected control populations: total colonic aganglionosis (n=10), Chagas' disease (n=6), isolated rectal evacuation disorders (n=6), and a control population of a range of ages (n=80). All sections were stained with haematoxylin and eosin and periodic acid Schiff. Further immunostains were used in an attempt to determine inclusion body composition. Round or ovoid (4-22 microm diameter) amphophilic inclusions increased in number in normal subjects with age. Inclusions were more frequent in idiopathic STC than in age-matched controls or rectal evacuation disorders [ileum (33% vs. 9%), ascending (50% vs. 19%, p<0.05), and sigmoid colon (43% vs. 20%)] and were very frequent in the sigmoid (71%) of patients with STC arising after pelvic surgery. The number of inclusions per unit area was significantly higher in patients with STC (p<0.001). Inclusions were found in all Chagas' patients, but not with aganglionosis. It was not possible to determine inclusion body composition, despite the use of a wide range of conventional and immunostains. This study demonstrates that inclusion body myopathy is identifiable in patients with STC and that it may arise secondary to denervation.

Adult↗
PubMed1984

Results of colectomy for severe idiopathic constipation in women (Arbuthnot Lane's disease).

Twenty-one women with slow-transit constipation have been treated by bowel resection. All had a normal barium enema, but an increased colonic transit time. Pathological examination of the resected colons showed no evidence of aganglionosis. Some of the patients were treated by segmental colonic resection, anorectal myectomy, anal stretch or internal sphincterectomy but were not helped. Colectomy with ileorectal or caecorectal anastomosis gave the best results; on balance, ileorectal anastomosis seems preferable. Of sixteen patients who underwent colectomy, ten subsequently had normal bowel function and four were markedly improved. The spontaneous bowel frequency in this group rose from 0.3 +/- 0.1 (s.e.m.) to 21.7 +/- 8.3 weekly (P less than 0.001).

Adolescent↗
PubMed1985

Experience of posterior division of the puborectalis muscle in the management of chronic constipation.

Nine women with severe chronic constipation who were unable to expel a water-filled rectal balloon underwent posterior division of the puborectalis muscle. Pre-operative concentric needle electromyography and measurement of the anorectal angle at rest and during straining suggested that the puborectalis muscle failed to relax during attempted defaecation in these patients. Two patients reported improvement after surgery and had normal balloon expulsion after operation. However seven patients reported no benefit from surgery and tests of defaecatory function and anorectal angle did not change. Incontinence for solid stool was not reported following puborectalis muscle division although five patients reported incontinence of flatus, liquid stool and mucus.

Adult↗
PubMed1989

Clinical results of colectomy for severe constipation.

Subtotal colectomy has been performed in 40 patients with severe constipation. Only one patient was male. Five patients (13 per cent) had a history of a serious psychiatric disorder. Twenty-six patients (65 per cent) could not expel a 100-ml air-filled balloon and 19 patients (48 per cent) had electromyographic evidence of abnormal puborectalis contraction during attempted defaecation before operation. Median preoperative passage of 50 radio-opaque markers over 5 days was 16 per cent. Sixteen patients had had a previous anorectal myectomy to exclude Hirschsprung's disease. Initial resections were subtotal colectomy and ileorectal anastomosis (n = 34), caecorectal (n = 5) or ileosigmoid (n = 1) anastomosis. Secondary operations included restorative proctocolectomy and ileal pouch-anal anastomosis (n = 6) and six patients eventually had an ileostomy. Median bowel frequency per week significantly increased after operation (0.3 (range 0-1) preoperatively to 21 (range 2-70) postoperatively, P less than 0.005), the percentage of patients with abdominal pain fell after operation from 93 to 39 per cent but symptoms of abdominal distension remained the same (86 per cent preoperatively and 82 per cent postoperatively).

Adult↗
PubMed1990

Triad of anorectal stenosis, sacral anomaly and presacral mass: a remediable cause of severe constipation.

Two neonates with intestinal obstruction and two children (aged 1 and 4 years) with severe constipation since birth are reported in whom stenosis of the distal rectum was found. In association with the rectal anomaly, three of them had a presacral tumour (teratoma in two, hamartoma in one) and all had a deformed sacrum. An embryological hypothesis to explain this association has been postulated by Currarino, after whom this triad has been named. Two patients were related (father and daughter). The role of hereditary factors in the occurrence of the syndrome has been reported before. Operative treatment of the rectal stenosis was necessary in all patients. Preoperative diverting colostomy was performed in three cases, followed by a posterior sagittal approach to excise the rectal stenosis and the presacral mass. In one case, persistent cerebrospinal fluid leakage required re-exploration for closure of a tear in a congenitally abnormal dural sac. The fourth patient had undergone a low anterior resection in the past via the abdominal route and needed rectal dilatation afterwards for some time. The final result in all patients appears satisfactory, although follow-up is short. Most cases of this triad have been reported in children but a number of patients have been diagnosed only as adults. Recognition of this triad should imply a careful search for neural crest malformations. Operative treatment to correct all soft tissue anomalies leads to good results.

Child, Preschool↗
PubMed1995

Colectomy as treatment for constipation in selected patients.

The aim of this study was to conduct a prospective assessment of the results of total abdominal colectomy and ileorectal anastomosis (TAC) in patients with colonic inertia. Overall, 416 patients were evaluated for chronic constipation. Of the patients 54 (13 per cent) had colonic inertia, defined as diffuse marker delay during transit study without paradoxical puborectalis contraction on cinedefaecography or electromyography. All 54 patients (42 women and 12 men), with a mean age of 49 (range 17-78) years, underwent TAC. Preoperative bowel frequency was a mean of one every 8 days, requiring large doses of laxatives, enemas or both. There was no major postoperative morbidity; five patients were readmitted due to bowel obstruction, three for successful conservative management while the other two required enterolysis. After a mean follow-up of 27 (range 2-51) months these 54 patients reported a mean frequency of spontaneous bowel movements of 3.7 (range 1-10) per day. 'Excellent' or 'good' outcome was reported by 51 patients (94 per cent). TAC can be performed with acceptable morbidity and 94 per cent of patients will have satisfactory improvement in bowel habit.

Adolescent↗