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Four cases of antenatal and intra-partum problems in nulliparous women, including early-onset pre-eclampsia, intrauterine growth retardation, placental abruption and placenta accreta, are offered with the underlying theme of sustained and persistent constipation over many years. Possible aetiological mechanisms are offered to account for these presentations.
BACKGROUND: Functional constipation (FC) is a common complaint during pregnancy and has been reported to be associated with physical activity and dietary intake. However, previous studies have reported inconsistent findings. Therefore, this study aimed to determine the prevalence of FC and examine its association with physical activity and dietary intake among pregnant women. METHOD: In this cross-sectional study, 381 healthy pregnant women attending urban health centres in Tabriz, Iran, between January 2024 and February 2025, were selected using a multistage cluster sampling method. FC was diagnosed according to the Rome IV criteria. Data were collected through face-to-face interviews using the International Physical Activity Questionnaire (IPAQ) and the Food Frequency Questionnaire (FFQ). Multivariable Generalised Estimating Equations (GEE) analysis was performed to identify factors associated with FC. RESULTS: The overall prevalence of FC throughout pregnancy was 37%. In the first trimester, 41 out of 73 women (56%) had FC, while in the second trimester 53 out of 146 women (36%), and in the third trimester 47 out of 162 women (29%) were affected. Multivariate GEE indicated that both higher dietary fibre intake (aOR= 0.88, 95%CI 0.86-0.91, p < 0.001) and higher fluid intake (aOR= 0.59, 95%CI 0.52-0.67, p < 0.001) were associated with a reduced risk of FC. A normal BMI was associated with a lower risk of FC (aOR= 0.35, 95% CI 0.16-0.77, p = 0.009), whereas, secondary education was associated with a higher risk (aOR= 2.81, 95%CI 1.33-5.95, p = 0.007). Physical activity (aOR= 1.00; 95%CI 1.00 to 1.01; p = 0.168), and other demographic characteristics (p > 0.05) were not independently associated with FC after adjustment. CONCLUSION: FC is highly prevalent during pregnancy and may adversely affect women's quality of life. Higher dietary fibre and fluid intake were associated with lower odds of FC, highlighting the importance of healthy lifestyle behaviours during pregnancy. Prospective longitudinal studies are warranted to confirm these findings.
Biofeedback is an effective treatment for anal sphincter dysfunction in many cases of childhood constipation and soiling. Conventional methodologies centre on clinic-based manometric apparatus but are compromised by equipment being thinly available and practice sessions often infrequent. To counter these shortcomings, we have designed a portable anorectal biofeedback apparatus (the Easograph) for domiciliary use. It can be lent to families, enabling carers to mediate what is an intrinsically sensitive procedure. In this paper, we provide a technical description of the device which is based on an inexpensive pressure transducer. Casework experience suggests it is reliable in operation and readily understood by users. In a pilot study of eight patients treated with the apparatus, five achieved bowel continence after lifelong soiling in one to eight weeks of daily practice. We believe this is an innovative approach that has good potential for treating faecal retentive and expulsive disorders in childhood associated with poor anal sphincter control.
OBJECTIVES: To evaluate effects of isomalto-oligosaccharides (IO) on the bowel function and nutritional status of elderly men. METHODS: Seven older male subjects participated in this study that consisted of a 30-day control low fiber period followed by a 30-day IO-supplemented (10 g active components) experimental period. Bowel functions such as defecation, enema use and bloating were monitored daily. Fecal characteristics such as wet and dry stool weights, stool moisture, pH and short-chain fatty acid contents were determined on five-day fecal composites collected in each period. Feces were further fractionated into plant, bacterial and soluble fractions to determine the bases for the increase in stool weight. Nutritional status of subjects was assessed with anthropometric parameters, nutrient intake and biochemical measurements. RESULTS: Incorporation of IO significantly increased the defecation frequency, wet stool output and dry stool weight by twofold, 70% and 55%, respectively. Fecal acetate and propionate concentrations significantly increased by nearly two and a half fold with IO supplement. The increase in stool bulk was mainly attributed by increased bacterial mass. Mean serum sodium concentration decreased in the experimental period while other blood characteristics did not change significantly. Anthropometric parameters and nutrient intake remained constant throughout the study. CONCLUSIONS: Consumption of IO effectively improved bowel movement, stool output and microbial fermentation in the colon without any adverse effect observed in this study. Therefore, supplementation of IO into ordinary low fiber diets may be practical in relieving constipation in the elderly population.
We present a case in which the classical histopathologic features associated with collagenous colitis were present throughout the colectomy specimen of a 69-year-old woman operated on for life-long intractable idiopathic constipation. This patient had never suffered from episodes of watery diarrhea. The reasons for this paradox are unclear, but suggest that a thickened collagen table and damaged surface epithelium may not be entirely specific pathologic findings marking the clinicopathological syndrome of collagenous colitis.
OBJECTIVE: To review the outcome data for colectomy performed for patients with slow transit constipation (STC). BACKGROUND: The outcome of surgical intervention in patients with STC is unpredictable. This may be a consequence of the lack of effectiveness of such interventions or may reflect heterogeneity within this group of patients. METHODS: The authors reviewed the data of all series in the English language that document the outcome of colectomy in > or = 10 patients in the treatment of STC. RESULTS: Thirty-two series fulfilled the entry criteria. There was widespread variability in patient satisfaction rates after colectomy (39% to 100%), reflecting large differences in the incidence of postoperative complications and in long-term functional results. Outcome was dependent on several clinical and pathophysiologic findings and on the type of study, the population studied, and the surgical procedure used. CONCLUSIONS: It may be possible to predict outcome on the basis of preoperative clinical and pathophysiologic findings. This review suggests a rationale for the selection of patients for colectomy.
Increasing the amount and type of fluid intake in children with simple constipation remains a common intervention recommended by both the medical profession and lay consumers. Efforts to increase overall water intake and/or high osmolarity liquid intake have no research or physiological basis that would result in softer and/or more frequent stools. The purpose of this project was to identify whether an effect on stooling characteristics would be noted with a concerted effort to increase liquid intake.
Bowel transit in two women with protracted constipation was evaluated after oral administration of In-111 DTPA in water. Serial abdominal images were obtained for as long as 96 hours to assess transit through the stomach, small bowel, and colon. In both patients, large bowel transit was delayed. A pattern of colonic inertia was observed in one patient, whereas retention in the distal colon was seen in the other patient. Both patients underwent total colectomy with marked symptomatic relief. Colonic transit studies of these patients are presented, and the literature is reviewed.
There is a relationship between low-fiber diet and chronic constipation, especially among inactive, geriatric nursing home and homebound patients. Increased bran fiber intake helps to promote normal bowel functioning among these patients.
Constipation is a collective term with different definitions and manifestations. In the present communication, I hope to shed light on the pathogenesis, investigation, and treatment of these manifestations. The levator ani is the principal muscle of defecation; together with anorectal reflex actions, it conducts the act of defecation. Strainodynia is the term I give to excessive and exhaustive straining at defecation. Band strainodynia has normal stool character but elevated rectal neck pressure due to the presence of a fibrous band in the rectal neck. Diet strainodynia presents with lower stool weight and frequency than normal; the internal anal sphincter is fibrous. The stools in levator strainodynia have been repeatedly obstructed at defecation due to levator dysfunction. Idiopathic oligofecorrhea or infrequent defecation was studied in 146 patients. Three stages could be identified: the deep and the everted intersphincteric groove and the cone anus. Fecoflowmetry is introduced as a new method for investigating anorectal disorders. It measures the defecated volume per time unit, and provides quantitative as well as qualitative data concerning the act of defecation. Changes in the fecal flow parameters or curve configuration from normal point to a defecation disorder.
A commercially available wheat bran preparation has been given to six infants between the ages of 6 and 16 months suffering from constipation not due to metabolic or anatomic causes. In all infants, normal bowel movements reappeared after a month of a diet containing bran. After a month on this diet, we observed the following: a decrease in blood levels of calcium, phosphate, and trace elements; an increase in fecal excretion of biliary salts and cholesterol; and an appearance of predominantly proteolytic fecal flora over the saccharolitic flora. These findings, especially the first one, indicate that bran preparations should be used in infancy with extreme caution because of possible side effect on the patient's nutritional status and growth. If bran is used, blood levels of minerals should be repeatedly checked in order to prevent the appearance of vitamin D-dependent rickets and the depletion of trace elements.
The efficacy of two medications commonly used in treatment of chronic functional constipation of children (CFC) was compared. Thirty-seven children (aged 3-12 years) with typical CFC were assigned at random to treatment with mineral oil or standardized senna concentrate (Senokot). The results of follow-up evaluations at 1, 3, and greater than 6 months indicate that symptom control (fecal soiling and decreased stool frequency) was significantly better in mineral-oil-treated patients. At least one recurrence of symptoms occurred in 66% of mineral-oil-treated and 89% of Senokot-treated patients. However, recurrences appeared later and less frequently in mineral-oil-treated patients. After 6 months, 55% of those treated with mineral oil had successfully discontinued regular medication. After 6 months, only 22% of Senokot-treated patients had successfully discontinued medication, while an additional 33% had stopped taking medication because of poor symptom control.
Fifty-eight encopretic children were placed on a habit training regimen consisting of initial disimpaction followed by attempts to defecate after a specific meal, and use of enemas contingent on failure to defecate for 2 successive days. All patients had gross incontinence of long duration. After an average of less than four visits in 5 months, 83% had an excellent outcome, 60% were completely continent, and 23% had only staining. Patients not achieving continence averaged a 90% decrease in frequency of incontinence. The mean frequency of incontinent episodes decreased from 13.2 to 0.52 per week, while appropriate bowel movements increased from 3.8 to 5.9 per week. At follow-up (average of 3 years), 61% of 43 patients contacted had excellent outcomes, 51% were continent, and 10% had only staining. Patients still incontinent at follow-up averaged 89% fewer episodes than they had prior to treatment. These findings show habit training to be a rapidly effective and long-lasting treatment for encopresis secondary to chronic constipation.
The difficulties of adequately managing constipation, particulary in patients with impaired or limited mobility as a result of surgery, cardiovascular or cerebral disease, or advanced age, led us to evaluate the use of stool softeners in a homogeneous group of institutionalized patients. Comparison was made between dioctyl sodium sulfosuccinate (DSS) (Colace), q.d. and b.i.d., and dioctyl calcium sulfosuccinate (DCS) (Surfak), q.d. Analysis of results showed 81% of the patients receiving DCS improved, a significant result (P is less than .02) when assessed by the sign test. By contrast, DSS caused no significant improvement over placebo, regardless of whether it was administered once or twice a day. The mean number of natural bowel movements among the DCS group increased approximately 62% over the placebo period, more than twice the 30% increase seen with DSS administered either b.i.d. or q.d. No adverse reactions were reported in any of the groups, and no significant study-induced changes occurred in laboratory measurements.
BACKGROUND: Patients presenting to gastroenterology clinics with symptoms suggestive of lower-bowel disorders often require extensive investigation to differentiate functional from organic disease. C-reactive protein (CRP) is a sensitive marker of systemic inflammation. Levels of CRP are frequently raised in cases of inflammatory bowel disease (IBD). However, using conventional assays, not all cases of IBD have a detectable level. OBJECTIVE: To determine whether a new highly sensitive CRP enzyme-linked immunosorbent assay (ELISA) can aid the differentiation between IBD and functional bowel disorders (FBDs) in gastroenterology outpatients presenting with lower-bowel symptoms. METHODS: Serum was taken from 224 subjects attending a gastroenterology outpatient clinic. Of these, 203 were new patients and 21 were follow-up patients with quiescent colitis. The serum was analysed using a sensitive in-house ELISA. All new patients had a rigid sigmoidoscopy and rectal biopsy. Patients were investigated as deemed appropriate by the attending physician. Notes were reviewed after at least 6 months to determine the final diagnosis. RESULTS: A cut-off value of 2.3 mg/l had a sensitivity of 100% and a specificity of 67% in differentiating FBD from new cases of IBD. The geometric mean CRP was 0.383 mg/l in the constipation-predominant FBD group, 1.435 mg/l in diarrhoea-predominant FBD, 1.455 mg/l in quiescent IBD, 8.892 mg/l in newly presenting cases of ulcerative colitis, and 13.123 mg/l in newly presenting cases of Crohn's disease. CONCLUSION: A new, highly sensitive assay for CRP may help to distinguish FBD from IBD.
Hereditary anal sphincter myopathy is rare. We present a family with one affected member with proctalgia fugax, constipation and internal anal sphincter hypertrophy. Ultrastructural findings show vacuolization of smooth muscle cells without the characteristic polyglucosan inclusion. Further relief of symptoms was obtained using an oral calcium antagonist. Based on clinical presentation, endosonography and morphological findings, we consider our case is a histological variant of the vacuolar myopathy originally described.
The gastrointestinal tract is one of the main sites of manifestation of systemic scleroderma. We describe a case of a 62-year-old patient with systemic scleroderma and progressive severe constipation that led to stercoral obstruction and perforation. We make a brief review of the literature on the gastrointestinal manifestations and the management of systemic scleroderma.
A case report of a 16-year-old girl who presented to the emergency department with constipation and recurrent urinary tract infections is examined. She gave a history of persistent coccygeal pain stemming from a fall on a trampoline 1 year ago. On examination, she was found to have an abdominal mass arising from the pelvis and paraesthesia of S1-S5 dermatomes in the right leg. An abdominal radiograph showed bony erosion of the sacrum. Magnetic resonance scanning revealed a mass arising from the sacrum and subsequent biopsy diagnosed the tumour as Ewing's sarcoma.