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At least 1,477 records · Page 82Linked to original sources
PubMed1993

Dietary fiber nursing intervention: prevention of constipation in older adults.

Constipation is a major complaint of older adults. Approximately 30% of older adults use laxatives at least once weekly, and laxatives account for 1% of physician prescriptions in addition to approximately 700 over-the-counter preparations. This study evaluated the efficacy of a fiber and fluid nursing intervention on the maintenance of bowel movements and elimination aid withdrawal in residents of a long-term health care facility. The findings indicated that the number of bowel movements reached a peak at 3 months and returned to baseline values at the 6-month point while the use of both laxatives and stool softeners decreased significantly. Enema and suppository use was so infrequent at baseline and throughout the study that changes in these variables were statistically insignificant. The results demonstrate that a natural means of maintaining bowel movements using a fiber and fluid nursing intervention can significantly decrease the number of laxatives and stool softeners needed by residents of a long-term facility.

Aged↗
PubMed1995

Fruitlax: management of constipation in children with disabilities.

Seven children, with a variety of disabilities, who had experienced chronic constipation, participated in a study of the use of Fruitlax, a natural laxative. Using an AB single-subject design, data were collected for each child for a baseline period A (2 weeks) and for an intervention period B (minimum of 3 weeks), which included the addition of Fruitlax to the subjects' diets. Whereas each child experienced some change in bowel pattern (consistency, effort required to have a bowel movement, color, amount, frequency, and number of bowel movements per day), the particular change was different for each child. Fruitlax does appear to be a useful natural laxative for some children; however, additional research with a larger sample is required. The Glenrose Stool Consistency Tool was developed for use in this study. Further work is needed in the use of the tool by clients, their families, and health care workers.

Child↗
PubMedDate not supplied

Comparison of "Duphalac" and "irritant" laxatives during and after treatment of chronic constipation: a preliminary study.

A multi-centre trial was carried out to compare the effectiveness in the treatment of chronic constipation of a lactulose preparation ("Duphalac") and "irritant" laxatives containing senna, anthraquinone derivatives or bisacodyl. The results, in 164 patients, indicate that the lactulose prepartion was more effective than the "irritant" laxatives. By Day 7, 58% of the lactulose-treated group were passing a normal stool whereas only 42% of the patients receiving an "irritant" laxative did so at the same stage in treatment. The lactulose preparation was shown to have a persistent CARRY-OVER" EFFECT, AND THIS EFFECT WAS SEEN IN SIGNIFICANTLY MORE PATIENTS RECEIVING "Duphalac" than in the "irritant" laxative group.

Adolescent↗
PubMed1985

An open study of oat bran meal biscuits ('Lejfibre') in the treatment of constipation in the elderly.

Fifty elderly patients consulting their general practitioner with the complaint of constipation were entered into an open trial to assess the benefit on their symptoms of adding bran biscuits ('Lejfibre') twice daily to their diet. Patients were followed-up over 12 weeks. Treatment caused a marked improvement in bowel frequency, stool consistency and pain on defaecation and no patients complained of side-effects. The biscuits were well tolerated and compliance with therapy was good. In addition to the improvement in bowel symptoms, it was noted that mean body weight was significantly reduced at the end of the study.

Aged↗
PubMed2006

Sodium picosulfate in opioid-induced constipation: results of an open-label, prospective, dose-ranging study.

Identification of a safe and effective dose of the laxative sodium picosulfate was investigated in a single-centre, open-label study of 23 patients (age 40-81 years) receiving > or =60 mg/day morphine sulphate and experiencing constipation. A starting dose of 5, 10 or 15 mg sodium picosulfate (1 mg/mL solution) was administered, based on the patient's clinical status at entry and recent requirements for laxatives. Dose titration was permitted (+/-2.5 or 5 mg increments), to a maximum daily dose of 60 mg. Bowel movements, concomitant medication and need for suppositories or enemas were recorded in daily diaries. Sixteen patients withdrew before the end of the planned 14-day treatment period because of deterioration of the underlying condition. Sodium picosulfate was well-tolerated. Serious adverse events were all related to the underlying condition. A satisfactory response (normal stool consistency, not requiring enemas, suppositories or manual evacuation, no significant adverse event) was achieved in 15/20 evaluable patients. The median daily dose to achieve this was 15 mg (range: 5-30 mg) and the median time to first bowel movement after dosing was 11.75 hours (range: 6-22.5 hours). There was no clear relationship between the opioid dose and the optimum dose of sodium picosulfate, confirming that individual dose titration is necessary.

Adult↗
PubMed2001

Nursing management of constipation in housebound older people.

In this article two algorithms are suggested for use by district nurses in the management of constipation in dependent older people at home. Prescribing for this group of patients requires a complex assessment of medical and social factors as 24-hour supervision is not always available and local health and social service resources may impact on the level of care that is available in terms of the provision of food and drink and the taking of medicines.

Aged↗
PubMedDate not supplied

Constipation: cause and control in an acute hospital setting.

Constipation is not a glamorous subject, but its prevention and management can make a vast difference to patients' quality of life. This literature review identifies causative factors and describes the mode of action, side-effects and contraindications of many remedies currently available. Recommendations include a systematic approach to management in an acute ward setting, based on assessment of risk, maintenance of normal bowel routine and appropriate dietary advice and the use of appropriate pharmaceutical interventions where necessary. To be effective, this process should be underpinned by accurate documentation and the maintenance of a high level of knowledge and awareness among staff.

Acute Disease↗
PubMed2000

Movicol in treatment of constipation and faecal impaction.

To resolve severe constipation or faecal impaction requires the induction of a large increase in faecal water content that hitherto has only been achieved with enemas. A novel iso-osmotic laxative has been shown to achieve a similar effect from oral dosing.

Cathartics↗
PubMed2004

Tegaserod: a serotonin 5-HT4 receptor agonist for treatment of constipation-predominant irritable bowel syndrome.

Activation of serotonin 5-HT(4) receptors has been proposed as treatment for irritable bowel syndrome, a common, complex and distressing gastrointestinal disorder. Abnormal intestinal motility and sensitivity in irritable bowel syndrome patients can result in diarrhea, constipation, abdominal pain, bloating, headache and fatigue; these and other symptoms can lead to exacerbation of psychological stress, which may in turn induce further physiological abnormalities and patient discomfort. The serotonin agonist tegaserod binds with high affinity to 5-HT(4) receptors and has demonstrated potent pharmacological effects on the mid- and distal gut. Tegaserod has been safely employed in clinical trials where it has demonstrated efficacy in normalizing intestinal function, thereby improving irritable bowel syndrome symptoms.

Constipation↗
PubMed1999

Neuronal anomalies and normal muscle morphology at the hypomotile ileocecocolonic region of patients affected by idiopathic chronic constipation.

Patients suffering from idiopathic slow-transit chronic constipation have a delayed colonic transit referable to a decrease or loss of propagating contractions. Myogenic and/or neural mechanisms have been implicated in the pathophysiology of this dysfunction and neuronal abnormalities have been described at the ascending, descending and sigmoid colon. The morphology and motile behaviour of the ileocecocolonic region, which in healthy subjects regulates cecum filling and emptying, have never been investigated in such disease. Therefore, we endoscopically ascertained whether a motility impairment was present at these junctional areas and neither spontaneous nor provoked occlusive contractions were found at the cecocolonic junction. Light and electron microscope examination of the entire colon revealed apparently normal features of neurons, smooth muscle cells and interstitial cells of Cajal, while immunohistochemistry and quantitative analysis demonstrated neuronal anomalies at the junctional areas. These anomalies consisted of low total neuron density and significantly few VIP-immunoreactive neurons at the two enteric plexuses, significantly few NOS-immunoreactive neurons at the myenteric plexus and significantly more NOS-immunoreactive neurons at the submucous plexus. These findings exclude a myopathy and demonstrate the existence of a neuropathy. In particular, the presence at the ileocecocolonic region of few VIP- and NO-producing neurons suggests that there might be a reduced VIP and NO production which may result in a compromised relaxation and/or onset of propagating contractions, slowing down bolus transit. The presence at the proximal colon of such an abnormality might explain why left colectomy and/or cecorectal anastomosis are unsuccessful in patients with this disease.

Adult↗
PubMed2002

Is it more than just constipation?

We report an infant presenting with constipation, whose history and physical examination initiated the investigation that led to the diagnosis of the Currarino triad in the proband and 2 other family members.

Abnormalities, Multiple↗
PubMed2001

Dietary fiber intake, stool frequency and colonic transit time in chronic functional constipation in children.

The objective of the present study was to evaluate associations between fiber intake, colonic transit time and stool frequency. Thirty-eight patients aged 4 to 14 years were submitted to alimentary evaluation and to measurement of colonic transit time. The median fiber intake of the total sample was age + 10.3 g/day. Only 18.4% of the subjects presented a daily dietary fiber intake below the levels recommended by the American Health Foundation. In this group, the median left colonic transit time was shorter than in the group with higher dietary fiber intake (11 vs 17 h, P = 0.067). The correlation between stool frequency and colonic transit time was negative and weak for left colon (r = -0.3, P = 0.04), and negative and moderate for rectosigmoid and total colon (r = -0.5, P<0.001 and r = -0.5, P<0.001, respectively). The stool frequency was lower in the group with slow transit time (0.8 vs 2.3 per week, P = 0.014). In conclusion, most patients with chronic functional constipation had adequate dietary fiber intake. The negative correlation between stool frequency and colonic transit time increased progressively from proximal segments to distal segments of the colon. Patients with normal and prolonged colonic transit time differ in terms of stool frequency.

Adolescent↗
PubMed2006

Pharmacologic management of constipation in the critically ill patient.

STUDY OBJECTIVE: To compare the effectiveness of common laxatives in producing a bowel movement in patients admitted to a medical intensive care unit (MICU). DESIGN: Retrospective medical record review. SETTING: MICU of an academic medical center. PATIENTS: Ninety-five patients admitted to the MICU from July 1-October 31, 2004. MEASUREMENTS AND MAIN RESULTS: Fifty patients satisfied the inclusion criteria. Patient-specific data such as age, weight, sex, length of MICU stay, Acute Physiology and Chronic Health Evaluation (APACHE) II score, dietary intake, opioid intake, laxative intake, and bowel movements were recorded during the first 96 hours of admission. Logistic regression analysis was used to compare patients who did and did not have a bowel movement. Of the 50 patients, 25 did not have a bowel movement during the first 96 hours of MICU admission. Patients given a stimulant laxative (senna, bisacodyl) and/or an osmotic laxative (lactulose, milk of magnesia) were more likely to have a bowel movement (odds ratio [OR] 26.6, 95% confidence interval [CI] 3.2-221, p=0.002). Opioid intake, expressed as logarithmic morphine equivalents, was negatively associated with occurrence of a bowel movement (OR 0.76, 95% CI 0.59-0.97, p=0.027). Disease severity, as determined by APACHE II score, was also negatively associated with a bowel movement (OR 0.84, 95% CI 0.7-0.99, p=0.04). CONCLUSION: Critically ill patients have a high frequency of constipation, and opioid therapy is a significant risk factor. Routine administration of stimulant or osmotic laxatives should be considered for this patient population.

Analgesics, Opioid↗
PubMed1994

Adverse effects of drugs used in the management of constipation and diarrhoea.

Most laxatives, if used intermittently in the absence of contraindications, are relatively safe. Bulking agents may diminish absorption of some minerals and drugs, but this is not usually clinically significant. Ispaghula can cause serious allergic reactions. The chronic ingestion of stimulant laxatives has been blamed for the development of the 'cathartic colon', but there are no definitive studies which have demonstrated this. Dantron (danthron) preparations should only be used in older patients and the terminally ill because of the risk of hepatotoxicity with this drug. Oral oxyphenisatine should no longer be used. Senna would appear to be the stimulant laxative of choice during pregnancy and lactation. Bisacodyl is the polyphenolic derivative of choice. Lactulose, sorbitol and lactilol rarely cause significant adverse effects. Magnesium salt laxatives and phosphate enemas can cause serious metabolic disturbances in babies and young children. Liquid paraffin is contraindicated if there is any risk of aspiration. Interference with the absorption of fat soluble vitamins would not appear to be clinically significant. Docusate sodium may potentiate the hepatotoxicity of other drugs, but reports of this are rare. The role of cisapride in constipation has not been established. Antidiarrhoeal drugs are second line drugs whose use is aimed at minimising inconvenience and discomfort. No antidiarrhoeals can be recommended for children under 4 years of age. Loperamide is the drug of choice in older children and adults. The atropine component of diphenoxylate/atropine combinations can cause significant adverse effects. Bismuth salicylate is an inconvenient treatment for travellers' diarrhoea as large frequent doses of the liquid formulation are needed. Some bismuth can be absorbed and there is the potential to cause encephalopathy. Octreotide, methysergide and cholestyramine have a role for specific causes of diarrhoea only. Octreotide is effective in high output states from the small or large bowel, with few adverse effects. Clonidine and lidamidine may have a role in the treatment of chronic diabetic diarrhoea. The role of lidamidine in nondiabetic chronic diarrhoea has not been established.

Antidiarrheals↗
PubMed1995

Epidemiology of constipation in elderly patients. Drug utilisation and cost-containment strategies.

Constipation is a common complaint among elderly people, resulting in large amounts of money being spent on laxatives. Strategies for improving patient care while reducing this expenditure include: (a) counselling patients that daily bowel movements and purging are not essential to good health, (b) greater use of nonpharmacological measures such as hydration, exercise and dietary fibre, and (c) considering safety, effectiveness and cost in the selection of a laxative. Generic preparations of psyllium and sorbitol can be recommended in this regard. The widespread use of stool softeners, magnesium hydroxide ('milk of magnesia') and stimulant laxatives is difficult to justify from the available data.

Aged↗
PubMed2003

Tegaserod: a review of its use in the management of irritable bowel syndrome with constipation in women.

The treatment of irritable bowel syndrome with constipation (IBS-C) has historically been based on the severity of symptoms, with education, reassurance, dietary advice, bulking agents and laxative therapy offered as appropriate. Tegaserod (Zelnorm, Zelmac) is the first selective serotonin 5-HT(4) receptor partial agonist to be approved for the treatment of this syndrome. Tegaserod is active against multiple irritable bowel syndrome (IBS) symptoms; it stimulates gut motility and reduces visceral sensitivity and pain. The drug does not cure IBS and was not designed to treat the diarrhoea-predominant version. Its efficacy in men has not been established. Three large well designed clinical trials of tegaserod 6 mg twice daily for 12 weeks in patients (mainly women) with IBS-C have demonstrated superiority versus placebo in global relief from symptoms. Global relief response rates were 38.4-46.8% with tegaserod 6 mg twice daily and 28.3-38.8% with placebo (p < 0.05-0.0001 vs placebo). The relative increases in response rates with tegaserod 6 mg twice daily over the already high responses in the placebo groups ranged from 12-65% after 4-12 weeks of treatment. A response was seen within the first week. The proportion of patients with satisfactory relief from symptoms fell over the 4-week period following withdrawal of tegaserod and placebo, but did not reach baseline levels during this time. Diarrhoea has been associated with tegaserod in clinical trials (an incidence of about 10% versus 5% with placebo, usually occurring in the first week of treatment), but the drug is otherwise well tolerated. There were no apparent changes in the tolerability profile with extended tegaserod treatment (</=12 months). In conclusion, oral tegaserod 6 mg twice daily for 12 weeks is effective and well tolerated in the treatment of IBS-C in women. Data on long term and comparative efficacy, cost-effectiveness and quality-of-life effects would be beneficial; however, in light of the fact that very few alternatives for the treatment of IBS-C have proven efficacy, tegaserod appears to be a promising option in women not responding to increased dietary fibre or osmotic laxative therapy.

Biological Availability↗
PubMed2006

Surgery for constipation.

Patients with intractable chronic constipation should be evaluated with physiologic tests after structural disorders and extracolonic causes have been excluded. Conservative treatment options should be tried excessively. If surgery is indicated subtotal colectomy with IRA is the treatment method of choice. However, segmental resection may be a good option for isolated megasigmoid, sigmoidocele or recurrent sigmoid volvulus. In general patients with GID should not be offered any surgical options because of their anticipated poor results. Moreover, patients with psychiatric disorders should be actively discouraged from resection as they tend to have poorer prognosis. Patients must be counseled that preoperative pain and/or bloating will likely persist even if surgery normalizes bowel frequency. Patients with associated problems may be better served by having a stoma without resection as both a therapeutic maneuver and a diagnostic trial. Colectomy is no option to treat pain and/or abdominal bloating.

Chronic Disease↗
PubMed1979

Transit time in constipated geriatric patients during treatment with a bulk laxative and bran: a comparison.

Transit time, as estimated from the passage through the gut of an isotope (131I)-containing capsule, was studied in 10 constipated, geriatric in-patients on a bulk laxative regimen and during treatment with wheat bran. The patients received a conventional bulk laxative (Vi-Siblin, 6 g twice daily) during a period of 8 weeks. The bulk laxative was then replaced by bran (10 g twice daily) during the following 8-week period. Measurements of transit time were taken after 4 and 6 weeks on each regimen. The mean transit time was 126 h for the bulk laxative regimen and 89 h for the bran treatment, the difference being statistically significant. The decrease in transit time for the bran treatment was essentially due to a faster passage through the rectosigmoid part of the bowel. Less additional laxative therapy was needed during bran treatment than during the bulk laxative treatment. The favourable properties of bran may tentatively be explained by the effects remaining in the distal part of the colon. A slight but significant lowering of the serum calcium level and a significant increase of the total iron-binding capacity of the serum were found after 7 weeks of bran administration, whereas no change was observed after 42 weeks. No significant change was demonstrated in serum iron during bran treatment.

Aged↗