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PubMed2003

Risk factors for chronic constipation based on a general practice sample.

OBJECTIVES: Many factors have been associated with the occurrence of constipation, particularly poor diet and lack of exercise. However, the importance of medications and general medical illnesses in constipation remains more uncertain. We aimed to identify risk factors for constipation from among patient clinical, therapeutic, and demographic characteristics. METHODS: The sample was composed of patients explicitly diagnosed with chronic constipation (n = 7251), those diagnosed with constipation of unspecified chronicity (n = 6441), and a sample of controls (n = 7103). All were drawn from a general practice research database representing more than 10 yr of data collection. RESULTS: A large number of clinical and therapeutic factors were independently associated with chronic constipation over and above age and gender. Primary neurological diseases were strongly associated with constipation but accounted for few cases. Opioids (OR = 1.6, population attributable risk [PAR] = 2.6%), diuretics (OR = 1.7, PAR = 5.6%), antidepressants (OR = 1.9, PAR = 8.2%), antihistamines (OR = 1.8, PAR = 9.2%), antispasmodics (OR = 3.3, PAR = 11.6%), anticonvulsants (OR = 2.8, PAR = 2.5%) and aluminum antacids (OR = 1.7, PAR = 3.0%) were associated with the highest risk among medications. CONCLUSIONS: Constipation is common in primary care, and multiple medications seem to be an important contributing factor. Concurrent diseases are also associated but at most are only contributing to a minority of cases.

Adolescent↗
PubMed1990

Anorectal manometry in irritable bowel syndrome: differences between diarrhoea and constipation predominant subjects.

Anorectal manometry with balloon distension was performed on 28 patients with diarrhoea predominant irritable bowel syndrome, 27 patients with constipation predominant irritable bowel syndrome and 30 normal controls. In the diarrhoea predominant group balloon volumes required to perceive the sensations of gas, stool, urgency of defecation and discomfort were significantly lower than in controls or constipation predominant patients (p less than 0.001). Diarrhoea predominant patients also had a significantly lower rectal compliance than controls or constipation predominant patients (p less than 0.03) but showed no difference in motor activity induced by distension. When the constipation predominant patients were compared with controls the only significant difference that emerged was in the volume at which discomfort was perceived. No significant differences between constipated subjects and controls were found in the distension induced motor activity. Symptom severity and psychological parameters were also recorded and the diarrhoea predominant patients were found to be more anxious than those with constipation (p = 0.04). It proved possible (by comparison with the control group) to identify three abnormal rectal subtypes in patients with irritable bowel syndrome. These were a sensitive rectum (low sensation thresholds, normal or low rectal pressure), a stiff rectum (normal or low sensation thresholds, high pressure) and an insensitive rectum (high sensation thresholds, normal or high pressure) and their distribution varied considerably depending on bowel habit. Some form of rectal abnormality was identified in 75% of diarrhoea predominant patients compared with 30% of constipation predominant subjects (p = 0.002). A sensitive rectum was a particular feature of diarrhoea predominant patients being observed in 57% of patients compared with only 7% of the constipated group (p less than 0.001).

Adolescent↗
PubMed2003

Probiotic beverage containing Lactobacillus casei Shirota improves gastrointestinal symptoms in patients with chronic constipation.

BACKGROUND: The aim of the present study was to investigate the effect of a probiotic beverage on gastrointestinal symptoms in patients with chronic constipation. METHODS: A double-blind, placebo-controlled, randomized study was conducted over a four-week period in patients with symptoms of chronic constipation (n=70). To all patients, 65 mL/day of a probiotic beverage containing Lactobacillus casei Shirota (LcS) or a sensorially identical placebo was administered. Patients completed a questionnaire on gastrointestinal symptoms, well-being and stool habits and underwent a medical examination weekly. Severity of constipation, flatulence and bloating was summarized into four categories (severe, moderately severe, mild and no symptoms). RESULTS: The consumption of LcS resulted in a significant improvement in self-reported severity of constipation and stool consistency, starting in the second week of the intervention phase (P<0.0001). Severe and moderately severe constipation was observed less in the LcS group. The occurrence and degree of flatulence or bloating sensation did not change. In the final examination, 89% of the LcS group and 56% of the placebo group showed a positive effect of their beverage on constipation (P=0.003). No adverse reactions were reported. CONCLUSIONS: The results indicate a beneficial effect on gastrointestinal symptoms of patients with chronic constipation. The administration of probiotic foodstuffs may be recommended as an adjunctive therapy of chronic constipation.

Adult↗
PubMed2005

Symptoms and pathophysiological correlations in patients with constipation and functional dyspepsia.

INTRODUCTION: Patients with constipation often report dyspeptic symptoms, but whether constipation is associated with specific dyspeptic symptoms and altered gastrointestinal (GI) motility, remains to be established. Our aim was to study symptoms association and GI motility parameters in patients with constipation and functional dyspepsia. PATIENTS AND METHOD: 42 patients with different symptoms and severity of constipation and dyspepsia were enrolled. Scintigraphic gastric emptying, colonic transit time and gallbladder contraction were studied in all subjects. RESULTS: No significant association was observed between individual symptoms of constipation and dyspepsia. Patients with more severe constipation did not have higher dyspepsia severity scores. Colonic transit time, gastric half emptying and gallbladder contraction were not significantly correlated. Although patients with severe nausea had faster colonic transit than those with absent/mild symptom (19 +/- 2 vs. 48 +/- 7 h; p < 0.05), the multivariate analysis only revealed a significant association between severe postprandial fullness, delayed t1/2 (OR 1.05, CI 1-1.1) and impaired gallbladder contraction (OR 0.94, CI 0.89-0.99). CONCLUSIONS: Constipation was not associated with severity, or any particular dyspeptic symptom. Although motor abnormalities of both colon and proximal GI tract regions existed in the subset of constipated dyspeptic patients, they did not seem associated with the genesis of different dyspeptic symptoms.

Adult↗
PubMedDate not supplied

Constipation in older patients: effects on quality of life.

Constipation, often related to diet, physical immobility, concurrent illness or multiple medication use, is common in older people. Despite potential for serious complications, constipation may often be overlooked. Management of constipation is a critical part of the care of older patients with chronic conditions. Risk assessment and appropriate nursing interventions and/or medication should mean that constipation can be minimized, preventing additional medication burden and reducing the risk of non-adherence. The relationship between quality of life and constipation has been assessed in numerous studies, showing that patients with constipation generally have an impaired quality of life compared with the general population, although studies in older patients are limited. In long-term survivors of colorectal or anal carcinoma, constipation is one of the factors that has the most negative impact on quality of life. Strategies for prevention and minimization of constipation have the potential to substantially improve quality of life for older people.

Aged↗
PubMed2005

Treatment of childhood constipation by primary care physicians: efficacy and predictors of outcome.

OBJECTIVE: Childhood constipation accounts for 3% of visits to general pediatric clinics and as many as 30% of visits to pediatric gastroenterologists. The majority of children who experience constipation and whose caregivers seek medical care are seen by primary care physicians such as pediatricians or family physicians. Little is known about how primary care physicians treat childhood constipation or the success of their treatments. With this study, we prospectively examined which treatments primary care physicians prescribe to children who present for the first time with constipation and how effective those treatments are. METHODS: A total of 119 children who were between 2 and 7 years of age (mean: 44.1 +/- 13.6 months) and presented to 26 different primary care physicians (15 pediatricians and 11 family physicians) for the treatment of constipation for the first time participated in this study. Parents completed daily diaries of their child's bowel habits for 2 weeks before starting treatment recommended by their primary care physician and again 2 months after treatment. The prescribed treatment was identified by reviewing office records of the treating physicians. RESULTS: After 2 months of treatment, 44 (37%) of 119 children remained constipated. In the majority (87%) of cases, physicians prescribed some form of laxative or stool softener. The most commonly prescribed laxatives were magnesium hydroxide (77%), senna syrup (23%), mineral oil (8%), and lactulose (8%). In nearly all cases, a specific fixed dose of laxative was recommended; in only 5% of cases were parents instructed clearly to adjust the dose of laxative up or down to get the desired effect. In approximately half of the cases, physicians recommended some sort of dietary intervention. Some form of behavioral intervention was mentioned in the office records of approximately one third of cases; however, in most cases, little detail was provided. In 45% of cases, physicians prescribed disimpaction using oral cathartics, enemas, or suppositories followed by daily laxatives. In 35% of cases, physicians prescribed daily laxatives without any disimpaction procedure. In the remainder, physicians prescribed only dietary changes (5%), the use of intermittent laxatives (9%), or no therapy (7%). Treatment success corresponded to how aggressively the child was treated. Specifically, children who underwent some form of colonic evacuation followed by daily laxative therapy were more likely to have responded to treatment than were those who were treated less aggressively. CONCLUSION: Primary care physicians tend to undertreat childhood constipation. After 2 months of treatment, nearly 40% of constipated children remain symptomatic.

Cathartics↗
PubMed2004

[Fiber and nutrients intake in children with chronic constipation].

OBJECTIVES: The aim of this case-control study was to evaluate the intake of fiber alimentary and macronutrients in constipated children. METHODS: Fifty-four children (aged 2-12 yr) with diagnosis of chronic functional constipation were investigated at the Pediatric Hospital, "Universidade Federal do Rio Grande do Norte", Natal, RN, Brazil. They were age and sex matched with 50 patients without constipation. A standard questionnaire was applied to both groups and a 3 day dietary record was analyzed by computer software. RESULTS: The mean age at onset of symptoms was 29,0 +/- 26,1 months. There was not sex predominance and no difference about nutritional condition between the groups. Constipated children ate less fiber, proteins, lipids, carbohydrates and less caloric and protein adequated percentuals. The proportion of children who ate less dietary fiber than recommended (age + 5 g /day) was greater in the constipated group (83,3%) than in controls (66,6%); odds ratio 2,6. CONCLUSION: Constipated children ate less fiber and macronutrients than children without constipation. Intake of dietary fiber below the minimum recommendation is a risk factor for chronic functional constipation in children.

Case-Control Studies↗
PubMed1996

Colectomy for severe slow-transit constipation in strictly selected patients.

BACKGROUND: Colectomy for severe constipation has in up to 25% of patients given unsatisfactory results. Failure to cure constipation is in most patients due to rectal dysfunction. The aim of the present study was to evaluate the effect of colectomy in a group of patients who fulfil all the criteria which, with our present knowledge, should predict a favourable result. METHODS: Twelve patients with long-standing severe constipation incurable by dietary regulation and medical treatment with demonstrable slow-transit constipation and normal rectal function entered the study. RESULTS: Ten patients were relieved of their constipation. Two patients continued to be constipated after subtotal colectomy. One had a very highly compliant rectum (preoperatively) with a maximal tolerable volume of 700 ml but normal emptying at defecography and normal emptying of viscous fluid. The patient was subsequently treated with proctectomy and ileo-pouch-anal anastomosis with satisfactory result. One patient with opioid abuse due to abdominal pain was improved by the operation but was still constipated. The opioid abuse continued, however, after the operation owing to continuing abdominal pain. A further three patients complained of abdominal pain, and two developed diarrhoea, one of whom became incontinent. CONCLUSION: Subtotal or segmental colectomy should be considered in a small number of patients with severe constipation provided strict criteria are fulfilled. Excessively high rectal volume tolerability may in spite of normal emptying capacity indicate the risk of development of rectal inertia postoperatively and may be a contraindication for surgery.

Adult↗
PubMed1997

Quality of life in patients with different types of functional constipation.

BACKGROUND: Little information is available about the health-related quality of life (QoL) in patients with different types of chronic constipation. METHODS: We used two self-administered questionnaires, the Psychological General Well-Being (PGWB) index and the Gastrointestinal Symptom Rating Scale (GSRS) to assess QoL and gastrointestinal symptoms in 102 consecutive patients with chronic constipation. The type of constipation was determined from transit time, electrophysiologic investigation of sphincter function, anorectal manometry, and defecography. RESULTS: Overall, our patients with constipation reported low scores for general well-being (mean score, 85.5, compared with 102.9 in a healthy population). Patients with normal-transit constipation (n = 49) reported considerably lower scores in the PGWB than those with slow-transit constipation (n = 35). The symptoms increased frequency of defecation, loose stools, and urgent need for defecation were commoner in normal-transit constipation, which indicates that this group may have a relation to the irritable bowel syndrome. The overall PGWB index was strongly correlated with the total GSRS (P < 0.001). CONCLUSIONS: The general well-being of patients with chronic constipation is lower than that of a comparable normal population. Symptom severity correlates negatively with perceived quality of life.

Adolescent↗
PubMedDate not supplied

[Idiopathic constipation in children: 10-year experience].

Constipation is a frequent clinical disorder in pediatric age and it is often difficult to resolve without a suitable diagnostic and therapeutic approach. Parents and pediatrician often underestimate this pathology, reaching the specialist only when it has already shown its complications. In the Department of Pediatric Surgery of Siena, in the last 10 years, we have activated a study centre on constipation in the pediatric age and we have developed a diagnostic and therapeutic protocol to give indications on the type of constipation and the consequent therapy. The Authors report their experience on 174 children with chronic constipation. The patients underwent a scintigraphic colonic transit time evaluation by radionuclides, an enema and an anorectal manometry. Such examinations were able to divide patients into two groups: with colonic and rectal constipation. The management consisted in common dietetic, behavioural and pharmacological treatment at first and then of specific treatment (biofeedback, prokinetic, emicolectomy), according to the type. The follow up showed recovery or improvement in 83.53% cases, unchanged clinical condition in 8.57%, aggravation in 1.9%. The Authors conclude emphasising the importance of diagnostic techniques that allow to frame correctly the pediatric patient affected by constipation. Particularly the anorectal manometry can be considered a first level examination, able to identify rectal constipation; together with scintigraphic colonic transit time that individualizes colonic constipation. The right diagnosis will be able to give a suitable therapeutic treatment.

Adolescent↗
PubMed2001

Substance P in rectal mucosa of children with chronic constipation.

Substance P content was determined by radioimmunoassay in rectal mucosa of 17 children with idiopathic constipation and 9 with normal bowel movements who were used as controls. In children with chronic idiopathic constipation, rectal mucosa substance P levels were lower than levels in the control group: 47.6 +/- 11 vs. 79.4 +/- 11 pg/mg net weight respectively (differences not statistically significant). Substance P levels in rectal mucosa of children with soiling (11/17) did not differ from those of chronically constipated children without soiling (46.0 +/- 16 vs. 50.5 +/- 19 pg/mg net weight). In children with constipation, substance P levels did not correlate either with age or duration of symptoms. Substance P levels in normal controls were similar to levels previously observed in non-constipated adults, whereas levels in constipated children were intermediate between levels observed in healthy subjects and levels in adults with chronic constipation. These findings may point to a motility derangement as a possible factor in the pathogenesis of chronic constipation in childhood.

Case-Control Studies↗
PubMed2001

[The epidemiology of irritable bowel syndrome and functional constipation of Guangzhou residents].

OBJECTIVE: To investigate the prevalence rates of irritable bowel syndrome (IBS) and functional constipation in Guangzhou City. METHODS: A structured history using a questionnaire on gastrointestinal symptoms during the preceding one year was obtained from random sampling 2,892 residents, 1,006 consecutively patients who visited general practitioner and 495 consecutively patients who visited gastroenterologists. All the questionnaires were filled by trained doctors. RESULTS: The overall prevalence rates of irritable bowel syndrome and functional constipation in Guangzhou City were 5.6% and 3.0%. There were 10.1%, 34.3% and 5.4%, 4.8% visitors who complained IBS and functional constipation in the general internal outpatient department and gastrointestinal outpatient department. The female was predominant in both IBS and functional constipation. The ratio of male to female was 1:1.51 and 1:1.77. With the increase of age, the prevalence rate of functional constipation rose; but IBS did not. There were 23.9% IBS patients and 17.6% functional constipation patients who had ever seen a doctor for these diseases in the community. The percentages of IBS subclasses were as the following: diarrhea predominant: 63.2%; constipation predominant: 27.0%; others: 9.8%. CONCLUSION: The prevalence rates of IBS and functional constipation in Guangzhou City were lower than that in west countries.

Adolescent↗
PubMedDate not supplied

Regulation of the enteric nervous system in the colon of patients with slow transit constipation.

BACKGROUND/AIMS: The cause of impaired motility in patients with slow transit constipation is unknown. To clarify the physiological significance of cholinergic, adrenergic, non-adrenergic non-cholinergic inhibitory nerves in the colon of patients with slow transit constipation, we investigated the enteric nerve responses on lesional and normal bowel segments derived from patients with slow transit constipation and patients who underwent colon resection for colonic cancers. METHODOLOGY: Twenty preparations were taken from the lesional colon of 6 patients with slow transit constipation (2 men and 4 women, aged 23 to 68 years, with a mean age of 44.0 years). Thirty-six preparations were taken from the normal colon of 12 patients with colonic cancer (6 men and 6 women, aged 40 to 60 years, with a mean age of 52.2 years). A mechanographic technique was used to evaluate in vitro muscle responses to acetylcholine, adrenalin, electrical field stimulation of adrenergic and cholinergic nerves before and after treatment with various autonomic nerve blockers. RESULTS: The contraction reaction to acetylcholine in the colon with slow transit constipation was significantly weaker than in the normal colon (P < 0.01). The relaxation reaction to adrenalin in the colon with slow transit constipation was stronger than in the normal colon. The colon with slow transit constipation was more strongly innervated by non-adrenergic non-cholinergic inhibitory nerves than the normal colon, significantly (P < 0.05). CONCLUSIONS: These findings suggest that a decrease of cholinergic nerve and an increase of non-adrenergic non-cholinergic inhibitory nerve play an important role in the impaired motility observed in the colon of patients with slow transit constipation.

Acetylcholine↗
PubMed2003

Differential therapy of constipation--a review.

Constipation is a common condition occurring with increasing frequency in advanced age. As a symptom, it is not always dealt with directly by the physician, but is often left to the care of nurses. Many patients rely on self-medication. Constipation not only interferes with the quality of life, but often has the rank of a syndrome requiring competent medical intervention. This is of clinical importance, because a thorough understanding of the pathophysiology of constipation enables the clinician to identify the potential causes and, if necessary, initiate a differentiated therapy with the aid of only simple additional investigations. This review outlines a clinical approach including medical history, spectrum of causes, radiopaque pellets method to differentiate between slow transit constipation and defecation disturbances for the differential diagnosis of constipation. The mechanisms of action of laxatives (anti-absorptive, secretagogue, osmotic, filling and swelling agents) are further components and important for the individual therapy. Based on this fundamental information, a differentiated therapy is possible in each specific case such as coprostasis. Chronic symptomatic constipation reduces the quality of life and should be evaluated by physicians. If situations such as drug-induced constipation or hypothyroidism which have to be treated causally can be ruled out, laxative treatment according to the clinical picture, mode of action of drug used and side effects of the laxative can be initiated. Laxative abuse due to chronic constipation is rare and almost always associated with psychosomatic-psychiatric disorders.

Cathartics↗
PubMed2004

[Scintigraphic assessment of the anorectal function in children with idiopathic constipation].

OBJECTIVE: The ability of the rectum to evacuate is valuable information in patients with constipation, or those who find defecation difficult. However, few published studies are available to evaluate this ability in most common examinations of anorectal function. A new, low-radiation, real-time scintigraphic technique has been used by several investigators to outline the 'neo-rectum' following ileoanal pouch anastomosis and the efficiency of rectal evacuation in adult patients with constipation. There was no similar report about the abilities of rectal evacuation in children with constipation. The aim of this study was to investigate the value and reliability of isotope defecography as an objective method for evaluation of anorectal function in patients with chronic idiopathic constipation. METHODS: Twenty five patients (10 were male and 15 were female, range of age was 5 - 15 years, mean age 8.99 years) suffering from chronic idiopathic constipation and 11 normal children were assessed by isotope defecography. The radiopharmaceuticals used were rehydrated potato labelled with 200 MBq (99m)TcO(4)(-). The volume of the potato paste used in each subject was determined by prior balloon proctometrogram studies, which measured the maximum rectal capacity. The patient was seated upright on a commode, and the computer was then set for the dynamic acquisition of 3-second images over 5 min per session. Using a region of interest program on computer, the dynamic radioactivity in anorectum during defecation showed as emptying curves by computer. The half defecation time, the rectal emptying rate and the residual rate could be calculated from the rectal emptying curves. The anorectal angles were measured from the images of anorectum during resting, squeezing and evacuation. All patients underwent X-ray defecography and colonic transit time measurement simultaneously. RESULTS: The rectal emptying curves showed a prompt evacuation in normal children, but it disappeared in most of patients with idiopathic constipation. The abilities of evacuation were damaged severely in patients. In normal group the half defecation time, the rectal emptying rate and the residual rate were 1.97 +/- 0.86 minutes, 78.30% +/- 12.03% and 20.50% +/- 7.67%, respectively, whereas they were 15.16 +/- 3.67 minutes, 44.84% +/- 14.00% and 53.52% +/- 15.02%, respectively, in patients group. There were significant differences between two groups (P < 0.05). According to the results of colonic transit time there were 6 patients with slow transit constipation, 17 patients with outlet dysfunction and 2 patients with normal colonic transit time. The abilities of evacuation were more seriously impaired in patients with outlet dysfunction compared with those patients with slow transit constipation. For the isotope defecography the mean anorectal angles at resting in patient group and normal group were 109 +/- 12 degrees and 101 +/- 17 degrees. There were no significant differences in anorectal angles between patient group and normal group or by both methods of isotope defecography and X-ray defecography. The correlation coefficients for anorectal angles at resting, squeezing and evacuation were 0.87, 0.82 and 0.73, respectively. CONCLUSION: The isotope defecography can be used to evaluate the anorectal function and the ability of defecation dynamically, also it was simple and safe because of the low dose radiation involved.

Adolescent↗
PubMed2004

[Effect of ear mushroom (Auricularia) on functional constipation].

BACKGROUND/AIMS: Constipation is one of the most prevalent gastrointestinal complaints. High fiber intake is recommended as an initial therapy for constipation. Ear mushroom is known to have higher fiber contents about 50% than other mushroom. The aim of this study was to evaluate the effect of fiber supplements using ear mushrooms on the improvement of functional constipation. METHODS: We conducted a double blind study with 3 groups (placebo, ear mushrooms alone, and ear mushrooms with additives including cascara sagrada, etc.), which were randomly assigned out of 34 patients with functional constipation, defined by modified Rome II criteria. Number of bowel movement, straining, sense of incomplete evacuation, stool consistency, satisfactory relief, abdominal pain/discomfort and colon transit time were evaluated and analyzed before, during and after the treatment. RESULTS: Both ear mushrooms alone and ear mushrooms with additives significantly improved number of bowel movement, straining, sense of incomplete evacuation, stool consistency and satisfactory relief in patients with functional chronic constipation (p<0.05). Although the use of ear mushrooms with additives was found to be more effective on the improvement of constipation than ear mushrooms alone, it may induce abdominal discomfort or pain. CONCLUSIONS: In patients with functional constipation, fiber supplements using ear mushrooms significantly improved constipation related symptoms without serious side effect.

Adult↗
PubMed2006

Evaluation and treatment of constipation in infants and children.

Constipation in children usually is functional and the result of stool retention. However, family physicians must be alert for red flags that may indicate the presence of an uncommon but serious organic cause of constipation, such as Hirschsprung's disease (congenital aganglionic megacolon), pseudo-obstruction, spinal cord abnormality, hypothyroidism, diabetes insipidus, cystic fibrosis, gluten enteropathy, or congenital anorectal malformation. Treatment of functional constipation involves disimpaction using oral or rectal medication. Polyethylene glycol is effective and well tolerated, but a number of alternatives are available. After disimpaction, a maintenance program may be required for months to years because relapse of functional constipation is common. Maintenance medications include mineral oil, lactulose, milk of magnesia, polyethylene glycol powder, and sorbitol. Education of the family and, when possible, the child is instrumental in improving functional constipation. Behavioral education improves response to treatment; biofeedback training does not. Because cow's milk may promote constipation in some children, a trial of withholding milk may be considered. Adding fiber to the diet may improve constipation. Despite treatment, only 50 to 70 percent of children with functional constipation demonstrate long-term improvement.

Child↗
PubMed1993

The constipated serviceman: prevalence among deployed U.S. troops.

The prevalence of constipation in deployed servicemen was determined in a sample of military personnel aboard the USS Iwo Jima LPH 2 during Operation Desert Shield. Results were obtained from a bowel function questionnaire issued to 500 deployed marines and sailors. When constipation is defined as no bowel movement for greater than 3 days, 3.9% of the Marine/sailor personnel are constipated when in their home environment as compared to 6.0% when they are aboard ship and 30.2% while in the field. Alternatively, when constipation is defined as the presence of certain anorectal complaints (hard stools, straining, painful defecation, and bleeding with defecation), the incidence is 7.2% when at home as compared to 10.4% aboard ship and 34.1% in the field. These results confirm that whether constipation is defined as infrequent bowel movements or presence of symptoms of constipation, significantly more servicemen will be constipated when in the field as compared to their home environment. Since approximately one-third of Navy/Marine Corps personnel deployed in a field environment will be constipated, preventive measures ought to be evaluated.

Adolescent↗