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Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12792705&dopt=Abstract constipation laxative
Braz J Med Biol Res. 2003 Jun;36(6):753-9. Epub 2003 Jun 03.
Dietary fiber, energy intake and nutritional status during the treatment of children with chronic constipation.
Speridi o PG, Tahan S, Fagundes-Neto U, Morais MB.
Programa de P s-Gradua o em Nutri o, Departamento de Pediatria, Escola Paulista de Medicina, Universidade Federal de S o Paulo, S o Paulo, SP, Brasil.
The present prospective study was carried out to determine dietary fiber and energy intake and nutritional status of children during the treatment of chronic constipation. Twenty-five patients aged 2 to 12 years with chronic constipation were submitted to clinical evaluation, assessment of dietary patterns, and anthropometry before and after 45 and 90 days of treatment. The treatment of chronic constipation included rectal disimpaction, ingestion of mineral oil and diet therapy. The standardized diet prescribed consisted of regular food without a fiber supplement and met the nutrient requirements according to the recommended daily allowance. The fiber content was 9.0 to 11.9 g for patients aged less than 6 years and 12.0 to 18.0 g for patients older than 6 years. Sixteen patients completed the 90-day follow-up and all presented clinical improvement. The anthropometric variables did not change, except midarm circumference and triceps skinfold thickness which were significantly increased. Statistically significant increases were also found in percent calorie intake adequacy in terms of recommended daily allowance (55.5 to 76.5% on day 45 and to 68.5% on day 90; P = 0.047). Percent adequacy of minimum recommended daily intake of dietary fiber (age + 5 g) increased during treatment (from 46.8 to 52.8% on day 45 and to 56.3% on day 90; P = 0.009). Food and dietary fiber intake and triceps skinfold thickness increased during follow-up. We conclude that the therapeutic program provided a good clinical outcome.
Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12790924&dopt=Abstract constipation laxative
Colorectal Dis. 2002 Nov;4(6):477-82.
Treatment of constipation in adults associated with idiopathic megarectum by behavioural retraining including biofeedback.
Mimura T, Nicholls T, Storrie JB, Kamm MA.
St Mark's Hospital, London, UK.
BACKGROUND: Constipation in adults associated with a grossly dilated rectum and recurrent faecal impaction, idiopathic megarectum, is rare. The aetiology of idiopathic megarectum is unknown, but may involve neuromuscular or behavioural factors. It is unknown whether the condition is reversible. This study aimed to determine the efficacy of behavioural therapy, including biofeedback, in such patients. METHODS: Six patients (4 female; median age 27) with a history of rectal faecal impaction and a grossly dilated rectum on radiological examination were evaluated by structured questionnaire before, immediately after biofeedback therapy, and on follow-up. Physiological testing was performed before treatment, and 2 patients were evaluated by repeat physiological testing and contrast radiology on follow-up. RESULTS: On median follow-up of 18 months (range 11-27), five patients felt major and one patient minor improvement in symptoms, including two with complete symptom relief. Four patients came off laxatives without recurrent faecal impaction. In the 2 studied patients rectal size did not appear to decrease. CONCLUSION: Behavioural retraining, including biofeedback, improved symptoms in most patients with idiopathic megarectum. In some patients symptoms completely resolved, without the need for laxatives. Although further studies are necessary in terms of both larger number of patients and longer follow-up period, behavioural treatment may be useful for such patients.
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Colorectal Dis. 2001 Nov;3(6):392-5.
Long-term results of subtotal colectomy for severe slow-transit constipation in patients with normal rectal function.
Aldulaymi BH, Rasmussen OO, Christiansen J.
Department of Surgery, D Herlev Hospital, University of Copenhagen.
OBJECTIVE: The outcome of subtotal colectomy for severe constipation may be difficult to predict. One factor, which probably is of major importance for the functional outcome, is rectal function. The aim of the study has been to evaluate long-term results after subtotal colectomy with ileo-rectal anastomosis in a group of patients with severe slow-transit constipation but without evidence of impaired rectal emptying. PATIENTS AND METHODS: Of 273 patients with constipation referred for surgical evaluation 18 (7%) fulfilled our criteria for subtotal colectomy. Slow-transit was confirmed by radio-opaque marker studies and normal rectal function by emptying of viscous fluid and normal emptying at defecography. RESULTS: At follow up between 3 and 9 years 15 patients had a bowel frequency between 2 and 6 daily. One patient, who had an ileostomy because of anastomotic leak, had not wanted bowel continuity restored. One patient with opiate abuse became less constipated with 2-3 bowel movements a week. One patient was still constipated one year after the operation and subsequently had an ileal pouch-anal anastomosis. This patient who had normal rectal emptying had a very high volume tolerability with a maximum tolerable volume of 700 ml. In 4 of 7 patients abdominal pain persisted after the operation, and 3 developed diarrhoea, which required daily intake of loperamide. CONCLUSION: Subtotal colectomy for severe slow-transit constipation is justified provided anorectal function is normal. In spite of normal rectal emptying very high rectal volume tolerability may be an indicator of functional megarectum and impaired rectal emptying postoperatively.
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Saudi Med J. 2003 May;24(5):S38.
Surgical management of chronic unremitting constipation and incontinence associated with massive elongation of left colon.
Mustafawi AR.
Department of Pediatric Surgery, Al-Wasl Maternity and Pediatric Hospital, Dubai, United Arab Emirates.
Aim of the study: Functional constipation rarely responds to medical management once huge delco sigma, the atomic baggy rectum or elongation of left colon has developed. We describe the treatment of 7 children with this difficult clinical problem by surgical management. Method: Seven children aged 3-11 years with a history of unremitting constipation and incontinence were referred for evaluation after failing medical management. All patients had normal lumbo sacrum, normal rectal biopsies, normal location of anus. However, 5 patients demonstrated a massive elongation of left colon and in 2 patients barium enema showed atomic baggy rectum. All of them had anal muscle stimulation, which was normal pre-operative. The elongated part of the left colon was resected as well as dilated rectum anastomosing the rest of the normal colon. Mean follow-up was 18 months. Results: Constipation and incontinence resolved within less than 2 months in 5 patients. The other 2 patients required some laxatives for 3-4 months after which they became normal. Barium enema obtained in 4 patients without evidence of recurrent elongation.
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Med Sci Monit. 2003 May;9(5):CR191-6.
Colonic pacing in patients with constipation due to colonic inertia.
Shafik A, Shafik AA, El-Sibai O, Ahmed I.
Dept.of Surgery and Experimental Reseearch.
BACKGROUND: The colon exhibits electrical activity in the form of pacesetter potentials (PPs) and action potentials (APs); no activity is recorded in total colonic inertia (TCI). Electrical activity mediates colonic motility. We have elsewhere demonstrated that 4 pacemakers initiate colonic electric activity. We investigated the hypothesis that the absence of electric activity in TCI is due to non-functioning pacemakers and that their stimulation produces colonic motility and defecation. MATERIAL/METHODS: 19 patients with TCI were divided into 2 groups: a study group of 11 patients (age 42.6I6.8 years; 7 women) and a control group of 8 patients (age 41.4I6.3 years, 5 women). 7 healthy volunteers (age 40.9I6.1 years, 5 women) were also studied. Pacing electrodes were endoscopically hooked to colonic mucosa: one stimulating and 2 or 3 recording. Stimulating electrodes were applied to the 4 potential pacemaker sites located at the cecal pole, the cecocolonic junction, the mid-transverse colon, and the colosigmoid junction. Electrical activity was recorded before and during electrical stimulation. RESULTS: Colonic pacing of healthy volunteers caused a significant increase in the frequency, amplitude and conduction velocity of basal electric waves. Colonic pacing in the study group produced PPs and APs, which varied between colonic segments. No waves were recorded from the control group in which the pacemakers were not activated. CONCLUSIONS: Colonic pacing produces electrical activity in patients with TCI. This method can be applied for the treatment of constipation in these patients.
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Rev Esp Enferm Dig. 2003 Mar;95(3):181-5, 186-90.
Measuring colonic transit time in chronic idiophatic constipation.
[Article in English, Spanish]
Husni-Hag-Ali R, Gomez Rodriguez BJ, Mendoza Olivares FJ, Garcia Montes JM, Sachez-Gey Venegas S, Herrerias Gutierrez JM.
Servicio de Aparato Digestivo. Hospital Universitario Virgen Macarena. Sevilla, Spain.
RESULTS: the average total colonic transit time was 38.2 hours in normal transit and 103 hours with disorder. The frequency in the three colonic segments, when there was a long total colonic transit time, was: 40% in the left colon, 33% in the recto-sigmoid and 27% in the right colon. We analysed the clinical characteristics of these three groups, finding more frequency of painful evacuation and defecation de-sire and lower dietary fibre intake in recto sigmoid. The most important abnormality in anorectal manometry was the hiposensitivity in the anorectal area, that only appeared in subjects with long segmental transit time in the right colon (colonic inertia), statistically significant. CONCLUSIONS: the measurement of colonic transit time with radio-opaque markers is a simple technique that allows for the objective detection of the different groups of patients with chronic idiopathic constipation. The exact typification of the abnormality is important for the individualization of each treatment.
Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12743445&dopt=Abstract constipation laxative
Digestion. 2003;67(1-2):82-9.
Prucalopride is effective in patients with severe chronic constipation in whom laxatives fail to provide adequate relief. Results of a double-blind, placebo-controlled clinical trial.
Coremans G, Kerstens R, De Pauw M, Stevens M.
Department of Gastroenterology, University Hospital Gasthuisberg, Catholic University Leuven, Leuven, Belgium.
BACKGROUND: Chronic constipation (CC) is common and there is a need for more effective and better-tolerated agents that normalize bowel function without affecting secretion. Prucalopride is a novel, selective serotonin(4) receptor agonist with enterokinetic properties. AIMS: Pilot study to compare the efficacy and tolerability of prucalopride and placebo in patients with severe CC referred to a tertiary centre. METHODS: After 4-weeks' run in, patients were randomized to 4 weeks' once daily, double-blind treatment with either prucalopride 4 mg (n = 27) or placebo (n = 26). A 50% dose reduction after 2 weeks' treatment was possible for patients with an excessive gastrointestinal response to the study medication (severe cramps, abdominal pain, and diarrhea). Patients assessed efficacy using a visual analogue scale (VAS) and recorded bowel function in daily diaries. The investigator assessed efficacy and total gut transit time (marker study). RESULTS: Patient VAS assessment demonstrated that prucalopride was significantly more effective than placebo in softening stools, and decreasing straining and time to first stool. Prucalopride also had a positive effect on stool frequency, feeling of complete evacuation and total gut transit time, although these differences were not statistically significant compared with placebo. The most common adverse events were gastrointestinal symptoms and headache; most were mild to moderate. There were no clinically relevant effects on cardiovascular or laboratory parameters. CONCLUSIONS: Once-daily prucalopride 4 mg for 4 weeks is effective and well tolerated in patients with severe CC. It improves whole gut transit, reducing straining, softening stools and reducing time to first bowel movement.
Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12742205&dopt=Abstract constipation laxative
J Am Coll Surg. 2003 May;196(5):729-34.
Study of the role of the second defecation reflex: anorectal excitatory reflex in the pathogenesis of constipation.
Shafik A, Shafik AA, El-Sibai O, Ahmed I.
Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, Cairo, Egypt.
BACKGROUND: Previous studies have shown that anal distension caused rectal contraction, an action mediated through the anorectal excitatory reflex. Anal anesthetization aborted rectal contraction and rectal evacuation was induced by excessive straining. We investigated the hypothesis that inhibition or absence of the anorectal excitatory reflex could lead to constipation. METHODS: We studied 18 patients (mean age +/- SD: 40.6 +/- 5.8 years, 14 women) with rectal inertia, 14 (41.7 +/- 6.6 years, 12 women) with puborectalis paradoxical syndrome, and 10 healthy volunteers (37.9 +/- 4.8 years, 8 women). The rectum was filled with normal saline until urge and then evacuated; residual fluid was calculated. The anal and rectal pressure response to anal balloon distension in increments of 2 mL of saline was recorded by a two-channel microtip catheter. RESULTS: In the healthy volunteers, saline was evacuated as a continuous stream without straining except occasionally at the start of evacuation; no residual fluid was encountered. Anal balloon distension effected notable rectal pressure increase. In rectal inertia patients, evacuation occurred in small fluid gushes produced with excessive straining; residual fluid of large volume was collected. Anal balloon distension up to 10 mL produced no notable rectal pressure changes. The patients with PPS failed to evacuate more than a few mL of fluid despite excessive straining; the volume of residual fluid was considerable. Anal balloon distension caused a notable rectal pressure rise. The results were reproducible. CONCLUSIONS: These results suggest that the defecation reflexes (rectoanal and anorectal) are absent in rectal inertia patients and this presumably denotes a neurogenic disorder. The anorectal reflex is active in puborectalis paradoxical syndrome, but the rectoanal reflex is not, indicating a possible myogenic defect in the puborectalis muscle.
Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12739323&dopt=Abstract constipation laxative
Clin Cornerstone. 2002;4(4):11-21.
A clinical approach to constipation.
Faigel DO.
Division of Gastroenterology, Oregon Health & Science University, Portland VA Medical Center, Portland, Oregon, USA.
The economic impact of constipation is large. The condition prompts an estimated 2.5 million physician visits per year, with 100,000 referrals to gastroenterologists. Almost all (85%) of these physician visits result in a prescription for a laxative. Each year, American spend approximately $800 million on laxatives. For patients referred for diagnostic evaluation, the average cost is approximately $3000, mostly due to the cost of colonoscopy. This article discusses the pathophysiology of constipation and presents a practical approach to evaluating and treating this disorder.
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Am J Gastroenterol. 2003 Apr;98(4):857-64.
Constipation, laxative use, and colon cancer in a North Carolina population.
Roberts MC, Millikan RC, Galanko JA, Martin C, Sandler RS.
Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
The aim of this study was to determine whether bowel movement frequency and laxative use and type were associated with risk of colon cancer in white and black men and women.We conducted a population-based, case-control study with equal representation by blacks. Eligible subjects between ages 40 and 80 yr residing in urban and rural communities in North Carolina were asked about bowel habits and laxatives during face-to-face interviews. There were 643 cases (349 white, 294 black) and 1048 controls (611 white, 437 black).Constipation, defined as fewer than three reported bowel movements per wk, was associated with a greater than two-fold risk of colon cancer (OR 2.36; 95% CI = 1.41-3.93) adjusted for age, race, sex, and relevant confounders. The association was greater for women (OR 2.69; 95% CI = 1.46-4.94) than for men (OR 1.73; 95% CI = 0.61-4.88) and stronger in blacks than whites. Black women had the highest risk (OR 3.42; 95% CI = 1.60-7.34), which remained significant (OR 3.21; 95% CI = 1.46-7.04) even after excluding subjects with late stage (distant) disease. The OR for constipation was slightly higher for distal than for proximal colon cancers. There was no association with laxative use (OR 0.88; 95% CI = 0.69-1.11). Fiber commercial laxatives appeared to exert a protective effect in a small subgroup.This study provides support for a positive association between constipation and increased risk for colon cancer. Women, especially black women with constipation, seem to be at the highest risk.
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Am J Gastroenterol. 2003 Apr;98(4):750-8.
Pharmacologic therapy for the irritable bowel syndrome.
Talley NJ.
Mayo Clinic Rochester, Charlton Building 8-110, 200 First Street, S.W., 55905, Rochester, MN, USA
The management of the irritable bowel syndrome (IBS) remains unsatisfactory. For abdominal pain, antispasmodics are, at best, of only modest efficacy. Tricyclic antidepressants in low dose are useful (with the number needed to treat being three), but side effects and patient concerns regarding use of a centrally acting agent for depression remain limitations. Selective serotonin reuptake inhibitors are of uncertain efficacy in IBS. Opioid agonists, especially loperamide, are useful for diarrhea but not for pain in IBS; rebound constipation also remains a problem. Bile salt sequestering agents are not of established value in IBS but seem to be useful clinically in a small group of IBS patients with diarrhea. Aloestron, a 5HT(3) antagonist, should be reserved, if available, for women with severe diarrhea predominant IBS who have failed to respond to conventional therapy, and started at a low dose. Fiber and bulking agents may help constipation in some trials, but the evidence that they are efficacious in IBS is equivocal; they are frequently prescribed as first-line drugs for IBS regardless of the primary bowel disturbance but often increase bloating, gas, and pain. Laxatives are not of established value in IBS but are often taken by patients with constipation predominant IBS. Tegaserod, a partial 5HT(4) agonist, is now available in the United States and other countries for use in women with IBS whose primary bowel symptom is constipation; its efficacy in men and in those with alternating bowel habits is unknown. Probiotics are of uncertain efficacy. Chinese herbal medicine data are insufficient. Other new drugs in development include the cholecystokinin antagonists and novel visceral analgesics. Both current and potential therapies for IBS are reviewed in this article.
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Appl Psychophysiol Biofeedback. 2003 Mar;28(1):47-61.
Biofeedback therapy in the colon and rectal practice.
Jorge JM, Habr-Gama A, Wexner SD.
Department of Coloproctology, University of Sao Paulo, Sao Paulo, Brazil.
In coloproctology, biofeedback has been used for more than 20 years to treat patients with fecal incontinence, constipation, and rectal pain. It can be performed in a number of conditions with minimal risk and discomfort. However, it does require the presence of some degree of sphincter contraction and rectal sensitivity. Biofeedback can be time-consuming and demands motivation. The purpose of this paper is to review the indications, methodology, and results of anorectal biofeedback in the treatment of these disorders. Mean success rates for biofeedback range from 72.3% for fecal incontinence of diverse etiology, 68.5% for constipation attributable to paradoxical puborectalis syndrome, and 41.2% for idiopathic rectal pain. However, criteria to define success vary tremendously among researchers and there is a tendency to indicate biofeedback in a myriad of conditions when other therapeutic options, including surgery, fail or are inappropriate. These factors make comparison of the results difficult and reinforce the need for randomized controlled trials and studies assessing long-term follow-up. In summary, biofeedback is a simple, cost-effective, and morbidity-free technique and remains an attractive option, especially considering the complexity of the functional disorders of the colon, rectum, anus, and pelvic floor.
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Am J Chin Med. 2003;31(1):129-35.
Effect of dai-kenchu-to on obstructive bowel disease in children.
Ohya T, Usui Y, Arii S, Iwai T, Susumu T.
Department of Surgery, Tokyo Medical and Dental University, School of Medicine 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
The aim of this study was to evaluate the effects of a traditional Chinese herbal medicine, dai-kenchu-to (DKT), on obstructive bowel diseases in children. We have treated 46 pediatric patients with various obstructive bowel diseases with DKT: six patients with postoperative ileus, 12 with large abdominal surgery (including three neonates), one with ano-rectal anomaly, three with Hirschsprung's disease, two with functional bowel obstructions, one with SMA syndrome, and 21 patients with chronic constipation. DKT (0.1-0.15 g/kg) was mixed with 5-10 ml of warm water, and was given orally two to three times a day. DKT was effective for 39 patients (85%) and their clinical symptoms improved. DKT was ineffective in seven patients: two with postoperative ileus, two with Hirschsprung's disease, and three with chronic constipation. DKT had mild but significant effects for various obstructive bowel diseases in children, while no side effects were encountered.Our current strategy for pediatric patients with obstructive bowel disease is to use DKT first and then test its efficacy. If DKT is effective, the regimen is continued. However, in cases where DKT is not effective, we will consider laparotomy or will further investigate the illness.
Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12720201&dopt=Abstract constipation laxative
J Pediatr Surg. 2003 May;38(5):819-23.
Combined approach to functional constipation in children.
Amendola S, De Angelis P, Dall'oglio L, Di Abriola GF, Di Lorenzo M.
Digestive Surgery and Endoscopic Unit and the Department of Gastroenterology, Bambino Gesu Children's Hospital, Rome, Italy, and the Department of Surgery, University of Montreal, Ste-Justine Hospital, Montreal, Quebec, Canada.
Background/Purpose: The authors' 15-year experience with children shows a high percentage of recurrence of functional constipation (FC) with conventional treatment. These data, confirmed in the international literature, led them to develop a new therapeutic approach. The aim of this study was to achieve intestinal control and avoid recurrence of FC in children through use of medical-psychological treatment. METHODS: The authors studied 25 children (18 boys; mean age, 4.7 years; range, 2.10 to 7), 20% of whom had anal fissure, 30% retentive soiling, 52% pain on defecation, and 88% fecal retention owing to FC. Children and parents were questioned about eating and sleeping habits, school, toilet training, and daily routine. Treatment included increasing water and fiber intake, laxatives, and family therapy including making rules and working on autonomy and paternal role. RESULTS: Mean onset of FC was 3.5 years, after "stressful events" in 88%. The questionnaire shows that 68% lacked parental autonomy and authority; 84% of children decided on their own about eating habits and sleeping; 68% had a "peripheral" father with a mother-child symbiotic relationship. After one month of therapy, 92% of children showed a modification of at least 2 behavioral patterns; after 3 months, 88% had regular bowel movements. During follow-up (range, 6 to 28 months), 48% had 2 or 3 recurrent episodes. After one year, 68% had reinforced the new behavioral patterns with resolution of the pathologic aspects. CONCLUSIONS: A multidisciplinary approach in the treatment of childhood functional constipation showed consistent therapeutic results by making rules and by equalizing family roles.
Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12715585&dopt=Abstract constipation laxative
Paediatr Nurs. 2003 Apr;15(3):20-1.
Reflexology in the management of encopresis and chronic constipation.
Bishop E, McKinnon E, Weir E, Brown DW.
Encopresis or faecal incontinence in children is an extremely distressing condition that is usually secondary to chronic constipation/stool withholding. Traditional management with enemas may add to the child's distress. This study investigated the efficacy of treating patients with encopresis and chronic constipation with reflexology. An observational study was carried out of 50 children between three and 14 years of age who had a diagnosis of encopresis/chronic constipation. The children received six sessions of 30-minutes of reflexology to their feet. With the help of their parents they completed questionnaires on bowel motions and soiling patterns before, during and after the treatment. A further questionnaire was completed by parents pre and post treatment on their attitude towards reflexology. Forty-eight of the children completed the sessions. The number of bowel motions increased and the incidence of soiling decreased. Parents were keen to try the reflexology and were satisfied with the effect of reflexology on their child's condition. It appears that reflexology has been an effective method of treating encopresis and constipation over a six-week period in this cohort of patients.
Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12712361&dopt=Abstract constipation laxative
Pediatr Surg Int. 2003 Apr 24 [Epub ahead of print].
Fecoflowmetric evaluation of anorectal function and ability to defecate in children with idiopathic chronic constipation.
Kayaba H, Hebiguchi T, Yoshino H, Mizuno M, Saitoh N, Kobayashi Y, Adachi T, Chihara J, Kato T.
Central Clinical Laboratory, Akita University School of Medicine, Akita, Japan,
Idiopathic chronic constipation (ICC) is one of the most common clinical conditions in children. The pathophysiology is multifactorial and differs from case to case. To investigate the relationship between anorectal motility (ARM) and clinical course in children with ICC, anorectal function was evaluated using fecoflowmetry in nine children aged 2-14 years (mean 6.1). Three were boys and six were girls. Pressure fluctuations in the rectum and anal canal were simultaneously recorded during saline (250-500 ml) infusion into the rectum. The dynamics of defecation were evaluated using recordings of the saline evacuation curve from the rectum in each patient. Seven patients showed periodic contractions of the rectum accompanied (five) or unaccompanied (two) by relaxations of the anal canal during saline infusion. These patients achieved comfortable spontaneous defecation during follow-up periods ranging from 5 to 20 months. The other two exhibited no rectal contractions in spite of relaxations of the anal canal, and did not respond well to long-term medical management. In eight patients segmental fecoflowmetric curves showed a significantly lower flow rate and longer evacuation time than those of controls. Fecoflowmetry is a simple and non-invasive technique for evaluation of the ability to defecate. Disturbances of ARM may play an important role in patients with severe ICC. When evaluating anorectal function in children with chronic constipation, more attention should be paid to ARM and fecodynamics.
Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12683044&dopt=Abstract constipation laxative
Nurs Times. 2003 Mar 18-24;99(11):34-5.
A national audit of chronic constipation in the community.
Addison R, Davies C, Haslam D, Powell M, Stowers L.
Mayday University Hospital, Surrey.
This article presents the first available data on current national bowel-care standards. It involves 923 patients based at home or in residential/nursing homes. The baseline findings indicate problems of poorly controlled constipation, a high level of impaction and high use of rectal interventions. All the patients have been receiving laxatives regularly and 42 per cent were on combination laxative therapy. The audit provides evidence of complex, ineffective and/or inappropriate laxative prescribing linked to sub-optimal bowel care.
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Int J Colorectal Dis. 2003 Apr 4 [Epub ahead of print].
Effect of electrical stimulation in constipated patients with impaired rectal sensation.
Chang HS, Myung SJ, Yang SK, Jung HY, Kim TH, Yoon IJ, Kwon OR, Hong WS, Kim JH, Min YI.
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, 138-736, Seoul, Korea.
BACKGROUND AND AIMS. A subgroup of constipated patients complain of absent or diminished sense of wanting to defecate, suggesting that one of the causes of constipation is impaired rectal sensation. Electrical stimulation therapy (EST) has recently been used to treat patients with urinary and/or fecal incontinence. This study evaluated the efficacy of EST in constipated patients, especially those with impaired rectal sensation. PATIENTS AND METHODS. Of the 130 patients with functional constipation as defined by Rome II criteria, 22 patients who had impaired rectal sensation (rectal desire threshold volume >/= 90 ml) on an anorectal manometry were selected. We treated 12 with EST and 10 with biofeedback therapy (BFT) according to a randomized order. RESULTS. Overall symptoms of patients significantly improved after each therapy in both groups. Interestingly, frequency of sense of wanting to defecate improved only after EST. On objective findings there was significant improvement in anal residual pressures on attempted defecation only after BFT solely. On the other hand, rectal sensory threshold volumes for desire and urge to defecate and maximal tolerated volume improved significantly only in the EST group. CONCLUSION. Our findings show that the efficacy of EST can be comparable to BFT in a subgroup of constipated patients, especially those with impaired rectal sensation. EST might be considered as an adjunctive therapeutic modality for the management of functional constipation with impaired rectal sensation.
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Coll Antropol. 2002 Dec;26 Suppl:93-101.
Efficiency of biofeedback therapy for chronic constipation in children.
Sunic-Omejc M, Mihanovic M, Bilic A, Jurcic D, Restek-Petrovic B, Maric N, Dujsin M, Bilic A.
Children's Hospital Zagreb, Zagreb, Croatia.
Chronic constipation is a common disorder in childhood. The underlying mechanisms responsible for chronic constipation remain unknown. Conventional methods of treatment often fail to produce satisfactory results. Favorable effects of biofeedback treatment for constipation have been suggested, however, with variable results reported in the literature. The main aim of the study was to evaluate biofeedback versus conventional therapeutic protocol in the treatment of chronic constipation over a short period of time (3 months). Forty-nine children with chronic idiopathic constipation, 24 allocated to conventional and 25 to biofeedback therapy were included in the study. Thorough history data on bowel function and symptoms, anorectal status and manometric testing were collected before and after treatment. Follow up consisted of a structured interview. Mean age was 94 and 92 months in the children treated by the conventional and biofeedback method, respectively. The initial prevalence of abnormal defecation dynamics was 58% and 56% in the group children allocated to conventional and biofeedback therapy, respectively. The difference was not statistically significant. After the treatment, the values of rectal sensation threshold, critical volume, and recto-anal inhibitory reflex volume were significantly higher, and the prevalence of abnormal defecation dynamics was significantly lower in the group on biofeedback therapy. Biofeedback is an effective method of treatment for chronic constipation in children in short term. Therapeutic results are especially favorable in the recovery of abnormal anorectal dynamics and manometric parameters. There is no clear evidence for long-term benefits of biofeedback therapy.
Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12653377&dopt=Abstract constipation laxative
J Natl Med Assoc. 2001 Jan;93(1):22-30.
Adult constipation: a review and clinical guide.
Jacobs TQ, Pamies RJ.
Case Western Reserve University School of Medicine, Cleveland, OH 44106-4966, USA.
Constipation is a common complaint that can be a symptom of serious disease. Awareness of the potential etiologies can help direct the history, physical exam and subsequent work-up for the presenting individual. This article details the differential diagnosis and pathophysiology of constipation based on a review of the literature. The article is also designed to be useful as a guide to the work-up of constipation. Key elements of the history, physical exam and testing are outlined. Included is a detailed flow diagram to guide the work-up of constipation. Testing methods and their value in the evaluation of chronic idiopathic constipation are discussed. Finally, although the focus of this article is the evaluation of constipation, a section on the treatment of constipation is included.
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Gastroenterol Clin North Am. 2003 Mar;32(1):309-22, vii.
Constipation, diarrhea, and symptomatic hemorrhoids during pregnancy.
Wald A.
University of Pittsburgh Medical Center, Division of Gastroenterology, Hepatology and Nutrition, PUH, Mezzanine Level, C-Wing, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
Constipation, diarrhea, and symptomatic hemorrhoids are disorders common in the general population, particularly in women. These conditions, if mild, often are self-treated with various home remedies or nonprescription preparations. Few of these patients, moreover, are referred to gastroenterologists, as primary care providers generally are confident managing these conditions, unless they are severe, refractory to conventional management, or require additional diagnostic studies.
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Bioorg Med Chem. 2003 Apr;11(7):1493-502.
New thiazole derivatives as potent and selective 5-hydroxytriptamine 3 (5-HT(3)) receptor agonists for the treatment of constipation.
Imanishi N, Iwaoka K, Koshio H, Nagashima S, Kazuta K, Ohta M, Sakamoto S, Ito H, Akuzawa S, Kiso T, Tsukamoto S, Mase T.
Institute for Drug Discovery Research,Yamanouchi Pharmaceutical Co., Ltd., 21Miyukigaoka, Tsukuba, 305-8585, Ibaraki, Japan
The syntheses and biological evaluation of a series of novel indeno[1,2-d]thiazole derivatives are described. Several groups reported 5-HT(3) receptor agonists which were mainly evaluated for their activities on the von Bezold-Jarisch reflex (B-J reflex). We discovered that tetrahydrothiazolopyridine derivative 1b had a contractile effect on the isolated guinea pig colon with weak B-J reflex. Our efforts to find a new type of 5-HT(3) receptor agonists on the isolated guinea pig colon focused on the synthesis of a fused thiazole derivative 1d modified from 1b and reverse-fused thiazole derivatives (7-10). In this series, 10f (YM-31636) showed high affinity and selectivity for the cloned human 5-HT(3) receptor; furthermore, it showed potent and selective 5-HT(3) receptor agonistic activity. YM-31636 was examined for its effects on defecation in animals, thus evaluating the compound as an agent against constipation.
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Child Care Health Dev. 2003 Mar;29(2):103-9.
A 6-year follow-up study of chronic constipation and soiling in a specialist paediatric service.
Procter E, Loader P.
Canada House, Barnsole Road, Gillingham, Kent, ME7 4JL, UK.
OBJECTIVE: Constipation and soiling is a relatively common condition in childhood and its course is often chronic. This study investigated long-term outcome of children with chronic constipation and soiling by following up a cohort of children 6 years after their presentation to a specialist paediatric gastroenterology clinic with chronic constipation and soiling. DESIGN: Retrospective postal survey. SETTING/SAMPLE: All children referred in 1991 to a specialist paediatric gastroenterology clinic accepting both secondary and tertiary referrals. MEASURES: A semi-structured postal questionnaire was sent to all families, and the Strengths and Difficulties Questionnaire (SDQ) was sent to a random sample. RESULTS: The response rate (of those who could be traced) was 89%. Of these, over a third (36%) still had a problem with constipation and soiling and 17% were using regular laxatives. Three people still having problems with constipation and soiling in the sample were aged over 18 years. No significant difference was found with regard to age, sex or age at referral between the group that improved and the group that did not. Both groups felt they had suffered a high degree of distress because of the problem, with parents highlighting their powerlessness to help their child and the child identifying the embarrassment caused by the problem. CONCLUSIONS: A significant number of children presenting to a specialist paediatric clinic continue to have problems for several years. Further research is needed to identify these cases and to identify which factors promote resolution of the problem.
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Am J Gastroenterol. 2003 Feb;98(2):420-30.
Symptoms across the menstrual cycle in women with irritable bowel syndrome.
Heitkemper MM, Cain KC, Jarrett ME, Burr RL, Hertig V, Bond EF.
Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle 98195, USA.
OBJECTIVE: The purpose of this study was to describe the patterns of GI, somatic, and psychological symptoms across the menstrual cycle in women with irritable bowel syndrome, and to determine whether symptoms differed by oral contraceptive use or predominant bowel pattern. METHODS: A daily diary was used to assess symptoms across one menstrual cycle. Repeated-measures analysis of covariance, controlling for age and body mass index, was used to compare patterns of symptoms across the menstrual cycle by oral contraceptive use and predominant bowel pattern (diarrhea, constipation, alternating). Data from control women are presented for comparison. RESULTS: For somatic and psychological as well as GI symptoms, women with irritable bowel syndrome had higher symptom severity than did controls. Women with irritable bowel syndrome using oral contraceptives had lower cognitive, anxiety, and depression symptoms (p < 0.05, but not significant after multiple comparison adjustment), but no differences were seen for most symptoms of irritable bowel syndrome. All symptoms except diarrhea were highest in the alternating group and lowest in the diarrhea group, with the constipation group either intermediate or close to the alternating group. This pattern was significant after multiple comparisons adjustment for GI symptoms, and trending toward significance (p < 0.05, but not significant after multiple comparison adjustment) for menstrual, sleep, and cognitive symptoms. The strongest menstrual cycle effect was seen in somatic and menstrual symptoms. The pattern of symptoms over the menstrual cycle did not differ by predominant bowel pattern or by oral contraceptive use. CONCLUSIONS: Many of the symptoms examined differed by predominant bowel pattern and menstrual cycle phase, not just the GI symptoms. The menstrual cycle variation was similar regardless of oral contraceptive use or predominant bowel pattern.
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Br J Community Nurs. 2000 Mar;5(3):110-7.
A protocol for treating acute constipation in the community setting.
Withell B.
Night Shared Care, Mid-Kent Healthcare Trust, Maidstone.
Constipation is a distressing symptom, common in many patient groups and traditionally treated by nurses. Ambiguity concerning limits of the nurse's role in treating constipation exists and guidelines are scarce. Theoretically constipation is largely preventable, but acute episodes arise for a number of reasons and often need prompt treatment. This article describes the development of a local protocol which empowers appropriately trained community nurses to treat adult patients with acute constipation. A flow chart was used to define the guidelines. Implementation of the protocol is briefly discussed in relation to other current local initiatives.
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Dis Colon Rectum. 2003 Feb;46(2):238-46.
Rectal hyposensitivity: prevalence and clinical impact in patients with intractable constipation and fecal incontinence.
Gladman MA, Scott SM, Chan CL, Williams NS, Lunniss PJ.
Academic Department of Surgery and Gastrointestinal Physiology Unit, Barts and The London, Queen Mary's School of Medicine and Dentistry, United Kingdom.
PURPOSE: Blunted rectal sensation, or rectal hyposensitivity, has been reported anecdotally in patients with functional disorders of evacuation and continence. The purpose of this study was to determine the prevalence of rectal hyposensitivity and whether the finding of such an abnormality was associated with any clinical impact. METHODS: One thousand three hundred fifty-one patients, referred for anorectal physiologic investigation, were divided according to presenting symptoms into the following categories: constipation (subdivided into infrequency of and/or obstructed defecation), fecal incontinence (subdivided into passive, postdefecation, and urge incontinence), fecal incontinence and constipation, or "other." Rectal hyposensitivity was judged to be present when at least one of the sensory threshold volumes was elevated beyond the normal range (mean plus 2 standard deviations). The prevalence of rectal hyposensitivity was then calculated in each group and in relation to other investigations. RESULTS: Rectal hyposensitivity was present in 16 percent of patients, with males and females equally affected. Twenty-three percent of patients with constipation, 10 percent of patients with fecal incontinence, 27 percent of patients with incontinence associated with constipation, and only 5 percent of patients with other symptoms were found to have rectal hyposensitivity. In patients with obstructed defecation, rectal hyposensitivity was present in 33 percent with rectocele, 40 percent with intussusception, and 53 percent with no mechanical obstruction evident on evacuation proctography. CONCLUSION: Rectal hyposensitivity is common in patients with constipation and/or fecal incontinence and may thus be important in the etiology of such conditions. Although the clinical relevance of this physiologic abnormality is unknown, its presence may have implications regarding the management of hindgut dysfunction and particularly the selection of patients for surgery.
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Int J Clin Pharmacol Ther. 2003 Jan;41(1):14-21.
Differential therapy of constipation--a review.
Wanitschke R, Goerg KJ, Loew D.
I. Medizinische Klinik und Poliklinik, Johannes Gutenberg-Universitat, Mainz, Germany.
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.
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Dis Colon Rectum. 2003 Jan;46(1):68-76.
Scintigraphic assessment of retrograde colonic washout in fecal incontinence and constipation.
Christensen P, Olsen N, Krogh K, Bacher T, Laurberg S.
Surgical Research Unit, Department of Surgery L, Section AAS, Aarhus University Hospital, Aarhus, Denmark.
PURPOSE: This study aimed to evaluate the colorectal luminal transport obtained by retrograde colonic washout with a new scintigraphic technique. METHODS: Nineteen patients (5 with spinal cord lesion, 6 with idiopathic fecal incontinence, and 8 with idiopathic constipation) treated with retrograde colonic washout took indium-111-labeled polystyrene pellets to label the bowel contents. Technetium-99m-diethylene-triamine-pentaacetic acid was mixed with the irrigation fluid to assess its extent within the colorectum. Scintigraphy was performed before and after a standardized washout procedure. The colorectum was divided into four segments: the cecum and ascending colon, the transverse colon, the descending colon, and the rectosigmoid. Assuming ordered evacuation of the colorectum, the contribution of each colonic segment to the total evacuation was expressed in percent of the original segmental counts. The contributions of each segment were summed to reach a total defecation score (range, 0-400), and directional segmental transports were estimated. RESULTS: The defecation score in patients with idiopathic constipation (median, 59; range, 21-130) differed significantly (P < 0.05) from the scores in those with spinal cord lesions (median, 204; range, 108-323) and idiopathic fecal incontinence (median, 188; range, 155-234). Thus, patients with spinal cord lesion or idiopathic fecal incontinence were able to empty most of the rectosigmoid and most of the descending colon, but those with idiopathic constipation could only empty 59 percent of the rectosigmoid. The irrigation fluid on average reached a point just beyond the right colic flexure that correlated with the defecation score (r(2) = 0.58, P < 0.001). CONCLUSION: The effect of retrograde colonic washout was significantly better in spinal cord lesion and idiopathic fecal incontinence than in idiopathic constipation, and its effect correlated with the extent to which the irrigation fluid had entered the colorectum.
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Ostomy Wound Manage. 2002 Dec;48(12):30-41.
When fiber is not enough: current thinking on constipation management.
Doughty DB.
Emory University Wound Ostomy Continence Nursing Education Center, Atlanta, GA 30322, USA.
Constipation is a common disorder and many patients fail to respond to the simple constipation remedies of increased fiber and fluid intake. When secondary to other conditions, medications, or disease processes, the focus of constipation management is correction of causative factors. However, primary constipation - ie, constipation with no identifiable causative factor - is very common. Patients generally present with one of three patterns: constipation-predominant irritable bowel syndrome, slow transit constipation, or pelvic floor dysfunction resulting in dyssynergic defecation. Baseline evaluation for patients with chronic constipation includes a careful history, focused physical examination, and limited laboratory studies. Patients with dyssynergic defecation usually respond best to biofeedback therapy and pelvic muscle re-education. Constipation-predominant irritable bowel syndrome is best managed with dietary monitoring and modifications, fiber therapy, and education regarding self-monitoring and self-care. Patients with slow transit constipation may benefit from fiber therapy and increased activity, but most also will require laxative therapy. Current guidelines for prescribing laxatives suggest bulk agents as first line and osmotic agents as second line therapy. Stimulant laxatives should generally be reserved for PRN use. Current understanding about the etiology, pathology, and classification of different types of constipation are summarized and a stepwise approach to evaluation and management is presented.
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Gastroenterol Nurs. 2002 Nov-Dec;25(6):253-6.
Teenage constipation: a case study.
Streeter BL.
Guthrie Clinic Endoscopy Center, Guthrie Square, Sayre, PA 18840, USA.
Constipation is a problem of significant magnitude. It can have a devastating impact on a patient's personal life. There are many causes of constipation. Among them are dietary factors such as decreased fiber and low fluid intake, decreased activity, lack of privacy for defecation, pharmacologic agents, physiologic problems such as bowel obstruction or metabolic disorders, and psychosocial distress. A young teenage boy is followed through a series of emergency room visits, office visits, and a hospitalization related to his experiences with constipation. A bowel program was identified and instituted with successful outcomes.
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J Pediatr Surg. 2002 Dec;37(12):1762-5.
Signs and symptoms of slow-transit constipation versus functional retention.
Shin YM, Southwell BR, Stanton MP, Hutson JM.
Department of Surgery, Kosin University, Kosin, Korea.
BACKGROUND/PURPOSE: Slow-transit constipation (STC) has been described recently in children. This retrospective study correlated symptoms, signs, transit times, and immunohistochemistry to determine the diagnostic differences between STC and functional fecal retention (FFR). METHODS: One hundred eighty children with intractable constipation underwent clinical assessment, nuclear transit study (NTS), with or without laparoscopic colonic muscle biopsy. Patients were divided by NTS into those with STC and those with FFR. Parents completed questionnaires on presenting symptoms. RESULTS: In 161 patients with STC and 19 with FFR, there were no differences in gender, gestation, or timing of symptom onset. Over 20% had the first meconium delayed more than 24 hours after birth even in FFR (4 of 19). Bloating and soiling were more common in STC. There were no differences between patients with STC but different histology on biopsy. More STC patients had soft stools (39%) than FFR (16%), and a lower stool frequency of less than once a week (STC 26% compared with 11% FFR). FFR was managed more often with medication or diet alone (53%) compared with STC (29%), where enemas, lavage, or surgery were more common. CONCLUSIONS: Children with STC showed similar symptoms and signs to those with FFR, but more had bloating and soiling, softer stools, and longer intervals between bowel actions. Delayed meconium stool beyond 24 hours after birth was common in both groups. Diagnosis of STC or FFR required NTS and was not possible on symptoms alone.
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Eur J Nutr. 2002 Dec;41(6):244-8.
Relationship between lifestyle factors and defecation in a Japanese population.
Nakaji S, Tokunaga S, Sakamoto J, Todate M, Shimoyama T, Umeda T, Sugawara K.
Department of Hygiene, Hirosaki University School of Medicine, 5 Zaifu-cho, Japan.
BACKGROUND: There is a paucity of accurate data regarding any association in the general population between defecation and lifestyle factors such as diet, exercise, physique, and childbirth. AIMS OF THE STUDY: To evaluate the effects of such lifestyle factors on defecation among regional residents of Japan. METHODS: Residents (n = 1,699) of northern Japan, aged over 40 years, were surveyed in 1995 using a questionnaire to assess their lifestyle factors (diet, beverage consumption, exercise, physique, and childbirth), and examining their defecation status. We evaluated the relationship between these lifestyle factors and defecation using logistic regression analysis. The authors used four measures (defecation frequency, subjective defecation state, subjective fecal properties, and fecal consistency) and assigned the subjects to a group defined by their defecatory status: constipation, diarrhea, or normal, depending on the responses of the subjects to all four criteria. RESULTS: The tendency for constipation correlated positively with age in males ( p = 0.130), although this trend was not observed in females ( p = 0.641). Of the dietary factors examined, only rice, which accounts for the largest proportion of daily dietary fiber intake in Japan, demonstrated a preventive effect on constipation in both sexes ( p = 0.050 in males and 0.003 in females). Walking was a preventive factor for constipation among males ( p = 0.049), and alcohol also inhibited constipation among males ( p = 0.007). CONCLUSIONS: These results suggest that exercise, such as walking, and a high intake of dietary fiber, such as rice, were useful in the maintenance of defecation.
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J Fam Health Care. 2002;12(5):127-32.
Managing children with constipation: a community perspective.
Burnett C, Wilkins G.
Department of Paediatrics, John Radcliffe Hospital, Oxford.
Two clinical nurse specialists explain the nature of constipation in children and how the primary health care team can achieve successful treatment and management strategies for this condition. Constipation in children is a common and often complex problem. It may begin at four months of age in relation to weaning, or at around two years of age in relation to potty training. Constipation can be a distressing problem for the child and the family. Treatment failure rates are high, frequently reflecting poor understanding of the pathophysiology of constipation and inappropriate management. Symptoms include infrequent defaecation, pain and distress and refusal to defaecate. Causes include a poor intake of dietary fibre and fluid, emotional disturbances, possibly intercurrent infection and change in routine. Management of children with constipation includes an increase in dietary fibre and fluids, behaviour modification and laxative medication. For treatment to be effective there should be regular follow-up. Management of this chronic problem by nurses is viewed as effective and acceptable to parents.
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Am J Hosp Palliat Care. 2002 Nov-Dec;19(6):426-30.
Presence and severity of constipation in hospice patients with advanced cancer.
McMillan SC.
University of South Florida, College of Nursing, Tampa, USA.
Although constipation is a problem commonly seen in hospice patients it is not often addressed in the literature as a target symptom needing management. The purpose of this study was to assess the levels of self-reported constipation in a group of patients with advanced cancer at admission to hospice and two weeks and one month after admission. The constipation assessment scale (CAS) measured the presence and intensity of constipation. Comparisons between time points were not possible, but trends seem to indicate that patient symptoms are not being successfully managed.
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Pediatr Surg Int. 2002 Sep;18(5-6):349-53. Epub 2002 May 23.
Acetylcholinesterase distribution and refractory constipation - a new criterion for diagnosis and management.
Kobayashi H, Li Z, Yamataka A, Lane GJ, Yokota H, Watanabe A, Miyano T.
Department of Paediatric Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
To describe manifestations of acetylcholinesterase (AchE) activity in the bowel of patients presenting with refractory constipation and correlate them with outcome, rectal biopsy specimens (RBS) from 165 patients who presented with refractory constipation between 1988 and 1999 were examined. Age at biopsy ranged from 4 days to 17 years; 45 subjects were excluded because they satisfied diagnostic criteria for Hirschsprung's disease, intestinal neuronal dysplasia, or hypoganglionosis. Thirty-five autopsy subjects were used as controls. All RBS were compared and AchE activity was assessed in the lamina propria (LP), muscularis mucosae (MM), and around the submucosal vessels (V). Variations in AchE distribution were classified as grade I (no AchE-positive nerve fibers in the LP or MM), grade II (some positive fibers in the LP or MM), grade III (moderate positive fibers in the LP or MM), grade IV (many positive fibers in the LP, MM, or V), or grade V (fibrillar, foamy, or amorphous staining for AchE). All grade I (11/120) and V (12/120) subjects achieved normal bowel control with laxatives alone and all grade II subjects (58/120) did with laxatives and enemas. Grade III subjects (34/120) required addition of cisapride. All grade IV subjects (5/120) were unresponsive to conservative management and 4/5 were found to have a megarectum, which was treated surgically. AchE distribution correlated well with eventual outcome and requirement for surgery. AchE distribution could also be used to classify bowel motility disorders, and we suggest the term AchE-positive disease be used to describe them.
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Gastroenterology. 2002 Nov;123(5):1459-67.
Enteric nerves and interstitial cells of Cajal are altered in patients with slow-transit constipation and megacolon.
Wedel T, Spiegler J, Soellner S, Roblick UJ, Schiedeck TH, Bruch HP, Krammer HJ.
Department of Anatomy, Medical Universitiy of Luebeck, Luebeck, Germany.
BACKGROUND & AIMS: A variety of gastrointestinal motility disorders have been attributed to alterations of interstitial cells of Cajal and malformations of the enteric nervous system. This study evaluates both the distribution of interstitial cells of Cajal and the pathohistology of the enteric nervous system in 2 severe human colorectal motility disorders. METHODS: Colonic specimens obtained from patients with slow-transit constipation (n = 11), patients with megacolon (n = 6), and a control group (n = 13, nonobstructing neoplasia) were stained with antibodies against c-kit (marker for interstitial cells of Cajal) and protein gene product 9.5 (neuronal marker). The morphometric analysis of interstitial cells of Cajal included the separate registration of the number and process length within the different regions of the muscularis propria. The structural architecture of the enteric nervous system was assessed on microdissected whole-mount preparations. RESULTS: In patients with slow-transit constipation, the number of interstitial cells of Cajal was significantly decreased in all layers except the outer longitudinal muscle layer. The myenteric plexus showed a reduced ganglionic density and size (moderate hypoganglionosis) compared with the control group. Patients with megacolon were characterized by a substantial decrease in both the number and the process length of interstitial cells of Cajal. The myenteric plexus exhibited either complete aganglionosis or severe hypoganglionosis. CONCLUSIONS: The enteric nervous system and interstitial cells of Cajal are altered concomitantly in slow-transit constipation and megacolon and may play a crucial role in the pathophysiology of colorectal motility disorders.
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Hepatogastroenterology. 2002 Nov-Dec;49(48):1540-4.
Regulation of the enteric nervous system in the colon of patients with slow transit constipation.
Tomita R, Tanjoh K, Fujisaki S, Ikeda T, Fukuzawa M.
Department of Surgery, Nippon Dental University School of Dentistry at Tokyo, First Department of Surgery, Nihon University School of Medicine, Tokyo, Japan.
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.
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Dig Dis Sci. 2002 Oct;47(10):2222-30.
Lack of objective evidence of efficacy of laxatives in chronic constipation.
Jones MP, Talley NJ, Nuyts G, Dubois D.
Department of Medicine, University of Sydney, NSW, Australia.
Laxatives are commonly used to treat constipation and can be bought over-the-counter in many countries, although some preparations need to be prescribed by physicians. A meta-analysis was conducted to quantitatively evaluate the published evidence on the efficacy of laxatives in constipation. We found that large, well-controlled, published studies whose data were comparable were lacking. Of 250 articles, 35 met the inclusion criteria but only 11 yielded usable data (N = 375 patients on laxatives, 174 on placebo). There was an effect of laxatives on stool frequency (mean increase 1.9 stools per week) and stool weight (mean increase 476 g) but this was not clearly distinguishable from that of placebo therapies (1 stool and 434 g, respectively) in studies up to 4 weeks in duration. Similarly, studies of 5-12 weeks yielded no differences overall. These results cannot definitively rule out laxatives as an effective treatment, due to the poor published evidence. Better evidence is required to justify the continued expenditure of funds on laxatives by both patients and formularies.
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J Clin Pharm Ther. 2002 Oct;27(5):343-52.
A systematic review of tegaserod for the treatment of irritable bowel syndrome.
Jones BW, Moore DJ, Robinson SM, Song F.
Department of Medicines Management, Keele University, Staffordshire, UK.
AIM: To assess the clinical effectiveness of tegaserod for the treatment of irritable bowel syndrome (IBS). DESIGN: Systematic review. SETTING: Six placebo-controlled, randomized controlled trials (RCTs) retrieved from electronic searches (Medline, Embase, FDA website) and hand-searching. MAIN OUTCOME MEASURES: Any outcome was accepted. RESULTS: In a small pharmacodynamic study, tegaserod 4 mg/day accelerated orocecal transit compared with placebo, but did not affect gastric emptying rate and colonic transit. Five placebo-controlled studies evaluated Subject's Global Assessment of gastrointestinal (GI) symptoms in predominantly female patients who fulfilled Rome criteria for constipation-predominant IBS. Responder rates were higher with tegaserod 1-24 mg/day than with placebo, although it was not possible in this review to evaluate the consistency of this effect, to fully quantify the effect size, or identify patients who may gain most benefit from this treatment. CONCLUSION: Currently published data on tegaserod for IBS are limited (two of six RCTs published in full, four as abstracts). Tegaserod may be an appropriate treatment for occasional use for relief of GI symptoms associated with constipation-predominant IBS. Further research, comparing tegaserod with alternative treatments for GI symptoms of IBS, should help define the place of this drug in therapy.
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Clin Med. 2003 Jan-Feb;3(1):48-51.
Bowel care in older people.
Potter J.
Clinical Effectiveness and Evaluation Unit, Royal College of Physicians.
Bowel dysfunction not only causes considerable hardship for many older people and their carers, it is also financially costly to the health service and to the individuals affected. Despite the prevalence of constipation and faecal incontinence amongst, for example, older people in institutionalised settings, both conditions are often iatrogenic and entirely preventable. One reason why these conditions are generally not well managed is that the research base is poor: there are few robust data because of methodological weaknesses in existing studies, so clinicians and care staff are left to rely on anecdote and personal experience. Secondly, the costs to the NHS involved in providing proper bowel care for the elderly would be considerable, although recent government documents have set out a specific commitment to improve standards of care in this area. In order to address some of these issues, the College has recently published a book which gathers together and assesses research on faecal incontinence and constipation, and provides informed guidance on current best practice. The contents of the publication, including comments from older people suffering from bowel dysfunction, are outlined in this article.
Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12539880&dopt=Abstract constipation laxative
Adv Ther. 2002 Sep-Oct;19(5):203-8.
Self-prescribed laxative use: a drug-utilization review.
Motola G, Mazzeo F, Rinaldi B, Capuano A, Rossi S, Russo F, Vitelli MR, Rossi F, Filippelli A.
Department of Experimental Medicine, Section of Pharmacology L. Donatelli, Faculty of Medicine and Surgery, Second University of Naples, Via Costantinopoli 16, 80138 Naples, Italy.
This study was conducted to determine the reasons for the choice of self-prescribed laxatives and to acquire information on how they were used and tolerated. From November 1999 to February 2000, 70 pharmacies, uniformly located throughout the Campania region of southern Italy, distributed a questionnaire to purchasers of over-the-counter laxatives. The average age of the (mostly female) respondents was 45.9 years; 23.8% were elderly. Among the 7324 individuals who completed the survey, 77.6% selected an oral product; 22.4% preferred rectal administration. A physician influenced the choice of a laxative in 37.7% of the cases, a pharmacist in 20.5%; other suggestions came from relatives (14%), acquaintances (12.1%), advertisements (11.7%), and miscellaneous sources (4%). Only 59.8% of respondents used these drugs correctly, and 58.2% consulted a physician or pharmacist because of constipation. Adverse effects, mainly gastrointestinal symptoms, occurred in 6.1% of those surveyed. The long-term use or abuse of laxatives can cause serious medical consequences, as well as mask diseases, delaying diagnosis and appropriate treatment. Physicians, pharmacists, and other health-care personnel should counsel patients on the proper use of these easily available, ubiquitous drugs.
Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12492746&dopt=Abstract constipation laxative
Aliment Pharmacol Ther. 2003 Jan;17(1):165-72.
Comparison of efficacy and safety of two doses of two different polyethylene glycol-based laxatives in the treatment of constipation.
Chaussade S, Minic M.
Department for Hepatogastroenterology, Hopital Cochin, Pavillon Achard, 27 rue du faubourg Saint Jacques, 75679 Paris cedex 14, France.
AIM: To compare standard and maximum daily doses of polyethylene glycol 3350 plus electrolytes (Transipeg) and polyethylene glycol 4000 (Forlax) in a multicentre, double-blind, randomized, parallel-group study. METHODS: Ambulatory patients with idiopathic chronic constipation were randomized to receive Forlax (10 or 20 g) or Transipeg (5.9 or 11.8 g) for 1 month. The primary efficacy end-point was stool frequency. Secondary efficacy parameters included stool consistency, date of occurrence of first motion, straining on defecation, rectal evacuation, abdominal pain and distension. Adverse events were recorded. RESULTS: Stool frequency was significantly increased compared with baseline in all treatment groups (P = 0.0001). Most patients (> or = 67.3%) had their first stool within 1 day of starting treatment. Stool consistency significantly improved compared with baseline in all treatment groups (P = 0.0001). The percentage of patients with normal stool consistency was significantly higher for standard-dose Transipeg vs. both maximum-dose treatments (P < 0.01). Other secondary parameters were also significantly improved compared with baseline in all treatment groups (P = 0.0001). All medications were well tolerated. CONCLUSIONS: Standard-dose Transipeg (5.9 g) normalized stool consistency with less semi-liquid or liquid stools than maximum-dose Transipeg and Forlax, with a non-significant trend towards less semi-liquid or liquid stools than standard-dose Forlax.
Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12352250&dopt=Abstract constipation laxative
Curr Opin Pediatr. 2002 Oct;14(5):570-5.
Encopresis.
Loening-Baucke V.
Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, University of Iowa, Iowa City, 52242-1083, USA.
A careful history and physical examination will help to differentiate between encopresis with or without constipation and fecal incontinence caused by anatomic or organic disease. Most children with encopresis with or without functional constipation require no or minimal laboratory workup. Successful treatment of encopresis requires a combination of parent and child education, behavioral intervention, medical therapy, and long-term compliance with the treatment regimen. The conventional treatment approach consists of behavior modification and laxative for children with encopresis with constipation and behavior modification alone for the few children with encopresis without constipation. Almost every patient will experience dramatic improvement in encopresis. Recovery rates are 30% to 50% after 1 year and 48% to 75% after 5 years.
Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12201887&dopt=Abstract constipation laxative
J Clin Nurs. 2002 Sep;11(5):603-12.
Older people seeking solutions to constipation: the laxative mire.
Annells M, Koch T.
MP Annells Research, Adelaide, Australia.
This article reports an extensive descriptive survey of 90 older people (65+ years) living in the community who sought through in-depth, semistructured interviews to explore their experiences and responses to constipation. The composite story of these older people is that seeking a solution to constipation may be fraught with great difficulty. Most commonly tried are laxatives, yet laxative use can be like a mire. The older people tend to be uncertain of which way to turn to avoid getting stuck in a murky conglomeration of laxative options. The imperative for self-management of constipation is strong amongst most of the older people and the process in which they engage when seeking for a solution is discussed. There is an evident frustrating lack of readily identifiable and accessible services and information that could help them navigate successfully through or around this mire. "Through the mire" would be the appropriate use of suitable laxatives with minimal side-effects. "Around the mire" would be the gaining of useful solutions other than laxative use. Solutions may be strategies to prevent constipation or to treat constipation. The needs of these older people seeking solutions to constipation are grouped into two main categories: provision of accessible, empathetic and useful advice about affordable solution choices, and accessibility to solutions, including laxatives, where evidence-based knowledge informs selection or prescription of the solution. Eight major recommendations, including research suggestions, are offered for consideration.
Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12169860&dopt=Abstract constipation laxative
Ann Nutr Metab. 2002;46(3-4):159-62.
Effect of probiotics on constipation, fecal azoreductase activity and fecal mucin content in the elderly.
Ouwehand AC, Lagstrom H, Suomalainen T, Salminen S.
Department of Biochemistry and Food Chemistry, University of Turku, Finland.
BACKGROUND: Constipation is a common problem in elderly subjects, probiotics have been suggested to improve intestinal motility and reduce fecal enzyme activity. METHODS: Elderly subjects (n = 28) were enrolled in an open parallel study. The subjects were divided into 3 groups: 1 control group receiving juice; 1 group receiving juice supplemented with Lactobacillus reuteri, and 1 group receiving juice supplemented with Lactobacillus rhamnosus and Propionibacterium freudenreichii. During the first 3 weeks all subjects consumed unsupplemented juice. In the subsequent 4 weeks, the subjects received their designated juice. During the last 3 weeks, all subjects again received unsupplemented juice. From the subjects, defecation frequency, laxative use, fecal pH, mucin content and azoreductase activity were assessed during the last week of each period. RESULTS: The subjects receiving the L. rhamnosus/P. freudenreichii-supplemented juice exhibited a 24% increase in defecation frequency. However, no reduction in laxative use was observed. The fecal azoreductase activity was also significantly reduced in this group. No changes in fecal pH or mucin excretion were observed. CONCLUSION: Some relief from constipation may be observed with the combination of L. rhamnosus/P. freudenreichii. This probiotic combination also reduced fecal enzyme activity. The tested probiotics did not affect the mucosal barrier.
Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12163329&dopt=Abstract constipation laxative
Cancer Epidemiol Biomarkers Prev. 2002 Aug;11(8):753-7.
Constipation, anthranoid laxatives, melanosis coli, and colon cancer: a risk assessment using aberrant crypt foci.
Nascimbeni R, Donato F, Ghirardi M, Mariani P, Villanacci V, Salerni B.
Cattedra di Chirurgia Generale, University of Brescia, 25124 Brescia, Italy.
The associations between colorectal cancer (CRC) and constipation, anthranoid laxative use, and melanosis coli are controversial. Aberrant crypt foci (ACF) are microscopic lesions of the colonic mucosa suspected of being preneoplastic, and their investigation has been advocated to evaluate the cause-effect relationship between putative risk factors and CRC. To this aim, we investigated the relationship between sigmoid cancer (SC) and constipation, anthranoid laxative use, and melanosis coli using ACF analysis as an additional tool of investigation. Fifty-five surgical patients with SC, 41 surgical patients with diverticular disease (DD), and 96 age- and sex-matched subjects without intestinal disease (controls) were interviewed on their history of constipation and anthranoid laxative use. Melanosis coli and ACF characteristics were investigated on sigmoid mucosa in patients with SC or DD. Constipation and anthranoid laxative use were similar between patients with SC (30.9% and 32.7%, respectively) and those with DD (39% and 26.8%) but higher than among controls (18.8% and 8.3%). Melanosis coli was found in 38.2% of patients with SC and in 39% of those with DD. Mean ACF frequency was higher in patients with SC (0.24/cm(2)) than in those with DD (0.10/cm(2); P < 0.0001), and it did not vary according to constipation, laxative use, or melanosis coli in either group. This study confirms the association of ACF frequency with colon cancer and does not support the hypothesis of a cause-effect relationship of CRC with constipation, anthranoid laxative, use or melanosis coli.
Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12144586&dopt=Abstract constipation laxative
Aliment Pharmacol Ther. 2002 Jul;16(7):1347-56.
Prucalopride, a systemic enterokinetic, for the treatment of constipation.
Emmanuel AV, Roy AJ, Nicholls TJ, Kamm MA.
St. Mark's Hospital, Harrow, Middlesex, UK.
BACKGROUND: Laxatives are frequently ineffective in treating constipation. An alternative therapeutic approach is to target serotonin-4 receptors, which are involved in initiating peristalsis. AIM: In a double-blind, placebo-controlled trial, to assess the efficacy and safety of a systemically active serotonin-4 agonist, prucalopride. METHODS: Seventy-four women with constipation were stratified into slow or normal transit groups, and each group was randomized to receive either placebo or 1 mg prucalopride daily for 4 weeks. A bowel function diary was maintained. Whole-gut and orocaecal transit, visceral sensitivity, quality of life and psychological state were assessed before and after treatment. RESULTS: Prucalopride, not placebo, increased spontaneous stool frequency (P=0.008) and reduced time to first stool (P < 0.001). Prucalopride reduced the number of retained markers in all patients compared to placebo (P=0.004). Prucalopride reduced the mean number of retained markers in slow transit (P=0.069), but did not alter the marker count in normal transit (P=0.86). Orocaecal transit was accelerated by prucalopride, not placebo (P=0.004). Prucalopride, notplacebo, increased rectal sensitivity to distension (urge volume, P=0.01) and electrical stimulation (P=0.001). Prucalopride significantly improved several domains of the Short Form Health Status Survey and the disease-specific quality of life. Adverse effects were similar for prucalopride and placebo. CONCLUSIONS: Prucalopride improves symptoms, upper gut transit and gut sensitivity in constipated patients with both slow and normal transit. It improves transit in patients with slow transit. These changes are associated with improved well-being.
Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12135034&dopt=Abstract constipation laxative
Am J Gastroenterol. 2002 Jul;97(7):1776-9.
Overnight efficacy of polyethylene glycol laxative.
Di Palma JA, Smith JR, Cleveland M.
Division of Gastroenterology, University of South Alabama, Mobile 36693, USA.
OBJECTIVES: Clinical studies in constipated adult patients have shown that a 17- or 34-g daily dose of polyethylene glycol (PEG) 3350 (MiraLax) is safe and effective for the treatment of constipation, with the best efficacy seen in wk 2 of treatment. The purpose of this study was to determine an optimal dose of PEG to provide satisfactory relief of constipation within 24 h. METHODS: A total of 24 adult study subjects who met Rome II criteria for constipation were randomized in a double-blind, parallel pilot study to receive a single dose of placebo or PEG laxative at doses of 51, 68, or 85 g in 500 ml of flavored water. Over a 72-h period, subjects rated bowel movements (BM), completeness of evacuation, and satisfaction. RESULTS: The 68-g dose seemed to be most satisfactory. Five of six subjects had a BM within 24 h. The time to first BM was 14.8 h for 68 g versus 27.3 h for placebo (p = NS). The time to second BM was 19.2 h versus 47.2 h for 68 g and placebo, respectively (p = 0.003). Of the subjects receiving 68 g of PEG, 50% and 100% reported complete evacuation for the first and second BM, respectively. The average number of BMs in 24 h for placebo, 51 g, 68 g, and 84 g were 0.5, 2.2, 2.2, and 4.2, respectively (p = 0.004). There were no adverse reactions, and no patient reported incontinence or complained of cramps or diarrhea at any dose. There were no changes in measured electrolytes, calcium, glucose, BUN, creatinine, or serum osmolality. CONCLUSIONS: A 68-g dose of PEG laxative seems to provide safe and effective relief in constipated adults within a 24-h period.
Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12120755&dopt=Abstract constipation laxative
Jpn J Pharmacol. 2002 Jun;89(2):133-41.
Laxative and anti-diarrheal activity of polycarbophil in mice and rats.
Saito T, Mizutani F, Iwanaga Y, Morikawa K, Kato H.
Research and Development Headquarters, Hokuriku Seiyaku, Co., Ltd., Katsuyama, Fukui, Japan.
We investigated the laxative and anti-diarrheal activity of polycarbophil, an insoluble hydrophilic polymer, in comparison with other agents used for treating functional bowel disorder (FBD). In naive rats, polycarbophil (500 mg/kg) increased fecal weight and water contents without producing diarrhea. Carboxymethylcellulose (CMC) did not produce evident changes in bowel movement. Picosulfate markedly produced diarrhea. Loperamide, trimebutine and granisetron decreased stool output dose-dependently. Constipation, indicated by decrease in fecal weight, was produced by loperamide and clonidine in rats. Polycarbophil (500 mg/kg) and CMC increased fecal weight without diarrhea. Conversely trimebutine further decreased fecal weight in constipated rats. Polycarbophil (500 mg/kg) suppressed diarrhea induced by castor oil, and at 250-500 mg/kg, it produced shaped stools in animals with stools loosened by prostaglandin E2, serotonin or carbachol in mice. Polycarbophil (500 mg/kg) also reduced stools in rats with stool output increased by wrap restraint stress (WRS). CMC had no effect in the diarrhea models, except for carbachol-induced diarrhea, and WRS-induced evacuation. Loperamide, trimebutine and granisetron inhibited diarrhea production and WRS-induced evacuation, except for carbachol-induced diarrhea. The results show that polycarbophil prevents constipation and diarrhea without inducing diarrhea or constipation, which is different from the other agents. Hydrophilic polymers such as polycarbophil will be promising agents for the treatment of FBD.
Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12074185&dopt=Abstract constipation laxative
Asia Pac J Clin Nutr. 2002;11(2):164-8.
Kiwifruit promotes laxation in the elderly.
Rush EC, Patel M, Plank LD, Ferguson LR.
Auckland University of Technology, New Zealand.
Numerous anecdotal reports have suggested that kiwifruit (Actinidia deliciosa) has laxative effects. This could be an acceptable dietary supplement, especially for elderly people who often present with constipation. We wished to obtain objective evidence as to whether or not kiwifruit eaten regularly could promote laxation in elderly people. Thirty-eight healthy adults of age > 60 years consumed their normal diet, with or without one kiwifruit per 30 kg bodyweight for three weeks, followed by a 3-week crossover period. Daily records were taken on frequency of defecation and characteristics of the stools. Kiwifruit significantly enhanced all tested measures of laxation in these adults. The regular use of kiwifruit appeared to lead to a bulkier and softer stool, as well as more frequent stool production. Kiwifruit as a natural remedy appears palatable to most of the population and provides improved laxation for elderly individuals who are otherwise healthy. It is likely that a number of factors in the whole fruit are involved, but the nature of the stools suggest fibre is important. This study provides evidence of the potential for improvement in bowel function, health and well-being through changes in diet.
Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12041718&dopt=Abstract constipation laxative
Clin Pediatr (Phila). 2002 May;41(4):225-9.
Comparison of polyethylene glycol 3350 and lactulose for treatment of chronic constipation in children.
Gremse DA, Hixon J, Crutchfield A.
The Division of Pediatric Gastroenterology and Nutrition, University of South Alabama College of Medicine, Mobile 36604, USA.
Polyethylene glycol (PEG) 3350 and lactulose were compared in an unblinded, randomized, crossover design for treatment of constipation in 37 children aged 2 to 16 years. Subjects received lactulose (1.3 g/kg/d divided twice daily up to 20 g) or PEG 3350 (10 g/m2/day) for 2 weeks. PEG 3350 significantly decreased the total colonic transit time compared to lactulose (47.6+/-2.7 vs 55.3+/-2.4 hours, mean +/- SE, PEG 3350 vs lactulose, respectively, p = 0.038). The stool frequency, form, and the ease of passage were similar for each laxative. Polyethylene glycol 3350 is an effective laxative for the treatment of chronic constipation in children.
Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11975694&dopt=Abstract constipation laxative
J Clin Pharm Ther. 2002 Apr;27(2):107-10.
Laxative prescribing in relation to opioid use and the influence of pharmacy-based intervention.
Bouvy ML, Buurma H, Egberts TC.
SIR Institute for Pharmacy Practice Research, Theda Mansholtstraat 5B, JE Leiden, The Netherlands.
INTRODUCTION: Opioid-induced constipation is a common problem and can cause serious complications. It is widely advised that laxatives should be started concurrently with opiates, unless there is a clear indication not to do so. OBJECTIVE: This study was undertaken to estimate how often laxatives were started concurrently with opiates and to describe the effect of pharmacy-based interventions to promote the use of laxatives in patients starting opioids. METHODS: Twenty-six community pharmacies identified all patients who received a first prescription for a strong opioid during January and February of 1998, 1999 or 2000. Pharmacists collected information on patient, drug and prescriber characteristics (age, gender, use of opiates and laxatives). A separate questionnaire was used to collect data on pharmacy-based interventions to promote the simultaneous prescribing of laxatives with the opiates. RESULTS: Overall, 37% of the patients receiving an opioid started taking laxatives within 5 days. The percentage of patients who received laxatives simultaneously with opioids increased from 31% in 1998 to 35% in 1999 and 42% in 2000. In 117 (43%) of the opioid prescriptions, pharmacy-based intervention had taken place before the prescription date. Of these, 48.7% was accompanied by a laxative. Opioid prescriptions (n=152) without a pharmacy based intervention were accompanied in 27.6%. After adjustment for covariates (including time trends), pharmacy-based intervention increased the probability of concomitant laxative use 1.9 [95% CI 1.1-3.3] times. DISCUSSION: This study shows that the widely used guideline to start a laxative when prescribing an opioid is not always followed in daily practice. In addition, we showed that pharmacy-based intervention contributed to increasing laxative use in patients receiving opioids.
Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11974784&dopt=Abstract constipation laxative
Nurs Stand. 2001 Nov 7-13;16(8):41-4.
The nurse's role in managing constipation.
Day A.
School of Health Care Practice, Anglia Polytechnic University, 40 Park Road, Chelmsford, Essex CM1 1LL.
Constipation is a problem that affects patients in many care settings. Although recommendations are made for specific groups of patients with constipation, such as older patients and children, there is less information available for general adult patients. Angela Day discusses the need for clinical audit to ensure that nurses are using the most effective options for managing and preventing constipation, and examines the treatment options currently available.
Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11930092&dopt=Abstract constipation laxative
J Pediatr Gastroenterol Nutr. 2002 Apr;34(4):372-7
Polyethylene glycol without electrolytes for children with constipation and encopresis.
Loening-Baucke V.
Department of Pediatrics, University of Iowa, Iowa City, Iowa 52242, USA.
BACKGROUND: Children with functional constipation and encopresis benefit from behavior modification and from long-term laxative medication. Polyethylene glycol without electrolytes has become the first option for many pediatric gastroenterologists. METHODS: Twenty-eight children treated with polyethylene glycol without electrolytes were compared with 21 children treated with milk of magnesia to evaluate the efficiency, acceptability, side effects, and treatment dosage of polyethylene glycol in long-term treatment of functional constipation and encopresis. Children were rated as "doing well," "improved," or "not doing well," depending on resolution of constipation and encopresis. RESULTS: At the 1-, 3-, 6-, and 12-month follow-ups, bowel movement frequency increased and soiling frequency decreased significantly in both groups. At the 1-month follow-up, children on polyethylene glycol were soiling more frequently (P < 0.01) and fewer were improved (P < 0.01). At the 3- and 6-month follow-ups, both groups had similarly improved. At the 12-month visit, 61% of children on polyethylene glycol and 67% of children on milk of magnesia were doing well. Children on polyethylene glycol soiled more frequently (P < 0.01). None refused polyethylene glycol, but 33% refused to take milk of magnesia. The mean initial treatment dosage of polyethylene glycol was 0.6 +/- 0.2 g/kg daily. Polyethylene glycol had no taste, and no loss of efficacy occurred. Polyethylene glycol did not cause clinically significant side effects. CONCLUSIONS: Polyethylene glycol without electrolytes is an alternative for long-term management of children with constipation and encopresis.
Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11915521&dopt=Abstract constipation laxative
Nippon Yakurigaku Zasshi. 2002 Mar;119(3):185-90.
Physicochemical and pharmacological characteristic and clinical efficacy of an anti-irritable bowel syndrome agent, polycarbophil calcium (Polyful)
[Article in Japanese]
Iwanaga Y.
Laboratory of Pharmacology, Research Division, Hokuriku Seiyaku Co., Ltd., 37-1-1 Inokuchi, Katsuyama City, Fukui 911-8555, Japan.
Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by abdominal pain or discomfort and abnormal defecation. Polycarbophil calcium, a water-absorbing polymer, is expected to improve stool consistency. Polycarbophil calcium decalcified under the acidic condition and then absorbed 70 times its weight of water under the neutral condition. In in situ experiments using rat jejunum and colon, polycarbophil decreased water absorption by the intestine without affecting water secretion. Polycarbophil inhibited prostaglandin E2-, 5-hydroxy-L-tryptophan- and castor oil-induced diarrhea in mice or rats. Polycarbophil calcium also inhibited sennoside-induced diarrhea in dogs. Polycarbophil increased the weight of feces in naive or low-fiber diet feeding rats. In naive dogs, polycarbophil calcium increased stool frequency, stool weight and moisture. Polycarbophil was not absorbed from the gastrointestine, not metabolized and eliminated into feces in rats and dogs. Polycarbophil calcium did not affect the absorption of coadministered drugs in dogs. In the dose-finding clinical study for IBS, polycarbophil calcium was effective both in diarrhea and constipation. In the Phase III study, polycarbophil calcium was superior to trimebutine maleate in efficacy and equal in safety. Emesis/vomiting and thirst were observed, but episodes of diarrhea or constipation by excessive action were few. Polycarbophil calcium seems promising as an anti-IBS agent.
Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11874554&dopt=Abstract constipation laxative
Neurogastroenterol Motil. 2002 Feb;14(1):55-61.
Effect of bowel cleansing on colonic transit in constipation due to slow transit or evacuation disorder.
Sloots CE, Felt-Bersma RJ.
Department of Gastroenterology of the 'Vrije Universiteit' Medical Centre, Amsterdam, The Netherlands.
Colon transit time measurement with radio-opaque markers is a method of studying the passage of luminal contents throughout the colon. Overall colonic transit time (CTT), as well as segmental transit times [right (RTT), left (LTT) and rectosigmoid (RSTT)], can be calculated. We hypothesize that CTT is influenced by faecal impaction when the rectum is emptied infrequently. The aim of this study is to investigate the effect of bowel cleansing on colonic transit time in patients with chronic constipation. In 25 women (age 41 years; range 20-65 years) with constipation according to Thompson criteria, CTT measurement was performed in an unprepared situation and repeated after cleansing with 4 L of Klean-Prepreg. Ten healthy female volunteers (age 41 years; range 27-57 years) were used as controls. In constipated patients, CTT decreased from a median 70 h (range 10-130 h) to 48 h (5-94 h) in the cleansed state (P < 0.001). A shortening of transit time was found in all three segments. In 10 patients with slow transit (ST) (CTT > 86 h), CTT decreased from 110 h (range 94-130) to 86 (38-94) (P < 0.001). Five of the 10 patients with ST before bowel cleansing had a CTT below 86 h after cleansing. In female controls, uncleansed CTT and RSTT shortened from 39 h (23 to 62) and 17 h (8-29) to 29 h (17-48) and 10 h (0-20) after bowel cleansing (P=0.058 and P=0.046). Colonic intraluminal contents have a substantial effect on colonic transit. In female controls, bowel cleansing shortened rectosigmoid transit. Women with constipation had faster transit in the cleansed state, however, the distribution of markers was not altered. Despite the effect of bowel cleansing on CTT, it seems unnecessary to prepare the bowel in clinical practice because the differentiation of patients between slow transit constipation and outlet obstruction is not changed. However, because in an infrequent defecation pattern, the influence of faecal impaction is considerable, CTT should be applied with care for critical clinical decisions in the treatment of constipation.
Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11828753&dopt=Abstract constipation laxative
Yakugaku Zasshi. 2002 Jan;122(1):89-95.
Investigation of actual use of laxatives and application to the active drug information offer in drug control guidance
[Article in Japanese]
Odanaka M, Asahi M, Yokogawa K, Miyamoto K.
Department of Pharmacy, Kanazawa University Hospital 13-1, Takara-machi, Kanazawa 920-8641, Japan.
On the therapy of constipation, there are few reports that surveyed the actual circumstance of patients taking laxatives and the effectiveness of the drug. In this study, we investigated the contents in prescription, the actual conditions of administration of laxatives, and the subjective symptoms of inpatients in all wards of Kanazawa University hospital (2000. 12.1-2000. 12. 10). As a result of the investigation, the percentage of patients prescribed some laxatives was found to be about 31.5% (274) of all hospitalized patients (871), and among them about 16% (43) of the patients had some problems in defecation control. One of the causes leading to the problems for some patients (11) among them seemed to be due to the lesser amount of magnesium oxide taken per day. Then, in the ophthalmology ward we further investigated the proper use of laxatives and the defecation condition of the patient using a questionnaire paper and a record paper (20 cases). Patients became constipated by hospitalization, and although being administered some laxatives, they were often insufficient to control the defecation. Some patients (7) with changeable defecation control could be improved by change or addition of prescription. Pharmacist concerned 5 cases of patients with change or addition of prescription. This study indicates that pharmacists should actively offer information and rational usage of laxatives to doctors and patients.
Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11760243&dopt=Abstract constipation laxative
N Z Med J. 2001 Oct 26;114(1142):474-7.
The prevalence of faecal incontinence and constipation in a general New Zealand population; a postal survey.
Lynch AC, Dobbs BR, Keating J, Frizelle FA.
Department of Surgery, Christchurch Hospital.
AIMS: To determine the prevalence of constipation and faecal incontinence in the community. METHODS: A 20-question multi-field postal questionnaire was sent to 1500 adults (over 18 years) randomly selected from the electoral roll in the Canterbury region. Questions detailed frequency of bowel function, time spent at the toilet, incidence and severity of faecal incontinence, constipation, and the effect of disordered bowel function. RESULTS: Of 1500 questionnaires, 717 (48%) were returned (male: female 388:329). The median age was 46 years (range 18-70). 24 (4%) had self-reported gastrointestinal disease. There was a median frequency of seven bowel motions per week (BM/wk) (range 1 to 70) with 89% having between two motions a day and one every two days. Faecal incontinence affected lifestyle in 58 (8.1%). Incontinence of solid stool at least once a month occurred in 70 (9.8%), of liquid stool in 91 (12.7%), of gas in 459 (64%), while 12 (2%) regularly wore a pad. Those with self-reported gastrointestinal disease had a significantly higher (p<0.05) bowel motion frequency (17 vs 7 BM/wk) and median faecal incontinence score (2.5 vs 0). Laxatives were used by 4.9% of the population, while 26.2% increased fibre to avoid constipation. CONCLUSIONS: The normal frequency of bowel motions (+/- 2SD) was 2-17 per week. Faecal incontinence affecting life style affected 8.1%, while constipation requiring regular laxative use affected 4.9% of people. There is acceptance in the community that a moderate degree of bowel dysfunction is normal. Stool frequency and faecal incontinence scores can be used to predict those most likely to have organic gastrointestinal disease.
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Cochrane Database Syst Rev. 2001;(3):CD002040.
What is the role of stimulant laxatives in the management of childhood constipation and soiling?.
Price KJ, Elliott TM.
Sheffield Children's Hospital, Western Bank, Sheffield, South Yorkshire, UK, S10 2 TH.
BACKGROUND: Constipation is extremely common in childhood and may lead to overflow soiling/encopresis. Standard treatment of the more severe case is to empty the bowels of impacted faeces by the use of oral or rectal laxatives and then maintain regular bowel movements by the continuation of osmotic and stimulant laxatives. OBJECTIVES: The objective of the review was to determine the effect of stimulant laxative treatment in children with chronic constipation who may also suffer from soiling / encopresis. SEARCH STRATEGY: The Cochrane database of randomised controlled trials was searched. Additional citations were sought by hand searching of paediatric journals and from contact with known professionals in the field. SELECTION CRITERIA: All identified randomised controlled trials (RCTs) which compare the administering of stimulant laxatives to children with either placebo or alternative treatment. DATA COLLECTION AND ANALYSIS: No trials were found that met the selection criteria. MAIN RESULTS: No trials were found that adequately met the selection criteria. REVIEWER'S CONCLUSIONS: The need exists to establish a secure footing for treatment decisions and adequately sized trials are required to provide comparative data on commonly used drugs.
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Am Fam Physician. 2001 Sep 15;64(6):1019-26.
Management of common symptoms in terminally ill patients: Part II. Constipation, delirium and dyspnea.
Ross DD, Alexander CS.
University of Maryland School of Medicine, Baltimore, USA.
In addition to pain, patients who are approaching the end of life commonly have other symptoms. Unless contraindicated, prophylaxis with a gastrointestinal motility stimulant laxative and a stool softener is appropriate in terminally ill patients who are being given opioids. Patients with low performance status are not candidates for surgical treatment of bowel obstruction. Cramping abdominal pain associated with mechanical bowel obstruction often can be managed with morphine (titrating the dosage for pain) and octreotide. Delirium is common at the end of life and is frequently caused by a combination of medications, dehydration, infections or hypoxia. Haloperidol is the pharmaceutical agent of choice for the management of delirium. Dyspnea, the subjective sensation of uncomfortable breathing, is often treated by titration of an opioid to relieve the symptom; a benzodiazepine is used when anxiety is a component of the breathlessness.
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J Pediatr. 2001 Sep;139(3):428-32.
Efficacy and optimal dose of daily polyethylene glycol 3350 for treatment of constipation and encopresis in children.
Pashankar DS, Bishop WP.
Division of Gastroenterology, Department of Pediatrics, University of Iowa College of Medicine, Iowa City, USA.
OBJECTIVE: To determine efficacy, safety, and optimal dose of a laxative, polyethylene glycol (PEG) 3350, in children with chronic constipation. STUDY DESIGN: Children with chronic constipation (n = 24) were treated with PEG for 8 weeks at an initial dose of 1 g/kg/d. The dose was adjusted every 3 days as required to achieve 2 soft stools per day. A diary was kept to monitor dose, stool frequency and consistency, soiling, and other symptoms. Stool consistency was rated from 1 (hard) to 5 (watery). Subjects were examined for fecal retention. The Student t test and the Fisher exact test were used for data analysis. RESULTS: All 20 children who completed the study found PEG to be palatable and were satisfied with the treatment. There were no significant adverse effects. Weekly stool frequency increased from 2.3 +/- 0.4 to 16.9 +/- 1.6 (P <.0001) during treatment and stool consistency from 1.2 +/- 0.1 to 3.3 +/- 0.1 (P <.0001). In 9 children with soiling, weekly soiling events declined from 10.0 +/- 2.4 to 1.3 +/- 0.7 (P =.003). The mean effective dose was 0.84 g/kg/d (range, 0.27-1.42 g/kg/d). CONCLUSION: Daily administration of PEG at a mean dose of 0.8 g/kg is an effective, safe, and palatable treatment for constipation.
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Dis Colon Rectum. 2001 Aug;44(8):1201-9.
Adverse effects of laxatives.
Xing JH, Soffer EE.
Department of Gastroenterology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Laxatives are among the most commonly used drugs or additives. Most are quite safe when used judiciously, intermittently when possible, and in the absence of contraindications. Bulking agents and nonabsorbable compounds such as lactulose can cause bloating but have very few serious adverse effects except for the allergic reaction to psyllium preparations. Osmotic laxatives containing poorly absorbable ions such as magnesium or phosphate can cause metabolic disturbances, particularly in the presence of renal impairment. However, if taken intermittently, in the absence of conditions such as ileus or bowel obstruction, they have few adverse effects. Polyethylene glycol solutions are emerging as an effective and safe mode of treatment for chronic constipation. Of stimulant laxatives, senna compounds and bisacodyl are the most commonly used. Although there are data to support the neoplastic potential of this class of drugs in in vitro studies, epidemiologic data in humans so far has not established a clear link between these laxatives and colonic neoplasia. The link between stimulant laxatives and structural changes, such as the "cathartic colon" or enteric nerve damage, is not well established either. Danthron compounds should be avoided because of hepatotoxicity.
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J Clin Gastroenterol. 2001 Sep;33(3):199-205.
Childhood constipation: evaluation and treatment.
Youssef NN, Di Lorenzo C.
Department of Pediatrics, Division of Gastroenterology, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
Constipation is common in children. It is estimated that between 5% and 10% of pediatric patients have constipation and/or encopresis. Constipation is the second most referred condition in pediatric gastroenterology practices, accounting for up to 25% of all visits. In this article, a practical approach is laid out for those not familiar with constipation in children. Emphasis is placed on the evaluation and management options that are available to the treating practitioner. The diagnosis of constipation requires careful history taking and interpretation. Diagnostic tests are not often needed and are reserved for those who are severely affected. The daily bowel habits of children are extremely susceptible to any changes in routine environment. Constipation and subsequent fecal retention behavior often begins soon after a child has experienced a painful evacuation. Childhood constipation can be very difficult to treat. It often requires prolonged support by physicians and parents, explanation, medical treatment, and, most important, the child's cooperation.
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Prim Care. 2001 Sep;28(3):577-90, vi.
Constipation: evaluation and management.
Borum ML.
Division of Gastroenterology, Department of Medicine, George Washington University Medical Center, Washington, DC 20037, USA.
Constipation is a common symptom that can result from several disorders. Most patients with chronic constipation do not have a medical disorder contributing to the constipation and, therefore, require limited evaluation. Initial intervention should include dietary measures and fiber supplements; however, if fiber supplementation is ineffective, other agents can be used. Surgery should be reserved for patients who meet specific clinical criteria.
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Eur J Gastroenterol Hepatol. 2001 Jun;13(6):631-3.
Of tubes and men: studying manometrically the effects of laxatives on colonic motility.
Bassotti G, Fratini M.
Department of Clinical and Experimental Medicine, University of Perugia Medical School, Italy.
Chronic constipation is encountered frequently in clinical practice, and the use of laxatives is widespread in the general population. The need for effective and safe compounds stimulates research in the field. Unfortunately, to assess the colonic motility effects of these compounds, we have to rely on objective measurements available only through relatively invasive studies, such as manometric recordings of the motor activity of the large bowel. However, the possibility of studying almost the entire length of the viscus with these techniques allows a better definition of the pathophysiological processes involved in the genesis of constipation, and more insights into the effects of specifically acting drugs.
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Pediatrics. 2001 Jul;108(1):E9.
The effect of anorectal manometry on the outcome of treatment in severe childhood constipation: a randomized, controlled trial.
van Ginkel R, Buller HA, Boeckxstaens GE, van Der Plas RN, Taminiau JA, Benninga MA.
Division of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.
OBJECTIVE: Approximately 50% of constipated children contract rather than relax the external sphincter complex during a defecation attempt. Although biofeedback training (BF) is able to change this defecation behavior, there is no additional effect of BF to conventional treatment (CT) on clinical outcome compared with CT alone. It has been postulated that the absence of a significant difference between these 2 treatment options might be because of a therapeutic, "demystifying" effect of performing anorectal manometry in conventionally treated children, necessary to obtain basal manometric data. The objective of this prospective, controlled, randomized study was to evaluate the effect of CT with 2 anorectal manometry sessions compared with CT alone (dietary advice, diary, toilet training, oral laxatives, and enemas) on clinical outcome. METHODS: A total of 212 constipated children (143 boys) who were visiting a referral pediatric gastroenterologic practice were randomized prospectively to CT alone (115 patients) or to CT combined with 2 manometry sessions (CTM; 97 patients). Patients were included in the study when they fulfilled at least 2 of the 4 following criteria: stool frequency fewer than 3 per week, 2 or more soiling and/or encopresis episodes per week, periodic passage of very large amounts of stool every 7 to 30 days, or a palpable rectal or abdominal fecal mass. CT comprises dietary advice, a daily diary, toilet training, and oral laxative treatment preceded by rectal disimpaction with enemas on 3 consecutive days. During both manometries, the child and the parent could watch the tracing on the computer screen. No explanation was given to either the child or the parents during the procedure. When the procedure was finished, the tracings were clarified. Successful treatment was defined as a defecation frequency of 3 or more per week and fewer than 1 soiling/encopresis episode per 2 weeks and no use of laxatives. RESULTS: Only 4 and 2 children from the CT and CTM groups showed no soiling and/or encopresis, whereas 76% and 65%, respectively, reported the periodic passage of large stools. In 26% and 30% of the patients, a rectal scybalum was found on physical examination. The success rates at 6, 26, 52, and 104 weeks' follow-up were 4%, 24%, 32%, and 43% and 7%, 22%, 30%, and 35% in the CT and CTM group, respectively. No significant difference in success percentage was observed between the 2 groups at any time of follow-up with relative risks (CT/CTM) and 95% confidence intervals, respectively, of 0.55 (0.16-1.89), 1.13 (0.67-1.89), 1.07 (0.69-1.65), and 1.23 (0.81-1.85). A significant increase in defecation frequency was observed between the first (intake) and second visits, which was sustained at all subsequent visits and stages of follow-up in both groups (not significant). Also in relation to the first visit, a significant decrease in encopresis episodes was shown and a further slow but significant decrease at 52 weeks of follow-up in both groups. The manometric data obtained from the CTM group showed a low percentage of children with normal defecation dynamics, namely 28%, which (significantly) increased to 38% at the last manometry. CONCLUSIONS: Anorectal manometry combined with CT compared with CT alone did not result in higher success rates in chronically constipated children. Therefore, anorectal manometry has no additional demystifying or educational effect on clinical outcome in chronically constipated children. This observation together with the observation in the current and previous studies that no correlation was found between (achievement of) normal defecation dynamics and success and that no relation was observed between volume of urge or critical volume and success leaves no diagnostic or therapeutic role for anorectal manometry in chronic constipated children, except its use as a diagnostic test to exclude Hirschsprung's disease. A simple CT is successful in 30% of severely constipated children who are referred to a tertiary hospital, underscoring the importance of long-lasting and adequate laxative treatment.
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Aliment Pharmacol Ther. 2001 Jun;15(6):749-63.
Review article: the therapy of constipation.
Schiller LR.
Baylor University Medical Center, Dallas, Texas 75246, USA.
Constipation is a common symptom that may be idiopathic or due to various identifiable disease processes. Laxatives are agents that add bulk to intestinal contents, that retain water within the bowel lumen by virtue of osmotic effects, or that stimulate intestinal secretion or motility, thereby increasing the frequency and ease of defecation. Drugs which improve constipation by stimulating gastrointestinal motility by direct actions on the enteric nervous system are under development. Other modalities used to treat constipation include biofeedback and surgery. Laxatives and lavage solutions are also used for colon preparation and evacuation of the bowels after toxic ingestions.
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South Med J. 2001 May;94(5):478-81.
New polyethylene glycol laxative for treatment of constipation in adults: a randomized, double-blind, placebo-controlled study.
Cleveland MV, Flavin DP, Ruben RA, Epstein RM, Clark GE.
Braintree Laboratories Inc, Mass 02185, USA.
BACKGROUND: This study evaluated the safety and effectiveness of a new polyethylene glycol (PEG) laxative (MiraLax, Braintree Laboratories Inc, Braintree, Mass) in 23 patients reporting a history of constipation. METHODS: After a 7-day placebo control period, patients were randomized into a double crossover trial of placebo versus 17 g of PEG daily for 4 days. Patient maintained a stool diary. RESULTS: Daily ingestion of a 17 g dose of PEG increased mean daily bowel movement frequency to once per day by the last 7 days of the 14-day treatment period. This was a statistically significant improvement over placebo, which provided about 1 bowel movement every 2 days during the last week of therapy. Patient diary ratings of related subjective symptoms were improved with PEG treatment over placebo. Both investigator and patients rated PEG therapy superior to placebo. No clinically significant changes in blood chemistry, complete blood count (CBC), or urinalysis were observed. CONCLUSIONS: Daily therapy with 17 g of PEG laxative for 14 days resulted in a significant improvement in bowel movement frequency in constipated patients relative to placebo by the second week of treatment.
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Dis Colon Rectum. 2001 May;44(5):737-9; discussion 739-40.
Biofeedback avoids surgery in patients with slow-transit constipation: report of four cases.
Brown SR, Donati D, Seow-Choen F, Ho YH.
Department of Colorectal Surgery, Singapore General Hospital, Singapore.
Biofeedback is established treatment for intractable constipation in patients with an element of pelvic floor dysfunction. In those with intractable slow-transit constipation and normal pelvic floor function, colectomy is usually recommended. We report four patients with isolated slow-transit constipation who benefited from biofeedback and avoided surgery. All four patients were extensively investigated for pelvic floor dysfunction before undergoing a standard biofeedback course of four outpatient sessions. All improved in terms of bowel frequency, laxative use, bloating, straining, and lifestyle. Improvement has been maintained for a median of nine (range, 5-12) months without the requirement for further treatment. Biofeedback represents a safe and inexpensive treatment for these patients and may avoid surgery in a significant proportion.
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Curr Pain Headache Rep. 2001 Jun;5(3):237-40.
Management of opioid-induced constipation.
Thorpe DM.
Pain Medicine and Palliative Care, The Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Suite 2100, Salt Lake City, UT 84112, USA.
Constipation is an expected side effect of opioid use and as such should be treated prophylactically. However, because it is often overlooked and under-appreciated it is one of the most common reasons patients avoid or abandon opioid use and, as a result, suffer pain needlessly. Thorough assessment, ongoing evaluation, and patient teaching are key factors in establishing an effective bowel regimen. A bowel clean-out is indicated for patients who have not had a bowel movement in more than 5 days. Once any impactions have been eliminated, a regular regimen of senna and docusate is recommended. Dietary modifications, fluids, and exercise are important but usually not sufficient to overcome opioid-induced constipation. Although many of the medicines that are used to treat pain and related symptoms come with a significant potential for distressing side effects, it is important to understand that most side effects, especially constipation, can be managed and quality of life can be preserved without sacrificing needed analgesia.
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J Clin Nurs. 2000 Jul;9(4):516-25.
Older people and laxative use: literature review and pilot study report.
Koch T, Hudson S.
Royal District Nursing Service of South Australia Inc., Domiciliary Nursing, School of Nursing, Flinders University of South Australia, GPO Box 2100, Adelaide 5001, South Australia, Australia.
This study explored older adults' perceptions of constipation, and the measures taken if they believed themselves to be afflicted by this condition. The paper provides an overview of the current literature surrounding laxative use, followed by a discussion of the pilot study and its findings. The objectives of the pilot study were to establish older people's definitions of the term 'constipation'; identify prescribed laxatives, over-the-counter laxatives, and home remedies used by older people to manage constipation; produce a detailed account of when these products are used; identify the older person's belief system underpinning their concepts of constipation, and their consequent use of laxative products; and produce information which will inform nursing practice, with a particular focus on nurses in community practice. People who identified themselves as being constipated were interviewed on a one to one basis. Participants shared their stories of loneliness, social isolation and anxiety related to constipation and the need to use laxatives on a daily basis, and described persis