References: Laxative
Dig Dis Sci. 1998 Nov;43(11):2353-62.
A comparison of stool characteristics from normal and constipated people.
Aichbichler BW, Wenzl HH, Santa Ana CA, Porter JL, Schiller LR, Fordtran JS.
Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas 75246, USA.
In people with constipation, it is not known if decreased frequency of defecation is associated with abnormalities in the weight or in the consistency of stools or if the weight or the consistency of stools correlates with the severity of various discomforts associated with bowel movements. In neither normal nor constipated subjects has the consistency of stools been carefully correlated with their relative contents of water and solids. Our aim was to gain insight into these questions. Twenty subjects with idiopathic chronic constipation and 20 age- and sex-matched control subjects were recruited by advertisement. Stools were collected for one week. After each bowel movement, the subject's perception of various discomforts associated with the bowel movement were recorded. The stools were then analyzed. The results and conclusions were as follows: (1) Stool weight per bowel movement was similar in the two groups but stool weight per week was markedly reduced in constipated subjects. (2) Reduced stool weight per week in constipated subjects was due to a nearly proportional reduction in stool water and stool solids output. (3) Using data from both groups, there was a curvilinear correlation between percent insoluble stool solids and stool hardness, as measured by a texture analyzer; hardness increased only slightly as percent insoluble solids increased between 7 and 20%, but hardness increased dramatically when percent insoluble solids exceeded 25%. (4) Only 6% of stools from constipated subjects (2 of 34) had abnormally high values for percent stool solids and physical hardness. (5) In subjects with constipation, the severity of various discomforts associated with bowel movements (such as straining) correlated poo
Dig Dis Sci. 1998 Nov;43(11):2379-83.
Effects of regular exercise in management of chronic idiopathic constipation.
Meshkinpour H, Selod S, Movahedi H, Nami N, James N, Wilson A.
Department of Medicine, University of California, Irvine, USA.
Regular physical exercise has long been considered in the management of chronic constipation. This recommendation is probably based on the assumption that exercise shortens the transit time through the gastrointestinal tract. However, on the basis of previous studies, the effect of exercise on the transit remains controversial at best. Therefore, it was the goal of the present study to assess the influence of regular physical exercise, what average people may consider routine exercise, in the management of chronic idiopathic constipation. The study population consisted of eight patients, seven women and a man, with chronic idiopathic constipation. They were studied for six weeks, including two weeks of rest and four weeks of regular exercise. Patients had a submaximal exercise test, before and after the exercise period, to determine their rate of perceived exertion (RPE), the target heart rate, and the intensity of exercise they can perform. In addition to their routine daily activities, they exercised 1 hr a day, five days a week according to their performance at the initial exercise tolerance test. They kept a daily activity log and maintained their normal dietary intake during this period. The patients overall physical activity was assessed by a pedometer. They also maintained a diary of the number and consistency of their bowel movements and the amount of straining required for defecation. The impact of exercise on constipation was assessed by utilizing an index that took into consideration all three parameters of bowel function. Results of the study revealed that patients covered 1.8+/-0.33 and 3.24+/-0.28 miles/day in the rest period and during the exercise period, respectively (P = 0.007). The intensity of exercise may have improved the level o
Eur J Pediatr Surg. 1998 Oct;8(5):299-303.
Desmosis of the colon: a working hypothesis of primary chronic constipation.
Meier-Ruge WA.
Department of Pathology, University Medical School, University of Basel, Switzerland.
INTRODUCTION: Over the last few years, resected specimens of colon from children and young adults have been systematically studied with regard to the vegetative innervation of the colon and its net of stabilizing connective tissue in the muscularis propria. From the basic investigations of Goerttler, it is known that this connective tissue net has important functions in the coordinated movement of longitudinal and circular muscles. The present study reports on cases of chronic constipation, which showed in most cases histopathologically a normal number of nerve cells and ganglia in the myenteric plexus, but abnormalities in the connective tissue net (desmosis). SUBJECTS AND METHODS: Over 6 years, 236 cases (12 +/- 8 years of age), which were treated surgically for an aganglionosis, hypoganglionosis, hypoperistalsis syndrome and megacolon development, were histopathologically investigated. All surgical specimens were native, caudo-cranially coiled, and were cut 15 microns (equiv. to 4-5 microns paraffin sections) by a cryostat. The vegetative nervous system of the gut was stained with acetylcholinesterase and dehydrogenase reactions. The tissue was also fixed in formalin, embedded in paraffin, and 4 microns sections were stained with hematoxylineosin and picric acid/sirius red. Collagen III; S 100 and PGP 9.5 immunohistochemical reactions were performed. RESULTS: 14 surgical specimens (6%) showed total or focal lack of the connective tissue net in the vicinity of the myenteric plexus. Between the connective tissue net of circular and longitudinal muscles, a continuous connection was missing. These cases were mainly characterized by a hypoperistalsis syndrome or a megacolon without any anomaly of the vegetative innervation. 222 cases (94%) were treated for Hirschsprung's disease
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