References: Laxative
J Pediatr Surg. 1997 Jun;32(6):843-8.
The Pediatric Bowel Management Clinic: initial results of a multidisciplinary approach to functional constipation in children.
Poenaru D, Roblin N, Bird M, Duce S, Groll A, Pietak D, Spry K, Thompson J.
Department of Surgery, Faculty of Medicine, Queen's University, Kingston, Ontario, Canada.
The multifactorial nature of functional constipation in children suggests that a multidisciplinary management approach may be effective. The authors tested this hypothesis in a newly created pediatric Bowel Management Clinic (BMC). Detailed data were collected prospectively on all patients seen in the clinic over the first 16 months. Both quantitative and qualitative analyses were performed to describe the index population and to demonstrate the impact of the intervention. Satisfaction with care in the clinic was measured using the Measure of Processes of Care tool, then compared with a normative sample. One hundred fourteen patients, all previously treated unsuccessfully for constipation, were referred to a team comprised of a physician, nurse practitioner, nurse educator, dietitian, and psychosocial nurse specialist. The mean age was 5.4 years with equal gender distribution. Between the first and last visits recorded, several variables including stool consistency and frequency, soiling frequency, abdominal pain, rectal pain, and rectal bleeding all showed statistically significant (P < .05) improvement. Qualitative data analysis showed the significant psychosocial impact of constipation on patients and their families. In the Measures of Processes of Care questionnaire, scores for the BMC were higher than normal on all scales except in provision of information. A multidisciplinary approach to functional constipation leads to both patient and parent satisfaction and significant short-term improvement. Further studies will examine the long-term impact of the clinic.
Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9200083&dopt=Abstract constipation laxative colon cleansing
Dis Colon Rectum. 1997 Jul;40(7):811-6.
Anal sensitivity test: what does it measure and do we need it? Cause or derivative of anorectal complaints.
Felt-Bersma RJ, Poen AC, Cuesta MA, Meuwissen SG.
Department of Surgery, Free University Hospital, Amsterdam, The Netherlands.
PURPOSE: This study was undertaken to determine the anal sensitivity in controls and in different patient groups and to establish factors that determine anal sensitivity. METHODS: Anorectal function tests were performed in 387 patients with different anorectal diseases. Anal sensitivity was measured in 36 controls. Anal sensitivity was measured by means of mucosal electrosensitivity (MES) using a catheter with two electrodes placed in the anal canal. A constant current (square wave stimuli 100 microsec, pulses per second) was increased stepwise from 1 to 20 mAmp until the threshold sensation was reached. Other tests used were anal manometry (maximum basal pressure, maximum squeeze pressure, rectal compliance (maximum rectal volume and pressure), endosonography (submucosal thickness), defects and thickness of internal and external sphincter), electromyography (maximum contraction pattern, Grade 1 (solitary contractions) to Grade 4 (interference pattern)), and pudendal nerve terminal motor latency. Multiple regression analysis was performed. It was postulated that age, local conditions (anal scars, anal fissures, hemorrhoids, mucosal prolapse, proctitis, sphincter thickness and defects, and submucosal thickness), and neurologic factors could influence anal sensitivity. RESULTS: Controls had an MES of 3.4 +/- 1.7. MES was significantly increased compared with controls in patients with fecal incontinence, soiling, hemorrhoids, mucosal prolapse, constipation, anal scars, anal surgery, and sphincter defects; patients with fecal incontinence had the highest MES (6.7 +/- 4.3; P < 0.0001). Patients with anal fissures and proctitis showed no differences compared with controls. MES correlated significantly with age (R = 0.29), m
Pediatrics. 1997 Aug;100(2 Pt 1):228-32.
Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood.
Loening-Baucke V.
Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
OBJECTIVES: To evaluate the frequency of urinary incontinence and urinary tract infection in children with chronic constipation and report on the resolution of these with treatment of the underlying constipation. METHODS: We evaluated the frequency of urinary incontinence and urinary tract infection in 234 chronic constipated and encopretic children before, and at least 12 months after, the start of treatment for constipation. RESULTS: Twenty-nine percent complained of daytime urinary incontinence and 34% of nighttime urinary incontinence. Urinary tract infection was present in 11% and was more commonly present in girls than in boys (33% vs 3%). Vesicoureteral reflux was present in four and megacystis in four of the 25 children who had a voiding cystourethrogram because of urinary tract infection. One girl who came in had constipation and acute urinary retention. The treatment for constipation consisted of disimpaction and maintenance treatment, which included the prevention of reaccumulation of stools and reconditioning to normal bowel habits through timed toilet sitting. Follow-up, at least 12 months after start of treatment for constipation, revealed that the constipation was relieved successfully in 52%. Relief of constipation resulted in disappearance of daytime urinary incontinence in 89% and nighttime urinary incontinence in 63% of patients, and disappearance of recurrent urinary tract infections in all patients who had no anatomic abnormality of the urinary tract. CONCLUSION: Urinary symptoms were found in a significant number of children who had functional constipation and encopresis. With treatment of the constipation, most patients became clean and dry and further recurrence of urinary tract infections was prevent
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