References: Laxative
Dig Dis Sci. 1997 Nov;42(11):2197-205.
Effects of biofeedback therapy on anorectal function in obstructive defecation.
Rao SS, Welcher KD, Pelsang RE.
Department of Internal Medicine, University of Iowa College of Medicine, Iowa City 52242, USA.
Biofeedback therapy improves symptoms in patients with constipation and obstructive defecation. Whether it also improves anorectal function is unclear. Our purpose was to investigate prospectively the effects of biofeedback therapy on subjective and objective parameters of anorectal function in 25 consecutive patients with obstructive defecation. Biofeedback therapy consisted of pelvic floor relaxation exercises (phase I) and neuromuscular conditioning of rectal sensation and rectoanal coordination, with a solid state manometry system and simulated defecation maneuvers (phase II). The number of sessions was customized for each patient. Clinical improvement was assessed from the changes in anorectal manometry, balloon (50 cc) expulsion test, and the symptom and stool diaries. The number of therapy sessions varied [mean (range) = 6 (2-10)]. After therapy, when straining as if to defecate, the percentage anal relaxation, intrarectal pressure, and defecation index increased (P < 0.001). The balloon expulsion time, laxative consumption, and straining effort decreased (P < 0.001). Before therapy, 16/25 (64%) patients had impaired rectal sensation, and after therapy this improved (P < 0.001). After therapy, 15/25 (60%) patients reported > or = 75% satisfaction with bowel habit and 8/25 (32%) reported > or = 50% satisfaction (P < 0.001); 15/16 (94%) patients discontinued digital disimpaction. Biofeedback therapy not only improves subjective but also objective parameters of anorectal function in at least 76% of patients by rectifying the underlying pathophysiologic disturbance(s). Sensory conditioning and customizing the number of sessions may offer additional benefits.
Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9398795&dopt=Abstract constipation laxative colon cleansing
Gut. 1997 Nov;41(5):675-81.
Clinical characteristics of chronic idiopathic intestinal pseudo-obstruction in adults.
Mann SD, Debinski HS, Kamm MA.
St Mark's Hospital, Harrow, Middlesex, UK.
BACKGROUND: Chronic idiopathic intestinal pseudo-obstruction, a syndrome of ineffectual motility due to a primary disorder of enteric nerve or muscle, is rare. AIMS: To determine the clinical spectrum, underlying pathologies, response to treatments, and prognosis in a consecutive unselected group of patients. METHODS: Cross sectional study of all patients with clinical and radiological features of intestinal obstruction in the absence of organic obstruction, associated with dilated small intestine (with or without dilated large intestine), being actively managed in one tertiary referral centre at one time. RESULTS: Twenty patients (11 men and nine women, median age 43 years, range 22-67) fulfilled the diagnostic criteria. Median age at onset of symptoms was 17 years (range two weeks to 59 years). Two patients had an autosomally dominant inherited visceral myopathy. Major presenting symptoms were pain (80%), vomiting (75%), constipation (40%), and diarrhoea (20%). Eighteen patients required abdominal surgery, and a further patient had a full thickness rectal biopsy. The mean time interval from symptom onset to first operation was 5.8 years. Histology showed visceral myopathy in 13, visceral neuropathy in three, and was indeterminate in three. In the one other patient small bowel motility studies were suggestive of neuropathy. Two patients died within two years of symptom onset, one from generalised thrombosis and the other from an inflammatory myopathy. Of the remaining 18 patients, eight were nutritionally independent of supplements, two had gastrostomy or jejunostomy feeds, and eight were receiving home parenteral nutrition. Five patients were opiate dependent, only one patient had benefited from prokinetic drug therapy, and five patients required formal psychological intervention and suppor
J Am Geriatr Soc. 1998 Jan;46(1):83-7.
Relation of colonic transit to functional bowel disease in older people: a population-based study.
Evans JM, Fleming KC, Talley NJ, Schleck CD, Zinsmeister AR, Melton LJ 3rd.
Division of Community Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
OBJECTIVE: The pathophysiology underlying chronic constipation in older people is poorly understood. Our objective was to determine if functional bowel disease (particularly constipation) in this population is associated with risk factors (age, immobility, low dietary fiber intake, and medication use) or directly with slow colonic transit. METHODS: A previously validated questionnaire was administered to a random sample of older residents (age range 65-104 years, n = 1609) of Olmsted County, MN. A random subset who met standard diagnostic criteria for functional constipation (n = 52) or irritable bowel syndrome (IBS) (n = 55) and a group without gastrointestinal symptoms (n = 93) were selected for further study. Each subject underwent structured interview and physical examination. Total caloric and fiber intake were assessed by dietitian interview, a food frequency questionnaire, and a food diary. Physical activity was assessed using a previously validated instrument. Medication use was determined by self-report, physician interview, and review of medical records. Total and segmental colonic transit was assessed radiographically using radioopaque markers. RESULTS: Total colonic transit times were prolonged in subjects with functional constipation (median 50.4 hours) but not in subjects with IBS (median 34.2 hours) or in healthy controls (median 28.8 hours); however, only rectosigmoid transit was delayed significantly. Age, gender, physical activity, and dietary fiber intake were not associated with total transit times, nor could they discriminate among the three patient groups. Laxative use was associated with prolonged total transit times independent of patient group. CONCLUSIONS: Older subjects can
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