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Gastroenterology. 2003 Aug;125(2):357-63.
Childhood constipation: longitudinal follow-up beyond puberty.

van Ginkel R, Reitsma JB, Buller HA, van Wijk MP, Taminiau JA, Benninga MA.

Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.

Background & Aims: Sparse data exist about the prognosis of childhood constipation and its possible persistence into adulthood. METHODS: A total of 418 constipated patients older than 5 years at intake (279 boys; median age, 8.0 yr) participated in studies evaluating therapeutic modalities for constipation. All children subsequently were enrolled in this follow-up study with prospective data collection after an initial 6-week intensive treatment protocol, at 6 months, and thereafter annually, using a standardized questionnaire. RESULTS: Follow-up was obtained in more than 95% of the children. The median duration of the follow-up period was 5 years (range, 1-8 yr). The cumulative percentage of children who were treated successfully during follow-up was 60% at 1 year, increasing to 80% at 8 years. Successful treatment was more frequent in children without encopresis and in children with an age of onset of defecation difficulty older than 4 years. In the group of children treated successfully, 50% experienced at least one period of relapse. Relapses occurred more frequently in boys than in girls (relative risk 1.73; 95% confidence interval, 1.15-2.62). In the subset of children aged 16 years and older, constipation still was present in 30%. CONCLUSIONS: After intensive initial medical and behavioral treatment, 60% of all children referred to a tertiary medical center for chronic constipation were treated successfully at 1 year of follow-up. One third of the children followed-up beyond puberty continued to have severe complaints of constipation. This finding contradicts the general belief that childhood constipation gradually disappears before or during puberty.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12891536&dopt=Abstract constipation laxative

J Pediatr Psychol. 2003 Sep;28(6):375-82.
Assessment of behavioral mechanisms maintaining encopresis: Virginia Encopresis-Constipation Apperception Test.

Cox DJ, Ritterband LM, Quillian W, Kovatchev B, Morris J, Sutphen J, Borowitz S.

Behavioral Medicine Center, University of Virginia Health System, Charlottesville 22908, USA..

OBJECTIVE: To develop and test a scale for parent and child, evaluating theoretical and clinical parameters relevant to children with encopresis. Encopretic children were hypothesized to have more bowel-specific, but not more generic, psychological problems, as compared with nonsymptomatic control children. In addition, mothers were also believed to be more discerning than children. METHODS: The Virginia Encopresis-Constipation Apperception Test (VECAT) consists of 9 pairs of bowel-specific and 9 parallel generic drawings. Respondents selected the picture in each pair that best described them/their child. It was administered to encopretic children (N = 87), nonsymptomatic siblings (N = 27), and nonsymptomatic nonsiblings (N = 35). The mothers of all the participants also completed the VECAT. Encopretic children were retested 6 and 12 months posttreatment with Enhanced Toilet Training. RESULTS: The VECAT demonstrated good test-retest reliability and internal consistency. Encopretic children and their mothers reported more bowel-specific, but not more generic, problems. Bowel-specific scores improved significantly posttreatment only for those patients who demonstrated significant symptom improvement. Mothers were significantly more discerning than children. CONCLUSION: The VECAT is a reliable, valid, discriminating, and sensitive test. Bowel-specific problems appear to best differentiate children with and without encopresis.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12904449&dopt=Abstract constipation laxative colon cleansing

Am J Gastroenterol. 2003 Aug;98(8):1790-6.
Association between physical activity, fiber intake, and other lifestyle variables and constipation in a study of women.

Dukas L, Willett WC, Giovannucci EL.

Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, Massachusetts 02115, USA.

Because the risk factors for constipation in the general population are poorly defined, we examined the association between age, body mass index, and selected lifestyle and dietary factors with the prevalence of constipation in the Nurses' Health Study.A total of 62,036 women, aged 36-61 yr and free of cancer, responded to mailed questionnaires in 1980 and 1982, which assessed bowel movement frequency, dietary, and lifestyle factors. Constipation was defined as two or fewer bowel movements weekly.A total of 3327 women (5.4%) were classified as having constipation. Age and body mass index were inversely associated with constipation (p for trend < 0.0001). In multivariate analysis, women who reported daily physical activity had a lower prevalence of constipation (prevalence ratio [PR] = 0.56, 95% CI = 0.44-0.70). Women in the highest quintile of dietary fiber intake (median intake 20 g/day) were less likely to experience constipation (PR = 0.64, 95% CI = 0.57-0.73) than women in the lowest quintile (median intake 7 g/day). The PR for constipation for women who both reported daily physical activity and were in the highest quintile of fiber intake was 0.32 (95% CI = 0.20-0.54) compared with those with physical activity less than once weekly and those who were in the lowest quintile of fiber intake. Higher frequency of aspirin intake was associated with an increasing prevalence of constipation (PR = 1.38, 95% CI = 1.17-1.62). Current smoking and alcohol use were inversely associated with constipation.Our data suggest that moderate physical activity and increasing fiber intake are associated with substantial reduction in the prevalence of constipation in women.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12907334&dopt=Abstract constipation laxative [PubMed

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