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References: Laxative

J Clin Gastroenterol. 1998 Jun;26(4):283-6.
Alterations in colonic anatomy induced by chronic stimulant laxatives: the cathartic colon revisited.

Joo JS, Ehrenpreis ED, Gonzalez L, Kaye M, Breno S, Wexner SD, Zaitman D, Secrest K.

Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale, USA.

Cathartic colon is a historic term for the anatomic alteration of the colon secondary to chronic stimulant laxative use. Because some have questioned whether this is a real entity, we investigated changes occurring on barium enema in patients ingesting stimulant laxatives. Our study consisted of two parts. In part 1, a retrospective review of consecutive barium enemas performed on two groups of patients with chronic constipation (group 1, stimulant laxative use [n=29]; group 2, no stimulant laxative use [n=26]) was presented to a radiologist who was blinded to the patient group. A data sheet containing classic descriptions of cathartic colon was completed for each study. Chronic stimulant laxative use was defined as stimulant laxative ingestion more than three times per week for 1 year or longer. To confirm the findings of the retrospective study, 18 consecutive patients who were chronic stimulant laxative users underwent barium enema examination, and data sheets for cathartic colon were completed by another radiologist (part 2). Colonic redundancy (group 1, 34.5%; group 2, 19.2%) and dilatation (group 1, 44.8%; group 2, 23.1%) were frequent radiographic findings in both patient groups and were not significantly different in the two groups. Loss of haustral folds, however, was a common finding in group 1 (27.6%) but was not seen in group 2 (p < 0.005). Loss of haustral markings occurred in 15 (40.5%) of the total stimulant laxative users in the two parts of the study and was seen in the left colon of 6 (40%) patients, in the right colon of 2 (13.3%) patients, in the transverse colon of 5 (33.3%) patients, and in the entire colon of 2 (13.3%) patients. Loss of haustra was seen in patie

Am J Gastroenterol. 1998 Jul;93(7):1042-50.
Obstructive defecation: a failure of rectoanal coordination.

Rao SS, Welcher KD, Leistikow JS.

Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, USA.

OBJECTIVE: The pathophysiology of obstructive defecation is unclear. We investigated whether impaired rectoanal coordination causes obstructive defecation and if this dysfunction can be corrected by biofeedback therapy. METHODS: We prospectively studied 25 healthy subjects and 35 consecutive patients with constipation (>1 year) with anorectal manometry and balloon expulsion test. Symptoms were assessed from diary cards. Patients found to have obstructive defecation were offered biofeedback therapy. After treatment, their defecation dynamics and symptoms were reassessed. RESULTS: Eighteen patients had obstructive defecation and 17 had normal defecation dynamics (nonobstructive). Five normals (20%) exhibited obstructive pattern but only one failed to expel balloon. In the obstructive group, during straining, the intrarectal pressure and defecation index were lower (p < 0.05), and anal residual pressure was higher (p < 0.01) when compared with the nonobstructive group or normals. After biofeedback therapy, the intrarectal pressure and defecation index increased (p < 0.02) and anal residual pressure decreased (p < 0.001); stool frequency, degree of straining, and bowel satisfaction scores improved (p < 0.05); 67% stopped laxatives and 11 patients discontinued stooling with digitation. CONCLUSION: Patients with obstructive defecation showed impaired rectal contraction, paradoxical anal contraction, or inadequate anal relaxation. These features suggest that rectoanal coordination was impaired. Biofeedback therapy rectified these pathophysiological disturbances and improved constipation.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9672327&dopt=Abstract constipation laxative

S Afr Med J. 1998 Jul;88(7):888-90.
Constipation in elderly patients attending a polyclinic.

Meiring PJ, Joubert G.

Department of Biostatistics, University of the Orange Free State, Bloemfontein.

OBJECTIVE: To determine the prevalence of and risk factors for constipation in the elderly. Differences between the white and black elderly populations in this regard were examined. DESIGN: Cross-section hospital-based study. SETTING: The family medicine clinics at National and Pelonomi hospitals in greater Bloemfontein. PARTICIPANTS: 179 white and 188 black patients, born before 1930, visiting the clinics during December and January 1994/95 and seen by one doctor. MAIN OUTCOME MEASURES: Constipation. RESULTS: In both the black and white population groups 29% of the participants were constipated according to the definition used in this study. Depression was a risk factor for constipation in both population groups. Age over 80 years was a risk factor in the black participants. The fibre and fluid contents of participants' diets were not found to be associated with constipation. Pain during defaecation was positively associated with constipation. Forty-three per cent of the white and 76.6% of the black participants used laxatives. Of the white and black laxative users 14.3% and 21.5%, respectively, used more than one laxative at a time. CONCLUSION: The prevalence of constipation was high in both groups. Laxative use and abuse are very common in the black elderly population.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9698719&dopt=Abstract constipation laxative

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