Constipation and encopresis in children

Chronic constipation is defined as a decrease in frequency or the painful passage of bowel movements present for several weeks. Retentive encopresis is the term reserved for the involuntary and uncontrollable soiling that occurs in children with chronic constipation. Constipation is a relatively common pediatric complaint accounting for up to 3% of general paediatirc outpatient visits and 25% of visits to a pediatric gastroenterologist. Encopresis is also common, occurring in at least 1.5% of all childrenpeer-reviewe

Laxatives do not improve symptoms of opioid-induced constipation: results of a patient survey

Introduction: Laxatives are commonly used to treat opioid-induced constipation, the commonest and most bothersome complication of opioids. However, laxatives have a non-specific action and do not target underlying mechanisms of opioid-induced constipation; their use is associated with abdominal symptoms that negatively impact quality of life. Objective: To assess the effects of laxatives in patients taking opioids for chronic pain. Methods: 198 UK patients who had taken opioid analgesics for at least one month completed a cross-sectional online or telephone survey. Questions addressed their pain condition and medication, and laxative use (including efficacy and side-effects). The survey also assessed bowel function using the Bowel Function Index. Results: Since starting their current opioid, 134/184 patients (73%) had used laxatives at some point and 122 (91%) of these were currently taking them. The most common laxatives were osmotics and stimulants. Laxative side-effects were reported in 75%, most commonly gas, bloating/fullness and a sudden urge to defecate. Side-effects were more common in patients <40 years old. Approximately half of patients said laxatives interfered with work and social activities, and one-fifth had needed an overnight hospital stay because of their pain condition and/or constipation. Laxatives did not improve the symptoms of constipation, as assessed by the Bowel Function Index. Constipation was not related to opioid strength or dose of opioid or number of laxatives taken. Conclusions: Use of laxatives to treat opioid-induced constipation is often ineffective and associated with side-effects. Instead of relieving the burden of opioid-induced constipation, laxative use is associated with a negative impact

Managing constipation in adults with co-morbidities

Constipation can be described in a number of ways but in general it is related to straining, reduced frequency of defecation and/or a sensation of incomplete bowel emptying. The ability of the bowel to empty is related to the effectiveness of colonic transit (movement of contents around the large bowel) and the normal function of the defecation mechanism. This paper provides an overview of constipation, its classification and management to relieve symptoms. An exploration of pharmacological agents is provided, particularly for those with co-morbidities. Current evidence-based practice underpins the discussion surrounding the prescribing of medicines suitable for adults presenting with constipation

Identifying and managing constipation in older people

Constipation is a major problem in residential care. It is a condition which, if left untreated, can result in major distress and health problems for sufferers. If the condition is not detected early, then resultant interventions become increasingly complex and costly, meaning staff spend time and resources managing what could have been, a simple problem. This paper seeks to define and identify the main causes of constipation in residential care settings. It evaluates lifestyle approaches to prevention which are relevant to residential care and provides information on early detection and strategies to manage the condition. Finally, a ‘red flag’ table is identified which will support carers and nurses to identify how constipation may be an early warning sign for more complex health conditions

Abdominal massage for the relief of constipation in people with Parkinson’s: a qualitative study

Objectives. To explore the experiences of people with Parkinson’s (PwP) who suffer from constipation, the impact this has on their lives, and the effect of using lifestyle changes and abdominal massage as a form of constipation management. Method. Fourteen semistructured interviews were completed (8 males and 6 females; mean age 72.2 years) at the end of a care programme, which consisted of either lifestyle advice and abdominal massage (intervention group;) or lifestyle advice only (control group;). Data were analysed using constant-comparison techniques and Framework methods. Themes and key quotes were identified to depict major findings. Findings. Four key themes were identified: (i) the adverse impact of bowel problems on quality of life; (ii) positive experience of behaviour adjustments: experimentation; (iii) abdominal massage as a dynamic and relaxing tool: experiential learning (intervention group only); (iv) abdominal massage as a contingency plan: hesitation (control group only). Constipation was reported as having a significant impact on quality of life. Participants in both groups perceived lifestyle advice to relieve symptoms. Specific improvements were described in those who also received the abdominal massage. Conclusions. Both lifestyle advice and abdominal massage were perceived to be beneficial in relieving symptoms of constipation for PwP

The Efficacy of Peripheral Opioid Antagonists in Opioid-Induced Constipation and Postoperative Ileus: A Systematic Review of the Literature.

Opioid-induced constipation has a negative impact on quality of life for patients with chronic pain and can affect more than a third of patients. A related but separate entity is postoperative ileus, which is an abnormal pattern of gastrointestinal motility after surgery. Nonselective μ-opioid receptor antagonists reverse constipation and opioid-induced ileus but cross the blood-brain barrier and may reverse analgesia. Peripherally acting μ-opioid receptor antagonists target the μ-opioid receptor without reversing analgesia. Three such agents are US Food and Drug Administration approved. We reviewed the literature for randomized controlled trials that studied the efficacy of alvimopan, methylnaltrexone, and naloxegol in treating either opioid-induced constipation or postoperative ileus. Peripherally acting μ-opioid receptor antagonists may be effective in treating both opioid-induced bowel dysfunction and postoperative ileus, but definitive conclusions are not possible because of study inconsistency and the relatively low quality of evidence. Comparisons of agents are difficult because of heterogeneous end points and no head-to-head studies

Ultrastructural analysis of changes in neurons of the mouse internal anal sphincter during ageing

Gastrointestinal disorders, including chronic constipation, faecal impaction and incontinence, are a major cause of morbidity in the elderly

Hara-kiri through anal orifice: a first-of-its-kind case.

Constipation and obstruction are distressing problems which not promptly treated can lead to dangerous complications. A common and potentially dangerous gastrointestinal problem is faecal impaction. Early diagnosis and prompt treatment avoids complications. Apart from manual extraction proximal and distal washout are the available options. However, the key lies in identifying the etiology of the problems and nipping it in the bud. We here present a first-of-its-kind case in which a female pulled out about 2 feet of her large intestine from her anal orifice after experiencing constipation for a period of two days. Damage control surgery was done and the patient was left with a permanent illeostomy

Relationship between psychological state and level of activity of extrinsic gut innervation in patients with a functional gut disorder

Background: Anxiety and depression are known to be associated with alterations in central autonomic activity, and this may manifest as a functional gut disturbance. However, the final expression of motility disturbance is non-specific and non-quantifiable. This study examines the relationship between psychological state and psychosocial functioning with a new direct measure of the level of activity of extrinsic autonomic gut innervation, rectal mucosal Doppler blood flow. Materials and methods: Thirty four female patients (mean age 36 years, range 19-45) with constipation for greater than five years and 19 healthy women (mean age 38 years, range 21-60) were studied. They completed the general health questionnaire28 point scale (GHQ-28; psychosocial functioning) and the Bem sex role inventory (BSRI; an index of women's psychological feelings about their own femininity). On the same day they underwent measurement of rectal mucosal Doppler blood flow, a new validated measure of the activity of gut extrinsic nerve innervation. Measurements were made during the follicular phase and in the fasted state. Results: Women with constipation scored higher on the total GHQ-28 score and the somatisation (p=0.05) and anxiety (p=0.05) subscales of the GHQ-28. There was a negative correlation between mucosal blood flow and GHQ somatisation subscale (r=0.45, p<0.005), anxiety (r=0.38, p<0.05), and depression (r=0.40, p<0.01) scores in women with constipation. Although constipated women scored no higher than controls on the BSRI, there was a significant negative correlation between blood flow and BSRI score (r=0.49, p<0.005) for constipated women. Conclusions: General psychosocial function, somatisation, anxiety, depression, and feelings about female role are impaired in women with constipation and associated with altered rectal mucosal blood flow, a measure of extrinsic gut innervation. These findings suggest that psychological factors are likely to influence gut function via autonomic efferent neural pathways

Incidence and predictors of new-onset constipation during acute hospitalisation after stroke

Objectives: We investigated new-onset constipation in patients with stroke compared with orthopaedic conditions and explored the predictors associated with constipation during acute hospitalisation. Methods: This was a prospective matched cohort study of 110 patients comparing stroke patients (n = 55) with orthopaedic patients (n = 55) admitted to a large tertiary acute hospital. Both cohorts were matched by age and sex. The incidence of new-onset constipation which occurred during a patient's acute hospitalisation was determined. Demographics, comorbidity, clinical factors, laboratory parameters and medications were evaluated as possible predictors of constipation. Results: The incidence of new-onset constipation was high for both stroke (33%) and orthopaedic patients (27%; p = 0.66). Seven stroke patients (39%) and four orthopaedic patients (27%) developed their first onset of constipation on day 2 of admission. Mobility gains (RR 0.741, p < 0.001) and the use of prophylactic laxatives (RR 0.331, p < 0.01) had a protective effect against constipation. Bedpan use (RR 2.058, p < 0.05) and longer length of stay (RR 1.032, p < 0.05) increased the risk of developing new-onset constipation. Conclusions: New-onset constipation is common among patients admitted for stroke and orthopaedic conditions during acute hospitalisation. The early occurrence, on day 2 of admission, calls for prompt preventive intervention for constipation