DOCSLIB.ORG

Constipation

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Constipation Constipation Constipation is defined as having a bowel movement fewer than three times per week. With constipation stools are usually hard, dry, Esophagus small in size, and difficult to eliminate. Some people who are constipated find it painful to Liver Stomach have a bowel movement and often experience straining, bloating, and the sensation of a full Pancreas bowel. Large Some people think they are constipated if they intestine do not have a bowel movement every day. However, normal stool elimination may be Small three times a day or three times a week, intestine depending on the person. Rectum Constipation is a symptom, not a disease. Anus Almost everyone experiences constipation at some point in their life, and a poor diet Appendix typically is the cause. Most constipation is temporary and not serious. Understanding its The digestive tract. causes, prevention, and treatment will help most people find relief. Self-treatment of constipation with overthe- counter (OTC) laxatives is by far the most Who gets constipated? common aid. Around $725 million is spent on Constipation is one of the most common laxative products each year in America. gastrointestinal complaints in the United States. More than 4 million Americans have frequent What causes constipation? constipation, accounting for 2.5 million To understand constipation, it helps to know physician visits a year. Those reporting how the colon, or large intestine, works. As food constipation most often are women and adults moves through the colon, the colon absorbs ages 65 and older. Pregnant women may have water from the food while it forms waste constipation, and it is a common problem products, or stool. Muscle contractions in the following childbirth or surgery. colon then push the stool toward the rectum. By the time stool reaches the rectum it is solid, because most of the water has been absorbed. Constipation occurs when the colon absorbs too may cause older people to eat soft foods that are much water or if the colon’s muscle contractions processed and low in fiber. are slow or sluggish, causing the stool to move through the colon too slowly. As a result, stools Not Enough Liquids can become hard and dry. Common causes of Research shows that although increased fluid constipation are intake does not necessarily help relieve not enough fiber in the diet constipation, many people report some relief lack of physical activity (especially in from their constipation if they drink fluids such the elderly) as water and juice and avoid dehydration. medications Liquids add fluid to the colon and bulk to stools, milk making bowel movements softer and easier to irritable bowel syndrome pass. People who have problems with changes in life or routine such as constipation should try to drink liquids every pregnancy, aging, and travel day. However, liquids that contain caffeine, such abuse of laxatives as coffee and cola drinks will worsen one’s ignoring the urge to have a bowel symptoms by causing dehydration. Alcohol is movement another beverage that causes dehydration. It is dehydration important to drink fluids that hydrate the body, specific diseases or conditions, such as especially when consuming caffeine containing stroke (most common) drinks or alcoholic beverages. problems with the colon and rectum problems with intestinal function Lack of Physical Activity (chronic idiopathic constipation) A lack of physical activity can lead to constipation, although doctors do not know Not Enough Fiber in the Diet precisely why. For example, constipation often People who eat a high-fiber diet are less likely to occurs after an accident or during an illness become constipated. The most common causes when one must stay in bed and cannot exercise. of constipation are a diet low in fiber or a diet Lack of physical activity is thought to be one of high in fats, such as cheese, eggs, and meats. the reasons constipation is common in older Fiber—both soluble and insoluble—is the part people. of fruits, vegetables, and grains that the body cannot digest. Soluble fiber dissolves easily in Medications water and takes on a soft, gel-like texture in the Some medications can cause constipation, intestines. Insoluble fiber passes through the including: intestines almost unchanged. The bulk and soft pain medications (especially narcotics) texture of fiber help prevent hard, dry stools that antacids that contain aluminum and are difficult to pass. calcium blood pressure medications (calcium Americans eat an average of 5 to 14 grams of channel blockers) fiber daily,* which is short of the 20 to 35 grams antiparkinson drugs recommended by the American Dietetic antispasmodics Association. Both children and adults often eat antidepressants too many refined and processed foods from which the natural fiber has been removed. iron supplements A low-fiber diet also plays a key role in diuretics constipation among older adults, who may lose anticonvulsants interest in eating and choose foods that are quick to make or buy, such as fast foods, or prepared foods, both of which are usually low in fiber. Also, difficulties with chewing or swallowing Changes in Life or Routine stroke During pregnancy, women may be constipated spinal cord injuries because of hormonal changes or because the Metabolic and endocrine conditions uterus compresses the intestine. Aging may also diabetes affect bowel regularity, because a slower uremia metabolism results in less intestinal activity and hypercalcemia muscle tone. In addition, people often become poor glycemic control constipated when traveling, because their normal hypothyroidism diet and daily routine are disrupted. Systemic disorders amyloidosis Abuse of Laxatives lupus The common belief that people must have a scleroderma daily bowel movement has led to self- medicating with OTC laxative products. Problems with the Colon Although people may feel relief when they use and Rectum laxatives, typically they must increase the dose Intestinal obstruction, scar tissue—also called over time because the body grows reliant on adhesions—diverticulosis, tumors, colorectal laxatives in order to have a bowel movement. As stricture, Hirschsprung’s disease, or cancer can a result, laxatives may become habit-forming. compress, squeeze, or narrow the intestine and Ignoring the Urge to Have a rectum and cause constipation. Bowel Movement Problems with Intestinal People who ignore the urge to have a bowel movement may eventually stop feeling the need Function to have one, which can lead to constipation. The two types of constipation are idiopathic Some people delay having a bowel movement constipation and functional constipation. because they do not want to use toilets outside Irritable bowel syndrome (IBS) with the home. Others ignore the urge because of predominant symptoms of constipation is emotional stress or because they are too busy. categorized separately. Children may postpone having a bowel Idiopathic—of unknown origin—constipation movement because of stressful toilet training or does not respond to standard treatment. because they do not want to interrupt their play. Functional constipation means that the bowel is Specific Diseases healthy but not working properly. Functional Diseases that cause constipation include constipation is often the result of poor dietary neurological disorders, metabolic and endocrine habits and lifestyle. It occurs in both children disorders, and systemic conditions that affect and adults and is most common in women. organ systems. These disorders can slow the Colonic inertia, delayed transit, and pelvic floor movement of stool through the colon, rectum, or dysfunction are three types of functional anus. constipation. Colonic inertia and delayed transit are caused by a decrease in muscle activity in Conditions that can cause constipation are the colon. These syndromes may affect the found below: entire colon or may be confined to the lower, or sigmoid, colon. Neurological disorders multiple sclerosis Pelvic floor dysfunction is caused by a weakness Parkinson’s disease of the muscles in the pelvis surrounding the anus chronic idiopathic intestinal pseudo- and rectum. However, because this group of obstruction muscles is voluntarily controlled to some extent, biofeedback training is somewhat successful in fewer than three bowel movements per retraining the muscles to function normally and week improving the ability to have a bowel movement. Physical Examination Functional constipation that stems from A physical exam may include a rectal exam with problems in the structure of the anus and rectum a gloved, lubricated finger to evaluate the tone is known as anorectal dysfunction, or anismus. of the muscle that closes off the anus—also These abnormalities result in an inability to relax called anal sphincter—and to detect tenderness, the rectal and anal muscles that allow stool to obstruction, or blood. In some cases, blood and exit. thyroid tests may be necessary to look for thyroid disease and serum calcium or to rule out People with IBS having predominantly inflammatory, metabolic, and other disorders. constipation also have pain and bloating as part of their symptoms. Extensive testing usually is reserved for people with severe symptoms, for those with sudden How is the cause of changes in the number and consistency of bowel movements or blood in the stool, and older constipation identified? adults. Additional tests that may be used to The tests the doctor performs depend on the evaluate constipation include duration and severity of the constipation, the a colorectal transit study person’s age, and whether blood in stools, anorectal function tests recent changes in bowel habits, or weight loss have occurred. Most people with constipation a defecography do not need extensive testing and can be treated with changes in diet and exercise. For Because of an increased risk of colorectal example, in young people with mild cancer in older adults, the doctor may use symptoms, a medical history and physical tests to rule out a diagnosis of cancer, exam may be all that is needed for diagnosis including a and treatment.
Load more

Recommended publications
  • The American Society of Colon and Rectal Surgeons' Clinical Practice
    CLINICAL PRACTICE GUIDELINES The American Society of Colon and Rectal Surgeons’ Clinical Practice Guideline for the Evaluation and Management of Constipation Ian M. Paquette, M.D. • Madhulika Varma, M.D. • Charles Ternent, M.D. Genevieve Melton-Meaux, M.D. • Janice F. Rafferty, M.D. • Daniel Feingold, M.D. Scott R. Steele, M.D. he American Society of Colon and Rectal Surgeons for functional constipation include at least 2 of the fol- is dedicated to assuring high-quality patient care lowing symptoms during ≥25% of defecations: straining, Tby advancing the science, prevention, and manage- lumpy or hard stools, sensation of incomplete evacuation, ment of disorders and diseases of the colon, rectum, and sensation of anorectal obstruction or blockage, relying on anus. The Clinical Practice Guidelines Committee is com- manual maneuvers to promote defecation, and having less posed of Society members who are chosen because they than 3 unassisted bowel movements per week.7,8 These cri- XXX have demonstrated expertise in the specialty of colon and teria include constipation related to the 3 common sub- rectal surgery. This committee was created to lead inter- types: colonic inertia or slow transit constipation, normal national efforts in defining quality care for conditions re- transit constipation, and pelvic floor or defecation dys- lated to the colon, rectum, and anus. This is accompanied function. However, in reality, many patients demonstrate by developing Clinical Practice Guidelines based on the symptoms attributable to more than 1 constipation sub- best available evidence. These guidelines are inclusive and type and to constipation-predominant IBS, as well. The not prescriptive.
    [Show full text]
  • Anorectal Disorders Satish S
    Gastroenterology 2016;150:1430–1442 Anorectal Disorders Satish S. C. Rao,1 Adil E. Bharucha,2 Giuseppe Chiarioni,3,4 Richelle Felt-Bersma,5 Charles Knowles,6 Allison Malcolm,7 and Arnold Wald8 1Division of Gastroenterology and Hepatology, Augusta University, Augusta, Georgia; 2Department of Gastroenterology and Hepatology, Mayo College of Medicine, Rochester, Minnesota; 3Division of Gastroenterology of the University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy; 4Division of Gastroenterology and Hepatology and UNC Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; 5Department of Gastroenterology/Hepatology, VU Medical Center, Amsterdam, The Netherlands; 6National Centre for Bowel Research and Surgical Innovation, Blizard Institute, Queen Mary University of London, London, United Kingdom; 7Division of Gastroenterology, Royal North Shore Hospital, and University of Sydney, Sydney, Australia; 8Division of Gastroenterology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin This report defines criteria and reviews the epidemiology, questionnaires and bowel diaries are correlated,5 some pathophysiology, and management of the following com- patients may not accurately recall bowel symptoms6; hence, mon anorectal disorders: fecal incontinence (FI), func- symptom diaries may be more reliable. tional anorectal pain, and functional defecation disorders. In this report, we examine the prevalence and patho- FI is defined as the recurrent uncontrolled passage of fecal physiology of anorectal disorders, listed in Table 1,and material for at least 3 months. The clinical features of FI provide recommendations for diagnostic evaluation and are useful for guiding diagnostic testing and therapy. management. These supplement practice guidelines rec- ANORECTAL Anorectal manometry and imaging are useful for evalu- ommended by the American Gastroenterological Associa- fl ating anal and pelvic oor structure and function.
    [Show full text]
  • Linaclotide: a Novel Therapy for Chronic Constipation and Constipation- Predominant Irritable Bowel Syndrome Brian E
    Linaclotide: A Novel Therapy for Chronic Constipation and Constipation- Predominant Irritable Bowel Syndrome Brian E. Lacy, PhD, MD, John M. Levenick, MD, and Michael D. Crowell, PhD, FACG Dr. Lacy is Section Chief of Gastroenter- Abstract: Chronic constipation and irritable bowel syndrome ology and Hepatology and Dr. Levenick (IBS) are functional gastrointestinal disorders that significantly is a Gastroenterology Fellow in the affect patients’ quality of life. Chronic constipation and IBS are Division of Gastroenterology and prevalent—12% of the US population meet the diagnostic crite- Hepatology at Dartmouth-Hitchcock Medical Center in Lebanon, New ria for IBS, and 15% meet the criteria for chronic constipation— Hampshire. Dr. Crowell is a Professor and these conditions negatively impact the healthcare system of Medicine in the Division of from an economic perspective. Despite attempts at dietary Gastroenterology and Hepatology at modification, exercise, or use of over-the-counter medications, Mayo Clinic in Scottsdale, Arizona. many patients have persistent symptoms. Alternative treatment options are limited. This article describes linaclotide (Linzess, Address correspondence to: Dr. Brian E. Lacy Ironwood Pharmaceuticals/Forest Pharmaceuticals), a new, first- Division of Gastroenterology and in-class medication for the treatment of chronic constipation Hepatology, Area 4C and constipation-predominant IBS. Dartmouth-Hitchcock Medical Center 1 Medical Center Drive Lebanon, NH 03756; Tel: 603-650-5215; Fax: 603-650-5225; onstipation is
    [Show full text]
  • Tegaserod in the Treatment of Constipation-Predominant Functional Gastrointestinal Disorders
    DRUG PROFILE Tegaserod in the treatment of constipation-predominant functional gastrointestinal disorders Anurag Agrawal & Irritable bowel syndrome is a common condition for which, until recently, treatment Peter Whorwell† options have been limited. Tegaserod has selective serotonin subtype 4 receptor agonist †Author for correspondence activity and acts by increasing gastrointestinal motility, secretion and possibly reducing ERC Building, First Floor, Wythenshawe Hospital, visceral sensitivity. It has been developed to treat patients with irritable bowel syndrome Southmoor Road, who suffer from abdominal pain, constipation and bloating. Studies so far suggest that it is Manchester, M23 9LT, an effective treatment for these symptoms with an excellent safety profile. Its role in other UK Tel.: +44 161 291 5813 functional gastrointestinal disorders, such as functional dyspepsia, is still being assessed. Fax: +44 161 291 4184 This review describes the structure, pharmacokinetic and pharmacodynamic properties of tegaserod and its effect on gastrointestinal physiology, as well as its clinical utility. Irritable bowel syndrome (IBS) is the most com- drugs such as antidiarrheals, laxatives, antispas- mon condition dealt with by gastroenterolo- modics and antidepressants. Behavioral therapy gists, accounting for up to 30% of their practice is sometimes tried in patients who do not and 10% of primary care case loads [1]. It is respond to conventional treatment. characterized by abdominal pain or discomfort In addition to its costs to the patient, IBS also often related to a change in bowel habit and fre- has a significant direct and indirect economic quently exacerbated by eating. Investigation burden. The direct cost in terms of healthcare reveals no structural abnormality, although a utilization has been estimated to be between variety of gastrointestinal (GI) physiological US$1.7–10 billion/year in the USA alone.
    [Show full text]
  • The Significance of the Gut Microbiome in Children with Functional Constipation
    Reviews The significance of the gut microbiome in children with functional constipation Monika KwiatkowskaA–F, Aneta KrogulskaA–F Department of Pediatrics, Allergology and Gastroenterology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland A – research concept and design; B – collection and/or assembly of data; C – data analysis and interpretation; D – writing the article; E – critical revision of the article; F – final approval of the article Advances in Clinical and Experimental Medicine, ISSN 1899–5276 (print), ISSN 2451–2680 (online) Adv Clin Exp Med. 2021;30(4):471–480 Address for correspondence Abstract Monika Kwiatkowska E-mail: [email protected] Constipation is a widespread problem in pediatric practice, affecting almost 30% of pediatric population. As much as 90–95% of constipation cases have a functional basis, and although the pathogenesis of func- Funding sources None declared tional constipation remains unclear, its etiology is considered to be multifactorial. Its growing prevalence has been attributed to the occurrence of disorders in the homeostasis of gastrointestinal microbiota. In humans, Conflict of interest the best known microbiome is that of the intestines, which has been the subject of a number of studies None declared based on recognition of the 16S rRNA gene sequence. Microbiota are believed to influence the pathogenesis of functional constipation by affecting peristalsis, relationship with diet, and physical activity. The paper evaluates the role of intestinal microbiota in functional constipation and describes its contribution to the onset Received on July 28, 2020 of disease. Determining the importance of the microbiome in the pathogenesis of functional constipation Reviewed on October 12, 2020 Accepted on December 6, 2020 creates hope for the development of new prevention and treatment methods.
    [Show full text]
  • Constipation in Adults Search Date October 2006 Frank Frizelle and Murray Barclay
    Dig . estive system disor Constipation in adults Search date October 2006 Frank Frizelle and Murray Barclay ABSTRACT INTRODUCTION: Although there are defined criteria for the diagnosis of constipation, in practice, diagnostic criteria are less rigid, and in part depend on the perception of normal bowel habit. Constipation is highly prevalent, with approximately 12 million general practitioner prescriptions for laxatives in England in 2001. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of non-drug interventions, and of other interventions, in adults with idiopathic chronic con- stipation? We searched: Medline, Embase, The Cochrane Library and other important databases up to October 2006 (BMJ Clinical evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 42 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: arachis oil, biofeedback, bisacodyl, cascara, docusate, exercise, glycerine suppositories, glycerol, high-fibre diet, increasing fluids, ispaghula husk, lactitol, lactulose, macrogols (polyethylene glycols), magnesium salts, methylcellulose, paraffin, phosphate enemas, seed oils, senna, sodium citrate enemas, sterculia. der QUESTIONS s What are the effects of non-drug interventions in adults with idiopathic chronic constipation?. 3 What are the effects of other treatments in adults with idiopathic chronic constipation?.
    [Show full text]
  • Systematic Literature Review and Indirect Treatment Comparison Of
    PGI8 Systematic literature review and indirect treatment comparison of linaclotide versus other oral constipation treatments in patients with chronic constipation H Okumura,1 W Tang,2 K Iwasaki,2 S Shoji,1 T Odaka,3 A Nakajima4 1Astellas Pharma Inc., Tokyo, Japan; 2Milliman Inc., Tokyo, Japan; 3Odaka Medical and Gastrointestinal Clinic, Chiba, Japan; 4Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan INTRODUCTION Figure 2. Treatments included in NMA. Figure 3. Risk of bias of included trials. ● Chronic constipation (CC), including functional constipation, irritable bowel CC Naloxegol 12.5Naloxegol mg 5 mg IBS-C syndrome with constipation (IBS-C), and opioid-induced constipation (OIC), Naloxegol 25 mg OIC [12w] [4w] [12w] 1 Naloxegol[4w, 50 12w] mg [12w] [3w, 12w] CC and IBS-C negatively affects patients’ quality of life and has a prevalence rate of [3w, 12w]Alvimopan 0.5 mg [12w] Random sequence generation Alvimopan 1 mg Methylnaltrexone 450 mg 2,3 [4w] Methylnaltrexone 300 mg CC and OIC (selection bias) approximately 14% and 28% worldwide and in Japan, respectively. Methylnaltrexone 150 mg Lactitol[2w] 20 g Naloxone 2.5 mg Lactitol[7d] 10 g Allocation concealment ● The most commonly recommended treatments are polyethylene glycol [3w] Wheat (triticum) 20 g (selection bias) Naloxone 5 mg [4w] (PEG), lubiprostone, linaclotide, prucalopride, lactulose, bisacodyl, and [3w] Naloxone 10 mg Ispaghula 20 g 4 [4w] Blinding of participants and personnel [3w] Ispaghula 10.8 g dietary fibre ; in Japan, magnesium oxide followed by stimulant laxatives Naloxone 20 mg [14d] (performance bias) [3w] 5 Bisacodyl 10 mg are commonly used.
    [Show full text]
  • A 5Ad Dietary Protocol for Functional Bowel Disorders
    nutrients Article A 5Ad Dietary Protocol for Functional Bowel Disorders Fandi Ibrahim * and Philippa Stribling Division of Life Sciences, School of Engineering, Arts, Science and Technology, University of Suffolk, Ipswich IP4 1QJ, UK * Correspondence: [email protected] Received: 3 July 2019; Accepted: 15 August 2019; Published: 17 August 2019 Abstract: Functional bowel disorders (FBDs) affect around 20% of the population worldwide and are associated with reduced quality of life and high healthcare costs. Dietary therapies are frequently implemented to assist with symptom relief in these individuals, however, there are concerns regarding their complexity, restrictiveness, nutritional adequacy, and effectiveness. Thus, to overcome these limitations, a novel approach, the 5Ad Dietary Protocol, was designed and tested for its efficacy in reducing the severity of a range of gastrointestinal symptoms in 22 subjects with FBDs. The protocol was evaluated in a repeated measures MANOVA design (baseline week and intervention week). Measures of stool consistency and frequency were subtyped based on the subject baseline status. Significant improvements were seen in all abdominal symptom measures (p < 0.01). The effect was independent of body mass index (BMI), age, gender, physical activity level, and whether or not the subjects were formally diagnosed with irritable bowel syndrome (IBS) prior to participation. Stool consistency and frequency also improved in the respective contrasting subtypes. The 5Ad Dietary Protocol proved to be a promising universal approach for varying forms and severities of FBDs. The present study paves the way for future research encompassing a longer study duration and the exploration of underlying physiological mechanisms. Keywords: functional bowel disorders; irritable bowel syndrome; dietary therapies; abdominal pain; bloating; constipation; diarrhoea; IBS; 5Ad Dietary Protocol; FODMAPs 1.
    [Show full text]
  • Constipation
    BOTTOM LINE RECOMMENDATIONS: Constipation Th e diagnosis of functional constipation (FC) requires a history of straining or pain with defecation, hard or large stools that may obstruct the toilet, infrequent bowel movements (BMs), retentive behaviors, and/or encopresis. Often, the chief complaint is colicky abdominal pain, which can mimic more sinister diagnoses which are often missed such as appendicitis, intussusception and bowel obstruction.1 » A closely related disorder with similar symptoms is irritable bowel syndrome subtype with predominant constipation (IBS-C). » The prevalence of FC in infants and toddlers is ~20%.2 IBS is also common, found in up to 15% of children.3 DIAGNOSIS The Rome IV Criteria are validated clinical criteria used to diagnose functional gastrointestinal disorders such as FC and IBS-C. The Bristol Stool Chart may help young patients in determining consistency of stool.4 ROME IV CRITERIA FOR FUNCTIONAL CONSTIPATION Infants and Toddlers » Must include one month of at least 2 of the following in infants/toddlers up to 4 years of age: 1. Two or fewer defecations per week 2. History of excessive stool retention 3. History of painful or hard BMs 4. History of large-diameter stools 5. Presence of a large fecal mass in the rectum » In toilet-trained children, the following additional criteria may be used: 6. At least one episode per week of fecal incontinence 7. History of large-diameter stools that may obstruct the toilet Children and Adolescents5 » Must include 2 or more of the following, occurring at least once per week for a minimum of one month with insufficient criteria for a diagnosis of irritable bowel syndrome: 1.
    [Show full text]
  • Clinical Evidence for the Role of Linaclotide for the Treatment of Irritable Bowel Syndrome
    Reviews: Clinical Trial Outcomes Clinical evidence for the role of linaclotide for the treatment of irritable bowel syndrome Clin. Invest. (2012) 2(10), 1039–1046 Linaclotide is an synthetic peptide that binds to the external domain of enteric JR Malagelada guanylate cyclase C, activating a molecular pathway that increases intestinal Digestive System Research Unit, Autonomous secretion into the lumen and may simultaneously reduce pain sensitivity. University, Barcelona, Spain These pharmacological properties make linaclotide specially well suited for E-mail: [email protected] the management of irritable bowel syndrome with constipation (IBS-C) a condition characterized by abdominal pain and decreased bowel movement frequency and/or increased stool consistency. Linaclotide has been evaluated by a series of clinical trials in both, patients with chronic constipation and patients with IBS-C. In both groups, reported trials have shown that this new drug is both efficacious and appears to be quite safe. Thus, linaclotide is an exciting new drug arriving timely to assist clinicians in the management of IBS-C, a benign yet common, and extremely inconvenient symptomatic condition that currently poses a significant therapeutic challenge Keywords: abdominal pain • bloating • constipation • irritable bowel syndrome • linaclotide Irritable bowel syndrome (IBS), as we recognize it today, is a clinical entity that was the subject of a structured consensus process initiated at a meeting in Rome approx- imately 20 years ago and refined through a series of subsequent meetings. The out- comes have been published and received Roman numeral indices from Rome I, the first, to Rome IV, the current consensus process due to be reported in 2016.
    [Show full text]
  • Effect of Laxatives and Pharmacological Therapies in Gut: First Published As 10.1136/Gut.2010.227132 on 4 January 2011
    Neurogastroenterology Effect of laxatives and pharmacological therapies in Gut: first published as 10.1136/gut.2010.227132 on 4 January 2011. Downloaded from chronic idiopathic constipation: systematic review and meta-analysis Alexander C Ford,1,2 Nicole C Suares1 1Leeds Gastroenterology ABSTRACT Institute, Leeds General Background There has been no definitive systematic Significance of this study Infirmary, Great George Street, review and meta-analysis to date examining the effect of Leeds, UK 2 laxatives and pharmacological therapies in chronic Leeds Institute of Molecular What is already known about this subject? idiopathic constipation (CIC). Medicine, University of Leeds, < Chronic idiopathic constipation is a common Leeds, UK Objective To assess efficacy of these therapies functional disorder of the gastrointestinal tract. systematically in CIC. < The condition is difficult to treat. Correspondence to Design Systematic review and meta-analysis of Dr Alex Ford, Leeds < Evidence for any benefit of laxatives is randomised controlled trials (RCTs). Gastroenterology Institute, conflicting, and there has been no definitive Data sources MEDLINE, EMBASE, and the Cochrane Room 230, D Floor, Clarendon summary of the evidence for efficacy of newer Wing, Leeds General Infirmary, central register of controlled trials were searched (up to pharmacological agents. Great George Street, Leeds, September 2010). LS1 3EX, UK; [email protected] Eligibility criteria for selecting studies Placebo- What are the new findings? controlled trials of laxatives or pharmacological therapies < Polyethylene glycol, sodium picosulfate, bisa- Revised 1 October 2010 in adult CIC patients were eligible. Minimum duration of codyl, prucalopride, lubiprostone and linaclotide Accepted 26 October 2010 therapy was 1 week. Trials had to report either were all more effective than placebo for treating a dichotomous assessment of overall response to chronic idiopathic constipation, but data to therapy at last point of follow-up in the trial, or mean support efficacy of lactulose were limited.
    [Show full text]
  • Constipation and Encopresis in Childhood
    Constipation and Encopresis in Childhood Jennifer M. Colombo, MD,* Matthew C. Wassom, PhD,† John M. Rosen, MD* *Division of Gastroenterology, Children’s Mercy Kansas City, University of Missouri at Kansas City School of Medicine, Kansas City, MO. †Division of Developmental & Behavioral Sciences, Children’s Mercy Kansas City, University of Missouri at Kansas City School of Medicine, Kansas City, MO. Educational Gap A recent study in Pediatrics concluded that 25% of children with functional constipation continued to experience symptoms at adult age, suggesting that referral to specialized clinics at an early stage for children who are unresponsive to first-line treatment may help improve outcomes. (1) Objectives After completing the article, the reader should be able to: 1. Know that constipation is a common problem in childhood with a diverse clinical presentation. 2. Understand that functional constipation is a symptom-based diagnosis that does not require extensive testing. 3. Recognize that most children who present with fecal incontinence or encopresis have associated constipation. 4. Describe the treatment of constipation and encopresis, which should include a medical-behavioral approach that focuses on maintaining soft and regular bowel movements and improving toileting behavior. INTRODUCTION What do the following children have in common? • A 12-month-old girl with hard pellet-like stools. • A 3-year-old girl with frequent complaints of dysuria and hard stools. • An 8-year-old boy with a weekly stool that is large enough to clog a toilet. • A 12-year-old boy with daily loose stools in his underpants. Answer: They share a familiar diagnosis: functional constipation. Constipation is a common pediatric problem and parental concern.
    [Show full text]