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Constipation. In: Bonci, L. American Dietetic Association Guide to Better Digestion. Hoboken, NJ: John Wiley and Sons, Inc. 2003. p. 184-200.

Coping with a gastrointestinal disorder, whether it is irritable bowel syndrome (IBS), gas (flatulence), constipation, heartburn, or another condition, can be embarrassing and debilitating. While medical treatments and prescriptions can offer relief, one of the most important ways patients can help themselves is in their dietary choices. This chapter on constipation is from a book that describes how patients can self-manage their digestive disorders through dietary choices. In this chapter, the author first defines constipation and considers the various causes for constipation, then discusses the symptoms of the condition, diagnostic considerations, treatment goals and strategies, the impact of diet on constipation, using diet to help prevent or treat constipation, strategies for boosting dietary fiber intake, the importance of fluids, the use of fiber supplements, dietary or herbal supplements that can worsen symptoms of constipation, and the role of physical activity. A chart of the fiber content of common foods and a menu plan for a 5 week fiber-increasing diet are provided. 4 figures.

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Constipation. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2003. 8 p.

This fact sheet describes constipation, defined as small amounts of hard, dry bowel movements, usually fewer than three times a week. People who are constipated may find it difficult and painful to have a bowel movement. Other symptoms of constipation include feeling bloated, uncomfortable, and sluggish. Written in a question-and-answer format, the fact sheet covers a definition of constipation, the incidence of constipation, causes of the condition, the diagnostic tests to confirm problems of constipation, treatment options, and complications. Common causes of constipation are not enough fiber in the diet, not enough liquids, lack of exercise, medications, irritable bowel syndrome (IBS), lifestyle changes (pregnancy, older age, travel), abuse of laxatives, ignoring the urge to have a bowel movement, specific diseases such as stroke, problems with the colon and rectum, and problems with intestinal function (chronic idiopathic constipation). Diagnostic tests include colorectal transit study, anorectal function tests, barium enema x ray, and sigmoidoscopy or colonoscopy. A final section describes the goals and work of the National Digestive Diseases Information Clearinghouse. 1 figure.

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Three Steps to Better Management of Constipation. Patient Care. 37(6): 37-40. June 2003.

This article presents a patient management plan that helps health care providers sort out the many treatment options for constipation, the main complaint in more than several million primary care visits each year. In addition to questions about the medical history and the symptoms and duration of constipation, caregivers are advised to obtain a complete list of the patient's prescription and over-the-counter (OTC) medications. The physical examination should focus on abdominal size and tenderness, organomegaly, masses, a perianal inspection, an internal rectal exam, and appropriate examinations for concomitant medical problems. The minimum laboratory assessment should consist of a CBC count; levels of serum calcium, potassium, glucose, creatinine, and thyroid-stimulating hormone; and a test for fecal occult (hidden) blood. The goal of treatment is to restore and maintain adequate stool frequency and consistency with as few artificial aids as possible. Obstructive problems need to be addressed, and concomitant diseases or disorders should be treated. Three-step management includes hydration and fiber, laxatives and stool softeners, and, in refractory cases, prescription stimulants and colonic irritants. 1 table. 7 references.

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What I Need to Know About Constipation. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2003. 13 p.

This brochure provides basic information about constipation, defined as three bowel movements or fewer in a week. In addition, the stool is hard and dry and can be painful to pass. Written in a question-and-answer format and using nontechnical language, the brochure reviews the causes of constipation and offers suggestions for preventing the problem. Recommendations include eating more fiber, drinking plenty of water and other liquids, getting enough exercise, allowing enough time for bowel movements, using laxatives only with the advice of a health care provider, and checking with the physician about medications that can cause constipation. Simple line drawings supplement and reinforce the textual material. A table of high-fiber foods is provided. The brochure includes a list of resource organizations where readers can get more information, a list of other titles in the series, and an acknowledgements page. A final page describes the goals and activities of the National Digestive Diseases Information Clearinghouse. The brochure is also available in Spanish. 3 figures. 1 table.

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Compliance, Tone and Sensitivity of the Rectum in Different Subtypes of Irritable Bowel Syndrome. Neurogastroenterology and Motility. 14(3): 241-247. June 2002.

Irritable bowel syndrome (IBS) consists of various subtypes; it is unknown whether these subtypes share a common pathophysiology. Evaluation of motor and sensory function of the rectum using a barostat may help to explore a common pathophysiological background or differences in pathophysiology in subtypes of BIS. This article reports on a study in which authors evaluated compliance, tone, and sensitivity of the rectum, in both fasting state and postprandially (after a meal), using a computerized barostat in 15 patients with diarrhea-predominant IBS (IBSD), 14 patients with constipation-predominant IBS (IBSC), and 12 healthy controls. Rectal compliance was decreased in both IBS groups compared with controls. The perception of urge was increased only in IBSD patients, whereas pain perception was significantly increased in both IBS groups. Spontaneous adaptive relaxation was decreased in IBSD patients. Postprandially, rectal volume decreased significantly in the controls and in IBSD patients, but not in IBSC patients. In conclusion, both rectal motor and sensory characteristics are different between IBSD and IBSC patients. Therefore, testing of rectal visceroperception, adaptive relaxation, and the rectal response to a meal may help distinguish groups of patients with different subtypes of IBS. 5 figures. 2 tables. 23 references.

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Constipation. In: Feldman, M.; Friedman, L.S.; Sleisenger, M.H. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 7th ed. [2-volume set]. St. Louis, MO: Saunders. 2002. p. 181-210.

Constipation is a common reason for consultation in primary care, in which its management is often simple and successful without the need for investigation or long term use of drugs. Only a small proportion of all patients with constipation are referred to a gastroenterologist when there has been no response to dietary or other measures. This chapter on constipation is from a comprehensive and authoritative textbook that covers disorders of the gastrointestinal tract, biliary tree, pancreas, and liver, as well as the related topics of nutrition and peritoneal disorders. Topics include presenting symptoms, epidemiology, clinical definition and classification, pathophysiology, constipation as a manifestation of systemic disorders, constipation as a manifestation of central nervous system or extrinsic nerve supply to the gut, constipation secondary to structural disorders of the colon, rectum, anus and pelvic floor, drug treatment that may cause of aggravate constipation, psychological disorders as causes of or aggravating factors in constipation, clinical assessment, diagnostic tests, medical treatment, behavioral treatments (including defecation training and biofeedback), surgical treatment, and particular clinical problems (including those in children, difficult defecation, pregnancy, laxative dependence, laxative abuse, and elderly patients with overflow incontinence). The chapter includes a mini-outline with page citations, full-color illustrations, and extensive references. 11 figures. 9 tables. 200 references.

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Constipation. In: Edmundowicz, S.A., ed. 20 Common Problems in Gastroenterology. New York, NY: McGraw-Hill, Inc. 2002. p. 179-187.

Constipation is the most common digestive complaint in the United States, accounting for 2.5 million physician visits annually. This chapter on constipation is from a book that focuses on the most common gastroenterological problems encountered in a primary practice setting. The chapter is organized to support rapid access to the information necessary to evaluate and treat most patients with this problems. Topics include incidence and definitions of constipation, principal diagnoses, key history and physical examination, specialized testing of colonic and anorectal function, treatment options, patient education, common errors, and emerging concepts. Treatments discussed include exercise and fiber; pharmacology, including nonabsorbable disaccharides, saline cathartics, lubricants, stool softeners, oral stimulants, enemas, prokinetic agents, and other pharmacologic treatments; biofeedback therapy; and surgical treatment. The chapter includes an outline for quick reference and selected references. 5 tables. 22 references.

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Constipation: Getting Relief. San Bruno, CA: StayWell Company. 2002. [2 p.].

This patient education brochure describes constipation and its treatment. Written in nontechnical language, the brochure first defines constipation as bowel movements that occur less often than usual or the need to strain to pass hard, dry stool. Symptoms of constipation include a feeling of fullness in the rectum, bloating and gas, feeling the urge but being unable to pass stool, abdominal pain and cramping, and nausea. One of the main causes of constipation is a diet that is too low in dietary fiber and water. Other causes can include travel (and changes in diet and bowel habits), pregnancy, too little exercise, misuse of laxatives, side effects of certain medications, systemic diseases (diabetes or hyperthyroidism, for example), and ignoring the urge to have a bowel movement. Diagnosis will include the patient's medical history and some diagnostic tests such as sigmoidoscopy and barium enema. Most treatment plans focus on increasing dietary fiber, getting regular exercise, and avoiding chronic laxative use. One section of the brochure illustrates and describes the physiology of normal bowel movements and what happens in constipation. The last page of the brochure summarizes the recommendations for increasing dietary fiber. The brochure is illustrated with full color line drawings. 7 figures.

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Disorders of Defecation. In: Corman, M.L.; Allison, S.I.; Kuehne, J.P. Handbook of Colon and Rectal Surgery. Philadelphia, PA: Lippincott Williams and Wilkins. 2002. p.225-245.

Chronic idiopathic constipation and abdominal pain are among the most common reasons for patients to solicit medical advice. This chapter addresses a number of conditions associated with bowel evacuation problems, the presenting complaint of which is often constipation. The chapter is from a handbook that addresses the entire range of diseases affecting the colon, rectum, and anus. Topics include physiology of the colon (absorption and propulsion), etiology of chronic constipation, clinical presentations, evaluation of the constipated patient, medical management (diet, exercise, laxatives, enemas, and suppositories), spastic pelvic floor syndrome, obstructed defecation, anismus, Hirschprung's disease, surgery in the management of constipation, intestinal pseudo-obstruction, proctalgia fugax, and coccygodynia. 1 figure. 1 table.

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Long-term Safety of Tegaserod in Patients with Constipation-Predominant Irritable Bowel Syndrome. Alimentary Pharmacology and Therapeutics. 16(10): 1701-1708. October 2002.

The oral administration of the drug tegaserod causes gastrointestinal (GI) effects resulting in increased gastrointestinal motility (movement of contents through the GI tract) and attenuation of visceral sensation. This article reports on a study undertaken to determine the long term safety and tolerability of tegaserod in patients with irritable bowel syndrome (IBS) with constipation as the predominant symptom of altered bowel habits. The multicenter, open label study included 579 patients. Of these, 304 (53 percent) completed the trial. The most common adverse events, classified as related to tegaserod for any dose, were mild and transient diarrhea (10.1 percent), headache (8.3 percent), abdominal pain (7.4 percent), and flatulence (5.5 percent). Forty serious adverse events were reported in 25 patients (4.4 percent of patients) leading to discontinuation in 6 patients. There was one serious adverse event, acute abdominal pain, classified as possibly related to tegaserod. There were no consistent differences in adverse events between patients previously exposed to tegaserod and those treated for the first time in this study. The authors conclude that tegaserod appears to be well tolerated in the treatment of patients with constipation-predominant IBS. The adverse event profile, clinical laboratory evaluations, vital signs, and electrocardiogram recordings revealed no evidence of any unexpected adverse events, and suggest that treatment is safe over a 12 month period. 1 figure. 4 tables. 23 references.

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