Link to this page

Your search term(s) "constipation" returned 61 results.

Page 1 2 3 4 5 6 7    Display All

Constipation in Infants and Children: Evaluation and Treatment. In: American Academy of Pediatric. Pediatric Clinical Practice Guidelines and Policies: A Compendium of Evidence-based Research for Pediatric Practice. Elk Grove Village, IL: American Academy of Pediatrics. 2001. p. 95-128.

Constipation, defined as a delay or difficulty in defecation, present for two or more weeks, is a common pediatric problem encountered by both primary and specialty medical providers. This publication offers clinical practice guidelines for the management of pediatric constipation. The guidelines were formulated by the Constipation Subcommittee of the Clinical Guidelines Committee of the North American Society for Pediatric Gastroenterology and Nutrition. The Constipation Subcommittee, consisting of two primary care pediatricians, a clinical epidemiologist, and pediatric gastroenterologists, based its recommendations on an integration of a comprehensive and systematic review of the medical literature combined with expert opinion. The Subcommittee developed two algorithms to assist with medical management, one for older infants and children, and the second for infants less than one year of age. The guidelines provide recommendations for management by the primary care provider, including evaluation, initial treatment, follow up management, and indications for consultation by a specialist. The report is designed as a general guideline to assist providers of medical care in the evaluation and treatment of constipation in children. 77 references.

Full Record   Printer Friendly Version

Constipation. Postgraduate Medicine. 109(3): 193-194. March 2001.

This patient education handout reviews the current recommendations for managing problems with constipation. Constipation is defined as passage of hard stool fewer than three times a week, or difficulty passing stool. Constipation is not a disease, but a symptom of slow movement of food through the large intestine. The problem can be caused by inadequate fluid intake, lack of fiber in the diet, inactivity, medications, bowel obstruction, surgery, prolonged laxative use, stress, or not paying attention to the urge to move one's bowels. Changing one's diet and fluid habits and getting more exercise often solve any problems with constipation. Readers are encouraged to increase their levels of dietary fiber slowly in order to avoid bloating and gas problems. Readers are also encouraged to try a natural vegetable fiber supplement (e.g., Citrucel, Fiberall, Metamucil) instead of using a laxative. Stool softeners (docusate sodium or Colace, or docusate calcium or Surfak) are gentle and may be helpful. Osmotic laxatives can increase the water content in the stool; these agents are safe to use a few times a month. Stimulant laxatives are the most powerful and should be used only with great caution. In severe cases, constipation can result in fecal impaction, which occurs when the hardened stool cannot be eliminated through the rectum. One sidebar lists medications that may cause constipation as an unintended side effect; another sidebar lists foods that are good sources of fiber. 2 figures.

Full Record   Printer Friendly Version

Dealing with Irregularity: Constipation, Diarrhea, Excessive Gas and Foul-Smelling Gas. Digestive Health and Nutrition. 3(1): 16-20. January-February 2001.

This article offers strategies for dealing with problems of bowel irregularity, including constipation, diarrhea, excessive gas, and foul-smelling gas. The author notes that bowel habits vary greatly among individuals, so each person's perception of whether there even is a problem and how to deal with it best is different. The author stresses that too little fiber and liquid in the diet are by far the most common reasons for constipation among people living in western cultures. The fiber found in foods such as fruits, grains, and vegetables adds bulk to the stool, making it easier to move through the colon (large intestine). Liquids add both bulk and fluid to the stool. Exercise helps prevent constipation by maintaining energy levels and promoting intestinal activity. A number of pain medications; antidepressants; antacids that contain aluminum; diuretics; and antiinflammatory and antiseizure medications are some of the many medications that can contribute to constipation. Changes in routines can also cause irregularity. The author explores the role of aging as a cause of constipation. Laxatives are an effective remedy for constipation, but they should be used with caution. As with constipation, diarrhea means different things to different people. Bacterial and viral infections are the most common causes of acute diarrhea; food intolerance is another frequent cause of both diarrhea and gas. Regardless of the cause, diarrhea usually lasts only a few days and ends on its own without the need for medical attention. The author reviews the concerns regarding dehydration, which can be a consequence of diarrhea, particularly in children and in the elderly. Gas comes from two sources: swallowed air and the breakdown of certain undigested foods in the large intestine. Simple ways of reducing the gas from swallowed air include eating and drinking more slowly, not chewing gum, and having dentures properly fitted. For episodes of excessive or smelly intestinal gas, the use of a food diary may help identify the offending items. The author concludes by reiterating the importance of adequate fiber and fluid intake. The websites of four information resource organizations are listed.

Full Record   Printer Friendly Version

Dyssynergic Defecation. Gastroenterology Clinics of North America. 30(1): 97-114. March 2001.

Studies have shown that most patients with difficult defecation show a failure of rectoanal coordination that consists of impaired abdominal and rectal pushing forces or paradoxical anal contraction or inadequate anal relaxation. This article reviews this condition, termed dyssynergic defecation. A lack of coordination or dyssynergia of the abdominal and pelvic floor muscles that are involved in defecation appears to be the primary underlying mechanism. The authors discuss epidemiology, etiology (including psychosocial factors and pathophysiology), clinical features, diagnostic tests (digital rectal examination, anorectal manometry, balloon expulsion test, defecography), diagnostic criteria, and treatment options. Patients with dyssynergic defecation may present with a variety of symptoms, including feeling of incomplete evacuation, excessive straining, hard stools, digital disimpaction and vaginal splinting, anorectal pain, lumplike sensation or perianal heaviness, and tenesmus (ineffective spasms of the rectum). Treatment consists of standard treatment for constipation; specific treatment (i.e., neuromuscular conditioning or biofeedback therapy); and other measures, including botulinum toxin injection, myectomy, and ileostomy. 62 references.

Full Record   Printer Friendly Version

Hirschsprung's Disease: An Overview. Milwaukee, WI: International Foundation for Functional Gastrointestinal Disorders (IFFGD). 2001. [2 p.].

This fact sheet offers an overview of Hirschsprung's disease, a genetic disorder that results in the absence of nerve cells in the wall of the bowel. Collections of nerve cells (ganglia) control the coordinate contraction and relaxation of the bowel wall, called peristalsis, that is necessary for bowel contents to advance. Without this action, the bowel remains collapsed and stools cannot pass. Bowel contents build up behind the obstruction, resulting in constipation. The fact sheet describes the condition in infants and very young children, the emergency conditions that can accompany Hirschsprung's disease, diagnostic strategies, and treatment options. To diagnose Hirschsprung's disease, a barium enema x ray tests is used to identify the narrow collapsed segment of bowel as well as the dilated bowel in front of the affected regions. Treating Hirschsprung's disease requires surgery to remove the affected bowel and then to join the healthy bowel segments. There are several different surgical approaches, each with a high rate of success. The fact sheet includes the contact information for the International Foundation for Functional Gastrointestinal Disorders (IFFGD, www.iffgd.org).

Full Record   Printer Friendly Version

Pediatric Anorectal Disorders. Gastroenterology Clinics of North America. 30(1): 269-287. March 2001.

Anorectal disorders are common in children; it is estimated that 10 percent of children are brought to medical attention because of a defecation disorder, and constipation is the chief complaint in 3 to 5 percent of all visits to pediatricians. This article explores pediatric anorectal disorders, emphasizing the differences between children and adults in terms of clinical presentations, pathophysiology, diagnosis, and treatment. Topics include constipation, functional nonretentive fecal soiling, Hirschsprung's disease, other colonic neuromuscular disorders, children with neurologic handicap (including cerebral palsy and spinal dysraphism), and imperforated anus. The author stresses that the child's developmental stage; the interaction between patient, family, and peers; and the presence of behavioral and psychological comorbidity need to be assessed carefully in any diagnosis of pediatric anorectal disorders. There are three periods when a child is particularly vulnerable to developing constipation: the introduction of cereals and solid food in the diet of an infant, toilet training, and the start of school. Childhood functional constipation is a clinical diagnosis that can be made in most cases on the basis of a typical history and an essentially normal physical examination. The most successful approach to a child with functional constipation includes a combination of parental education, behavioral modification, and medial intervention. 3 figures. 2 tables. 58 references.

Full Record   Printer Friendly Version

Slow Transit Constipation. Gastroenterology Clinics of North America. 30(1): 77-95. March 2001.

This article reviews slow transit constipation, a clinical syndrome characterized by intractable constipation poorly responsive to dietary fiber and laxatives. Other gastrointestinal manifestations include abdominal pain, bloating, malaise, nausea, anorectal symptoms suggestive of difficult fecal expulsion, and delayed colonic transit without megacolon. Extragastrointestinal symptoms in this syndrome include painful or irregular menses, hesitancy in initiating micturition (urination), and somatic symptoms such as cold hands or blackout. The authors briefly discuss terminology and stress that slow transit constipation is the term used to define a disorder of colonic motor function, and is generally used for patients with delayed colonic transit but no underlying systemic disorder or pelvic floor dysfunction that explains their symptoms. The authors discuss epidemiology, pathophysiology, histology, clinical features, differential diagnosis, radiopaque marker diagnostic methods, scintigraphic techniques, medical treatments, surgical treatment, and the special situation of colonic dysfunction after spinal cord injury. The authors note that the disorder spans a spectrum of variable severity, ranging from patients who have relatively mild delays in transit but who are otherwise indistinguishable from irritable bowel syndrome patients at one extreme, to patients with colonic inertia or chronic megacolon at the other extreme. Potential mechanisms for impaired colonic propulsion include fewer colonic HAPCs (high amplitude propagated contractions) or a reduced colonic contractile response to a meal. The treatment is primarily medical; surgery is reserved for patients with severe disease or colonic inertia. 3 figures. 1 table. 85 references.

Full Record   Printer Friendly Version

Slow Transit Constipation: A Disorder of Pelvic Autonomic Nerves?. Digestive Diseases and Sciences. 46(2): 389-401. February 2001.

Slow transit constipation (STC) is a severe motility disorder, which in the majority of cases is of unknown etiology. In some patients, symptoms arise in childhood, but a proportion of patients present in later life, including after pelvic surgery or childbirth. In this article, the authors describe the current knowledge of the anatomy and function of the pelvic autonomic nerves with respect to colonic motility (experimental and observational studies); discuss evidence for pelvic nerve injury in STC arising after pelvic surgery or childbirth; and, on the basis that such patients are clinically indistinguishable from patients with chronic idiopathic (of unknown cause) STC, to evaluate whether there is evidence that pelvic autonomic neuropathy (nerve damage or disease) has an etiologic role in patients with chronic idiopathic STC. The authors document the clear importance of the pelvic autonomic nerves in colonic motor function. While there is an association between pelvic surgery and childbirth, and the onset of STC, there is little direct anatomical evidence that pelvic denervation occurs in these patients. However, the phenotype of these patients is similar to results of experimental and observational studies. The authors present evidence for possible pathogenetic mechanisms underlying the pelvic autonomic neuropathy in chronic idiopathic STC. 1 figure. 3 tables. 162 references.

Full Record   Printer Friendly Version

Surgical Treatment of Constipation and Fecal Incontinence. Gastroenterology Clinics of North America. 30(1): 131-166. March 2001.

This lengthy article reviews the surgical treatment of constipation and fecal incontinence. The authors emphasize that success in the management of constipation depends on an accurate determination of the cause. Because there are many extracolonic causes that can produce constipation, a detailed clinical history should be taken. Before physiologic investigation, patients must discontinue the use of medications that may cause or exacerbate their symptoms. A proper diet should be maintained, and patients must be supervised by a dietitian or a physician for a minimum of 3 to 6 months before any extensive physiologic evaluation is undertaken and before any surgery is considered. Diagnostic tests may include anorectal examination, colonic transit study, proctography and cinedefecography, electromyography, manometry, small bowel transit study, Minnesota Multiphasic Personality Inventory, and rectal biopsy. Surgery for constipation is reserved for a highly select group of patients; the authors review the indications for patients with pelvic outlet obstruction, with colonic inertia (slow transit throughout the colon), and with combined outlet obstruction and colonic inertia. The authors then discuss fecal incontinence, noting that obstetric injury (during childbirth) is a major cause and one amenable to surgical correction. Diagnostic tests can include physical examination, manometry, electromyography, pudendal nerve terminal motor latency, anal ultrasonography, and magnetic resonance imaging (MRI). The treatment of fecal incontinence should always be directed to the cause; many individuals can be managed adequately by noninvasive means. Surgical treatment can include sphincter repair, muscle transplant, the use of synthetic material, and diversion (the creation of a stoma). 4 figures. 9 tables. 297 references.

Full Record   Printer Friendly Version

Therapy of Constipation. Alimentary Pharmacology and Therapeutics. 15(6): 749-763. June 2001.

Constipation is a common symptom that may be idiopathic (of unknown cause) or due to various identifiable disease processes. This article reviews the current recommendations for treating constipation. Laxatives are agents that add bulk to intestinal contents, that retain water within the bowel lumen by virtue of osmotic effects, or that stimulate intestinal secretion or motility, thereby increasing the frequency and ease of defecation. Drugs which improve constipation by stimulating gastrointestinal motility (movement) by direct actions on the enteric nervous system are under development. Mineral oil is a lubricating agent that facilitates defecation by altering stool consistency and by forming a slippery layer around fecal pellets. Other modalities used to treat constipation include biofeedback and surgery. Laxatives and lavage (cleaning) solutions are also used for colon preparation and evaluation of the bowels after toxic ingestions. Most patients with constipation will try to treat this condition themselves before seeking medical attention. Therefore, it is important for the health care provider to obtain a good history of the treatments that have been tried previously in addition to trying to develop a good understanding of exactly what problems the patient is having with defecation. A detailed physical examination, including a thorough rectal examination is also important. 3 tables. 133 references.

Full Record   Printer Friendly Version

Page 1 2 3 4 5 6 7    Display All

Start a new search.