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Functional Bowel Disorders. IN: Drossman, D.A., ed. Rome III: The Functional Gastrointestinal Disorders. 3rd ed. McLean, VA: Degnon Associates, Inc. 2006. pp. 487-555.

This chapter on functional bowel disorders is from a lengthy reference book that presents the Rome III criteria for functional gastrointestinal disorders (FGIDs), a classification system based on the assumption and premise that for each disorder there are identifiable symptom clusters that emerge across clinical and population groups. The authors of this chapter define functional bowel disorders as FGIDs with symptoms attributable to the middle or lower gastrointestinal tract. These disorders include irritable bowel syndrome (IBS), functional bloating, functional constipation, functional diarrhea, and unspecified functional bowel disorder. In each of these categories, the authors provide a definition and discuss epidemiology, symptoms, nomenclature and classification, clinical evaluation, physiological features, and treatment strategies. Specific topics include gastrointestinal motor disturbances, visceral hypersensitivity, postinfectious IBS, history of physical or sexual abuse, food intolerance, drug therapy, measurements of colonic transit, fiber supplementation and bulk laxatives, osmotic laxatives, and unspecified functional bowel disorder. The chapter concludes with a list of recommendations for future research in functional bowel disorders. 4 tables. 464 references.

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Chronic Constipation : From Evaluation to Treatment. Digestive Health Matters. 14(4): 4-9. Winter 2005.

This article brings readers up-to-date on the evaluation and treatment of chronic constipation. The author begins by defining constipation and differentiating chronic constipation from irritable bowel syndrome (IBS), a condition that can be characterized by constipation as one of its features. The term constipation includes a complex group of symptoms related to slow, impaired, difficult, or painful defecation. The article then addresses the major identifiable causes of constipation, when to consult a doctor for evaluation, the role of colonoscopy in diagnosis, the indications for specialized testing, including anorectal manometry and defecography, and treatment strategies, which are dependent upon diagnosis. The author discusses the use of drug therapies, biofeedback therapy, dietary fiber and fluids, and surgical options. The author concludes that most people with constipation can be successfully treated when a complete evaluation is performed and a rational treatment plan is pursued in partnership with their health care provider. 2 figures. 3 tables. 3 references.

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Common Questions About Constipation: Myths and Misconceptions. Digestive Health Matters. 14(2): 13-14. Summer 2005.

This article presents some common myths and misconceptions about constipation, along with the facts. The issues discussed include autointoxication (the release of toxins from stool kept in the colon for a long period of time), the interplay between hormones and constipation, the role of a high fiber diet in preventing or treating constipation, and the use of stimulant laxatives. The author recommends a diet that is high in fiber as a first-line therapy for constipation and also notes that overall, the available data indicates that laxatives are safe and effective treatments for constipation. 1 reference.

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Defecation Disorders After Surgery for Hirschsprung's Disease. Digestive Health Matters. 14(02): 10-12 p. Summer 2005.

This article describes Hirschsprung's disease, a congenital disorder characterized by the absence of nerve cells in the rectum or colon. Usually the problem involves only the bottom portion of the colon, but sometimes the entire colon or even part of the small intestine can be involved. The part of the bowel that lacks nerve cells cannot propel stool toward the anus, and the disorder results in obstruction, severe constipation, or inflammation (enterocolitis). The author outlines the defecation disorders that may be encountered after surgery for Hirschsprung's disease. Topics include constipation, functional fecal retention, dilation treatment, fecal incontinence, neuropathy (abnormal functioning of the nerves), hypertensive anal sphincter, the use of colon manometry, abdominal pain, and expected outcomes. The author concludes with a brief discussion of the psychosocial impact to a child of coping with Hirschsprung's disease. 5 references.

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Medication for Inflammatory Bowel Disease. Toronto, Canada: Crohn’s and Colitis Foundation of Canada. 8 p.

This brochure reviews some of the medications that may be used for inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis. After an introductory section that briefly summarizes these diseases, the booklet describes medications used to reduce inflammation in the gastrointestinal tract; medications used to reduce symptoms of the disease, such as diarrhea and cramps; and medications used to treat complications. Specific drugs discussed include sulfasalazine; 5-aminosalicylate, also known as mesalamine, mesalazine, and olsalazine; glucocorticosteroids, including prednisone, hydrocortisone, betamethasone, tixocortol, and budensonide; immunosuppressive agents, including azathioprine, 6-mercaptopurine, methotrexate, and cyclosporine A; antibiotics, including metronidazole, ciprofloxacin, ampicillin, cefazolin, gentamicin, and tobramycin; new biological therapies, including infliximab; antidiarrheal drugs, including Loperamide, codeine, diphenoxylate, tincture of opium, and paregoric; bulk-formers, primarily natural fiber sources; bile salt binders, i.e., cholestyramine, used for Crohn’s disease only; and nicotine, which is sometimes used for ulcerative colitis. For each drug, the brochure notes synonyms, how the drug is prescribed, how it works, possible side effects, and the different forms, if any, the drug comes in. The remainder of the article considers medications for other symptoms and problems, complications of IBD that may require therapy, alternative therapies, and conventional therapies. The contact information and mission of the Crohn’s and Colitis Foundation of Canada are noted. A form to join the organization or contribute money to its causes is included. 1 figure.

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Your Guide to High Fiber Diet. Cincinnati, OH: Procter & Gamble Company. 2005. 8 p.

Fiber is the part of a plant that humans cannot digest and that does not provide the body with any nutrients, vitamins, or minerals. Instead, fiber adds bulk to the foods that are eaten, to help them move more easily through the digestive system. This brochure describes the use of dietary fiber to promote good health. The brochure reviews the latest information about dietary fiber, describes why fiber is important, outlines daily fiber recommendations, describes easy ways to increase fiber, and explains the use of a fiber supplement. Fiber helps maintain regularity and helps reduce constipation and its discomfort. A blank chart is provided for readers to track the fiber they ingest in one week. One section shows a sample menu of increased-fiber foods; another chart offers a list of common foods and their fiber amount. The brochure is produced by the maker of Metamucil, a popular fiber supplement, and readers are encouraged to consider the use of Metamucil in their efforts to increase fiber intake. 4 figures. 3 tables.

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Colonic Motor Disorders: Constipation. In: Kelly, K.A.; Sarr, M.G.; Hinder, R.A., eds. Mayo Clinic Gastrointestinal Surgery. St. Louis, MO: Elsevier Science. 2004. p. 475-487.

Constipation is a very common complaint, however its definition is complex. There are two fundamental causes of functional constipation: anorectal dysfunction and slow colonic transit. This chapter on constipation is from a book that focuses on the major diseases treated by gastrointestinal surgeons, from the esophagus to the anal canal. The presentation has a definite clinical orientation and a major emphasis on practical applications as they are applied at the Mayo Clinic. The authors of this chapter review pathogenesis and etiology, diagnosis and imaging, psychologic evaluation, indications for operation, conduct of operation, surgical outcomes, and long term follow up. The authors stress that few patients presenting with constipation are surgical candidates. Selection of operative candidates is based on evaluation of colonic transit with either radiopaque markers or scintigraphy. Patients with anorectal dysfunction should be treated with pelvic floor retraining. The chapter is illustrated with line drawings and full-color photographs. 6 figures. 3 tables. 91 references.

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Epidemiology and Quality of Life in Functional Gastrointestinal Disorders. Alimentary Pharmacology and Therapeutics. 20: 31-39. November 2004.

This article reviews the epidemiology and quality of life in patients with functional gastrointestinal disorders, particularly irritable bowel syndrome (IBS), functional dyspepsia, and chronic constipation. Data shows that the prevalence of functional gastrointestinal disorders is statistically significant across the world, with a higher rate seen in woman with IBS and chronic constipation, but not those with functional dyspepsia. The author cautions, however, that differences between global and gender prevalence rates may be due to cultural factors and study methodology. IBS was found to be associated with a significant health care burden, including increased outpatient service, abdominal and pelvic surgeries, physician visits, and health care costs. Impaired health-related quality of life (HRQoL) was shown in patients with IBS, particularly in those with moderate to severe disease seen in referral settings. The HRQoL appears to improve in treatment responders, or correlates with symptom improvement. Predictors of HRQoL in patients with functional gastrointestinal disorders include psychosocial factors, such as early adverse life events, and symptoms related to visceral perception (e.g., pain and chronic stress). The author concludes that although gastrointestinal-related symptoms are obviously important, non-gastrointestinal symptoms appear to have a major, if not greater, effect on health care visits, health care costs, and HRQoL in patients with IBS. 1 figure. 1 table. 67 references.

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Approach to the Patient with Constipation. In: Textbook of Gastroenterology. 4th ed. [2-volume set]. Hagerstown, MD: Lippincott Williams and Wilkins. 2003. p. 894-910.

Although constipation is a common gastrointestinal complaint in clinical practice, some uncertainty exists as to the precise definition of the term. This lack of objectivity has contributed to the controversy concerning the incidence, pathogenesis, and treatment of constipation and defecation disorders. Furthermore, the availability of over-the-counter laxatives and their long-term and often inappropriate use may result in laxative dependence, may damage the bowel, and may lead to problems where none previously existed. This chapter on the approach to patients with constipation is from a lengthy, two-volume textbook that integrates the various demands of science, technology, expanding information, good judgment, and common sense into the diagnosis and management of gastrointestinal patients. Topics include definitions, the socioeconomic and medical consequences of constipation, pathophysiological considerations, evaluation of constipation, diagnostic strategies, and treatment options. The author notes that there is general agreement that selecting treatment strategies requires understanding of the whole patient, fiber supplements should be added to the diet, establishing proper toileting arrangements can help certain patients, and long-term use of stimulant laxatives should be judicious. Surgery has a role in selected patients with severe constipation in whom abnormal bowel function can be ameliorated by operative intervention. 2 figures. 5 tables. 185 references.

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Constipation in Children. Flourtown, PA: American Society for Pediatric Gastroenterology, Hepatology and Nutrition. 2003. 1 p.

Constipation is defined as either a decrease in the frequency of bowel movements, or the painful passage of bowel movements. This brief fact sheet considers the problem of constipation in children. The fact sheet defines the condition, outlines etiology (causes), the symptoms that can accompany the constipation (including stomach pain, poor appetite, crankiness) and epidemiology (how common the condition is), then discusses treatment options. Constipation can begin when there are changes in the diet, the time of toilet training, following travel, or after a viral illness. In most cases, there is no need for diagnostic testing prior to treatment for constipation. Treatment of constipation varies according to the source of the problem and the child's age and personality. Some children may only require changes in diet such as an increase in fiber, fresh fruits, or in the amount of water they drink each day. For more information, readers are encouraged to visit www.naspghan.org (the web site of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition).

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