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Neurogastroenterology and Motility Aug 2011Although constipation can be a chronic and severe problem, it is largely treated empirically. Evidence for the efficacy of some of the older laxatives from well-designed... (Review)
Review
BACKGROUND
Although constipation can be a chronic and severe problem, it is largely treated empirically. Evidence for the efficacy of some of the older laxatives from well-designed trials is limited. Patients often report high levels of dissatisfaction with their treatment, which is attributed to a lack of efficacy or unpleasant side-effects. Management guidelines and recommendations are limited and are not sufficiently current to include treatments that became available more recently, such as prokinetic agents in Europe.
PURPOSE
We present an overview of the pathophysiology, diagnosis, current management and available guidelines for the treatment of chronic constipation, and include recent data on the efficacy and potential clinical use of the more newly available therapeutic agents. Based on published algorithms and guidelines on the management of chronic constipation, secondary pathologies and causes are first excluded and then diet, lifestyle, and, if available, behavioral measures adopted. If these fail, bulk-forming, osmotic, and stimulant laxatives can be used. If symptoms are not satisfactorily resolved, a prokinetic agent such as prucalopride can be prescribed. Biofeedback is recommended as a treatment for chronic constipation in patients with disordered defecation. Surgery should only be considered once all other treatment options have been exhausted.
Topics: Chronic Disease; Clinical Trials as Topic; Constipation; Defecation; Europe; Gastrointestinal Agents; Gastrointestinal Transit; Guidelines as Topic; Humans; Laxatives; Patient Satisfaction
PubMed: 21605282
DOI: 10.1111/j.1365-2982.2011.01709.x -
Environmental Health Perspectives Jun 2022According to the World Health Organization/United Nations International Children's Fund Joint Monitoring Program, people practice open defecation globally. After... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
According to the World Health Organization/United Nations International Children's Fund Joint Monitoring Program, people practice open defecation globally. After achieving open defecation-free (ODF) status through efforts such as Community-Led Total Sanitation (CLTS), communities (particularly vulnerable households) may revert to open defecation, especially when toilet collapse is common and durable toilets are unaffordable. Accordingly, there is increasing interest in pro-poor sanitation subsidies.
OBJECTIVES
This study determined the impacts of a pro-poor sanitation subsidy program on sanitation conditions among the most vulnerable households and others in the community.
METHODS
In 109 post-ODF communities in Northern Ghana, we conducted a cluster randomized controlled trial to evaluate a pro-poor subsidy program that identified the most vulnerable households through community consultation to receive vouchers for durable toilet substructures. We surveyed households to assess toilet coverage, quality, and use before and after the intervention and tracked program costs.
RESULTS
Overall, sanitation conditions deteriorated substantially from baseline to endline (average of 21 months). In control communities (not receiving the pro-poor subsidy), open defecation increased from 25% (baseline) to 69% (endline). The subsidy intervention attenuated this deterioration (open defecation increased from 25% to only 54% in subsidy communities), with the greatest impacts among voucher-eligible households. Noneligible households in compounds with subsidized toilets also exhibited lower open defecation levels owing to in-compound sharing (common in this context). CLTS followed by the subsidy program would benefit more households than CLTS alone but would cost 21-37% more per household that no longer practiced open defecation or upgraded to a durable toilet.
DISCUSSION
Sanitation declines, often due to toilet collapse, suggest a need for approaches beyond CLTS alone. This subsidy program attenuated declines, but durable toilets likely remained unaffordable for noneligible households. Targeting criteria more closely aligned with sanitation inequities, such as household heads who are female or did not complete primary education, may help to generate greater and more sustainable impacts in Northern Ghana and, potentially, other contexts facing toilet collapse and limited market access. https://doi.org/10.1289/EHP10443.
Topics: Child; Defecation; Female; Ghana; Humans; Male; Rural Population; Sanitation; Toilet Facilities
PubMed: 35674667
DOI: 10.1289/EHP10443 -
Neurogastroenterology and Motility Dec 2022Although high-resolution manometry (HR_ARM) is commonly used to diagnose defecatory disorders, its intraindividual day-to-day reproducibility is unknown. Since these...
BACKGROUND AND AIMS
Although high-resolution manometry (HR_ARM) is commonly used to diagnose defecatory disorders, its intraindividual day-to-day reproducibility is unknown. Since these measurements entail voluntary effort, this study aimed to evaluate the intraindividual day-to-day reproducibility of HR_ARM.
METHODS
In 22 healthy women (35 years [14] mean [SD]) and 53 constipated patients (42 years [13], 46 women), the rectal balloon expulsion time (BET), and anorectal pressures were measured with HR_ARM on 2 days separated by a median (interquartile range) of 15 days (11-53) in healthy and 40 days (8-75) in constipated patients. Anorectal pressures were evaluated at rest (20 s), during squeeze, and during evacuation. Rectal sensation was also evaluated in constipated patients. The agreement between both measurements was evaluated with Lin's concordance correlation coefficient (CCC) and other tests.
RESULTS
Among constipated patients, the anal resting (mean CCC [95%CI] 0.62 [0.43-0.76]) and squeeze pressures (CCC 0.65 [0.47-0.79]), rectoanal gradient during evacuation (CCC 0.42 [0.17-0.62]), and rectal sensory thresholds (CCC for urgency 0.72 [0.52-0.84]) were concordant. Between days 1 and 2, one or more outcomes, characterized as normal or abnormal, differed in 79% of constipated patients, i.e., anal resting and squeeze pressures, the gradient, and the rectal BET differed in, respectively, 25%, 19%, 36%, and 10% of constipated patients. The rectal BET was prolonged in three healthy persons (both days) and either on 1 day (six patients) or 2 days (33 patients) in constipated patients.
CONCLUSIONS
While HR_ARM variables and the BET are reproducible within healthy and constipated persons, the outcome on repeat testing differed in 79% of constipated patients.
Topics: Humans; Female; Reproducibility of Results; Manometry; Constipation; Anal Canal; Rectum; Defecation
PubMed: 36017816
DOI: 10.1111/nmo.14438 -
Journal of Oncology Pharmacy Practice :... Oct 2019Opioid-induced constipation is a clinically relevant side effect and a cause of potentially avoidable drug-related hospital admissions. (Observational Study)
Observational Study
INTRODUCTION
Opioid-induced constipation is a clinically relevant side effect and a cause of potentially avoidable drug-related hospital admissions.
OBJECTIVES
To describe the presence of laxative co-medication, the reasons for not starting laxatives and to evaluate changes in stool patterns of opioid initiators.
METHODS
In this observational study community pharmacists evaluated the availability of laxative co-medication in starting opioid users and registered reasons for non-use. Two opioid initiators per pharmacy were invited to complete questionnaires ('Bristol stool form scale' and 'Rome III Diagnostic Questionnaire for the Adult Functional Gastrointestinal Disorders') on their defecation prior to and during opioid use. Descriptive statistics and Chi square tests were used to analyse reasons for non-use of laxatives and changes in defecation patterns.
RESULTS
Eighty-one pharmacists collected data from 460 opioid initiators. Of those, 344 (74.8%) used laxatives concomitantly. Main reason not to use laxatives was that either prescribers or patients did not consider them necessary. Sixty-seven (89.3%) of the 75 opioid starters with two questionnaires completed were not constipated at opioid start. Eleven of them (16%) developed constipation during opioid use (Chi square p=0.003). At follow-up within laxative users 10.6% were constipated compared to 20.7% in subjects without laxatives.
CONCLUSION
One in four opioid starters did not dispose of laxative co-medication, mainly because they were not considered necessary by either the prescriber or the patient. The prevalence of constipation doubled during opioid use. A watchful waiting strategy for the use of laxative co-medication might include a monitoring of defecation patterns with validated questionnaires.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Analgesics, Opioid; Constipation; Defecation; Female; Humans; Laxatives; Male; Middle Aged; Prospective Studies; Surveys and Questionnaires; Young Adult
PubMed: 30260269
DOI: 10.1177/1078155218801066 -
PloS One 2022Autonomic dysfunction is a factor in irritable bowel syndrome (IBS). However, there are no reports of autonomic nervous system (ANS) activity during natural defecation...
BACKGROUND
Autonomic dysfunction is a factor in irritable bowel syndrome (IBS). However, there are no reports of autonomic nervous system (ANS) activity during natural defecation in patients with IBS. We aimed to clarify the relationship between ANS activity and life events, such as defecation and abdominal symptoms, using real-time recording.
METHODS
Six patients with IBS and 14 healthy controls were enrolled in this prospective multicenter study. ANS activity was recorded for 24 h using a T-shirt wearable device, and life events were recorded simultaneously in real time using a smartphone application software. Low frequency/high frequency (LF/HF) and HF calculated by power spectrum analysis were defined as activity indicators of the sympathetic and parasympathetic nerves, respectively.
RESULTS
The means of LF/HF and HF in the period with positive symptoms were comparable between the groups; however, the sum of LF/HF, sum of ΔLF/HF, and the maximum variation in ΔLF/HF were significantly higher in the IBS group. In the IBS group, the sum of ΔLF/HF and LF/HF increased significantly from 2 min before defecation, and the sum of LF/HF remained significantly higher until 9 min after defecation. The sum of ΔLF/HF at 2 min before defecation was significantly positively correlated with the intensity of abdominal pain and diarrhea and constipation scores. In contrast, it was significantly negatively correlated with defecation satisfaction and health-related quality of life.
CONCLUSIONS
In patients with IBS, sympathetic nerve activity was activated 2 min before defecation, which was correlated with abdominal symptoms and lower QOL.
Topics: Humans; Irritable Bowel Syndrome; Quality of Life; Prospective Studies; Constipation; Wearable Electronic Devices; Defecation
PubMed: 36490298
DOI: 10.1371/journal.pone.0278922 -
Revista Espanola de Enfermedades... Jun 2020Obstructed defecation syndrome produces constipation with anal blockage and a feeling of incomplete evacuation, due to either anatomic and functional causes. This is a...
Obstructed defecation syndrome produces constipation with anal blockage and a feeling of incomplete evacuation, due to either anatomic and functional causes. This is a complex and multifactorial entity due to diverse etiological factors that may coexist in many patients. Therefore, a diagnostic approach requires structural and functional assessment. The concordance between findings of diagnostic tests is suboptimal, thus an individualized analysis is mandatory in each patient. Therapeutic strategies require the best understanding of anatomic and functional aspects. Consequently, this entity is a diagnostic and therapeutic challenge.
Topics: Anal Canal; Constipation; Defecation; Humans; Syndrome
PubMed: 32450707
DOI: 10.17235/reed.2020.6921/2020 -
Acta Cirurgica Brasileira Mar 2012To identify the current status of scientific knowledge in fructo-oligosaccharides (FOS), non-conventional sugars that play an important role in glycemia control. (Review)
Review
PURPOSE
To identify the current status of scientific knowledge in fructo-oligosaccharides (FOS), non-conventional sugars that play an important role in glycemia control.
METHODS
We performed a search for scientific articles in MEDLINE and LILACS databases, from January 1962 to December 2011, using English/Portuguese key words: "blood glucose/glicemia", "prebiotics/prebióticos" and "dietary fiber/fibras na dieta". From an initial number of 434 references, some repeated, 43 references published from 1962 to 2011 were included in this study. The selected texts were distributed in three topics: (1) metabolism of FOS, (2) FOS and experimental studies involving glucose and (3) human studies involving glucose and FOS.
RESULTS
Five studies have shown that the use of FOS reduces the fecal content and increases intestinal transit time. Experimental studies have shown that dietary supplementation with high doses (60 g/Kg) of propionate, a short-chain fatty acid decreased glycemia. The use of lower doses (3 g/kg) did not produce the same results. Study in subjects with diabetes type II showed that the addition of 8 grams of FOS in the diet for 14 days, caused a reduction in serum glucose. In another study with healthy subjects, there were no changes in glycemic control.
CONCLUSIONS
This review demonstrates that consumption of FOS has a beneficial influence on glucose metabolism. The controversies appear to be due to inadequate methodological designs and/or the small number of individuals included in some studies.
Topics: Adult; Blood Glucose; Child; Defecation; Dietary Fiber; Dietary Supplements; Humans; Oligosaccharides
PubMed: 22460261
DOI: 10.1590/s0102-86502012000300013 -
ELife Jun 2022Biological clocks are fundamental to an organism's health, controlling periodicity of behaviour and metabolism. Here, we identify two acid-sensing ion channels, with...
Biological clocks are fundamental to an organism's health, controlling periodicity of behaviour and metabolism. Here, we identify two acid-sensing ion channels, with very different proton sensing properties, and describe their role in an ultradian clock, the defecation motor program (DMP) of the nematode . An ACD-5-containing channel, on the apical membrane of the intestinal epithelium, is essential for maintenance of luminal acidity, and thus the rhythmic oscillations in lumen pH. In contrast, the second channel, composed of FLR-1, ACD-3 and/or DEL-5, located on the basolateral membrane, controls the intracellular Ca wave and forms a core component of the master oscillator that controls the timing and rhythmicity of the DMP. and mutants show severe developmental and metabolic defects. We thus directly link the proton-sensing properties of these channels to their physiological roles in pH regulation and Ca signalling, the generation of an ultradian oscillator, and its metabolic consequences.
Topics: Acid Sensing Ion Channels; Animals; Caenorhabditis elegans; Caenorhabditis elegans Proteins; Defecation; Protons
PubMed: 35666106
DOI: 10.7554/eLife.75837 -
Sensors (Basel, Switzerland) Sep 2022The elderly population in China is continuously increasing, and the disabled account for a large proportion of the elderly population. An effective solution is urgently...
The elderly population in China is continuously increasing, and the disabled account for a large proportion of the elderly population. An effective solution is urgently needed for incontinence among disabled elderly people. Compared with disposable adult diapers, artificial sphincter implantation and medication for incontinence, the defecation pre-warning method is more flexible and convenient. However, due to the complex human physiology and individual differences, its development is limited. Based on the aging trend of the population and clinical needs, this paper proposes a bowel sound acquisition system and a defecation pre-warning method and system based on a semi-supervised generative adversarial network. A network model was established to predict defecation using bowel sounds. The experimental results show that the proposed method can effectively classify bowel sounds with or without defecation tendency, and the accuracy reached 94.4%.
Topics: Adult; Aged; Algorithms; China; Defecation; Disabled Persons; Humans
PubMed: 36081167
DOI: 10.3390/s22176704 -
American Journal of Obstetrics and... Apr 2017Posterior vaginal prolapse is thought to cause difficult defecation and splinting for bowel movements. However, the temporal relationship between difficult defecation...
BACKGROUND
Posterior vaginal prolapse is thought to cause difficult defecation and splinting for bowel movements. However, the temporal relationship between difficult defecation and prolapse is unknown. Does posterior vaginal prolapse lead to the development of defecation symptoms? Conversely, does difficult defecation lead to posterior prolapse? This prospective longitudinal study offered an opportunity to study these unanswered questions.
OBJECTIVE
We sought to investigate the following questions: (1) Are symptoms of difficult defecation more likely to develop (and less likely to resolve) among women with posterior vaginal prolapse? (2) Is posterior vaginal prolapse more likely to develop among women who complain of difficult defecation?
STUDY DESIGN
In this longitudinal study, parous women were assessed annually for defecatory symptoms (Epidemiology of Prolapse and Incontinence Questionnaire) and pelvic organ support (POP-Q examination). The unit of analysis for this study was a visit-pair (2 sequential visits from any participant). We created logistic regression models for symptom onset among those women who were symptom-free at the index visit and for symptom resolution among those women who had symptoms at the index visit. To investigate the change in posterior vaginal support (assessed at point Bp) as a function of symptom status, we created a standard regression model that controlled for Bp at the index visit for each visit-pair.
RESULTS
We derived 3888 visit-pairs from 1223 women (each completed 2-7 annual visits). At the index visit, 1143 women (29%) reported difficulty with bowel movements, and 643 women (17%) reported splinting for bowel movements. Posterior vaginal prolapse (Bp≥0) was observed among 80 women (2%). Among those women without symptoms, posterior vaginal prolapse did not significantly increase the odds that defecatory symptoms would develop (difficult bowel movements, P=.378; splinting, P=.765). In contrast, among those with defecatory symptoms, posterior vaginal prolapse reduced the probability of symptom resolution (difficult bowel movements, P<.001; splinting, P=.162). The mean rate of change in posterior wall support was +0.13 cm. Among women without posterior vaginal prolapse, the presence of defecatory symptoms at the index visit did not have an effect on changes in Bp over time; however, among those with posterior vaginal prolapse (Bp≥0), defecatory symptoms were associated with more rapid worsening of posterior support (difficulty with bowel movements, P=.005; splinting, P=.057).
CONCLUSION
Posterior vaginal prolapse did not increase the odds that new defecatory symptoms would develop among asymptomatic women but did increase the probability that defecatory symptoms would persist over time. Furthermore, among those women with established posterior vaginal prolapse, defecatory symptoms were associated with more rapid worsening of posterior vaginal wall descent.
Topics: Adult; Defecation; Female; Humans; Longitudinal Studies; Prospective Studies; Time Factors; Uterine Prolapse
PubMed: 27780707
DOI: 10.1016/j.ajog.2016.10.021