scholarly journals Severe Postoperative Chronic Constipation Related to Anorectal Malformation Managed with Osteopathic Manipulative Treatment

2020 ◽  
Vol 14 (1) ◽  
pp. 220-225
Author(s):  
Luca Vismara ◽  
Vincenzo Cozzolino ◽  
Luca Guglielmo Pradotto ◽  
Riccardo Gentile ◽  
Andrea Gianmaria Tarantino
Keyword(s):  
Pelvic Floor ◽  
Chronic Constipation ◽  
Anorectal Malformation ◽  
Bowel Movement ◽  
Functional Constipation ◽  
Good Prognosis ◽  
Osteopathic Manipulative Treatment ◽  
Severe Constipation ◽  
Bowel Movements ◽  
Functional Alteration

Constipation is frequent amongst infants who have undergone surgery for anorectal malformation (ARM). Faecal retention, due to a dysfunctional enteric reflex of defaecation, can cause abdominal cramps, pseudoincontinence and, in the worst cases, megacolon. Prokinetic protocols are used to stimulate at least 1 bowel movement per day, including laxatives, enema, stools softeners and dietary schedules. While osteopathic manipulative treatment is adopted in adults for functional constipation, it has not been described for infants. Herein, we report the case of an infant undergoing anorectoplasty for a low ARM who was referred to the osteopath 2 years after the onset of severe constipation associated with pseudoincontinence and abdominal cramps and was refractory to the prokinetic protocol. In a child with a good ARM prognosis, autonomous daily bowel movements should be achieved. In this child, the imbalanced tension of the pelvic floor and immaturity of the parasympathetic plexus led to a functional alteration of the defaecation reflex. After adjunction of osteopathic manipulative treatment (OMT) to the therapeutic panel, the constipation showed gradual remission, with acquisition of autonomous defaecation 4 months after the therapy began. This suggests the importance of investigating the efficacy of OMT inclusion in the postsurgical prokinetic protocols for ARM patients with a good prognosis.

The Effect of Lactobacillus reuteri Supplementation in Adults with Chronic Functional Constipation: a Randomized, Double-Blind, Placebo-Controlled Trial*

2014 ◽  
Vol 23 (4) ◽  
pp. 387-391 ◽  
Author(s):  
Veronica Ojetti ◽  
Gianluca Ianiro ◽  
Annalisa Tortora ◽  
Giovanna D‘Angelo ◽  
Teresa Antonella Di Rienzo ◽  
...  
Keyword(s):  
Bowel Movement ◽  
Lactobacillus Reuteri ◽  
Controlled Trial ◽  
Functional Constipation ◽  
Stool Consistency ◽  
Double Blind ◽  
Movement Frequency ◽  
Bowel Movements ◽  
Bowel Movement Frequency ◽  
The Mean

Background & Aims: There is a growing interest for the use of probiotics for chronic constipation. A recent randomized controlled trial (RCT) showed a positive effect of Lactobacillus reuteri (L. reuteri) on bowel movement frequency in infants with chronic constipation. The aim of the present study was to evaluate the effects of L. reuteri in adult patients with functional constipation.Methods: A double-blind, placebo RCT was conducted in 40 adults (18M/22F, 35±15 years) affected by functional constipation according to the Rome III criteria. Patients were randomly assigned to receive a supplementation of L. reuteri (DSM 17938), or matching placebo for 4 weeks. The increase of bowel movements/week was the primary outcome, while the improvement of stool consistency was the secondary outcome.Results: At week 4, the mean increase in bowel movements/week was 2.6 (SD±1.14, 95% CI:1.6-3.6) in the L. reuteri group and 1.0 (SD±1. 95% CI:0.12-1.88) in the placebo group (p=0.046). At the end of the treatment, the mean bowel movements/week was 5.28±1.93 in the L. reuteri group and 3.89±1.79 in the placebo group. There was a not significant difference in the stool consistency between the two groups.Conclusions: L. reuteri is more effective than the placebo in improving bowel movement frequency in adult patients with functional constipation as previously demonstrated in children, even if it seems to have no effect on stool consistency.

scholarly journals Anorectal biofeedback: an effective therapy, but can we shorten the course to improve access to treatment?

2019 ◽  
Vol 12 ◽  
pp. 175628481983607
Author(s):  
Yoav Mazor ◽  
John E. Kellow ◽  
Gillian M. Prott ◽  
Michael P. Jones ◽  
Allison Malcolm
Keyword(s):  
Quality Of Life ◽  
Faecal Incontinence ◽  
Chronic Constipation ◽  
Functional Constipation ◽  
Rectal Sensation ◽  
Access To Treatment ◽  
Bowel Movements ◽  
Defecation Disorder ◽  
Improve Access

Background: Instrumented anorectal biofeedback (BF) improves symptoms and quality of life in patients with faecal incontinence and defecation disorder-associated chronic constipation. However, demand for BF greatly outweighs availability, so refinement of the BF protocol, in terms of the time and resources required, is of importance. Our aim was to evaluate the outcomes of an abbreviated BF protocol in patients with defecation disorder-associated chronic constipation and/or faecal incontinence compared to standard BF. Methods: Data were collected from consecutive patients ( n = 31; age 54 ± 15; 29 females; 61% functional constipation) undergoing an intentionally abbreviated BF protocol, and compared in a 1:2 ratio with 62 age, gender and functional anorectal disorder-matched control patients undergoing a standard BF. Outcomes included change in symptoms, physiology, patient satisfaction and quality of life. Results: On intention to treat, patients in both protocols showed significant improvement in symptom scores and the magnitude did not differ between groups. Impact on quality of life, satisfaction and control over bowel movements improved in both protocols, but satisfaction improved to a greater extent in the standard BF protocol ( p = 0.009). Physiological parameters were unchanged after BF apart from improvement in rectal sensation in the standard BF group compared to abbreviated BF ( p ⩽ 0.002). Conclusions: Abbreviated anorectal BF offered to patients travelling from far away was not different to a standard BF in providing substantial, at least short term, improvements in symptoms of constipation and faecal incontinence, quality of life and feeling of control over bowel movements. Refinement of the standard BF protocol according to individual patient phenotypes and desired outcomes warrants further study in order to maximize efficacy and improve access for patients.

scholarly journals The efficacy of Bifidobacterium bifidum G9-1 in improving quality of life in patients with chronic constipation

2020 ◽  
Author(s):  
Akiko Fuyuki ◽  
Takuma Higurashi ◽  
Takaomi Kessoku ◽  
Keiichi Ashikari ◽  
Tsutomu Yoshihara ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Constipation ◽  
Bowel Movement ◽  
Clinical Symptoms ◽  
Intestinal Flora ◽  
Bifidobacterium Bifidum ◽  
Stool Consistency ◽  
Feasibility Trial ◽  
Bowel Movements

Abstract Background: Chronic constipation is a functional disorder that decreases patient’s quality of life (QOL). Because dysbiosis has been associated with constipation, we aimed to investigate the efficacy of Bifidobacterium bifidum G9-1 (BBG9-1) in improving QOL in constipated patients. Methods: This was a prospective, single-center, non-blinded, single-arm, feasibility trial. A total of 31 patients received BBG9-1 treatment for 8 weeks, followed by a 2-week washout period. The primary endpoint was the change in the overall Patient Assessment of Constipation of QOL (PAC-QOL) score relative to that at the baseline after probiotic administration. Secondary endpoints included changes in intestinal flora, stool consistency, frequency of bowel movement, degree of straining, sensation of incomplete evacuation, and frequency of rescue drug use. Results: The overall PAC-QOL scores and frequency of bowel movement were significantly improved after BBG9-1 administration compared to those at baseline (p < 0.05, p < 0.05, respectively). There were no statistically significant changes in other clinical symptoms. Subset analysis revealed that patients with the initial Bristol Stool Form Scale of < 4 had improvements in stool consistency, a significant increase in the frequency of their bowel movements, and a significant alleviation in their degree of straining following BBG9-1 administration. Sarcina at the genus level and Sarcina maxima at the species level were significantly increased. Functional analysis showed that butanoate metabolism increased significantly, whereas methane metabolism decreased significantly. Conclusions: BBG9-1 is safe and improves the QOL of constipated patients. The underlying improvements may be due to changes in stool consistency. Trial registration: UMIN 000029969. Registered 15 November 2017, https://www.umin.ac.jp/

Correction of functional constipation in patients with limited mobility after stroke

2019 ◽  
Vol 1 (6) ◽  
pp. 53-55
Author(s):  
M. S. Turchina ◽  
M. V. Bukreeva ◽  
L. Yu. Korolyova ◽  
Zh. E. Annenkova ◽  
L. G. Polyakov
Keyword(s):  
Quality Of Life ◽  
Chronic Constipation ◽  
Functional Constipation ◽  
Cerebrovascular Diseases ◽  
Medical Rehabilitation ◽  
Stroke Patients ◽  
Limited Mobility ◽  
Complete Restoration ◽  
The World

Currently, the problem of early rehabilitation of stroke patients is important, since in terms of the prevalence of cerebrovascular diseases and disability after suffering a stroke, Russia is one of the first places in the world. The complex of medical rehabilitation of such patients should provide for the early and most complete restoration of all body functions, patient education for lost skills, re-socialization of the patient and improvement of the quality of life. One of the factors contributing to a significant reduction in the quality of life after a stroke is the development of chronic constipation. The article reflects the modern methods of correction of chronic constipation in patients with limited mobility.

Benefit of Pelvic Floor Physical Therapy in Pediatric Patients with Dyssynergic Defecation Constipation

2019 ◽  
Vol 37 (6) ◽  
pp. 478-485 ◽  
Author(s):  
Claire Zar-Kessler ◽  
Braden Kuo ◽  
Elizabeth Cole ◽  
Anna Benedix ◽  
Jaime Belkind-Gerson
Keyword(s):  
Physical Therapy ◽  
Pelvic Floor ◽  
Chronic Constipation ◽  
Muscle Tone ◽  
Colonic Surgery ◽  
Tertiary Referral Center ◽  
Dyssynergic Defecation ◽  
Pelvic Floor Physical Therapy ◽  
Novel Treatment ◽  
Balloon Expulsion

Objectives: Chronic constipation is a common childhood problem and often caused or worsened by abnormal dynamics of defecation. The aim of this study was to assess the benefit of pelvic floor physical therapy (PFPT), a novel treatment in pediatrics for the treatment of chronic constipation with dyssynergic defecation. Methods: This was a retrospective study of 69 children seen at a pediatric neurogastroenterology program of a large tertiary referral center for chronic constipation and dyssynergic defecation, determined by anorectal manometry and balloon expulsion testing. We compared the clinical outcome of patients who underwent PFPT (n = 49) to control patients (n = 20) whom received only medical treatment (laxatives/stool softeners). Additionally, characteristics of the treatment group were analyzed in relation to therapeutic response. Results: Thirty-seven (76%) of the patients who received physical therapy had improvement in constipation symptoms, compared to 5 (25%) of the patients on conservative treatment (p < 0.01). Additionally, patients who received pelvic physical therapy had fewer hospitalizations for cleanouts (4 vs. 25%, p = 0.01) and ­colonic surgery than those that were treated with medical therapy exclusively (0 vs. 10%, p = 0.03). Among the patients who received physical therapy, those that suffered from anxiety and/or low muscle tone had a higher response rate (100%). There were no adverse effects from the intervention. Conclusion: The new field of pediatric PFPT is a safe and effective intervention for children with dyssynergic defecation causing or contributing to chronic constipation, particularly in children whose comorbidities include anxiety and low ­muscle tone.

scholarly journals Constipation: A common problem in childhood

2005 ◽  
Vol 58 (7-8) ◽  
pp. 357-361
Author(s):  
Svetlana Bukarica ◽  
Smiljana Marinkovic ◽  
Slobodan Grebeldinger ◽  
Dusanka Dobanovacki ◽  
Milanka Tatic ◽  
...  
Keyword(s):  
Anal Canal ◽  
Bowel Movement ◽  
Digital Rectal Examination ◽  
Functional Constipation ◽  
Response To Treatment ◽  
First Year ◽  
Intestinal Transit Time ◽  
Anatomy And Physiology ◽  
The Family ◽  
First Year Of Life

Introduction Constipation in children is defined as the infrequent and difficult passage of hard stool, not necessarily associated with infrequent stools. All healthy newborns have their first stool within the first 24 to 48 hours after birth. Intestinal transit time increases with age, therapy decreasing the frequency of stooling. Anatomy and Physiology of Anus and Rectum Acquisition of fecal continence requires: normal internal and external anal sphincters, puborectal muscle as well as intact sensory input from both the rectal vault and anal canal. Etiology and Differential Diagnosis During the first year of life, failure to have bowel movement every other day warrants evaluation. During infancy, constipation is usually due to dietary manipulations, malnutrition or some other functional abnormalities. Anatomic causes are found only in 5% of patients. Diagnosis and Therapy Diagnosis relies on history and physical examination. Digital rectal examination usually reveals a shorter anal canal with decreased sphincter tone. The rectal ampulla is dilated and filled with stool. Anorectal manometry is helpful in differentiating functional constipation from aganglionosis or other neurologic problems. Treatment varies depending on the underlying cause. Bowel retraining, aimed at establishing regular daily bowel movement, is of utmost importance in children. The response to treatment is usually dramatic. Conclusion Constipation in children causes anxiety in the family and successful treatment requires persistent reassurance and repeated reevaluation.

scholarly journals EFFICACY AND SAFETY OF INTESTINAL SECRETAGOGUES FOR CHRONIC CONSTIPATION: A SYSTEMATIC REVIEW AND META-ANALYSIS

2018 ◽  
Vol 55 (suppl 1) ◽  
pp. 2-12 ◽  
Author(s):  
Juan Sebastian LASA ◽  
María Josefina ALTAMIRANO ◽  
Luis Florez BRACHO ◽  
Silvina PAZ ◽  
Ignacio ZUBIAURRE
Keyword(s):  
Irritable Bowel Syndrome ◽  
Chronic Constipation ◽  
Meta Analysis ◽  
Efficacy And Safety ◽  
Spontaneous Bowel Movement ◽  
Intention To Treat ◽  
Mesh Terms ◽  
Bowel Movements ◽  
Irritable Bowel ◽  
Therapeutic Alternatives

ABSTRACT BACKGROUND: Intestinal secretagogues have been tested for the treatment of chronic constipation and constipation-predominant irritable bowel syndrome. The class-effect of these type of drugs has not been studied. OBJECTIVE: To determine the efficacy and safety of intestinal secretagogues for the treatment of chronic constipation and constipation-predominant irritable bowel syndrome. METHODS: A computer-based search of papers from 1966 to September 2017 was performed. Search strategy consisted of the following MESH terms: intestinal secretagogues OR linaclotide OR lubiprostone OR plecanatide OR tenapanor OR chloride channel AND chronic constipation OR irritable bowel syndrome. Data were extracted as intention-to-treat analyses. A random-effects model was used to give a more conservative estimate of the effect of individual therapies, allowing for any heterogeneity among studies. Outcome measures were described as Relative Risk of achieving an improvement in the symptom under consideration. RESULTS: Database Search yielded 520 bibliographic citations: 16 trials were included for analysis, which enrolled 7658 patients. Twelve trials assessed the efficacy of intestinal secretagogues for chronic constipation. These were better than placebo at achieving an increase in the number of complete spontaneous bowel movements per week [RR 1.87 (1.24-2.83)], at achieving three or more spontaneous bowel movements per week [RR 1.56 (1.31-1.85)] and at inducing spontaneous bowel movement after medication intake [RR 1.49 (1.07-2.06)]. Similar results were observed when assessing the efficacy of intestinal secretagogues on constipation-predominant irritable bowel syndrome based on the results of six trials. CONCLUSION: Intestinal secretagogues are useful and safe therapeutic alternatives for the treatment of constipation-related syndromes.

Chronic Nonspecific Diarrhea

1996 ◽  
Vol 17 (11) ◽  
pp. 379-384
Author(s):  
Robert H. Judd
Keyword(s):  
Child Care ◽  
Young Child ◽  
Physical Examination ◽  
Bowel Movement ◽  
Laboratory Evaluation ◽  
Gastrointestinal Disorders ◽  
Office Visits ◽  
Case Presentation ◽  
Abdominal Symptoms ◽  
Bowel Movements

Case Presentation A toddler is seen for his 2-year well child examination. His parents are concerned and have received complaints from his child care provider that he has three to four loose, watery bowel movements daily; each bowel movement requires a clean-up and change of clothes. This diarrhea has been present intermittently for at least 6 months. He has a very good appetite, no other abdominal symptoms, and no blood in his stools. His development appears normal. Physical examination is entirely normal, including a weight of 13 kg and height of 90 cm, both at the 75th percentile for age. What additional history is useful, what laboratory evaluation would you perform, and how would you advise his parents? Introduction Gastrointestinal disorders account for approximately 5% of pediatric office visits. Many of these visits are for acute diarrhea that usually is infectious in origin and resolves in fewer than 7 days. Diarrhea in the young child that persists for longer than 3 weeks is termed chronic and can be frustrating and anxiety provoking for both physicians and parents. Through careful clinical assessment, the clinician can separate the majority of patients who require only observation from those who require a limited number of simple tests or those who require extensive testing. Definition

Effectiveness of probiotics for antipsychotic-induced functional bowel disorders: A single-center retrospective observational study

2019 ◽  
Author(s):  
Masaru Nakamura ◽  
Takahiko Nagamine
Keyword(s):  
Observational Study ◽  
Bowel Movement ◽  
Functional Constipation ◽  
Antipsychotic Treatment ◽  
Intestinal Function ◽  
Single Center ◽  
Functional Bowel Disorders ◽  
Psychiatric Setting ◽  
Stool Form ◽  
Bowel Disorders

Abstract Background Probiotics have the potential to improve functional constipation, however, evidence is lacking regarding its recommendation related to gut microbiota. Constipation is highly prevalent and a serious side-effect in antipsychotic treatment. This study was to investigate the effects of probiotics supplementation on defecation in psychiatry.Methods Subjects consisted of 31 male and 37 female inpatients who were co-administrated either of two probiotics: BIO-THREE or BIOFERMIN tablets. The medications that affect bowel movement including gastrointestinal drugs and antipsychotics in addition to their levels of chlorpromazine equivalent (CPeq) doses were compared between the two groups. Intestinal function was evaluated at baseline and one and two months using Bristol stool form scale. Sequential change of the three indices: average, constipation and diarrhea levels were compared within the group and analyzed to see any significant correlation against the CPeq levels. Results There were no significant differences in the medical treatment between the groups. In both groups, the average and constipation levels increased, and the diarrhea levels decreased at two months from baseline; in particular, the constipation levels were significantly increased at two months from baseline in the BIO-THREE group (-9.6±1.0 vs -6.5±0.9, mean±se). In the BIO-THREE group, only the diarrhea levels were significantly negatively correlated with the CPeq levels at two months (r= -0.341), while no such correlations were found in the BIOFERMIN group.Conclusions Probiotics supplementation may improve stool consistency, especially severe constipation and ameliorate diarrhea depended on antipsychotic dosage in psychiatric setting.

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