Association Of Constipation Research Articles

Association of Constipation with Modes of Delivery: A Retrospective Questionnaire-based Study

Introduction and HypothesisPelvic floor damage can contribute to pelvic floor dysfunction, including constipation. Most studies focus on constipation during pregnancy, whereas information regarding the mode of delivery in relation to constipation is limited. We hypothesise that women with a history of vaginal delivery report constipation more often than women with a history of caesarean section.MethodsThis was a retrospective cross-sectional multicentre study conducted in the Netherlands. All included patients (n = 2,643) completed the Groningen Defecation and Fecal Continence questionnaire to assess bowel problems of the last 6 months. Parametric tests, Chi-squared, univariable and multivariable regression analyses were performed.ResultsAmong 2,643 parous women, 2,248 delivered vaginally (85.1%) and 395 (14.9%) by caesarean section. Altogether, 649 women (24.6%) suffered from constipation. Women in the vaginal delivery group were constipated more often than women in the caesarean section group (25.5% versus 19.0%, p = 0.005). For women who had delivered vaginally, multivariable regression analysis showed an odds ratio for constipation of 1.47 (95% confidence interval, 1.109–1.938, p = 0.007). The odds ratio for constipation in women with a spontaneous perineal tear was 1.4 times higher than in women with an intact perineum (p = 0.030). Furthermore, the vaginal delivery group reported difficulties regarding bowel emptying (p = 0.048), straining (p = 0.027), incomplete defecation (p = 0.043), not able to defecate daily (p = 0.018), manually assisted defecation (p = 0.015) and had higher Renzi scores (p = 0.043) more often.ConclusionsWomen in the vaginal delivery group have higher prevalences and odds ratios for constipation. Furthermore, a perineal tear during vaginal delivery increases the odds ratio for constipation.

IJCM_180A: Risk factors for hemorrhoids among patients attending selected tertiary care hospitals in Mangalore: A matched case control study

Background: Hemorrhoids is a common anorectal condition affecting a vast majority of population all around the world. The establishment of a definite association of hemorrhoids with bowel habits and other factors like BMI is less explored. Objectives: To find out the association of hemorrhoids especially with bowel habits and to establish the association of BMI with respect to the onset of hemorrhoids. Methodology: This case control study was conducted among 90 cases and controls from the hospitals affiliated to Kasturba Medical college, Mangalore. Data were analyzed using SPSS version 29. Uni-variate analysis was done, and the odds ratio and confidence levels were tested and determined using binary logistic regression. Results: Majority of the controls were normal with respect to BMI categorization (36.8%) whereas 34.9% of the cases were obese (p=0.095) . The number of people who consumed mixed diet was greater in the cases (72.3%) than in the controls (64.4%). 61.5% of patients complained of blood in stools compared to 2.2% of controls, there were 10.5% of cases with pus in stools and none in controls (p=0.249). Use of laxatives was seen in 27.7% of cases and only 2.1% of controls (p=0.001). A total score of >=15 was indicative of constipation. 12.8% showed constipation compared to none in the controls. (p=0.026). Conclusion: Association of constipation with hemorrhoids was statistically significant. The occurrence of hemorrhoids was not associated with the body mass index of the individual and the occurrence of diarrhea was not significant with respect to hemorrhoids.

Association of Constipation with risk of end-stage renal disease in patients with chronic kidney disease

BackgroundChronic Kidney Disease (CKD) is a growing public health problem. Many risk factors were identified and interventions were applied accordingly, but the incidence of end-stage renal disease continued increasing. Some other risk factors may be ignored. Gut microbiota has been recognized as an important endogenous organ. The kidney-gut axis would contribute to gut dysbiosis, which might worsen CKD. Constipation, commonly seen in CKD, was one of the clinical presentation of gut dysbiosis. The clinical impact of constipation to CKD remains unknown. Our study aimed at assessing the risk of ESRD between CKD patients with and without constipation in a nationwide database.MethodsWe identified newly diagnosed cases of CKD without constipation history before in 2000–2011 from the Taiwan National Health Insurance database. Subjects who developed constipation later formed constipation group. The others without constipation matched by propensity score formed non-constipation group. The incidence rates and hazards of ESRD in patients with and without constipation by the end of 2013 were compared by using Cox proportional hazard models with a time-dependent variable.ResultsThe incidences of ESRD per 1000 person-years were 22.9 for constipation group and 12.2 for non-constipation group, respectively. Cox proportional hazard models with a time-dependent variable revealed an adjusted hazard ratio of 1.90 (95% CI, 1.60–2.27). Compared to the CKD patients without constipation, adjusted hazard ratio for the CKD patients with laxatives < 33, 33–197 and ≥ 198 days per year were 0.45 (0.31–0.63), 1.85 (1.47–2.31) and 4.41 (3.61–5.39) respectively.ConclusionIn a population of newly-diagnosed CKD patients, we observed that subjects with de novo constipation, as compared with non-constipation, have increased risk of developing ESRD. More severe constipation would increase the risk further.

Are there any association between colonic diverticula and bowel symptoms?(neurogastroenterol motil 2015;27:333-338).

The association of constipation and colonic diverticula was a wide-spread hypothesis. But there are no previous reports showing a relationship of diverticula and their location with bowel habits. Recently, Yamada et al1 suggested constipation was not associated with colonic diverticula, but on the other hand it was more prevalent in patients without diverticula than with diverticula. They evaluated the association between diverticula and bowel habits in Japanese individuals. Bowel habits and stool form were evaluated using the Gastrointestinal Symptom Rating Scale (GSRS)2 and a part of the Bristol Scale with Rome III criteria, respectively. The presence of constipation was associated with a significantly reduced likelihood of diverticula (odds ratio [OR], 0.70; 95% confidence interval [CI], 0.52–0.93), especially left-sided diverticula (OR, 0.39; 95% CI, 0.16–0.93). Stool form was unrelated with the presence or absence of diverticula. The authors concluded that the absence of diverticula was associated with constipation, suggesting the need to reassess the etiology of colonic diverticula.

A longitudinal study of constipation and laxative use in a community-dwelling elderly population

BackgroundLittle is known about laxative use, the association of constipation with laxative use, risk factors for constipation and how each of these changes over time in the community-dwelling elderly. ObjectiveThe aim was to explore the prevalence of laxative use and of self-reported constipation, and identify risk factors (including age) associated with constipation, in a cohort of community-dwelling elderly residents. MethodsData from the Australian Longitudinal Study of Ageing (ALSA) was used to compare differences in constipation and laxative use in the community-dwelling elderly between 1992–1993 and 2003–2004. ResultsRelevant data was available for 239 ALSA participants. The prevalence of self-reported constipation increased from 14% in 1992–1993 to 21% in 2003–2004. There was a corresponding increase in the prevalence of laxative use from 6% to 15% over the same period. At both time points, females reported a higher prevalence of both constipation and laxative use however the female:male prevalence ratios decreased over time indicating higher increases in the prevalence of each among males. Persistent chronic constipation occurred in 9% of the cohort. The association between laxative use and self-reported constipation was poor and laxative use was associated with self-reported constipation in less than a third of cases. ConclusionThe prevalence of both constipation and laxative use increases with age in the elderly, and these increases are greater for males than for females. Discrepancies between self-reported constipation and laxative use may suggest sub-optimal management of constipation in the community-dwelling elderly and further work is needed to fully understand this.

Association of Constipation and Fecal Incontinence With Attention-Deficit/Hyperactivity Disorder

Functional constipation and fecal incontinence are common childhood gastrointestinal conditions. Both conditions may be associated with behavioral problems. Attention-deficit/hyperactivity disorder (ADHD) is the most common behavioral disorder of childhood, characterized by shortened attention span and hyperactivity. We hypothesize that a diagnosis of ADHD increases the risk for functional constipation and fecal incontinence. A retrospective cohort study of children was performed by using the military health system database. Children of active-duty military personnel, aged 4 to 12 years, from October 2005 to September 2007, were included. ADHD, constipation, and fecal incontinence were identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes. Relative risks and adjusted incidence rate ratios (IRRs) were calculated. A subgroup analysis of subjects receiving medical therapy was performed. There were 742,939 children identified in the study, 32,773 (4.4%) of whom had ADHD. Children with ADHD had an increased prevalence of constipation (4.1% of children with ADHD vs 1.5% children without ADHD; P < .001) and fecal incontinence (0.9% of children with ADHD vs 0.15% of children without ADHD; P < .0001). Children with ADHD had more visits than those without ADHD for both constipation (IRR 3.39; 95% confidence interval 2.59-4.43) and fecal incontinence (IRR 7.74; 95% confidence interval 5.01-11.98). Children with ADHD receiving medicinal therapy did not differ significantly from children with ADHD not receiving medicinal therapy on rates of constipation visits (P = .57) or fecal incontinence visits (P = .32). Children with ADHD are significantly more likely to have constipation and fecal incontinence. Medical therapy for ADHD does not impact visit rates for defecation disorders.

Association of Constipation and Fecal Incontinence With Attention-Deficit/Hyperactivity Disorder

Association of Constipation and Fecal Incontinence With Attention-Deficit/Hyperactivity Disorder

Definition of Reliable, Objective Criteria by Abdominal Radiography to Identify Occult Constipation in Children with Lower Urinary Tract Symptoms

Treating constipation in children with voiding dysfunction may improve or resolve urinary symptoms. A clinical diagnosis of constipation may not identify all patients. Abdominal radiographs (plain x-ray of the kidneys, ureters and bladder) are often used to assess constipation but no objective definition of constipation based on abdominal radiographs exists. Most abdominal radiograph rating scales use subjective criteria and our previous series showed that these scales have poor reliability. We identified reliable, objective parameters on abdominal radiograph to predict constipation. The abdominal radiographs of 80 children 4 to 12 years old, including 40 with constipation and 40 successfully treated for constipation, were assessed for several measurable parameters. Logistic regression was used to construct a model to predict constipation status based on these abdominal radiograph parameters. Model accuracy was assessed using AUC analysis of ROC curves. The most predictive model included cecal diameter, total length of stool measured, stool length in the rectum, and patient age and gender. As measured by the area under the ROC curve, accuracy was excellent at 0.87. We calculated cutoffs for individual parameters on abdominal radiograph, including total stool length greater than 33.4 cm, cecal diameter greater than 3.7 cm and stool length in the rectum greater than 5.9 cm. We identified accurate, reliable criteria based on objective measurements on abdominal radiograph to differentiate patients with and without constipation. These criteria may be applied to objectively assess constipation status in children with urinary symptoms without a history of constipation. Further study will determine whether these criteria predict the response to treatment.

The association of constipation with childhood urinary tract infections

Objective Previous studies have suggested a correlation between constipation and urinary tract infections (UTIs) in children. However, historical information about constipation may be unreliable and the relationship between a history of constipation and radiographic findings of fecal load is unclear. Patients and methods A total of 133 children undergoing an abdominal X-ray were evaluated. Parents were asked to complete a questionnaire on bowel habits. Three observers using a documented objective scoring system evaluated plain films of the abdomen. The symptom and radiographic scores were compared with the history and each other. Results Out of the 133 children, 100 had documented previous UTIs and 33 did not. Children with prior UTIs had significantly more symptoms of constipation than those without prior UTIs ( p < 0.02). Children with a history of UTIs tended to have more fecal loading on radiographic studies than those without, although this difference was not statistically significant ( p < 0.11). When only children of >3 years old are evaluated, the trends persist, but neither were statistically significant ( p < 0.11 and 0.56, respectively). There was a poor correlation between the symptoms of constipation and fecal load on abdominal X-rays (correlation coefficient of 0.08). Conclusions Our findings support the concept that children with UTIs have a higher rate of constipation, especially by history. However, diagnosing constipation in individual patients is difficult. Not only is there a poor correlation between history and radiographic findings of constipation in any individual patient, but at this time there is no gold standard.

559: Ths Association of Constipation with Childhood Urinary Tract Infections

559: Ths Association of Constipation with Childhood Urinary Tract Infections

Ectopic Anus in Childhood

The treatment of ten cases of ectopic anus is presented in this paper. The association of constipation with perineal anus due to alignment disturbance of the external sphincter triple loop system during evacuation has been described by Hendren (1978), Leape and Ramenofsky (1978), Upadhyaya (1984) et al. Hendren, Leape and Ramenofsky described two valid surgical techniques for this association. In this paper we describe the effect of non-invasive treatment in patients affected by symptomatic "primary" perineal anus. We also describe the effect of posterior anal transplant via the perineum in six infants and children with vulvar anus. This approach gave good results within three months without having to perform more complex operative techniques (Peña for example). Posterior anal transplant leads not only to an esthetic improvement but also to an improvement in fecal continence, which is sometimes deficient due to reduced anorectal angulation. It appears to us that an adequate perineal spur plays an important complementary role in the complex mechanism which controls fecal continence.