Constipation Research Articles

Investigating the lumbar proprioception and core muscles recruitment pattern while getting up from a chair with weight lifting in patients with chronic functional constipation: cross-sectional study.

Patients with chronic functional constipation have some problems such as weakness of pelvic floor muscles, and a lack of coordination of pelvic floor and abdominal muscles has been seen. The goal of this study was to investigate the lumbar proprioception and the core muscle recruitment pattern. The study type is a cross-sectional case-control study. There were 30 participants (case, n= 15, and control, n= 15). Electromyography of the core muscles was recorded while the subjects were getting up from the chair accompanied by lifting a weight, to check the pattern of muscle recruitment. Moreover, the lumbar proprioception was evaluated by an isokinetic device in both groups. The study was analyzed using independent t test and Mann-Whitney U test, and a nonparametric Friedman test was performed followed by Bonferroni pairwise comparison. The comparison of muscle activity delay between the two groups showed that there was a significant difference between the two groups regarding the abdominal muscles, anal sphincter, and erector spinae (p< 0.05). However, there was no significant difference in the rectus femoris and gluteal muscles between the two groups (p> 0.05). Moreover, the proprioception of the lumbar region showed a significant difference (p< 0.05) between the two groups. The results of this study demonstrated that the lumbar proprioception sense was reduced in the case group. This result can be justified, based on the problems in constipation (lack of coordination of muscles, weakness of pelvic floor muscles). The coordination of core muscles changed in patients with chronic functional constipation during a functional task.

Melanosis coli in a Nigerian female: A case report

Melanosis coli is a rare condition characterized by dark discoloration of the colonic mucosa. It is associated with long term use of anthraquinone-containing laxatives. It may be mistaken for other colonic diseases including ischaemic colitis. We present a middle-aged female with history of chronic constipation and longterm use of laxatives. Colonoscopy identified dark brown – black discoloration of the colonic mucosa which was suggestive of melanosis coli and confirmed by histology. The significance lies in the rarity of melanosis coli and the importance of avoiding a misdiagnosis. Dietary measures should be instituted in individuals with chronic constipation in order to avoid prolonged laxative use and possible development of melanosis coli.

Common gastrointestinal diseases and chronic obstructive pulmonary disease risk: a bidirectional Mendelian randomization analysis.

Background: Observational studies suggest an association between gastrointestinal diseases and chronic obstructive pulmonary disease (COPD), but the causal relationship remains unclear. Methods: We conducted bidirectional Mendelian randomization (MR) analysis using summary data from genome-wide association study (GWAS) to explore the causal relationship between common gastrointestinal diseases and COPD. Gastrointestinal diseases included gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), irritable bowel syndrome (IBS), Crohn's disease (CD), ulcerative colitis (UC), functional dyspepsia (FD), non-infectious gastroenteritis (NGE), and constipation (CP). Significant MR analysis results were replicated in the COPD validation cohort. Results: Bidirectional MR analysis supported a bidirectional causal relationship between GERD and COPD, and COPD was also found to increase the risk of IBS and CP. Our study also provided evidence for a bidirectional causal relationship between PUD and COPD, although the strength of evidence may be insufficient. Furthermore, we provided evidence that there is no causal association between CD, UC, FD, NGE, and COPD. Conclusion: This study offers some evidence to clarify the causal relationship between common gastrointestinal diseases and COPD. Further research is needed to understand the underlying mechanisms of these associations.

Association between frailty and chronic constipation and chronic diarrhea among American older adults: National Health and Nutrition Examination Survey

BackgroundThis study was to explore the relationship between chronic constipation, chronic diarrhea, and frailty in older Americans.MethodsThis cross-sectional study selected a total of 4241 community-dwelling individuals aged 60 years and older from the 2005–2010 National Health and Nutrition Examination Survey. Frailty was measured using a 49-item frailty index, and a frailty index > 0.21 was defined as a frail status. Chronic constipation and chronic diarrhea were defined as the “usual or most common type of stool” by the Bristol Stool Form Scale (BSFS) Types 1 and 2 and BSFS Types 6 and 7, respectively. Weighted logistic regression analysis was used to examine the relationship between gut health and frailty status. Restricted cubic spline (RCS) curves were built to assess the association between frailty index and stool frequency.ResultsFrailty status was associated with higher odds of constipation in an unadjusted model; however, after further adjusting for confounding variables, the relationship between frailty status and constipation was not statistically significant. We discovered a positive correlation between the frailty status and diarrhea after adjustment for all variables. The frailty index showed a U-shaped relationship with stool frequency, and the frailty index was the smallest at a frequency of 10 stools/week.ConclusionNegative associations were observed between frailty status and chronic constipation and diarrhea among older adults. Older adults who have a bowel movement frequency of about 10 times per week are the least frail. Future studies are warranted to confirm the causal relationship in this association.

Obstrucción intestinal por fecaloma gigante en adolescente con enfermedad de Hirschsprung

Hirschsprung’s disease (HD) is uncommon, and most of the cases occur in neonates. It is rarely diagnosed during adolescence, and even fewer cases are documented. We present the case of a 16-year-old male who had 15 days of constipation, anorexia, postprandial vomiting and abdominal distension. Imaging examinations showed a massive fecaloma obstructing the colon, and histopathological examinations showed HD. Given the failure of conservative evacuation measures, an extended left hemicolectomy and colostomy were performed, plus appendectomy for bowel obstruction. The patient was discharged with antibiotic therapy. This case highlights the importance of considering HD in adolescents with chronic constipation and abdominal masses. Although patients may experience postoperative problems, surgery is the most effective treatment for HD.

Histological changes in the colon wall in adult patients with chronic slow-transit constipation

The prevalence of chronic constipation in the population ranges from 3% to 27%. Women, senile people, and people of low socio‑economic status are in this risk group more often. Many histological studies of the intestinal wall were performed in order to find the causes of slow‑transit constipation [6, 4]. The different pathological changes, including myopathies, neuropathy, and pathology of the interstitial cells of Cajal, were established. The specific distribution of the types of histological changes in the colon wall in patients with slow‑transit constipation, as presented in the London classification, is currently unknown.&#x0D; Objective — to determine the specific distribution of the types of histological changes in the colon wall in patients with slow‑transit constipation unresponsive to conservative treatment.&#x0D; Materials and methods. A pathomorphological comparative case‑control study was performed. The main group included 105 patients who underwent colectomy as a treatment for chronic slow‑transit constipation in the period 2011—2023. The surgical intervention was indicated for patients with chronic slow‑transit constipation, resistance to conservative treatment, and a notable decline in quality of life. The comparison group included 27 deceased persons who did not experience constipation during their lifetime. The patient exclusion criteria were Hirschsprung’s disease, proctogenic constipation (dysfunction of the rectum and pelvic floor), medication‑associated constipation, as well as mental disorders. The histological and immunological examinations of samples were carried out in both groups, in the comparison group — appendix, ileum, cecum, colon and sigmoid colon.&#x0D; Results. Four main morphological phenotypes of the colon wall structure elements in patients with chronic slow‑transit constipation were identified according to the research data: 1) histologically intact type, 2) myopathic type, 3) Cajal type, 4) neuropathic. A combination of different types of histological changes was also registered, but one of them usually dominated.&#x0D; Conclusions. Four main types of histological changes in the intestinal wall were found in patients with chronic slow‑transit constipation resistant to conservative treatment: myopathic changes (56.2%), Cajal cell pathology (19%), neuropathic changes (19%), and a histologically intact variant (5.8%). The myopathic type is characterised by the heterogeneity of morphological manifestations, which can be referred to as dystrophic changes (dystrophic subtype 79.7%) and inflammatory changes (inflammatory subtype 20.3%), p=0.001.&#x0D;

Total alditols from Cistanche deserticola attenuate functional constipation by regulating bile acid metabolism

Headings ethnopharmacological relevanceFunctional constipation (FC), characterized by chronic constipation, significantly impacts physiological function and induces psychological stress in patients. However, current clinical treatment options for FC are currently limited. Cistanche deserticola, a traditional Chinese medicine that promotes intestinal moisture and bowel relaxation, contains cistanche total alditol extract (CTAE) as its primary active extract. However, the production of CTAE, its overall efficacy, and potential mechanisms for treating FC have yet to been investigated. Aim of the studyThis study aimed to reveal the overall efficacy and potential mechanism of action of CTAE in rats with FC using a combination of stable preparation, pharmacodynamics, non-targeted metabolomics, bile acid metabolomics, and western blotting. Materials and methodsFourteen batches of CTAE underwent quality testing. A rat model of FC was developed using diphenoxylate tablets. The comprehensive pharmacodynamic effects of CTAE on FC were evaluated using fecal characteristics (wet weight, dry weight, and water content), intestinal transmission (colonic EMG amplitude, colonic EMG frequency, propulsion length, and propulsion rate), serum and colon biochemical indicators, distribution of interstitial cells of Cajal (ICC), and pathological examination. Non-targeted metabolomics was performed to assess the changes in endogenous metabolite profiles induced by CTAE. Bile acid metabolomics and western blotting analyses were employed to validate the potential mechanisms of action of CTAE. ResultsCTAE, with a total content of betaine, mannitol, D-fructose, glucose, and sucrose of (75.67 ± 3.73) %, significantly enhanced intestinal transit, regulated neurotransmitters, increased the expression of c-kit in ICC, and alleviated intestinal inflammation in rats with FC. Non-targeted metabolomics revealed that CTAE significantly alleviated FC-induced metabolic disorders, mainly the biosynthesis of primary bile acids. Targeted metabolomic analysis confirmed that CTAE regulated FC-induced bile acid disorders. Western-blotting results confirmed that CTAE increased the expression of CYP8B1, FGF15, TGR5, and FXR, thereby modulating bile acid synthesis and enterohepatic circulation. ConclusionCTAE demonstrates significant therapeutic effects on FC, primarily through the regulation of bile acid synthesis and enterohepatic circulation. These findings provide a promising foundation for the development and clinical application of novel CATE-based drugs.

Genetic testing and prenatal diagnosis for a Chinese pedigree affected with Waardenburg syndrome type 4C due to heterozygous deletion of SOX10 gene

To explore the genetic basis for a Chinese pedigree featuring congenital profound syndromic deafness and chronic constipation, and provide prenatal diagnosis for a high-risk fetus. Whole-exome sequencing was carried out to analyze the sequences of genes associated with hereditary deafness, and multiplex ligation-dependent probe amplification (MLPA) was used to verify the candidate variant in the proband's parents and the fetus. The proband was found to have harbored a heterozygous deletion of SOX10, a pathogenic gene associated with Waardenburg syndrome type 4C (WS4C). The same deletion was found in her mother (with profound syndromic deafness and chronic constipation) and the fetus, but not in her father with normal hearing. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG) and Association for Molecular Pathology (AMP), the SOX10 gene deletion was predicted to be a pathogenic variant (PVS1+PM2_Supporting+PP1+PP4). The pedigree was diagnosed with WS4C, which has conformed to an autosomal dominant inheritance. Deletion of the entire SOX10 gene, as a loss-of-function variant, probably underlay its pathogenesis. Above finding has facilitated genetic counseling and prenatal diagnosis for this family.

Role of chronic constipation in development of cardiovascular pathology

Today, constipation is one of the most important medical and social problems of world health. Its prevalence, according to various estimates, exceeds 30%. There is no doubt that this pathology precedes the occurrence of a number of diseases and not only of the gastrointestinal tract. For example, studies conducted at La Trobe University in Australia have shown a link between chronic constipation and the development of cardiovascular diseases. In the management of a patient suffering from chronic constipation, in addition to knowledge about the regulation of intestinal secretion and motility, recognition and possible elimination of the cause of its development, the choice of therapy tactics, taking into account concomitant diseases, especially in the presence of pathology from the cardiovascular system, is of great importance. In the treatment regimens, it is customary to use drugs with a laxative effect and different mechanisms of their action, allowing achieving a rapid positive effect in a short time.

Nocebo effects and influencing factors in the randomized clinical trials of chronic constipation: A systematic review and meta-analysis.

Nocebo effects are unavoidable in randomized clinical trials. We aimed to assess the magnitude of nocebo effects and explore the influencing factors in chronic constipation. We searched the PubMed, Embase, and Cochrane Library databases up to July 2022. Randomized, placebo-controlled trials investigating interventions in chronic constipation were included. We conducted a random effects meta-analysis of the proportion of adverse events (AEs) in placebo-treated participants and evaluated the effect of trial characteristics on nocebo effects. We identified 20,204 studies from the databases, of which 61 were included in the final analysis. The pooled placebo AE rate was 30.41%, and AE-related withdrawal rate was 1.53%. The most commonly reported AEs were headache (5.67%), diarrhea (4.45%), abdominal pain (3.98%), nasopharyngitis (3.39%), nausea (3.36%), and flatulence (2.95%). The placebo AE rate was lower in trials conducted in Asia compared to those in Europe, North America, and international trials. It was also lower in trials diagnosed by Rome III compared to clinician's opinion and Rome II. Additionally, the placebo AE rate was lower in single-center trials compared to multicenter trials, lower in 5-8 weeks therapy compared to 9-12 weeks therapy, lower in participants with FC compared to those with IBS-C and CC, lower in trials with 2 arms compared to 3 arms, and higher in trials with prokinetic drugs compared to secretagogues and laxatives. The placebo AE rate was 30.41% in patients with chronic constipation. Based on our findings, we recommend that researchers take the nocebo effects into consideration when designing and conducting clinical trials and adopt specific measures to mitigate the negative influence of nocebo effects.

Using machine learning methods to analyze the association between urinary polycyclic aromatic hydrocarbons and chronic bowel disorders in American adults

The etiology of chronic bowel disorders is multifaceted, with environmental exposure to harmful substances potentially playing a significant role in their pathogenesis. However, research on the correlation between polycyclic aromatic hydrocarbons (PAHs) and chronic bowel disorders remains limited. Using data from the National Health and Nutrition Examination Survey (NHANES) conducted in 2009–2010, we investigated the relationship between 9 PAHs and chronic diarrhea and constipation in U.S. adults. We employed unsupervised methods such as clustering and Principal Component Analysis (PCA) to identify participants with similar exposure patterns. Additionally, we used supervised learning techniques, namely weighted quantile sum (WQS) and Bayesian kernel machine (BKMR) regressions, to assess the association between PAHs and the occurrence of chronic diarrhea and chronic constipation. PCA identified three principal components in the unsupervised analysis, explaining 86.5% of the total PAH variability. The first component displayed a mild association with chronic diarrhea, but no correlation with chronic constipation. Participants were divided into three clusters via K-means clustering, based on PAH concentrations. Clusters with higher PAH exposure demonstrated an increased odds ratio for chronic diarrhea, but no meaningful connection with chronic constipation. In the supervised analysis, the WQS regression underscored a positive relationship between the PAH mixture and chronic diarrhea, with three PAHs significantly impacting the mixture effect. The mixture index showed no correlation with chronic constipation. BKMR analysis illustrated a positive trend in the impact of four specific PAHs on chronic diarrhea, given other metabolites were fixed at their 50th percentiles. Our results suggest a clear association between higher PAH exposure and an increased risk of chronic diarrhea, but not chronic constipation. It also underscores the potential role of specific PAHs in contributing to the risk of chronic diarrhea.

Irritable bowel syndrome: modern ideas about pathology and the possibility of its correction

Among the defecating disorders with constipation or diarrhea, there is a group of major intestinal disorders defined by the Rome IV Diagnostic Criteria (2016): irritable bowel syndrome, functional constipation, functional diarrhea. The presence of several updates of the Rome criteria is due to the current lack of objective signs of the listed disorders while many options for describing subjective sensation by patients from different countries. It calls for their terminological multilingual standardization. Both constipation and diarrhea can be caused by a variety of exogenous and endogenous factors and have different pathogenetic mechanisms, but they cannot be identified properly using modern clinical and laboratory methods for functional intestinal disorders. However, the high prevalence of these syndromes, characterized by the presence of complaints that reduce patients’ quality of life, necessitates their correction. The drug choice for defecation disorders and abdominal pain is often limited by contradictions from international clinical guidelines and national regulations.Therefore, the Recommendations of the Russian Gastroenterological Association for the treatment of functional intestinal diseases contain many instructions on general therapeutic and dietary measures. The pain syndrome treatment is based on the spasmolytics. Among the laxatives that have long been used in the treatment of chronic constipation, sodium picosulfate has long been successfully used. This drug has high efficacy and safety profiles; the instructions for its medical use allow to prescribe it in patients suffered from irritable bowel syndrome with constipation. The use of sodium picosulfate for IBS is regulated by many clinical recommendations. However, this drug may be ineffective against abdominal pain. It is incorrect to assign the mission of pain relief to a laxative because of multifactorial pathogenesis of IBS pain with constipation or diarrhea and uncertainty of methods for its pharmacological control.

Elobixibat improves rectal sensation in patients with chronic constipation aged ≥60 years: a randomised placebo-controlled study

ObjectiveHigh rectal sensory thresholds (RSTs) are associated with chronic constipation (CC), especially in older patients. Bile acids (BAs) affect the RSTs of healthy individuals. Here, we aimed to investigate the...

Drug-Induced Fanconi Syndrome Presenting as Chronic Constipation: A Well-Known but Forgotten Entity

Drug-Induced Fanconi Syndrome Presenting as Chronic Constipation: A Well-Known but Forgotten Entity

Systematic review and meta-analysis: Foods, drinks and diets and their effect on chronic constipation in adults.

Dietary approaches are recommended for the management of chronic constipation. Until now, there has been no systematic review and meta-analysis on foods, drinks and diets in constipation. To investigate the effect of foods, drinks and diets on response to treatment, stool output, gut transit time, symptoms, quality of life, adverse events and compliance in adults with chronic constipation via a systematic review and meta-analysis. Studies were identified using electronic databases (12th July 2023). Intervention trials (randomised controlled trials [RCTs], non-randomised, uncontrolled) were included. Risk of bias was assessed using Cochrane 2.0 (RCTs) or JBI Critical Appraisal (uncontrolled trials). Data from RCTs only were synthesised using risk ratios (RRs), mean differences (MDs), standardised mean differences (95% CI) using random-effects. We included 23 studies (17 RCTs, 6 uncontrolled; 1714 participants): kiwifruit (n = 7), high-mineral water (n = 4), prunes (n = 2), rye bread (n = 2), mango, fig, cereal, oat bran, yoghurt, water supplementation, prune juice, high-fibre diet, no-fibre diet (n = 1). Fruits resulted in higher stool frequency than psyllium (MD: +0.36 bowel movements [BM]/week, [0.25-0.48], n = 232), kiwifruits in particular (MD: +0.36 BM/week, [0.24-0.48], n = 192); there was no difference for prunes compared with psyllium. Rye bread resulted in higher stool frequency than white bread (MD: +0.43 BM/week, [0.03-0.83], n = 48). High-mineral water resulted in higher response to treatment than low-mineral water (RR: 1.47, [1.20-1.81], n = 539). Fruits and rye bread may improve certain constipation-related outcomes. There is a scarcity of evidence on foods, drinks and diets in constipation and further RCTs are needed.

Morphological features of basal laminas of enteral nervous system structures in chronic slow transit constipation

BACKGROUND: Studies on basal laminas in the tissues of the enteric nervous system are few and are carried out on experimental models in vivo and in vitro, performed on animals. The morphological features of the structure and localization of BL, their cellular sources of origin in various tissues of the gastrointestinal tract in normal and pathological conditions remain poorly studied.&#x0D; AIM: Study of morphological features and distribution of basal laminas in human colon tissues and their changes in pathology.&#x0D; MATERIALS AND METHODS: Fragments of the large intestine, obtained as a result of surgery for chronic slow-transit constipation, performed in S. M. Kirov Military Medical Academy were studied. The selective marker of basal laminas, type IV collagen, as well as neuronal and glial immunohistochemical markers (PGP 9.5, GFAP, S100 proteins) were used in the work&#x0D; RESULTS: It has been shown that the greatest immunoreactivity within the intestinal wall is observed in the myenteric membrane, weak in the vessels of the submucosa, locally expressed in the subepithelial region of the mucous membrane (in the upper sections of the crypts). In smooth muscle, basal laminas were found around the smooth muscle cells of the longitudinal and concentric layers of the muscular membrane, mucous membrane, veins and arteries, as well as in the endothelium. It has been shown that the ganglionic Auerbachs plexus is delimited from closely adjacent muscle layers of a continuous basal lamina, similar to the basal plate (glia limitans) of the brain and spinal cord of the CNS. It is clearly defined by its appearance it has the form of a continuous hollow tubular structure. The sources of the formation of the basal plate around the ganglia of Auerbach and Meissners plexuses are various glial elements: in the first plexus, astrocyte-like and non-myelinated Schwann cells (both types located in the neuropil), and in the second plexus, glia of the autonomic nervous system (satellite cells of neurons and neurolemmocytes of postganglionic nerve fibers).&#x0D; CONCLUSIONS: For the first time, the transition of basal lamina from the Auerbachs plexus to numerous basal plates of neurolemmocytes of the Remakov fibers of the main terminal nerve plexus, which are involved in the innervation of the smooth muscle cells of the muscular membrane, is shown. Signs of dystrophic changes in the basal lamina structure associated with pathological changes in chronic slow transit constipation (tissue edema, inflammatory reactions, manifestations of agangliosis, gliosis, focal denervation of muscle cells, degeneration of nerve endings of neuromuscular and ganglionic plexuses) are shown in the work.

Constipation syndrome and its treatment

The relevance of the problem of HC is also related to the issues of etiology, pathogenesis, diagnosis, conservative and surgical treatment. To date, none of the many proposed methods of conservative and surgical treatment has one hundred percent effectiveness. According to literature data, there are no official epidemiological data at the federal level on the prevalence of chronic constipation in Russia. On the territory of the Russian Federation, the diagnosis is made according to the leading clinical disease, syndrome and/or symptom corresponding to ICD 10 – K59.0 – constipation. Modern scientific evidence suggests that the detection of metabolic disorders, chronic constipation, and microbiota disorders in a patient should be regarded as clinical and pathogenetic links of a single pathological process.

Effectiveness of a high fiber diet in improving constipation in patients with defecatory dyssynergy under treatment with anorrectal biofeedback. Exploratory, randomized clinical trial

Introductionfiber is the initial treatment in chronic functional constipation. However, its role in the group of patients with defecatory dyssynergy is not well established. The objective of the study is to evaluate the efficacy and safety of a high fiber diet in patients with defecatory dyssynergy in the treatment with anorectal biofeedback. Patients and methodsAn exploratory, randomized (1:1), double-blind, controlled "add-on" clinical trial was carried out in a reference center in Spain in patients with functional constipation and defecatory dyssynergy according to the ROME IV criteria. Control group: treatment with biofeedback and low-fiber diet (15−20 g/day). Experimental group: treatment with biofeedback and high fiber diet (25−30 g/day). Analyzed: responder (primary endpoint), patient whose defecatory dyssynergy had been corrected (>20% reduction in anal pressure during the defecation maneuver and normal balloon expulsion test); anorectal parameters (anal relaxation, reduced straining); safety (abdominal symptoms: flatulence, pain, borborygmus, bloating). ResultsA total of 44 patients were randomized: 22 per group. The percentage of responders was 75% (15/20, 95% CI: 53 89%) control group and 70% (14/20, 95% CI: 48–85%) experimental group, p value: 0.225. Differences in favor of the control group were only observed in abdominal symptoms: flatulence (p-value: 0.028), abdominal distension (p-value: 0.041) and digestive comfort (p value: 0.043). ConclusionsIn patients with defecatory dyssynergy, a high-fiber diet not only does not improve the efficacy of anorectal biofeedback but is associated with a loss of improvement in abdominal symptoms.

Association of environmental tobacco smoke exposure with chronic constipation: a nationwide survey (NHANES 2005-2010).

Environmental tobacco smoke (ETS) exposure has been proven to induce digestive diseases such as hepatic steatosis, cirrhosis, and gastrointestinal cancer, yet little is known about the link between ETS exposure and constipation. This study aimed to investigate the impact of ETS exposure on the risk of chronic constipation in adults aged 20years or older. This is a cross-sectional study based on population. A total number of 7705 participants from the National Health and Nutrition Examination Survey (NHANES) 2005-2010 were included. Cotinine, an alkaloid found in tobacco, serves as a reliable and precise biomarker for measuring exposure to ETS. Hence, the categorization of exposure to ETS was conducted based on serum cotinine levels, resulting in four distinct categories. The association between ETS exposure and the risk of constipation was assessed using multivariable restricted cubic spline and logistic regression with odds ratio (OR) and 95% confidence interval (CI). The weighted prevalence of constipation in this study was estimated to be 7.51% based on stool consistency, or 3.11% based on stool frequency. The fully adjusted models indicated a positive correlation between exposure to ETS and constipation as measured by stool frequency, among adults with poor dietary quality (OR (95% CI): moderate exposure: 2.49 (1.05, 5.94); high exposure: 2.36(1.13, 4.95), P for trend = 0.03), while no significant difference was observed in the subgroup with a higher healthy eating index. Furthermore, the log10-transformed serum cotinine level exhibited a non-linear inverted U-shaped association with constipation in individuals with poor dietary quality (P overall = 0.0207, P non-linear = 0.0427). Conversely, a J-shaped non-linear relationship was observed in the subgroup with a higher healthy eating index (P overall = 0.0028, P non-linear = 0.0036). Our results show that ETS exposure appears to be positively associated with stool frequency-related chronic constipation in adults with poor dietary quality.

Transanal irrigation to treat chronic constipation in patients with spinal cord injury: a case study.

This case study explores the benefits of transanal irrigation as a treatment for a patient with a spinal cord injury who was experiencing chronic constipation. In this case, the patient was having episodes of autonomic dysreflexia as a result of the constipation. This condition is unique to patients with spinal cord injury and presents a stroke risk. The article outlines the contraindications and cautions that need to be considered in assessing a patient's suitability for transanal irrigation, and the elements that form part of a holistic assessment by a specialist nurse.