Chronic Functional Constipation Research Articles

Evaluating pelvic floor muscle activity in chronic functional constipation: A transabdominal ultrasound study

IntroductionChronic functional constipation (CFC) is one of the most challenging types of constipation which negatively influences patients’ quality of life. Recently, investigators mentioned pelvic floor muscles (PFMs) as an influential factor in the symptoms of patients with CFC, while its underlying mechanism is still unclear. The aim of this study is to investigate the PFMs function in people with and without CFC using transabdominal ultrasound. MethodIn this cross-sectional and prospective study, we utilized a convenience sample of 200 individuals (100 CFC and 100 non-CFC) aged between 20 and 50 years old. The data collection included the measurement of the bladder base diameters displacement between rest and contraction using transabdominal ultrasound in all subjects. Also, individuals’ diet and physical activity were assessed as contributing factors using International Physical Activity Questionnaire and Food Frequency Questionnaire. ResultsThe result of MANCOVA revealed no significant group by physical activity level interaction for bladder base diameter at rest and bladder base displacement. Moreover, the Kruskal-Wallis test showed significant difference in physical activity level of patients with CFC in comparison with healthy individuals. Independent T-test results revealed that there is a significant difference in the consumption of fat and dairy subgroups between two groups. Discussion and conclusionsThe results indicated that there is no significant association between the bladder base displacement and the development of CFC. Moreover, our data revealed that people with CFC experience a more sedentary life and consume more fat and dairy products in comparison with individuals without CFC.

Assessment of Behavioral Disorders in Iranian Children with Functional Constipation

Background: Functional constipation (FC) is a common issue in pediatric healthcare, causing significant physical and emotional distress for patients and their families. Objectives: This study aimed to investigate the prevalence of behavioral issues in children diagnosed with functional constipation, exploring their characteristics and relationship with various factors. Methods: We conducted a case-control study involving 107 children and adolescents (aged 2 to 18 years) with chronic functional constipation as the case group and 107 children without this condition as the control group. The Strengths and Difficulties Questionnaire (SDQ) was employed to evaluate different aspects of behavioral patterns. Results: The comparison of various behavioral components assessed by the SDQ between the case and control groups revealed significantly higher average scores for emotional symptoms (0.85 ± 0.81 vs. 0.55 ± 1.03, P = 0.019), peer relationship problems (1.76 ± 2.23 vs. 0.76 ± 1.18, P = 0.001), and prosocial behavior (8.12 ± 1.87 vs. 7.42 ± 1.64, P = 0.002) in children with chronic functional constipation. Within the chronic constipation group, peer relationship issues were more common in boys, whereas girls exhibited more problems with prosocial behavior. Moreover, issues related to hyperactivity/inattention and prosocial behavior were more frequent in older children with chronic constipation. Conclusions: Chronic functional constipation in children is strongly associated with behavioral changes and problems, which are influenced by the demographic and anthropometric features of the patients.

Placebo response to sham electroacupuncture in patients with chronic functional constipation: A secondary analysis.

Chronic severe functional constipation is a common disease that requires novel and effective treatment strategies. Acupuncture might constitute a promising therapeutic approach for chronic constipation, but it reportedly engenders an enhanced placebo response. Herein, we aimed to determine the magnitude of the placebo responses to electroacupuncture for constipation and identify its influencing factors. In this secondary analysis of a multicenter randomized trial, patients were randomized to a sham electroacupuncture group, which was administered for 8 weeks in 24 sessions of superficial needling at nonacupoints. The placebo response rates were assessed using three responder criteria: ≥3 complete spontaneous bowel movements per week (CSBMs/week), overall CSBM, and sustained CSBM. Logistic regression with backward selection method was employed to identify the potential factors that affected the placebo response. Overall, 539 patients were included in the study. The placebo response rate was 10.58%, 9.46%, and 9.09% according to the three aforementioned criteria, respectively. Those who exhibited more CSBMs/week at baseline were more likely to respond to sham electroacupuncture. Among patients with more than one CSBM per week at baseline, the response rates for achieving the criteria of ≥3 CSBMs per week, overall CSBM, and sustained CSBM were 25.40%, 30.16%, and 22.22%. Electroacupuncture did not demonstrate a large placebo response in functional constipation treatment. The number of CSBMs at baseline may be a moderator of the placebo response to sham electroacupuncture. Thus, superficial needling sham acupuncture may be considered an ideal sham control for clinical trials of chronic constipation.

Psychiatric Features of Children with Chronic Functional Constipation: Focusing on Individuals with Autism Spectrum Disorder.

The present study aimed to assess the psychiatric characteristics of children with chronic functional constipation using the Aberrant Behavior Checklist-Japanese version and the Pervasive Developmental Disorders/Autism Society Japan Rating Scale, and to examine the frequency of autism spectrum disorder in children with chronic functional constipation. We also investigated differences in treatment duration between children with and without autism spectrum disorder. Treatment outcomes were examined retrospectively for 55 participants (chronic functional constipation group: n = 30, mean age 3.4 years; control group: n = 25, mean age, 4.5 years). The association between chronic functional constipation and autism spectrum disorder was evaluated using multivariable logistic regression analysis. The mean Aberrant Behavior Checklist score and frequency of individuals with autism spectrum disorder were significantly higher in the chronic functional constipation group. After adjusting for age and sex, chronic functional constipation was significantly associated with autism spectrum disorder. In the chronic functional constipation group, the frequency of onset was significantly higher in children with autism spectrum disorder under 1 year of age. When treated, the mean duration of constipation was significantly longer in children with autism spectrum disorder. Pediatricians, pediatric surgeons, and child psychiatrists should work closely to ensure appropriate treatment of chronic functional constipation in children with autism spectrum disorder.

The Effectiveness of Osteopathic Treatment in Bowel Constipation Patients: A Clinical Perspective

Introduction: Functional chronic bowel constipation is a motility disorder of great relevance and prevalence worldwide. Objective: Analyze the efficiency of visceral manipulation technique in individuals with bowel constipation diagnose according to Roma III criteria. Methods: This is a crossover clinical study that included individuals of both genders aged between 20 and 40 years who had had bowel constipation symptoms for over one year. Individuals were randomized into two groups: the intervention (IG) and control (CG) groups. A four weeks washout period was given. Each volunteer underwent 24 individual osteopathic sessions, twice a week that lasted up to 30 minutes. Three intervention techniques were performed: two for the large intestine and one for the small intestine. Results: Thirty four patients were recruited but nine were excluded. Our sample consisted in 25 participants, 13 were allocated in the IG and 12 in the CG. No significant difference was found between groups for anthropometric, educational, marital status, proportion of smokers and alcoholics, and VAS for lumbar spine pain measures. Lumbar spine flexibility, was significant increased for the IG (p<0.0001). A higher proportion of patients in the IG presented reduced hard stools, effort to evacuate, incomplete evacuation feeling, anorectal obstruction sensation and manual maneuvers to facilitate evacuation after treatment (p<0.0001). A significant correlation was found between pain (VAS) and the Schober test (r=-0.41). Conclusion: This study was successful in showing that there seems to be a positive effect of the osteopathic treatment for chronic bowel constipation at short and long terms.

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.

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.

Лактулоза: преимущества и место препарата в клинических рекомендациях

Lactulose is a disaccharide derived from lactose milk sugar using β-galactosidase or epimerase and consisting of fructose and galactose. The first mention of lactulose dates back to 1929, but clinical interest in this drug appeared much later. In 1957, Petuely discovered that the use of lactulose increased the number of fecal bacteria of the genus Bifidobacterium in infants. The features of the drug are described, the mechanism of action of which allows reproducing both laxative and prebiotic effects. The restoration of intestinal microbiocenosis is associated with the improvement in the course of diseases (constipation, hepatic encephalopathy) and the quality of patients’ life. Due to the possibility of use in different age periods, especially in sensitive categories, children, pregnant and elderly patients, as well as the duration and safety of its use, lactulose has advantages in comparison with other drugs. Considered the principles of lactulose use in patients with chronic functional constipation and liver diseases reflected in clinical recommendations

Multidisciplinary co-development of a chronic constipation management education programme for older people with dementia and the establishment of a model facility

Chronic constipation (CC) is prevalent among the elderly population and particularly those with dementia. Associate Professor Tomoyoshi Naito, School of Nursing, Seirei Christopher University, Japan, is exploring supportive care of elderly patients with dementia. He is working with collaborators to develop a multidisciplinary CC management education programme for healthcare professionals involved with elderly patients suffering from dementia. The researchers will also build a model facility to implement and verify the impact of the programme. Part of this research concerns gaining a more in-depth understanding of management and care techniques, based on the Japanese Chronic Constipation Treatment Guidelines from 2017, especially in relation to the diet and differentiation of chronic functional constipation. The goal is to reduce the number of painful medical procedures by enhancing therapy, exercise therapy, lifestyle guidance and making it possible to select step-by-step drug therapy. The programme will be executed at two facilities in Japan, targeting specialist caregivers who work with elderly patients with dementia, including doctors, nurses, pharmacists and other healthcare professionals. They will receive basic education on chronic constipation in elderly people with dementia, as well as practical training on the management of CC in addition to self-training and evaluations based on case studies. In a randomised controlled trial, Naito sought to verify the impact of bowel training as a treatment for CC and found that, together with the training, encouraging patients to use appropriate defecation posture significantly improved the condition. This was associated with a corresponding improvement in the mental health and wellbeing of patients and caregivers.

Screening of iron deficiency anemia in children with chronic functional constipation

Background Iron deficiency anemia (IDA) is one of the most common nutritional deficiencies worldwide. Constipation is one of the most common gastrointestinal disorders in childhood. Aim To screen for IDA or iron deficiency (ID) among children with chronic functional constipation (CFC). Patients and methods It was a prospective study. Two groups of children in the age range of 1–15 years were collected for 6 months from June 2022 to December 2022 at Alexandria University gastroenterology clinic. Children who fulfilled Rome IV criteria of CFC were assigned to CFC group. Children who did not have constipation were considered as the control group. Complete blood count, serum iron, total iron binding capacity, and serum ferritin were done for both groups. Data were fed to the computer and analyzed using IBM SPSS software package version 20.0. Quantitative data were described using range (minimum and maximum), mean, standard deviation, and median. Results Hemoglobin levels, serum ferritin and serum iron were significantly lower in the CFC group when matched with the control group. ID and IDA were significantly higher in the CFC group. The longer days of constipation were correlated with significantly lower hemoglobin, serum iron, and serum ferritin. Conclusion CFC causes mild IDA or ID. The longer the days of CF, the lower values of hemoglobin, iron and ferritin are present. ID and IDA are more common in the CFC group.

Intestinal flora in the constipation patients before versus after lactulose intervention.

This study aimed to investigate the characteristics of intestinal flora in patients with chronic functional constipation before and after lactulose intervention. Twenty-nine patients with constipation in the treatment group received oral lactulose (15 mL/d) for a month. Twenty healthy subjects served as controls. Stool specimens were collected before and after lactulose treatment. Fecal bacteria were examined by 16SrRNA gene sequencing and bioinformatics analysis. After lactulose treatment, most bacteria in the constipation group, including Bifidobacteria, Bacillus cereus, Prevotella, Bacillus, Anaerostipes, Oribacterium, and Mogibacterium increased as compared to those in the healthy control group. Anaerotruncus declined in the healthy control group after lactulose treatment. Our study shows lactulose can increase the abundance of probiotics, optimize the intestinal microenvironment, and alleviate constipation.

The effectiveness of preventive use of partially hydrolyzed dietary fibers of cyamopsis tetrahedral (OptiFibre®) in patients with benign prostatic hyperplasia and chronic functional constipation

Anatomical proximity of the prostate gland and colon, common innervation, blood and lymph circulation create prerequisites for the involvement of the intestine in the pathological process in prostate diseases.&#x0D; Aim To evaluate the effectiveness of preventive treatment of chronic constipation (CC) with the use of partially hydrolyzed dietary fibers of cyamopsis tetrahedral (OptiFiber®) in patients with benign prostatic hyperplasia (BPH) who are shown to have a prostate tour and its effect on the course of the postoperative period.&#x0D; Materials and methods. We examined 60 patients with BPH who were referred for surgical treatment (transurethral resection of the prostate), who had chronic functional constipation. By random sampling, the patients were divided into two groups of 30 people. In group 1, standard preparation for surgical treatment was carried out for 1 month. In group 2, patients, in combination with standard preparation for surgical treatment, took partially hydrolyzed dietary fibers of cyamopsis tetrahedral (OptiFiber®) with food for the first 3 days – 1 sachet (5 g) per day, from the 4th to the 6th day – 2 sachets per day. From day 7, patients in group 2 were divided into two subgroups. In subgroup 2a, patients whose bowel function returned to normal continued taking the drug at a dose of 2 sachets per day. Those patients in whom the effect of restoring the regularity of bowel function was not satisfactory, took 3 sachets a day from the 7th day and were assigned to subgroup 2b. In the preoperative period, patients were examined on the 1st day (visit 1), 15th day (visit 2) and 30th day (visit 3) of observation. The average number of acts of defecation during the previous week, the severity and dynamics of clinical manifestations of constipation were evaluated on the basis of the Patient Assessment of Constipation Symptoms (PAC-SYM questionnaire), according to the totality of symptoms in points, as well as for each criterion separately. Evaluation of the effectiveness of treatment in the postoperative period was carried out on the basis of dynamic observation for 5–7 days.&#x0D; Results. Initially, all patients in the two groups had signs characteristic of BPH and chronic functional constipation, the groups were homogeneous. According to the results obtained in group 1 for 30 days of follow-up before surgery, none of the studied parameters significantly changed (p0.05). In group 2, after 15 days of follow-up, a significant (p0.05) positive dynamics was revealed for all the studied indicators, both in comparison with group 1 and in comparison with the results obtained at visit 1. By visit 3, despite the absence of statistically significant dynamics in the indicators of both group 1 and group 2, in comparison with visit 2, significant (p0.05) differences remained between the groups. During the study, subgroup 2a included 19 patients who took 2 sachets of OptiFiber® per day, and subgroup 2b included 11 men who took 3 sachets per day from the 7th day of observation. Restoration of intestinal motility in patients taking dietary fiber occurred at an earlier time, while the differences were also statistically significant (p0.05). In group 1, 14 cases of early postoperative complications were registered, and in group 2–9 cases, which is 35.7% less. The number of cases of antibiotic-associated diarrhea in group 1 was 3, while in group 2 there was 1 such case, which is 66.7% less. When analyzing the results obtained, there were no significant differences in the studied parameters in the postoperative period between subgroups 2a and 2b. All 30 (100%) patients of group 2 gave a positive review of partially hydrolyzed dietary fibers of cyamopsis tetrahedral (OptiFiber®), and plan to continue taking them after completing participation in the study.&#x0D; Conclusion. Thus, according to the results of the study, we consider it appropriate to use partially hydrolyzed dietary fibers of cyamopsis tetrahedral (OptiFiber®) in the treatment of CC in patients with BPH who are shown to have a prostate tour as a means to effectively eliminate the manifestations of CC, improve the results of surgical treatment and improve the quality of life of this category of patients.

Acupuncture for chronic constipation

Objectives This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of acupuncture therapy for functional chronic constipation.

Хронический функциональный запор у пациентов молодого и среднего возраста: деликатная проблема – деликатное решение

Хронический функциональный запор у пациентов молодого и среднего возраста: деликатная проблема – деликатное решение

The Prevalence of Sleep Disorders Among Children with Chronic Functional Constipation, a Study in Arak, Iran

Background: Functional constipation (FC) is a common problem in childhood worldwide. This disorder can lead to various physical and behavioral problems and ultimately reduce the quality of life. Sleep disorders are also among the complaints of patients with FC. Objectives: In this study, we aimed to investigate the prevalence of sleep disorders in children with chronic FC. Methods: This cross-sectional study was conducted on 140 children aged 5 to 12 with chronic FC referred to the specialized pediatrics clinic of Amirkabir Hospital of Arak, Iran. The functional constipation was diagnosed based on Rome ΙV criteria. Children and their parents were requested to complete the Children’s Sleep Habits Questionnaire (CSHQ). Data analysis was performed in SPSS version 22 using the chi-square and Mann-Whitney tests to find significant associations at the significance level of 5%. Results: The mean (SD) age of the participants was 7.36 ± 1.6, and most participants were boys (65.7%). The prevalence of sleep disorders in children with chronic FC was 62.9% (95% CI: 54.5 - 70.2). Sleep resistance and sleep apnea were the most common minor sleep disorders. The prevalence of sleep disorders was significantly higher in girls (81.3%) than in boys (53.3%) with chronic FC (P = 0.001). There was no significant difference in the prevalence of sleep disorders in children with chronic FC aged 5 to 8 and 9 to 12. Conclusions: In the present study, the results showed that the prevalence of sleep disorders in children with chronic FC was significant, and it was higher compared to other studies conducted on healthy children, and also it was found that girls had a significantly higher rate of sleep disorders than boys.

Laser acupuncture improving functional chronic constipation in children: a randomized controlled trial

Functional chronic constipation (FCC) is a disorder caused by low fiber consumption, lack of fluid intake, lack of mobility, or side effects of medications. The objective of this study was to compare the effects of laser acupuncture and the commonly used osmotic laxative, lactulose (as the control), both combined with behavioral therapy and dietary modification, on children with FCC in a randomized controlled trial (RCT). Forty children were randomly chosen, aged 5–15 years with FCC, and randomized into two equal groups (gender ratio (50% male; 50% female), mean ± SD weight (24.2 ± 6.27 kg and 25.7 ± 7.47 kg for groups A and B, respectively)). Study group (group A): used laser acupuncture (650 nm), 30 mW, 0.15 cm2 spot size, 90 s per acupuncture point (ST25, ST36, ST37, BL25, and LI11). Control group (group B): lactulose syrup (1 to 3 mL/kg/day) orally, in divided doses 3 times weekly for 4 weeks, and behavioral training for both groups. Evaluations were conducted before and after the study to assess the efficacy of the therapy. Median value frequency significantly increased in groups A and B post-treatment (4 (6.75–3) and 3 (3.75–2), respectively) compared to pre-treatment (2 (2–1) and 2 (2–0.25), respectively) (p = 0.0001), in favor of group A (p = 0.01). Significant improvement of stool consistency according to Bristol stool scale (BSS) in groups A and B (p = 0.0001), (p = 0.002) respectively in favor of group A (p = 0.03). T-test, Fisher, and Wilcoxon signed rank tests were conducted to compare groups. Non-invasive, painless laser acupuncture therapy can be considered as an alternative therapy for patients with FCC.

Eficacia de la dieta alta en fibra en la mejora del estreñimiento en pacientes con disinergia defecatoria en tratamiento con biofeedback anorrectal. Ensayo clínico exploratorio, aleatorizado

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 ROMEIV criteria. Control group: treatment with biofeedback and low-fiber diet (15-20g/day). Experimental group: treatment with biofeedback and high fiber diet (25-30g/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=.225. Differences in favor of the control group were only observed in abdominal symptoms: flatulence (P=.028), abdominal distension (P=.041) and digestive comfort (P=.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.

The Prevalence of Social Anxiety in Children with Chronic Functional Constipation

Background: Functional constipation (FC) is a common disease in children. This disease can cause many behavioral and mental problems and ultimately reduce the quality of life. Reciprocally, psychological factors can play a role in the development and persistence of FC. Objectives: In this study, we aimed to determine the prevalence of social anxiety in children with chronic FC in Arak city, Iran. Methods: In this cross-sectional study, 200 children between 10 - 17 years with chronic FC referred to Amirkabir Hospital in Arak, Iran, which is a specialized center, were enrolled. This study was done in 2022, and the participants' disease was diagnosed based on Rome ΙV criteria. The Social Anxiety Scale for Adolescents (SASA) was completed by children under the guidance and supervision of their parents. Statistical analyses were performed in SPSS 22 using the Chi-square test and independent sample T-test. Results: The participants’ mean age (SD) was 13.43 ± 1.54 years. The prevalence of social anxiety was estimated at 67.5% (95%CI: 60.6 - 73.4), of whom 70% had moderate anxiety, and 30% had severe anxiety. There was no significant difference in the prevalence of social anxiety between the age groups (P = 0.167). The prevalence of social anxiety was significantly higher in girls (74.8%) than in boys (59.8%) (P = 0.034). Also, girls showed a significantly higher prevalence of severe social anxiety than boys (P = 0.023). Conclusions: In this study, the prevalence of social anxiety was found to be considerably high in children with chronic FC. There was no significant difference between different age groups in terms of the prevalence of social anxiety; however, the prevalence and severity of this disease were significantly higher in girls than in boys.

Effectiveness of management program of chronic functional constipation in children who are attending the Pediatric Gastroenterology Clinic at Elbeheira Specialized Children's Hospital

Effectiveness of management program of chronic functional constipation in children who are attending the Pediatric Gastroenterology Clinic at Elbeheira Specialized Children's Hospital

Clinical Observation and Nursing Guidance of Chronic Functional Constipation in the Elderly

Clinical Observation and Nursing Guidance of Chronic Functional Constipation in the Elderly