Management Of Constipation Research Articles

Comparison of Effectiveness, Tolerability, and Compliance of Pharmacotherapies in Patients with Functional Constipation: A Real-World Evidence Study

Background: duphalac® bulk, a combination of bulking agents and an osmotic laxative might prove beneficial in the management of functional constipation (FC) as compared to the existing therapies. Objective: To evaluate and compare the effectiveness, safety, and compliance of duphalac® bulk with other available therapeutic options for the management of constipation. Methods: In this retrospective study, electronic medical records (EMRs) of adult patients suffering from FC who were prescribed various dietary fibers or their combinations between May 2021 to September 2021 and visiting healthcare setups/clinics were reviewed. The patients were divided into four groups (2:1:1:1): Group I-duphalac® bulk; Group II-isabgol alone; Group III-lactitol and isabgol combination; and Group IV-Polyethylene glycol (PEG) and isabgol combination. Effectiveness was determined using the constipation scoring system (CSS). Adverse events and compliance were assessed. Additionally, lipid and glycemic parameters were analyzed. Results: Out of 110 patients screened, 96 met the inclusion criteria and participated in the study. Majority of the patients (42.7%) received duphalac® bulk, followed by lactitol and isabgol combination (19.7%), PEG and isabgol combination (18.7%), and isabgol (18.7%). A significant reduction in overall mean CSS was observed among all the groups; however, the maximum decrease (3.49, p<0.001) was found in Group I as compared to Groups II (3.28, p<0.001), III (2.58, p=0.001), and IV (2.50, p=0.002). All treatments were well tolerated. Improvements in glycemic and lipid parameters were observed in all groups. Conclusion: duphalac® bulk was well tolerated with significant symptomatic improvement in patients suffering from FC. Keywords: Constipation scoring system, Duphalac® bulk, Functional constipation, Glycemic control, Lipid profile

Oral Lactulose – A Safe and Effective Strategy for the Management of Constipation in Individuals with Impaired Glucose Tolerance and Diabetes

Lactulose, either as crystals or liquid syrup, is a frequently prescribed osmotic laxative agent in patients with diabetes mellitus (DM). During the manufacturing process, carbohydrate impurities can arise which could increase blood glucose levels with a possible impact on glycemic control. This important issue has now been addressed for the first time in individuals with type 2 DM. A recent RCT confirmed that there is no need to consider carbohydrate impurities in oral lactulose products administered at the recommended doses of 20 g/day and 30 g/day for blood glucose management.

Clinical Factors Affecting Constipation in Patients with Schizophrenia Taking Clozapine

Objectives: To investigate clinical factors affecting constipation in patients with schizophrenia taking clozapine.Methods: The participants were patients with schizophrenia taking clozapine and tested for the Therapeutic Drug Monitoring from September 1, 2020 to July 1, 2022 at a university hospital. To evaluate the effect of clozapine on constipation, clozapine dosage, clozapine concentration, and norclozapine concentration were investigated. To evaluate effects of drugs other than clozapine on constipation, dosage and type of other drug were investigated. Anticholinergic Drug Scale was used to evaluate anticholinergic action.Results: A total of 56 patients were enrolled in the study. Clozapine daily dose, clozapine concentration, and norclozapine concentration were higher in the constipated patient group. Through logistic regression analysis, it was discovered that the risk of constipation increased as the norclozapine concentration increased, and the results remained similarly even after adjustments of related variables was performed.Conclusion: It was discoverd that among patients taking clozapine, the higher the norclozapine concentration, the higher the probability of constipation. Among patients taking clozapine, patients with high norclozapine concentration may need additional evaluation and management of constipation.

Probiotics and synbiotics in chronic constipation in adults: A systematic review and meta-analysis of randomized controlled trials

Probiotics and synbiotics have been increasingly investigated for the management of chronic constipation. We aimed to investigate the effect of probiotics and synbiotics on stool output, gut transit time, symptoms and quality of life in adults with chronic constipation via a systematic review and meta-analysis of randomized controlled trials (RCTs). Studies were identified using electronic databases, backward citation and hand-searching abstracts. The search date was 10 July 2022. RCTs reporting administration of probiotics or synbiotics in adults with chronic constipation were included. Risk of bias (RoB) was assessed with the Cochrane RoB 2.0 tool. Meta-analysis was conducted separately for probiotics and synbiotics. Results were synthesized using risk ratios (RRs), mean differences or standardized mean differences (SMDs) and 95% confidence intervals (CIs) using a random-effects model. Thirty RCTs investigating probiotics and four RCTs investigating synbiotics were included. Overall, 369/647 (57%) responded to probiotic treatment and 252/567 (44%) to control (RR 1.28, 95% CI 1.07, 1.52, p=0.007). Probiotics increased stool frequency (SMD 0.71, 95% CI 0.37, 1.04, p<0.00001), with Bifidobacterium lactis having a significant effect, but not mixtures of probiotics, Bacillus coagulans Unique IS2 or Lactobacillus casei Shirota. Probiotics did not impact stool consistency (SMD 0.26, 95% CI-0.03, 0.54, p=0.08). Probiotics improved integrative symptom scores compared to control (SMD -0.46, 95% CI-0.89,-0.04). Synbiotics did not impact stool output or integrative symptom scores compared to control. Certain probiotics may improve response to treatment, stool frequency and integrative constipation symptoms, providing cautious optimism for their use as a dietary management option. There is currently insufficient evidence to recommend synbiotics in the management of chronic constipation. Caution is needed when interpreting these results due to high heterogeneity and risk of bias amongst the studies.

Role of 3D high resolution anorectal manometry compared to conventional technique in management of constipation and fecal incontinence in children

BackgroundAnorectal manometry is a valuable tool for objective assessment of motility motor and sensory function of the anorectum. The aim of this study was to investigate role of water-perfused (WP) three dimensional high-resolution anorectal manometry (3D-HRARM) compared to WP conventional manometry (CM) in the management of chronic idiopathic constipation (CIC) and faecal incontinence (FI) in children. MethodsThis was a retrospective review of 122 consecutive children, who had WP 8-channel CM or 24 channel 3D-HRARM and endosonography under ketamine anaesthesia from September 2012 to February 2019. All patients had a validated symptom severity score questionnaire ranging from 0 (best) to 65 (worst). Mann-Whitney-U test and Spearman rank test were used and p<0.05 was considered significant. ResultsSubjects were divided according to investigation: CM group (n = 75) and 3D-HRAM (n = 47), who were otherwise comparable. Median anal resting pressure was 50 mmHg and rectoanal inhibitory reflex (RAIR) threshold volume was 10mls across the entire cohort. There were no significant differences in resting pressure or RAIR threshold when using conventional or 3D-HRARM. Rectal capacity was significantly higher in the CM group (p = 0.002). Rectal capacity and internal anal sphincter (IAS) thickness positively correlated with symptom severity, duration and patient age. 3D-HRARM provided a more detailed depiction of the anorectal pressure profile. Botulinum toxin was injected into the external anal sphincter (EAS) muscle (n = 75, 61%) and an anterograde colonic enema (ACE) stoma was needed subsequently in 19 (16%) to treat recurrent constipation and soiling symptoms. Rectal biopsy was done in 43(35%) patients, if RAIR was absent or inconclusive. ConclusionCM and 3D-HRARM are comparable in terms of resting pressure and RAIR threshold. 3D-HRAM is safe and provides detailed functional morphology of anal sphincters and it is useful to understand underlying pathophysiology of constipation and faecal incontinence in children and plan further treatment. Level of EvidenceLevel I

Pencil Beam Scanning (PBS) Proton Therapy for Children Requiring Radiotherapy with Anesthesia (GA) for Pelvic Rhabdomyosarcoma (RMS)

<h3>Purpose/Objective(s)</h3> Radiotherapy (RT) for pediatric pelvic RMS presents unique challenges, particularly for young children who require GA during RT, for whom bladder/rectal filling can be particularly variable. PBS may reduce dose to OARs and risk of second malignancy vs. double scatter (DS) protons; however, the precision of PBS requires highly reproducible daily setup. This study was undertaken to describe use of PBS in patients requiring RT for pelvic RMS with daily GA. <h3>Materials/Methods</h3> Pts with RMS of pelvic soft tissues treated with PBS from 1/2013-6/2020 with GA were included in this IRB-approved retrospective analysis. PBS proton plans were developed for all. DS plans were generated for all, and photon (VMAT) backup plans for 9/11 pts. Statistical analyses used 2-sided Student's t-tests. <h3>Results</h3> 11 total pts, median age 2.4 y (R 9 m – 5.9 y), 6 male patients, all had fusion-negative RMS (10 group 3 disease; 1 recurrent bladder/vaginal wall). Primary site included bladder (1), prostate (6), uterus (2), and vagina (1). During simulation/daily treatments under GA, Foley catheter with bladder filling to 75% expected capacity was used for 10. Rectal balloon was used for 2; aggressive management of constipation to promote empty rectum was used for all. All pts had IGRT (daily kV +/- CT [6]). RT dose was 41.4 Gy after delayed primary excision (DPE) (3) and 50.4 Gy without (8). Of 10 pts with FU data, all were without evidence of disease at median FU 1.3 y (range 0.3 – 5.6 y). Acute G3 toxicities included anorexia (3), diarrhea (1), and dermatitis (1), with no G4+ toxicities. One pt developed late RT cystitis. Among pts treated to 50.4 Gy, mean bladder dose (p<0.05) and body V5 (p<0.001) were significantly lower for PBS vs. photons. Max bladder, rectum, and body doses were significantly lower for PBS vs. DS (p<0.05 for each). <h3>Conclusion</h3> PBS proton therapy for very young children with pelvic RMS demonstrates acceptable rates of local control and toxicity when delivered under GA with deliberate management of bladder/rectal filling. Integral dose is reduced with PBS vs. VMAT, and OAR doses are reduced with PBS vs. DS. PBS should be considered in future trials as a standard RT approach for pediatric pelvic RMS.

Evaluation of Management of Functional Constipation in Children among South Indian Population – Cross Sectional Study

Functional constipation is a common bowel disorder in the communitywhich affects one in six children. The overall prevalence of constipation was 14.7%and 4.6% for FC while only 1.8% of respondents reported laxative use every day.The aim of this study is to evaluate the current trend of diagnosing and treatment of functional constipation among children. After getting informed consent, we reviewed the prescription of these patients, and data was collected using a semi-structured pre-validated questionnaire. Data were entered in Microsoft excel 2010 and statistical analyses were done using SPSS 17. The total number of cases included in the study was 138. Of which majority of cases are in the age group of below 5 years with a female preponderance. Almost all the cases reported laxatives use for the relief of constipation along with few dietary modifications. Lactulose and PEG played a major role in FC.Dietary habits and physical activity also played an important role as FC children reported low fruit and vegetable consumption, high fast-food consumption, and low levels of physical activity.

Two Gold Kiwifruit Daily for Effective Treatment of Constipation in Adults-A Randomized Clinical Trial.

Chronic constipation is highly prevalent worldwide and may be managed with two green or three gold kiwifruit daily. It is unknown whether a smaller standard serve of gold kiwifruit (two daily) is as effective in constipation management. The study aimed to improve chronic constipation with two gold kiwifruit and psyllium in lieu of a placebo daily over four weeks. Adult participants (18–65 years) with functional constipation (FC, n = 11), constipation-predominant irritable bowel syndrome (IBS-C, n = 13), and healthy controls (n = 32) were block-randomized to the treatment order: gold kiwifruit (2/day) or psyllium (fiber-matched, 7.5 g/day) for four weeks, followed by four weeks washout before crossover. Outcomes included alterations of Gastrointestinal Symptom Rating Scale (GSRS) domains and weekly complete spontaneous bowel movements (CSBM) as part of a larger study. Both interventions reduced GSRS constipation domain scores in all subjects compared to baseline values (p = 0.004). All participants reported significantly more weekly CSBM (p = 0.014). Two gold kiwifruit decreased straining (p = 0.021). Two gold kiwifruit daily are as effective as fiber-matched psyllium in treating constipation in adults and should be considered as a treatment option.

Nurse-Initiated Constipation Education (NICE) protocol: Improved health outcomes in the outpatient oncology setting.

237 Background: Many patients living with cancer experience pain requiring opioid therapy, and appreciation of the risks and benefits of opioids has grown in recent years. Opioid induced constipation (OIC) is one of the potential sequelae of opioid therapy. Evidence-based management strategies for OIC utilize lifestyle modifications and over-the-counter medications as initial steps. At a community cancer center, nurses are often the first team members identifying patients with OIC and suggesting management strategies. Thus, providing updated education and tools to nurses is an appropriate means for improving constipation management for patients living with cancer. Methods: Participants in the intervention included RNs and LPNs working in a specific region of the outpatient oncology practice. An evidence-based teaching tool was developed that included five handouts and a 20-minute pre-recorded educational presentation. Changes in nurse knowledge and confidence level were measured using a pretest/post-test design, and constipation related incidents were measured across a 2 month pre- and post-intervention period through review of the triage call tracking system. Data collection also included OIC incidents during the same timeframe. Results: 14 nurse participants completed a pre- and post-test after watching the presentation. Nursing constipation management knowledge scores increased by almost 30% and confidence ratings increased by 16.2%, indicating both an improved knowledge base and comfort level. Constipation-related incidents decreased by 39% post-implementation. Conclusions: Arming nurses with constipation management tools based on current evidence-based practices resulted in improved knowledge and comfort levels and led to decreased patient-reported incidents of constipation and OIC. Utilizing quality evidence-based tools and resources can help to prevent future negative health outcomes.

Reported Prevalence and Nutritional Management of Functional Constipation among Young Children from Healthcare Professionals in Eight Countries across Asia, Europe and Latin America.

Background: The prevalence of functional constipation (FC) among children varies widely. A survey among healthcare professionals (HCPs) was conducted to better understand the HCP-reported prevalence and (nutritional) management of FC in children 12–36 months old. Methods: An anonymous e-survey using SurveyMonkey was disseminated via emails or WhatsApp among HCPs in eight countries/regions. Results: Data from 2199 respondents were analyzed. The majority of the respondents (65.9%) were from Russia, followed by other countries (Indonesia (11.0%), Malaysia (6.0%)), Mexico, KSA (5.1% (5.7%), Turkey (3.0%), Hong Kong (2.2%), Singapore (1.1%)). In total, 80% of the respondents (n = 1759) were pediatricians. The prevalence of FC in toddlers was reported at less than 5% by 43% of the respondents. Overall, 40% of the respondents reported using ROME IV criteria in > 70% of the cases to diagnose FC, while 11% never uses Rome IV. History of painful defecation and defecations < 2 x/week are the two most important criteria for diagnosing FC. In total, 33% of the respondents reported changing the standard formula to a specific nutritional solution, accompanied by parental reassurance. Conclusion: The most reported prevalence of FC in toddlers in this survey was less than five percent. ROME IV criteria are frequently used for establishing the diagnosis. Nutritional management is preferred over pharmacological treatment in managing FC.

The success rate of antegrade enemas for the management of idiopathic constipation.

Most patients with idiopathic constipation achieve daily voluntary bowel movements with stimulant laxatives after a "Structured Bowel Management Program" (BMP). A small percentage require rectal enemas. One week in a BMP to find the right enema recipe results in a success rate great than 95%. Once the enema is radiologically and clinically effective, antegrade continent enema procedures (ACE) can afford patients an alternative route of enema administration. This study summarized the outcomes of children with idiopathic constipation who receive antegrade enemas (AE) with or without a prior BMP. This was a single institution, retrospective cohort study of children with idiopathic constipation who underwent ACE procedures indicated by different providers from 2015-2020. We categorized the outcomes with AE after the ACE procedure as: "successful outcome" when the AE produced a daily bowel movement, no involuntary bowel movements, and no more fecal impactions, "unsuccessful outcome" was defined when the patient continued having involuntary bowel movements or fecal impaction requiring cleanouts despite a daily AE, and "unnecessary outcome" was defined when the patient was no longer doing AE, but had daily bowel movements, and no involuntary bowel movements or fecal impactions. Thirty-eight children with idiopathic constipation had an ACE. The most frequent indication for ACE was a failure of medical treatment. The most common medical treatment was polyethylene glycol. Before ACE, 34 (89%) patients did not have a BMP; 18 patients were on rectal enemas and 16 on laxatives. All four with BMP (100%) had a successful rectal enema. After ACE, 12 (31%) patients had successful antegrade enemas, including the four with previous successful BMP with rectal enemas. Twenty patients (52%) had unsuccessful antegrade enemas, and in 6 (15%), the ACE was unnecessary (Fig. 1). Using antegrade enemas without a previously successful formula for rectal enemas has resulted in a high rate of unsuccessful and unnecessary procedures. BMP for children with idiopathic constipation who needs rectal enemas offers a high possibility to find the proper rectal enema recipe and ensures higher rates of successful AE.

Evidence-based treatment recommendations for OTC management of chronic constipation.

ABSTRACTChronic constipation is a common gastrointestinal condition, and most individuals self-treat with multiple over-the-counter (OTC) laxatives prior to consulting a health care provider. This brief report is a synopsis of an updated systematic review the authors conducted of published data on the efficacy and safety of OTC treatments to provide evidence-based recommendations. After applying the selection criteria, 41 randomized controlled clinical trials of ≥ 4-week duration were identified and analyzed. Standardized definitions of constipation were applied across these studies; however, definitions for stool frequency and consistency varied. Overall, the short- and long-term efficacy of polyethylene glycol-based preparations and senna were supported by good (grade A) evidence suggesting their use as first-line laxatives. Modest evidence (grade B) supported the use of other agents including the stimulants bisacodyl and sodium picosulfate, fiber, fruit-based laxatives, and magnesium oxide. Additional evidence from rigorously designed studies is needed to support the use of other options for chronic constipation. The OTC products studied were generally well tolerated with common adverse effects being abdominal pain, cramping, bloating, diarrhea, and nausea.

Impact of a probiotic chewable tablet on stool habits and microbial profile in children with functional constipation: A randomized controlled clinical trial.

Constipation is a common and typically multifactorial childhood complaint, and the clinical management of childhood functional constipation (FC) is challenging. A randomized, single-blind, placebo-controlled, multi-center clinical trial was conducted in 92 children (47 from Beijing, China and 45 from Shanghai, China) aged 4–12 with FC according to Rome III criteria. Children were assigned to receive a probiotic chewable tablet (5 × 109 CFU/day, n = 47), consisting of Lactobacillus acidophilus DDS-1® and Bifidobacterium animalis subsp. lactis UABla-12™ or placebo (n = 45), twice daily for 4 weeks, followed by a week follow-up period. Results suggested that the probiotic group showed a faster and more pronounced normalization of stool frequency over the intervention period (3.15 vs. 1.83) when compared to placebo group (2.51 vs. 1.87). Meanwhile, the percentage of subjects with hard defecation decreased from 43 to 14% in the probiotic group, while the percentage of subjects with normal defecation increased from 56 to 80% in the probiotic group, further confirming the normalization of stools habits. This randomized controlled trial demonstrated the potential of a probiotic chewable tablet containing L. acidophilus DDS-1® and B. Lactis UABla-12™ as a daily probiotic dosage form for children with FC.

Alleviating effects of gut micro-ecologically regulatory treatments on mice with constipation.

Treatments targeted for gut microbial regulation are newly developed strategies in constipation management. In this study, the alleviating effects of gut micro-ecologically regulatory treatments on constipation in mice were investigated. Male BALB/c mice were treated with loperamide to induce constipation, and then the corresponding intervention was administered in each group, respectively. The results showed that administration of mixed probiotics (MP), a 5-fold dose of postbiotics (P5), both synbiotics (S and S2), as well as mixed probiotics and postbiotics (MPP) blend for 8 days shortened the time to the first black stool, raised fecal water content, promoted intestinal motility, and increased serum motilin level in loperamide-treated mice. Furthermore, these treatments altered gut microbial composition and metabolism of short-chain fatty acids (SCFA). Based on linear regression analysis, SCFA was positively correlated with serum motilin except for isobutyrate. It suggested gut microbial metabolites affected secretion of motilin to increase gastrointestinal movement and transportation function and thus improved pathological symptoms of mice with constipation. In conclusion, the alteration of gut micro-ecology is closely associated with gastrointestinal function, and it is an effective way to improve constipation via probiotic, prebiotic, and postbiotic treatment.

Herbal Medicine for the Management of Laxative Activity.

Constipation is one of the most common and prevalent chronic gastrointestinal conditions across the globe that is treated or managed through various methods. Laxatives are used for the treatment or management of chronic/acute constipation. But due to the adverse effects associated with these laxatives, herbal foods should be considered as alternative therapies for constipation. In this review, the laxative potential of plant-based medicines used for constipation is discussed. Constipation may be caused by various factors such as lifestyle, particular food habits, pregnancy and even due to some medication. Chronic constipation is responsible for different health issues. Pharmacological and non-pharmacological paradigms are applied for the treatment or management of constipation. In the pharmacological way of treatment, medicinal plants have a key role because of their fibrous nature. Numerous plants such as Prunus persica (Rosaceae), Cyamopsis tetragonolobus (Leguminosae), Citrus sinensis (Rutaceae), Planta goovata (Plantaginaceae), Rheum emodi (Polygonaceae), Cassia auriculata (Caesalpinacea), Ricinus communis (Euphorbiaceae), Croton tiglium (Euphorbiaceae), Aloe barbadensis (Liliaceae), Mareya micrantha (Euphorbiaceae), Euphorbia thymifolia (Euphorbiaceae), Cascara sagrada (Rhamnaceae), Cassia angustifolia (Fabaceae) have laxative activity. Medicinal plants possess a significant laxative potential and support their folklore; therefore, further, well-designed clinical-based studies are required to prove and improve the efficacy of herbal medicine for constipation. The present review showed that herbs laxative effect in various in vivo/ in vitro models.

Management of antipsychotic-induced constipation requires more attention

Management of antipsychotic-induced constipation requires more attention

An analysis of the construct validity and responsiveness of the ICECAP-SCM capability wellbeing measure in a palliative care hospice setting

BackgroundFor outcome measures to be useful in health and care decision-making, they need to have certain psychometric properties. The ICECAP-Supportive Care Measure (ICECAP-SCM), a seven attribute measure (1. Choice, 2. Love and affection, 3. Physical suffering, 4. Emotional suffering, 5. Dignity, 6. Being supported, 7. Preparation) developed for use in economic evaluation of end-of-life interventions, has face validity and is feasible to use. This study aimed to assess the construct validity and responsiveness of the ICECAP-SCM in hospice inpatient and outpatient settings.MethodsA secondary analysis of data collated from two studies, one focusing on palliative care day services and the other on constipation management, undertaken in the same national hospice organisation across three UK hospices, was conducted. Other quality of life and wellbeing outcome measures used were the EQ-5D-5L, McGill Quality of Life Questionnaire – Expanded (MQOL-E), Patient Health Questionnaire-2 (PHQ-2) and Palliative Outcomes Scale Symptom list (POS-S). The construct validity of the ICECAP-SCM was assessed, following hypotheses generation, by calculating correlations between: (i) its domains and the domains of other outcome measures, (ii) its summary score and the other measures’ domains, (iii) its summary score and the summary scores of the other measures. The responsiveness of the ICECAP-SCM was assessed using anchor-based methods to understand change over time. Statistical analysis consisted of Spearman and Pearson correlations for construct validity and paired t-tests for the responsiveness analysis.ResultsSixty-eight participants were included in the baseline analysis. Five strong correlations were found with ICECAP-SCM attributes and items on the other measures: four with the Emotional suffering attribute (Anxiety/depression on EQ-5D-5L, Psychological and Burden on MQOL-E and Feeling down, depressed or hopeless on PHQ-2), and one with Physical suffering (Weakness or lack of energy on POS-S). ICECAP-SCM attributes and scores were most strongly associated with the MQOL-E measure (0.73 correlation coefficient between summary scores). The responsiveness analysis (n = 36) showed the ICECAP-SCM score was responsive to change when anchored to changes on the MQOL-E over time (p < 0.05).ConclusionsThis study provides initial evidence of construct validity and responsiveness of the ICECAP-SCM in hospice settings and suggests its potential for use in end-of-life care research.

Management of Functional Constipation in Children

Management of Functional Constipation in Children

Risk and main contributing factors for constipation in patients with gastrointestinal cancer: a multicenter cross-sectional study in China

The purpose of this study is to determine the risk of constipation and to identify the significant risk factors for constipation in patients with gastrointestinal cancer using the Chinese version of the constipation risk assessment scale (CRAS-C), as well as to explore the complementary constipation risk factors in patients with gastrointestinal cancer, to improve the specificity of the CRAS-C in this population, and finally to provide a theoretical basis for constipation prevention. A cross-sectional study involving multiple centers was conducted. A total of 190 patients with gastrointestinal cancer completed surveys that included demographic information, defecation habits, and the CRAS-C. The mean, SD, median, maximum, minimum, frequency, and percentage were used as indicators for the constipation risk and significant risk factors. The t test and Chi-square tests were used to analyze constipation indicators in patients with gastrointestinal cancer. The mean (SD) age of the 190 participants was 61.68 (12.35) years. The total CRAS-C mean (SD) score was 13.22 (4.69). Fifty-one patients (26.8%) scored lower than 11, who were at the low-risk level of constipation. One hundred thirty-nine patients (73.2%) scored 11 or above, who were at the high-risk level of constipation. The top 10 factors were insufficient liquid intake (81.1%), failure to consume bran products daily (78.9%), insufficient fiber intake (77.9%), antiemetics (74.7%), cytotoxic chemotherapy (52.6%), colorectal/abdominal diseases (42.6%), female (35.3%), opioid analgesics(26.8%), calcium channel blockers (16.3%), and endocrine disorders (14.2%). Chi-square test showed that constipating for most of the past 3months, ascites and ECOG score were complementary constipation risk factors in gastrointestinal cancer patients. The findings indicate that most gastrointestinal cancer patients were at a high risk of constipation. There are also several complementary constipation risk factors, and CRAS-C can be further revised in future studies to make it more specific in gastrointestinal cancer patients. Integrating CRAS into the pathway of constipation management, carrying out constipation risk screening for hospitalized cancer patients, and building systematic constipation prevention plan based on risk assessment are important to reduce the incidence of constipation in patients with gastrointestinal cancer and improve the quality of life.

Yogic Management of Constipation

CONSTIPATION is a major physical issue in today's age. Emerged as a problem. Therefore, in the form of treatment of constipation. There are immediate and incomplete benefit of resorting to various medical methods. But in the long run and full benefit is not visible. Today again after the renaissance of yoga. Yoga for protection and protection from diseases are using more and more. In fact less should be understood as a warning by which other diseases. Can surrounded a person like - Indigestion, gas, acidity etc., due to this reason the father of diseases (the giver of birth). Due to which root located in the intestine creates many disturbance, some symptoms of this disease also occur due to which constipation disease occurs.