Therapy For Constipation Research Articles

Efficacy of Probiotics Compared With Pharmacological Treatments for Maintenance Therapy for Functional Constipation in Children: A Systematic Review and Network Meta-analysis.

There has been an increase in randomized controlled trials (RCTs) comparing probiotics with various maintenance therapies, such as polyethylene glycol, lactulose, and mineral oil, to treat functional constipation in children. The aim was to compare probiotics with all other oral maintenance therapies for functional constipation in children and rank all treatments in terms of effectiveness in a network meta-analysis. RCTs were identified through systematically searching the MEDLINE, Scopus, EMBASE, and Cochrane Library databases, trial registries, and forward and backward citation searching. Within-study risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and confidence in the estimates was assessed using the CINeMA (Confidence in Network Meta-Analysis) framework. Random-effects network meta-analyses were conducted. Data were pooled from 41 and 29 RCTs for network meta-analysis of defecation frequency and treatment success, respectively. Probiotics did not significantly increase the number of bowel movements per week when compared with any conventional treatment or placebo. A combination of mineral oil and probiotics was the most effective treatment for increasing defecation frequency (mean difference: 3.13; 95% confidence interval [CI]: 0.64, 5.63). The most effective treatments for increasing the risk of treatment success as compared with placebo were mineral oil (relative risk [RR]: 2.41; 95% CI: 1.53, 3.81) and a combined treatment of polyethylene glycol and lactulose (RR: 2.45; 95% CI: 1.21, 4.97). Confidence in the estimates ranged from very low to moderate. Currently, there is no evidence to suggest that probiotics should be used as a standalone treatment for functional constipation in children. More high-quality studies are needed to evaluate different strains of probiotics and their potential benefit as an additional treatment component to conventional treatments. Mineral oil and polyethylene glycol were the most effective treatments to increase defecation frequency and treatment success rates and should remain the first line of treatment for children with functional constipation. PROSPERO registration no.

Post-infection gastrointestinal disorders and treatment options

The development of post-infectious pathology is determined by the type of pathogen, the genesis of damage to the intestinal barrier and the premorbid background of the child. On the scale of recent epidemiological events, attention is drawn to the SARS-CoV-2 virus, which has tropism for cells of the gastrointestinal tract, distorts the composition and function of the intestinal microbiome. The importance of the functions of intestinal microbes in the genesis and outcome of SARS-CoV-2 infection has been highlighted. It has been proven that a microbiota disorder with a new coronavirus infection affects not only the duration and severity of the infectious process, but also the risk of the formation of systemic diseases and malignant neoplasms. After the acute phase of SARS-CoV-2 infection, post-COVID-19 syndrome may occur, the pathophysiology of which has not yet been fully established. Although it is believed that the main reason for its appearance is the diversification of the intestinal microbial landscape against the background of the direct effect of SARS-CoV-2 on the ACE2 receptors of intestinal epitheliocytes, followed by a pathoimmune response and impaired hemostasis. Established post-COVID-19 dysbiosis underlies functional gastrointestinal disorders with pronounced impairment in the brain-gut-microbiota axis and imbalance of the migrating motor complex, leading to the development of constipation. Post-infectious constipation debut within the first 3 months after an acute infection. The main goal of therapy for post-infectious constipation is to achieve regular painless defecation with soft-consistency stool and prevent feces. Numerous foreign studies and clinical guidelines indicate that stimulating laxatives are effective and safe in the treatment of constipation, include the children’s practice. Sodium picosulfate is considered one of the topical drugs of this group of laxatives.

Optimizing Cost-Effective Care for Chronic Constipation in General Gastroenterology Using an Office-Based, Point-Of-Care Test (RED): Cost-Effectiveness and Cost-Minimization Analysis.

We aimed to evaluate the cost-effectiveness/cost-savings of point-of-care anorectal function testing with an investigational device (RED) to triage therapy for chronic constipation in general gastroenterology. A Markov model was constructed to evaluate cost-effectiveness/cost-savings over a 1-year time horizon comparing empiric drug/pelvic floor physical therapy to testing guided care. RED appears to inform the cost-effective strategy for chronic constipation. Compared with usual care without RED, it reduces insurer costs by $810 and patient costs by $6,903. Point-of-care testing using RED appears cost-effective/cost-saving to triage chronic constipation care in general gastroenterology.

Electroacupuncture Combined with Chinese Medicine Ironing Therapy for Functional Constipation.

Functional constipation (FC) is a dysfunctional gastrointestinal disease with the main clinical manifestations of complex bowel movements, incomplete bowel movements, reduced frequency of bowel movements, and dry and hard stools, which seriously affect patients' quality of life and psychology. Electroacupuncture improves constipation by performing acupuncture on specific points in the body to accelerate intestinal peristalsis. Chinese medicine ironing therapy (CMIT) can warm up the meridians, accelerate local blood circulation, promote gastrointestinal dynamics, and accelerate gastric emptying. This study elaborated on the method and steps of electroacupuncture combined with CMIT for functional constipation, including patient selection, material preparation, operation procedure, postoperative care, and precautions. The therapeutic effect of the method was also evaluated. The results of the study showed that after 4 weeks of treatment, compared with Western medicine alone, electroacupuncture combined with CMIT can improve the frequency of FC patients' voluntary bowel movements, constipation, and quality of life. There were no obvious adverse reactions.

Introduction to the Chinese Medicine Characteristic Therapy of Constipation

Constipation is defined as having fewer than three bowel movements per week, dry stools, and difficulty in defecation. Occasional constipation is common, but when constipation lasts more than 12 weeks for chronic constipation. Traditional Chinese medicine (TCM) has a long history of treating constipation, and has been used in a large number of clinical applications with good results. The role of Chinese medicine in the treatment of constipation is also growing.

Evaluation of Polyethylene Glycol Dosing for Functional Constipation in Children.

Objective: The goal of this study was to evaluate the current use of polyethylene glycol (PEG) in a pediatric gastroenterology outpatient clinic. The primary endpoint was to determine the current weight-based PEG dosing schedules used for home cleanouts and maintenance treatment for functional constipation. The secondary endpoint was to assess the dosing efficacy for home cleanouts. Methods: This study was a retrospective cohort analysis of electronic medical records documenting new patient visits at our pediatric gastroenterology clinic between September 2017 and October 2018. Patients included in the study were 13 months to 18 years of age and prescribed PEG for an at-home cleanout and/or maintenance therapy for functional or slow transit constipation. Study participants given a clean-out regimen were divided into those who received treatment for less than 2 days or more. Cleanouts were considered successful if documented as such by the prescriber in the follow-up note or if there was documentation of clear flow. Results: Of the 201 new patients included, 112 (55.7%) received a recommendation for a home cleanout. Of these, 111 patients (99%) underwent PEG-based therapy with or without additional agents. The median weight-based PEG dose was 5.3 ± 2.4 and 4.6 ± 1.9 g/kg/day for 1- and 2-day cleanouts, respectively (P = 0.124). Of the 38 patients with documented outcomes, 28 (73.7%) were successful. We observed no statistically significant differences in the number of successful versus unsuccessful outcomes based on PEG dosing (P = 0.3) or cumulative dose exposures (P = 0.388). Similarly, we observed no significant differences when comparing those on 1-day versus 2-or-more-day cleanouts, (P = 0.17). The median weight-based maintenance PEG dose was 0.74 g/kg/day (interquartile range [IQR], 0.55, 0.96). Conclusions: While the PEG doses used by this clinic for 1-day bowel cleanouts align with the NASPGHAN best practices for colonoscopy report, patients who underwent a 2-day cleanout were provided more than double the weight-based doses. The doses were nearly 3-fold higher than the recommended doses for functional constipation home cleanouts. More information will be needed to determine if these higher doses for home cleanouts are needed for the successful management of patients with functional constipation.

Nonpharmacologic Treatment of Chronic Constipation.

Functional constipation is a common clinical diagnosis that affects approximately 14% of the world's population. Non-pharmacological therapies often represent the initial steps in management and may include lifestyle adjustments or changes such as physical activity and diet. Pharmacological options have been used when the non-pharmacological approach has been ineffective. Biofeedback therapy, surgery, sacral nerve stimulation, botulinum toxin injection, and vibrating capsules can be considered in scenarios where the laxatives are ineffective. Biofeedback therapy is highly effective and safe in treating dyssynergic defecation, which affects more than half of patients with chronic constipation. This paper overviews non-pharmacological therapies for functional constipation.

Considering traditional Chinese medicine as adjunct therapy in the management of chronic constipation by regulating intestinal flora.

Chronic constipation is one of the most common gastrointestinal disorders worldwide. Due to changes in diet, lifestyle, and the aging population, the incidence of chronic constipation has increased year by year. It has had an impact on daily life and poses a considerable economic burden. Nowadays, many patients with chronic constipation try to seek help from complementary and alternative therapies, and traditional Chinese medicine (TCM) is often their choice. The intestinal flora play an important role in the pathogenesis of constipation by affecting the body's metabolism, secretion, and immunity. Regulating the intestinal flora and optimizing its composition might become an important prevention and treatment for chronic constipation. TCM has unique advantages in regulating the imbalance of intestinal flora, and its curative effect is precise. Therefore, we reviewed the relationship between intestinal flora and chronic constipation as well as advances in research on TCM as adjunct therapy in the management of chronic constipation by regulating intestinal flora. Some single Chinese herbs and their active ingredients (e.g., Rheum palmatum, Radix Astragalus, and Cistanche deserticola), some traditional herbal formulations (e.g., Jichuan decoction, Zengye decoction, and Zhizhu decoction) and some Chinese patent medicines (e.g., Maren pills and Shouhui Tongbian capsules) that are commonly used to treat chronic constipation by regulating intestinal flora are highlighted and summarized. Moreover, some external forms of TCM, and especially acupuncture, have also been found to improve intestinal movement and alleviate constipation symptoms by regulating intestinal flora. We hope this review can contribute to an understanding of TCM as an adjunct therapy for chronic constipation and that it can provide useful information for the development of more effective constipation therapies.

Literature Review: Senam Kegel Terhadap Inkontinensia Urine Pada Lanjut Usia

Physiological changes include the nervous system, hearing, vision, cardiovascular, body temperature regulation, breathing, endocrine system, skin system, urinary tract system, musculoskeletal, and mental changes in the elderly, especially personality changes, and changes in memory. and intelligence, Lifestyle changes are psychosocial changes. Method using a literature study with a narrative method from research results published in 2018-2023. The search used the Kegel exercise keyword strategy at BAK frequency on Google Scholar and PubMed with the criteria used, namely articles that discuss incontinence and Kegel exercises which can be used as an alternative therapy for constipation, availability of full text, sample, year of publication in the last 5 years. From 10 articles it was described that Kegel exercises were proven to be effective as an alternative therapy for patients with constipation.

Efficacy and safety of auricular therapy in the treatment of post-stroke constipation: A protocol for systematic review and meta-analysis.

Constipation is one of the common gastrointestinal complications after stroke. It not only aggravates the condition of stroke, but also brings huge medical burden to patients, and has a negative impact on the quality of life of patients. Auricular therapy, as a part of Chinese traditional acupuncture and moxibustion, has been found to be effective in the clinical treatment of constipation. However, no systematic review has investigated the efficacy and safety of auricular therapy in the treatment of post-stroke constipation. Therefore, the aim of this systematic review is to assess the effectiveness and safety of auricular therapy for post-stroke constipation. Eight electronic databases including PubMed, Cochrane Library/Cochrane Central Register of Controlled Trials, Web of Science, Embase, China National Knowledge Internet, Chinese Biomedical Literature Database, Wanfang, and VIP databases, will be searched for relevant studies published from inception to February 2023. Two reviewers will independently conduct research selection, data extraction, and evaluation of research quality. Only randomized controlled trials (RCTs) that assess the efficacy and safety of auricular therapy for the treatment of post-stroke constipation will be included in this study. We will use the Cochrane risk of bias assessment tool to evaluate the methodological qualities (including bias risk). If possible, a meta-analysis will be performed after screening. This study may provide high-quality evidence for the efficacy and safety of auricular therapy in treating post-stroke constipation. The conclusions of our study will provide an evidence to judge whether auricular therapy is an effective and safe intervention for patients with post-stroke constipation. Ethical approval is not required, as this study was based on a review of published research. This review will be published in a peer-reviewed journal and disseminated electronically and in print. Registration number: PROSPERO CRD42023402242.

Pengaruh Pijat Medic Pediatric sebagai Terapi Konstipasi pada Bayi Usia 6-12 Bulan

Constipation is a health problem that often occurs in infants. Basedon an initial survey at the Sei Langkai health center, data was obtained that out of 10 babies, 7 of them had experienced constipation and most mothers did not know how to deal with constipation in infants. The purpose of the study was to determine the effect of Pediatric Medical Massage asa Constipation Therapy. The subjects in this study were infants aged 6-12 months. Thisresearch was carried out in the Working Area of the Sei Langkai Health Center in Batam City using Quasi Experiments with pre and posttest control design. This research was conducted in.The results showed that in the intervention group obtained a value of p = 0.000 < 0.05 which showed that there was an effect of Pediatric Medical Massage as a Constipation Therapy in infants aged 6-12 months, while in the control group the test results showed that the value of p = 0.083 > 0.05 so that it could be stated that There is no effect on the treatment of control groups against constipation in infants aged 6-12 months. Theconclusion of the study is that pediatric medical massage can be a method in overcoming constipation in infants so that mothers can overcome the incidence of constipation in infants at home

5-HT4 Receptor is Protective for MPTP-induced Parkinson's Disease Mice Via Altering Gastrointestinal Motility or Gut Microbiota.

Serotonergic dysfunction is related to both motor and nonmotor symptoms in Parkinson's disease (PD). As a 5-HT receptor, 5-HT4 receptor (5-HT4R) is well-studied and already-used in clinical therapy of constipation, which is a typical non-motor symptom in PD. In this study, we investigated the role of 5-HT4R as a regulator of gut function in MPTP-induced acute PD mice model. Daily intraperitoneal injection of GR 125487 (5-HT4R antagonist) was administered 3 days before MPTP treatment until sacrifice. Seven days post-MPTP treatment, feces were collected and gastrointestinal transit time (GITT) was measured, 8 days post-MPTP treatment, behavioral tests were performed, and then animals were sacrificed for the further analysis. We found GR 125487 pretreatment not only increased GITT, but also aggravated MPTP-induced motor bradykinesia. In addition, GR 125487 pretreatment exacerbated the loss of dopaminergic neurons probably by suppressing JAK2/PKA/CREB signaling pathway and increased reactive glia and neuroinflammation in the striatum. 16S rRNA sequencing of fecal microbiota showed that GR 125487 pretreatment altered the composition of gut microbiota, in which the abundance of Akkermansia muciniphila and Clostridium clostridioforme was increased, whereas that of Parabacteroides distasonis and Bacteroides fragilis was decreased, which are closely associated with inflammation condition. Taken together, we demonstrated that GR 125487 pretreatment exacerbates MPTP-induced striatal neurodegenerative processes possibly via the JAK2/PKA/CREB pathway and neuroinflammation by altering gut microbiota composition. In the microbiota-gut-brain axis of PD, 5-HT4R should be further explored and might serve as a target for PD diagnosis and treatment.

Review on the application of acupoint sticking therapy for constipation in adult patients

Review on the application of acupoint sticking therapy for constipation in adult patients

Functional constipation in preschool and school age children: ways to solve the problem

Functional constipation is a significant medical problem in pediatrics. Constipation often causes discomfort in children of any age and, in the absence of timely and effective treatment, can lead to chronic intoxication and the development of various complications, ultimately affecting the patient's quality of life. The article presents the definition of functional constipation in children over 4 years of age in accordance with the Rome IV Criteria (2016), etiology, pathophysiological mechanisms, clinic, diagnostic criteria and differential diagnosis of functional and organic constipation in preschool and school age children, possible complications. In accordance with the draft Consensus of the Society of Pediatric Gastroenterologists (2013), for a more objective assessment of the nature of the stool, the Bristol scale of stool forms is given. The physiology of the colon and the role of motor disorders in the occurrence of functional constipation are described. The physiology of the colon and the role of motor disorders in the occurrence of functional constipation are described. In accordance with the recommendations of the National School of Gastroenterology, the National Institute of Health and Clinical Excellence (NICE) in the UK, ESPGHAN and NASPGHAN, the basic principles of constipation therapy in preschool and school age children are given. The main groups of drugs that are used in the treatment of constipation in children of this age are described: stimulating and osmotic laxatives, prokinetics. Numerous foreign studies and clinical recommendations indicate that stimulants are effective and safe for the treatment of functional constipation, including in children's practice and are most in demand. The analysis of the use of one of the main drugs of the group of stimulating laxatives - sodium picosulfate in numerous international and Russian clinical studies is presented. The effectiveness and favorable safety profile of sodium picosulfate, the possibility of individual dose selection in connection with the liquid form of release are shown. A clinical example of the treatment of functional constipation in a 6-year-old child is given.

Ligand-Modified Gold Nanoparticles as Mitochondrial Modulators: Regulation of Intestinal Barrier and Therapy for Constipation.

Intestinal metabolism-related diseases, such as constipation, inflammatory bowel disease, irritable bowel syndrome, and colorectal cancer, could be associated with the dysfunction of intestinal mitochondria. The mitochondria of intestinal epithelial cells are of great significance for promoting intestinal motility and maintaining intestinal metabolism. It is necessary for the prophylaxis and therapy of intestinal metabolism-related diseases to improve mitochondrial function. We investigated the effect of 4,6-diamino-2-pyrimidinethiol-modified gold nanoparticles (D-Au NPs) on intestinal mitochondria and studied the regulatory role of D-Au NPs on mitochondria metabolism-related disease. D-Au NPs improved the antioxidation capability of mitochondria, regulated the mitochondrial metabolism, and maintained intestinal cellular homeostasis via the activation of AMPK and regulation of PGC-1α with its downstream signaling (UCP2 and DRP1), enhancing the intestinal mechanical barrier. D-Au NPs improved the intestinal mitochondrial function to intervene in the emergence of constipation, which could help develop drugs to treat and prevent mitochondrial metabolism-related diseases. Our findings provided an in-depth understanding of the mitochondrial effects of Au NPs for improving human intestinal barriers.

The use of sodium thiosulfate in the treatment of hemorrhoids

Hemorrhoidal disease is one ofthe most common pathologies ofthe anorectal region, its specific weight in the structure of diseases ofthe colon is about 40%. Hemorrhoids are a socially significant disease, most often found in the able-bodied population. The reason for the development of hemorrhoids, on the one hand, is a violation of blood circulation in the cavernous corpuscles, due to which they increase and nodes form, and on the other hand, dystrophic changes in the ligamentous apparatus of hemorrhoids, in connection with which they gradually shift down and begin to fall out of the anal canal. One of the factors provoking the development of hemorrhoidal disease may be the presence of dissinergia of the pelvic floor muscles, which, in accordance with the Roman criteria IV, is part of the functional constipation syndrome. Not only dissinergia, but also high basal pressure in the anal canal (increased tone of the internal anal sphincter) can lead to stool retention. High rates of basal anal pressure can occur as a result of damage to the mucous membrane of the anal canal during straining, which leads to reflex spasm of the anal sphincter (anal continuity reflex). Thus, a vicious circle can form and thereby exacerbate constipation and the course of hemorrhoidal disease. Also, the relationship between dysenergic defecation and hemorrhoidal disease can be justified by the fact that physiotherapy aimed at correcting the work of the pelvic floor muscles contributes to better control over the manifestations of hemorrhoidal disease in complex therapy. The return of symptoms or, in other words, the recurrence of the disease in patients after surgery for hemorrhoids more often occurs with concomitant constipation. In accordance with clinical recommendations for the treatment of hemorrhoids, the use of an adequate amount of fluid and the intake of dietary fiber (fiber preparations) is indicated to normalize the activity of the gastrointestinal tract and eliminate constipation as part of complex therapy. If it is impossible to take dietary fiber, laxatives come to the fore of constipation therapy. This article presents clinical examples of the efficacy and safety of using sodium picosulfate.

Interferential therapy for chronic constipation in adults: The CON-COUR randomizedcontrolled trial.

Chronic constipation (CC) is a frequent condition, and the first-line treatment includes dietary rules, the use of laxatives, and biofeedback for evacuation disorders. However, almost half of the patients are dissatisfied with their current treatment. We report the first double-blind randomized multicenter trial assessing the effectiveness of transabdominal electrical stimulation by interferential therapy (IFT) in the treatment of CC in adults. A prospective, multicenter, randomized, double-blind, sham-controlled, parallel-group, phase 3 trial was conducted at 7 centers in France. The primary endpoint was 8-week efficacy as defined by the number of complete spontaneous bowel movements during the last 4weeks of the 8-week stimulation period. Secondary endpoints included the evaluation of the effects of IFT on symptoms (Patient Assessment of Constipation Symptoms questionnair (PAC-SYM)), quality of life (QOL) (Patient Assessment of Constipation Quality of Life), Colonic transit time (CTT), anorectal manometry, and patient satisfaction. The proportion of 8-week responders was not significantly different between the two groups (73.2% in the IFT group vs. 67.1% in the sham group). After 8weeks of stimulation, the mean overall PAC-SYM score and the mean reduction in the overall PAC-SYM score were significantly greater in the IFT group than in the sham group. No differences were observed concerning CTT, anorectal manometry, or patient satisfaction. Although the primary endpoint was not reached, IFT can significantly alleviate the symptoms and improve the QOL of CC patients. It can be assumed that new treatments require different modes of evaluation and that the assessment of patient-reported outcomes may become a priority among therapeutic targets of CC. Trial registration number NCT02381665.

Effectiveness of Acupressure Therapy against Constipation and comfort Cancer Patients Undergoing Chemotherapy: Systematic Review

The complex state of cancer causes sufferers to face a variety of clinical symptoms, both physically and psychologically, dramatically affecting the Patient's daily life. Chemotherapy treatment or therapy undertaken by cancer patients has severe side effects. Some side effects, such as headache, myalgia, hypotension, urinary retention, and constipation, can cause discomfort in cancer patients. Therefore, complementary acupressure therapy is needed to reduce the symptoms of constipation and pain caused by the symptoms. This study aims to find evidence based on the effectiveness of acupressure therapy for constipation and the comfort of cancer patients undergoing Chemotherapy. The study method uses the eight stages in this review: identifying nursing problems, prioritizing problems and research questions, primary and secondary data frameworks, identifying relevant studies, prism flow diagrams, critical appraisal, data analysis, and data extraction. This review uses five databases with a period of 2013-2022. The search results for the total number of articles obtained were 1,241, and ten were selected for review. Several reports comparing constipation symptoms and comfort levels in the acupressure therapy group and without acupressure therapy showed that acupressure therapy is an effective nonpharmacological therapy to reduce constipation symptoms and discomfort in cancer patients undergoing Chemotherapy. Based on reviews of acupressure therapy's effectiveness in lowering constipation symptoms and distress in cancer patients, more high-quality evidence is needed to determine whether acupressure is more effective than other treatments.

Opioids and constipation therapy in the last week of life: Their impact on patients, caregivers, and the location of death.

The use of opioids to control pain at the end of life may cause constipation, a symptom that can negatively influence the well-being of patients and caregivers. The main aim of this study was to evaluate the impact of constipation on symptomatic control and patients' overall quality of life at this stage. A particular focus was placed on opioids. We also intended to investigate whether constipation and caregiver fatigue is related to the place of death (hospital vs home). The approach of 121 patients followed in 2021 in their last week of life by a home team specialized in palliative care was analyzed in an observational, retrospective, non-interventional study. The patients were followed up for an average of 39.7 days. A total of 82.6% wished to die at home, which occurred in 74% of the cases. The constipation prevention protocol reduced constipation by 55.1%. It seems that morphine is more related with constipation and tapentadol seems to reduce constipation induced by opioids. Patients tended to die in hospitals when their caregivers were exhausted; however, it was not possible to determine a cutoff point using the Zarit scale, which was used to assess caregiver burden. Constipation in the last week of life does not seem to influence the well-being of patients or their caregivers significantly and the individualization of intensive treatment of constipation is needed. Different opioids have different probabilities of causing adverse effects such as constipation. Future special support mechanisms can be created and activated for the most tired caregivers to avoid exhaustion and promote death at home, if that is the patient's will.

Parasympathetic control of gastrointestinal motility and cross-branch actions of parasympathetic neuromodulation.

Parasympathetic control of gastrointestinal motility and cross-branch actions of parasympathetic neuromodulation.