History Of Constipation Research Articles

Estudio caso-control de los factores de riesgo asociados al estreñimiento. Estudio FREI

Children represent one of the patient groups most affected by constipation. Our objective was to identify and describe the risk factors associated with childhood constipation. The study had a case-control, retrospective, open and multicenter design. Clinical data on possible risk factors were collected through an ad-hoc questionnaire. Two groups were studied: children with and without constipation. Nine hundred twenty-one children were recruited; of these, 898 (97.6%) were included in the statistical analysis. There were 408 (45.4%) children in the constipated group and 490 (54.5%) in the non-constipated group. Most of the children with constipation (53.6%) had a maternal history of constipation compared with 21.4% of children without constipation (p < 0.05). More than half (53.2%) of the constipated children reported a lack of regularity in their toilet habits while 64.9 % of the children without constipation went to the toilet regularly. Toilet training started slightly earlier (at 3 years) in children without constipation (93.2%) than in those with the disorder (83.8%) (p < 0.05). At school, 57.4% of the children with constipation never used the toilet compared with 26.8% of those without constipation (p < 0.05). A total of 73.4% of children with constipation drank less than four glasses of water per day compared with 47.1% of those without constipation (p < 0.05). Consumption of vegetables and legumes in the diet was significantly lower in children with constipation than in those without (p < 0.05). The risk factors linked to childhood constipation found in this study were a familial history of constipation, irregular toilet habits, low dietary fiber contents and no fruit intake. The main preventive factors against constipation were water and vegetable consumption and training on the use of the toilet at school. Daily toilet training and dietary changes are needed to prevent constipation among children and to achieve regular defecation. This preventive intervention should be reinforced at school.

A new approach in the treatment of faecaloma of the colon

A 43-year-old woman presented with a 12-hour history of colicky abdominal pain increasing in severity and frequency. There was nausea but no vomiting. She last opened her bowels and passed flatus 48 hours before and otherwise had no history of constipation. There was no recent change in bowel habit and no blood or mucus per rectum. There had been no systemic disturbance and there was no family history of malignancy of the large intestine. The only surgical history was an appendicectomy performed at the age of 39 years. There was no relevant medical history. On clinical examination, the patient was apyrexial, normotensive, tachycardic and distressed. The abdomen was distended and tympanic but with no signs of peritonism. There was a palpable non-tender mass in the left lower abdominal quadrant. Her basic haematology and biochemistry were unremarkable; plain radiography of the chest showed a right basal pleural effusion with some patchy collapse at the right lung base. Erect and supine abdominal radiographs showed severe distension of the colon with only slight dilatation of the small intestine and multiple fluid levels. A computed tomograph examination of the abdomen and pelvis (Figure 1) showed free fluid in the pelvis and a small amount of inflammatory change in the fat of the abdominal cavity. There was extensive dilatation of the large intestine, with only slight dilatation of the small intestine. The appearances were consistant with a distal large bowel obstruction with an essentially competent ileocaecal valve. A large faecal sphere was shown in the sigmoid colon, which appeared rather thick-walled. There was no evidence of free peritoneal gas. A gastrografin enema showed a rounded filling defect in the upper sigmoid colon. Following a period of resuscitation, the patient was taken to theatre for colonoscopy to exclude a malignant or benign stricture and to attempt to disrupt the faecaloma to relieve the large bowel obstruction and avoid proximal and/or local perforation. The procedure was performed under general anaesthetic with the patient in the lithotomy position and with an arrangement to proceed to laparotomy should the colonoscopy procedure fail. Colonoscopy showed a faecal mass 55 cm from the anal verge, which proved resistant to all attempts at dislodging and disruption. A size 18F nasogastric tube (NGT) was inserted under direct vision through the anus and past the faecal obstruction (Figure 2). The proximal large intestine was successfully decompressed with the NGT. Liquid paraffin 200 ml was injected proximal to the faecaloma. In the post-procedure period, care was taken to keep the lumen of the NGT clear by an occasional injection of normal saline (30 ml hourly) to ensure free drainage. The catheter was left in situ. The patient was returned to theatre the next morning for a repeat colonoscopy. On this occasion the faecal mass was noted to be slowly showing signs of fragmentation and softening (Figure 3). Vigorous saline irrigation completely disrupted the mass with relief of the obstruction. There was an area of superficial ulceration at the site of the impaction but no evidence of a benign or neoplastic stricture. Subsequent colonoscopy 3 weeks later showed no abnormalities, with the superficial ulceration completely healed and benign biopsies. The patient remains well 6 months after the episode and has increased her fibre intake and now exercises regularly.

Primary and Secondary Nocturnal Enuresis: Similarities in Presentation

To determine the differences or similarities in the clinical presentation between patients with primary and secondary nocturnal enuresis. A total of 170 patients with nocturnal enuresis were assessed at a busy tertiary care pediatric voiding dysfunction clinic at the University of Oklahoma Health Sciences Center. Patients with primary nocturnal enuresis (PNE) were compared with patients with secondary nocturnal enuresis (SNE) for a variety of clinical features, including gender, age when first voiding on their own, age on presentation, infrequent voiding, frequent voiding, urgency, daytime wetting, nocturia, urinary tract infection, constipation, vesicoureteral reflux, attention-deficit/hyperactivity disorder, uroflow results, and ultrasound evidence of a postvoid residual. The only significant difference between the patients with PNE and those with SNE was in the prevalence of constipation. Constipation was significantly associated with PNE (74.59% vs 57.54%; odds ratio: 2.17; 95% confidence interval: 1.07-4.41). When adjusted for a history of constipation, the age at which a child began to void on his or her own became statistically significant. Patients with SNE started to void on their own at 2.13 years (SD: 0.61), an average of 0.22 years earlier than those with PNE, who started to void on their own at 2.35 years. PNE and SNE likely share a common pathogenesis. Symptoms of daytime voiding dysfunction are common in patients with PNE and SNE. Daytime voiding habits might influence how the central nervous system responds at night to a full or contracting bladder.

The ‘wandering’ abdominal lump: intussusception up to splenic flexure of an ileocaecal adenocarcinoma

A63-year old woman presented with a 4-day history of watery diarrhoea that was preceded by acute constipation. This was associated with intermittent colicky abdominal pain and one episode of fresh rectal bleeding on the previous day. Past history included haemorrhoids, cholecystectomy and reflux disease with no significant family history of cancer. She was seen in the accident and emergency department with a mass in right iliac fossa (RIF), which was managed as scabylous mass owing to the history of constipation. The next day, the woman came back with continued symptoms. On this occasion, she had a firm, mobile mass, now palpable in the left hypochondrium associated with abdominal distension. Rectal examination revealed an empty rectum. Haematological and biochemical tests including tumour markers were essentially normal. Plain X-ray of the abdomen revealed a partial small bowel obstruction and the patient was commenced on conservative management. The following day, although her symptoms resolved, the mobile abdominal mass was still persistent but now palpable in the RIF. An ultrasound examination of the abdomen and pelvis showed ‘a pseudo-kidney’ sign in the RIF (Figure 1). An unprepared contrast enema revealed a possible neoplastic lesion at the splenic flexure (Figure 2). Helical computed tomography showed a ‘bowel within bowel’ appearance in the left hypochondrium with proximally-dilated small bowel loops (Figure 3). She underwent a laparotomy, which showed a mobile, ileocaecal tumour with intussusception reaching the splenic flexure. There was no evidence of disseminated disease. An extended right hemicolectomy with en-bloc resection of the intussuscepting mass was performed. She had an uneventful postoperative period. Pathological examination of the resected specimen revealed a 4.0 cm × 4.5 cm × 3.0 cm nodular tumour of the ileocaecal valve with intussusception of a 6.0 cm length of terminal ileum. Histological examination showed a moderately well differentiated adenocarcinoma with clear resection margins (Figure 4). There was no nodal or vascular invasion. Pathological staging of the tumour was Dukes' A, T2 (tumor confined to bowel wall), N0 (no tumor deposit in 11 lymph node harvested) (0/11), M0 (no distance metastasis).

The association of constipation with childhood urinary tract infections

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

Life and loathes of a new doctor: Team colours

During my recent stint as a receiving preregistration house officer in surgery I spent several hours running around the accident and emergency department each day meeting the patients sent up by their general practitioners. “Acute complaints” ranged from the sublime--boils on bottom--to the ridiculous--three year history of constipation. While in the emergency department you work with colleagues from every specialty in the medical world, from rookie house officer to senior consultant. I found that as there is …

Childhood Constipation: Is There New Light in The Tunnel?

IntroductionConstipation is a common phenomenon in childhood worldwide. The symptoms vary from mild and short-lived to severe and chronic with faecal impaction and encopresis. Although our understanding of pathophysiology has grown rapidly in recent decades, the causes and management of constipation

Mortality due to constipation and short-segment Hirschsprung?s disease

We report a case of mortality secondary to constipation. A 12-year-old child with a history of constipation from the age of 9 years presented in moribund condition with intestinal obstruction secondary to idiopathic constipation. He underwent laparotomy and died within 24 h of operation. At postmortem there was no evidence of abnormalities of the enteric nervous system. A 2nd case of early neonatal death from Hirschsprung's disease is presented to demonstrate that short-segment aganglionosis can be detected at postmortem. Enterocolitis can rapidly progress and be fatal in short-segment Hirschsprung's disease.

RECURRENCE RISK IN INFANTS WITH URINARY TRACT INFECTIONS AND A NEGATIVE RADIOGRAPHIC EVALUATION

Infants with urinary tract infections (UTI) and no abnormality on radiological evaluation are usually discharged from urological followup but the natural history of these children is unknown. We evaluate the rate of and potential risk factors for UTI recurrence in this specific population. We reviewed retrospectively charts of children evaluated for first UTI before age 6 months between January 1996 and February 2001. Only patients with a normal ultrasound and voiding cystourethrogram were included in this study. A telephone questionnaire was administered to the parents, which inquired about the UTI, duration of breast-feeding, type of formula, family history of UTI, neurological problems, history of constipation or recurrent fevers, as well as social status. Chi-square test was performed for statistical analysis. We identified 264 children with UTIs, of whom 119 (45%) had a negative ultrasound and voiding cystourethrogram. Followup was available on 68 girls (81%) and 16 boys (19%) of the 119 children (71%). Of the 84 children 16 (19%) had recurrent UTI. Mean followup was 4.4 years (range 1.9 to 7.0). No factors had a statistically significant correlation for UTI recurrence. The p value for gender and history of undiagnosed fevers was 0.077 and 0.082, respectively. About 20% of children will have recurrent UTIs despite negative radiological evaluation. Although not statistically significant, there was a trend for an increased risk in girls and those with recurrent febrile illnesses. History of daytime dryness and/or constipation was not predictive of recurrent UTIs in our series.

Case 2: An infant with hypotonia and constipation

A five-month-old female infant was brought to the emergency department with a three-day history of poor feeding and a one-week history of constipation. There was no history of fever, irritability, vomiting, breathing difficulty, or exposure to sick contacts or medications. She was born after an uncomplicated full-term pregnancy and delivery, and her developmental milestones were attained appropriately. She was breastfed, and three weeks before admission, the parents introduced fruits and vegetables made by pureeing organic produce in a blender. On physical examination, she was afebrile, alert and in no respiratory distress. The neurological examination was notable for ptosis, decreased facial expression, weak cry, diffuse hypotonia, reduced muscle power and absent deep tendon reflexes. Initial investigations revealed normal serum electrolytes, calcium, magnesium, phosphate, venous blood gas, complete blood count, ammonium, lactate and creatine kinase. Cultures of blood, urine and cerebrospinal fluid were performed (and subsequently found to be negative), and a computed tomography scan of the head was normal. The infant required nasogastric tube feeding and suctioning of her oral secretions due to poor swallowing. An electromyogram was performed demonstrating an abnormality at the level of the neuromuscular junction; no improvement occurred with a dose of pyridostigmine bromide. Three days after presentation, increasing respiratory distress and right upper lobe collapse developed, requiring intubation, ventilation and transfer to the critical care unit. The clue to her diagnosis was found in her stool specimen.

Polyethylene glycol electrolyte solution (Isocolan) for constipation during pregnancy: an observational open-label study

To evaluate the efficacy of a polyethylene glycol electrolyte solution (PEG-4000) in pregnant women affected by constipation, 40 consecutive pregnant women from 6 to 38 weeks’ gestation were enrolled in this preliminary study. Constipation was defined as spontaneous evacuation less than four times a week or the presence of symptoms such as defecation pain, rectal urgency, tenesmus, anal injury, or abdominal pain. A PEG-4000 solution (Isocolan, also marketed in the United States as Golitely/Nulitely) was administered for 15 days at a dose of 250 mL by mouth once or twice a day. The number of bowel movements per week, the presence or absence of liquid stools, tenesmus, urgency, defecation pain, anal lesions, and abdominal pain were evaluated before and after 15 days of treatment. Treatment with PEG-4000 significantly increased the evacuation episodes per week (from 1.66 ± 0.48 to 3.16 ± 1.05; P < .01), and constipation was resolved in 27 of 37 women (73%). Defecation pain, anal injury, and abdominal pain significantly improved after PEG-4000 administration. Improvement occurred in both patients with new-onset constipation during pregnancy as well as patients with a history of constipation before pregnancy. These preliminary findings indicate that PEG-4000 may be an effective choice for the treatment of constipation during pregnancy.

P0478 QUALITY OF LIFE IN CHILDHOOD CONSTIPATION: A CASE CONTROL STUDY

Introduction: The aim of this study was to determine the effect of chronic constipation on quality of life (QoL) in children and adolescents. Methods: From 10/ 2002 to 11/ 2003, 224 children, (140 male, aged 10.6 +/− 2.9 yrs) and 224 parents were administered a health related QoL tool (PedsQL) in pediatric gastroenterology and general pediatric practices at time of initial evaluation. The PedsQL consists of 4 measures (physical, emotional, social, school) and are scored on a 0 (poor) to100 (best) scale. Children and their families with constipation (CONS, n=80) were compared to control patients: inflammatory bowel disease (IBD, n=42), gastroesophageal reflux disease (GERD, n=56), and healthy children (HC, n=46). Children with constipation had associated abdominal pain (89%) and fecal soiling (29%). Scores were also compared between children and parents to assess differences in perception. Results: CONS children had overall lower quality of life self-reported scores compared to controls: IBD (70 vs. 84, p<0.05); GERD (70 vs. 80, p <0.05); HC (70 vs. 88, p<0.05). There was no difference in QoL between CONS children with or without fecal soiling (70 vs. 74, p=ns). CONS children reported lower physical scores: IBD (75 vs. 85, p<0.02); GERD (75 vs. 85, p<0.05); HC (75 vs. 87, p<0.05). Parents of CONS children reported overall lower quality of life scores compared to their own children’s self reported scores: (61 vs. 70, p<0.05). CONS children presented with longer duration of symptoms versus controls (43.8 months vs. 14.2 months, p<0.001). Duration of symptoms for CONS was associated with lower parent reported scores (p<0.002). Families of CONS children reported a positive family history of constipation and/or irritable bowel syndrome more than controls (40.2% vs. 8.9%, p<0.05). Conclusion: At time of initial evaluation, children with chronic constipation have a lower QoL as compared to those who have IBD and GERD. Self-reported lower QoL scores maybe a reflection of associated abdominal pain and painful defecation leading to impaired physical ability. Parents perceptions of low QoL in their children likely represent concerns with duration of symptoms and family members that have similar complaints. Increased recognition by practioners on the lowered QoL and high level of parental concern in pediatric chronic constipation may lead to more prompt and aggressive management as is seen in children with IBD and GERD. Disease specific health related QOL tools need to be created for better evaluation and assessment of therapeutic intervention.

Chronic functional constipation in adolescents: clinical findings and motility studies

Objective To evaluate the clinical findings and colonic transit time in adolescents with chronic functional constipation. Methods Forty-eight consecutive adolescents with chronic functional constipation referred to the Gastroenterology Service at the Hospital de Clínicas de Porto Alegre, Brazil were studied. Clinical parameters were assessed using a questionnaire. Total and segmental colonic transit time were measured with radiopaque markers. Results Mean age at first visit was 14 ± 2 years, and age at onset of constipation was 6 ± 4 years; 90% of patients depended on laxatives, and 86% on intermittent enemas; 76% had a family history of constipation. There was no statistical difference in the amount of daily fiber ingested by patients and controls. Measurements of colonic transit time revealed that 60% of patients had slow transit constipation, 13% had pelvic floor dysfunction, 10% had slow transit constipation associated with pelvic floor dysfunction, and 17% had a normal colonic transit time. Decreased frequency of evacuation and palpable abdominal fecal mass were significantly associated with slow transit constipation. Conclusions Functional constipation in adolescence consists of a heterogeneous group of colonic functional disorders. The identification of these different functional disorders in adolescents will guide specific treatment, which may prevent the progression of this symptom into adult life.

Epidemiology of constipation in North America: a systematic review.

The aim of this study was to systematically review the published literature regarding prevalence, risk factors, incidence, natural history, and the effect on quality of life of constipation in North America. A computer-assisted search of MEDLINE, EMBASE, and Current Contents databases was performed independently by two investigators. Study selection criteria included the following: (1) North American population-based sample of adults with constipation; (2) publication in full manuscript form in English; and (3) report on the prevalence, incidence, and natural history of constipation or impact of constipation on quality of life. Eligible articles were reviewed in a duplicate, independent manner. Data extracted were compiled in tables and presented in descriptive form. The estimates of the prevalence of constipation in North America ranged from 1.9% to 27.2%, with most estimates from 12% to 19%. Prevalence estimates by gender support a female-to-male ratio of 2.2:1. Constipation appears to increase with increasing age, particularly after age 65. No true population-based incidence studies or natural history studies were identified. In one cohort, 89% of patients with constipation still reported constipation at 14.7 months follow-up. From limited data, quality of life appears to be diminished by constipation, but the clinical significance of this is unclear. Constipation is very common, as approximately 63 million people in North America meet the Rome II criteria for constipation. Minimal data are available regarding incidence, natural history, and quality of life in patients with constipation. Effort should be expended toward the study of these topics, particularly in the elderly, who are disproportionately affected by this condition.

Giant rectosigmoid lithobezoar in a child: four significant clues obtained from history, abdominal palpation, rectal examination and plain abdominal X-ray

Colonic bezoars, especially lithobezoars are very rare findings in children. We report a 6-year-old girl with a giant rectosigmoid lithobezoar. History of constipation and pica, abdominal palpation of intraluminal fecoliths, a prickly hard mass found on rectal examination and plain abdominal X-ray showing radioopaque innumerable calculi scattered in colon and congregated in rectosigmoid region provide important clues for diagnosis of colonic lithobezoar.

Simple data from history and physical examination help to exclude bowel obstruction and to avoid radiographic studies in patients with acute abdominal pain.

To assess the value of plain abdominal radiographs and of data from the medical history and physical examination in the diagnosis of acute abdominal pain in general and of bowel obstruction in particular. Prospective study. 4 university and 2 community hospitals, Germany. 1254 patients with acute abdominal pain lasting less than 7 days, and with no history of abdominal injury including surgery. Standardised and structured medical history and physical examination, study of results of plain abdominal radiographs. Positive predictive value and sensitivity of clinical variables and abdominal film with respect to the diagnosis at discharge. 48 patients (3.8%) had bowel obstruction. 704 patients (56.1%) had plain abdominal films taken at the time of initial presentation. 111 studies (15.8%) showed important findings leading to diagnosis or immediate treatment, 455 (64.7%) showed unimportant or no findings. In 138 (19.6%) results of films were not reported. 16 of 45 single variables were of help in diagnosing bowel obstruction. The six with the highest sensitivity were distended abdomen, increased bowel sounds, history of constipation, previous abdominal surgery, age over 50, and vomiting. If only patients presenting with any two of these symptoms had had radiographs taken, 300 (42.6%) could have been avoided without loss in diagnostic accuracy. A considerable number of plain abdominal films taken for patients with acute abdominal pain could be avoided by focusing on clinical variables relevant to the diagnosis of bowel obstruction.

Predictors of response to biofeedback treatment in anal incontinence.

Biofeedback is considered an effective treatment for anal incontinence, but a substantial proportion of patients fails to improve. The purpose of this study was to identify the key predictors of outcome. We retrospectively analyzed the clinical and physiologic data of 145 patients consecutively treated in our unit for anal incontinence by biofeedback. Clinical evaluation was performed by means of a structured questionnaire that included previous history, symptoms of incontinence, and bowel habit. Anorectal evaluation measured anal pressure profiles, neural reflexes, defecatory dynamics, rectal compliance, and rectal sensitivity. Biofeedback treatment was performed by a manometric technique with reinforcement sessions scheduled every three months and daily exercising at home. Six months after the onset of biofeedback treatment the clinical response was evaluated as good (improvement of incontinence) or poor (no improvement or worsening). Of 126 patients (104 female; age range, 17-82 years) with at least six-month follow-up, 84 percent had a good response to treatment. By univariate analysis, several factors, such as age, history of constipation, abnormal defecatory maneuver, and rectal compliance, were significantly related to treatment response, but by multivariate logistic regression only age and defecatory maneuver were independent predictors of the response. The association of both factors provided the best sensitivity and specificity; 48 percent of patients younger than age 55 years and with abnormal defecatory maneuver had negative response to treatment, whereas 96 percent of patients age 55 years or older with normal defecatory maneuver had a positive response. In patients with anal incontinence scheduled for biofeedback treatment, potential alterations of defecation should be first searched for and corrected, particularly in younger patients.

Cystic duct-duodenal fistula: an unusual complication of laparoscopic cholecystectomy

A 47 year-old woman with a past medical history significant for hepatitis C presented 11 days after undergoing a laparoscopic cholecystectomy. The patient complained of acute right upper quadrant abdominal pain associated with nausea and vomiting. The patient denied any history of constipation, diarrhea, bright red blood per rectum, melena, fever, or chills. The patient's admission laboratory values were significant for total bilirubin of 2.0 mg/dL, alkaline phosphatase of 49 U/L, AST of 317 U/L and ALT of 141 U/L with WBC of 10.3 K/CMM. The physical exam was only significant for right upper quadrant tenderness. The patient was afebrile and clinically stable. She was empirically started on IV antibiotics. CT of the abdomen and pelvis revealed surgical clips from the cholecystectomy and a small residual postoperative collection in the gallbladder fossa with no evidence of intra or extrahepatic biliary ductal dilatation. Hospital day two revealed changes in the laboratory values with total bilirubin of 4.4 mg/dL, alkaline phosphatase of 245 U/L, AST of 127 U/L and ALT of 89U/L. The patient subsequently underwent a HIDA scan revealing findings consistent with intrahepatic cholestasis versus partial common bile duct obstruction. The patient underwent an ERCP which revealed extravasation of contrast in the region of the cystic duct with two small filling defects in the common bile duct representing stones. After biliary sphincterotomy, the stones were extracted and a 7 Fr 7cm long straight plastic stent was successfully placed in the common bile duct. The patient was continued on antibiotics. One month later the patient returned for an ERCP to remove the biliary stent and to assess for residual bile duct stones. A single 4mm stone was identified and removed with a balloon from the common bile duct. On completion, a cholangiogram revealed a communication between the cystic duct and the duodenum. This case represents an unusual complication of laparoscopic cholecystectomy. The cytic duct to duodenum fistula was originally unnoticed because of the concomitant cystic duct leak. However, once the leak resolved the fistula became apparent.

Precipitants of constipation during early childhood.

Childhood constipation is a common problem, accounting for 3% of visits to pediatric clinics and 30% of visits to pediatric gastroenterologists. Estimates of the prevalence of childhood constipation vary from 0.3% to 28% with younger children being affected most often. We were unable to find any studies that specifically examine the causes of constipation in young children. Our objective of the study was to determine precipitants to constipation during early childhood. Findings from 125 families visiting their primary care physician for the first time with a child aged between 2 and 7 years with the complaint of constipation were compared with findings from 95 children between 2 and 7 years without any history of constipation. Parents answered questions concerning family history, toilet training, and bowel habits. Parents of constipated children were asked to describe events that occurred during the 3 months before the onset of constipation and whether these events contributed to the child's constipation. The age and sex of children who did and did not suffer from constipation were comparable (P > .3). When compared with control children, constipated children were no more likely to have a parent (30% vs 40%, P = .14) or sibling (17% vs 14%, P = .54) with a history of constipation. Constipated children did not begin toilet training earlier than did control children (28 +/- 7 vs 27 +/- 6 months, P = .30). When compared with parents of control children, parents of constipated children reported more difficulties with toilet training (P < .001). Parents of constipated children indicated their children had more difficult and more painful defecation experiences than did parents of control children (P < .001), and constipated children were more likely to express worry about future painful defecation than were control children (P < .001). Parents of constipated children described a number of events that occurred before the onset of constipation; however, they did not consider many of the events important contributors to the constipation. Painful defecation was the event most often reported as causing the constipation. Painful defecation is the primary precipitant of constipation during early childhood. Parents should be counseled to be attentive to such experiences and taught to intervene quickly to lessen the risk that their child will develop persistent constipation or fecal soiling.

Paraneoplastic cerebellar degeneration with ovarian endometroid carcinoma

Paraneoplastic cerebellar degeneration with ovarian endometroid carcinoma