Incomplete Movement Research Articles

The magnitude of chronic constipation and associated factors among type 2 diabetic patients in Harar, Eastern Ethiopia

BackgroundConstipation, which affects 16% of adults worldwide, is a chronic health problem characterized by unsatisfactory frequency of bowel movements, causing pain, bloating or incomplete bowel movements. The study aims to assess the magnitude of chronic constipation and associated factors among T2DM patients attending the endocrinology outpatient clinic at Hiwot Fana Comprehensive Specialized University Hospital from January 1 to May 30, 2023.MethodsHospital-based cross-sectional study design was carried out to assess the magnitude and associated factors of chronic constipation among T2DM patients at Hiwot Fana Comprehensive Specialized University Hospital. Using a single population formula 300 T2DM patients were enrolled in this study. The data was analyzed by using the Epi-Data 4.6 and SPSS version 25. Descriptive, bivariate, multivariate, and logistic regression were used. P < 0.05 was used to declare association.Results300 T2DM patients participated in this survey. Of these 137 (45.7%) were male and 163 (54.3%) were female and the mean age was 58.57 ± 11.09 SD years, the range from 35 to 85 years. The prevalence of constipation was 73 (24.3%) (95% CI: 0.196–0.296). Education status above high school (AOR: 0.151.95% CI: 0.032–0.718), less than 7 h of sleep per day (AOR: 12.39.95% CI: 2.712–56.69), frequent depression (AOR: 6, 84, 95% CI: 2.639–17.743), parents with constipation (AOR: 6.843.95% CI: 2.639–17.743), daily water intake < 1300 ml (AOR: 4.760.95% CI: 1.146–19.773), TAG levels below 150 mg/dl (AOR: 0.050, 95% CI: 0.015–0.166), HbAlc between 6 and 7% (AOR: 0.013.95% CI: 0.001–0.132) ,HbAlc between 7.1 and 8% (AOR: 0.006, 95% CI: 0.001–0.067), and LDL levels were significantly associated with chronic constipation in T2DM patients.ConclusionsThe prevalence of chronic constipation was considerable in T2DM patients. Education level above high school, less than 7 h of sleep per day, frequent depression, parents with constipation, daily water intake < 1300 ml, TAG and HbAlc play a significant role in the development of chronic constipation in T2DM patients. T2DM patients can reduce the extent of constipation by treating the above problem in a timely and timely manner.

High-Resolution Anorectal Manometry and Balloon Expulsion Test Outcomes in Functional Constipation: A Comparative Study.

BACKGROUND Functional constipation can occur in children and adults and consists of difficult or infrequent bowel movements, painful defecation, or the sensation of incomplete bowel movement, and it can be idiopathic. This study aimed to compare the findings from high-resolution anorectal manometry (HRAM) and the balloon expulsion test (BET) in 360 patients with functional constipation and 73 healthy volunteers. MATERIAL AND METHODS In total, 360 patients with functional constipation and 73 healthy volunteers underwent HRAM and BET in our hospital from January 2017 to December 2023. We collected the general data of all participants and surveyed the defecation symptoms of patients with functional constipation. RESULTS Our study showed no significant correlation between HRAM results and age in healthy volunteers, while men had a higher residual anal pressure (P=0.022), higher anal squeeze pressure (P=0.020), and lower rectoanal pressure gradient than women (P=0.017). Using logistic regression analysis, it was concluded that sex (OR=2.880, 95% CI [1.654,5.015], P=0.000) and sensation of incomplete evacuation (OR=1.892, 95% CI [1.023,3.500], P=0.042) affected the occurrence of dyssynergic defecation. The specificity of BET in diagnosing dyssynergic defecation was 81.89%, while that of HRAM was 52.78%. CONCLUSIONS This observation provides normal values for anorectal pressures by HRAM. HRAM and BET are effective methods for assessing functional constipation. Being male and having sensation of incomplete evacuation are risk factors for dyssynergic defecation. The specificity of BET for diagnosing dyssynergic defecation was higher than that of HRAM.

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.

Predictors of Low Anterior Resection Syndrome after Long-Course Chemoradiation for Locally Advanced Rectal Cancer

Low anterior resection syndrome (LARS) describes disordered bowel function including tenesmus, frequent, clustered, incomplete, urgent or incontinent bowel movements. The impact of clinical and radiation dosimetric factors on LARS score is unknown. We aimed to evaluate the radiation plans for patients who received long course chemoradiation (LC-CRT) to identify potential dosimetric predictors of LARS. We identified patients with rectal cancer treated with LC-CRT (50.4Gy in 28 fractions) at our institution from 2016-2020 who were alive and without disease. As a part of a larger patient-reported outcome survey, we obtained the Low Anterior Resection Syndrome Score (LARS) for patients without an ostomy at the time of the survey. We utilized clinical and dosimetric variables in a multivariate analysis including age at LC-CRT, body mass index, sex, distance of the tumor from the anal verge (AV), threatened mesorectal fascia (MRF) on staging imaging, T-stage, N-stage, receipt of surgery (vs non-operative management (NOM), radiation technique (3DCRT vs VMAT), mean dose and D0.03ccs for the anal canal (defined as 4cm from the anal verge) and D0.03cc, V30Gy and V45Gy for the small bowel loops. We then created a multiple linear regression model to predict LARS using P>.20 on univariate testing. Of 110 patients treated with preoperative LC-CRT and who did not have an ostomy, 57 responded (51.8%). The median [interquartile range (IQR)] interval from completion of LC-CRT to survey completion was 38.4 months [26.3-48.9]. Thirty-four patients (60%) were men, the median [IQR] BMI was 28 [24-31.9], the median [IQR] distance of the tumor to the anal verge was 7cm [5-10], 40 (70%) had T3 tumors, 7 (12%) had T4 tumors, 45 (79%) were N+. Forty-one patients (72%) had surgery following LC-CRT, and 16 (28%) had non-operative management. 3D conformal technique was used for 47 (82%) and VMAT used for 10 patients (18%). The median [IQR] LARS score was 32 [24-38] with 35 patients (61%) classified as Major LARS (LARS score = 30-42). On multiple linear regression modeling (Table), only receipt of surgery significantly predicted for higher (worse) LARS score. In our cohort, patients who received surgery after LC-CRT had a significantly higher LARS score. Of the dosimetric parameters tested, D0.03ccs was the best predictor and could potentially be significant with a larger number of patients. Further work is needed to improve bowel function and quality of life for patients treated with LC-CRT for rectal adenocarcinoma.

Intermittent colonic exoperistalsis for chronic constipation in spinal cord-injured individuals. A long-term structured patient feedback survey to evaluate home care use

Study designStructured patient feedback survey evaluating real-world home care use.ObjectivesTo assess the long-term effectiveness, tolerability, and satisfaction with the intermittent colonic exoperistalsis (ICE) treatment device MOWOOT in spinal cord-injured (SCI) individuals with chronic constipation.SettingFour specialized German hospitals.MethodsSCI individuals with chronic constipation were invited to use MOWOOT 10–20 min daily and answer a questionnaire about their bowel situation before treatment (feedback 1, F1) and after ≥10 months of use (feedback 2, F2). Collected variables were device use, bowel function effectiveness, chronic constipation symptoms, concomitant use of laxatives and evacuation aids, and satisfaction with bowel function and management, which were compared between time points. At F2, participants reported efficacy, tolerability/side effects, and ease of use.ResultsEleven participants used the device for a mean (SD) of 13.27 (4.03) months. From F1 to F2, mean time per evacuation decreased by 24.5 min (p = 0.0076) and the number of failed attempts to evacuate/week, by 1.05 (p = 0.0354) with a tendency toward increased bowel movements and softer stool consistency, and decreased incomplete bowel movements. Participants experienced decreased difficulty/strain (p = 0.0055), abdominal pain (p = 0.0230), bloating (p = 0.0010), abdominal cramps (p = 0.0019), and spasms (p = 0.0198), without significant changes in the use of laxatives and evacuation aids. Satisfaction with bowel function and management improved (p = 0.0095) and more participants reported being very satisfied/satisfied (p = 0.0300). Most reported tolerability, efficacy, and ease of use as very good/good.ConclusionLong-term in-home ICE treatment improved bowel function and chronic constipation symptoms in SCI individuals, providing clinical benefits to this population.Sponsorship (MOWOOT devices lending)4 M Medical GmbH, Norderstedt, Germany.

Partially-hydrolyzed guar gum plus simethicone in patients with irritable bowel syndrome: a real-life survey

BACKGROUND: Irritable bowel syndrome (IBS) is a common medical condition characterized by different phenotypes. Constipation and excessive gas production are prevalent in IBS patients, but diarrhea also frequently affects them. Conventional therapies do not modify the IBS natural history. However, a new medical device containing partially hydrolyzed gum guar (PHGG) and simethicone is currently on the market. The present real-life survey investigated this product in IBS patients.METHODS: A large number of Greek gastroenterologists (N.=114) enrolled an ample sample of IBS patients. For three months, patients took the compound (PHGG 5 g and simethicone 100 mg) one sachet daily. A questionary evaluated IBS symptoms (abdominal pain, distention, flatulence, constipation, diarrhea, urgent bowel movement, and incomplete bowel movement) scored on a seven-level scale. Patients were evaluated at baseline and after 4, 8, and 12 weeks.RESULTS: The survey included 1190 patients (683 females and 507 males; mean age of 45.8 years). The medical device significantly reduced all symptoms (P<0.001). Constipation and gas-related symptoms (flatulence, distention, and abdominal pain) were the IBS complaints that obtained the highest reduction. The treatment was well tolerated and received high compliance (more than three-quarters took the product for more than 90 days as satisfied).CONCLUSIONS: This real-life survey demonstrated that PHGG plus simethicone could be suitable for managing IBS patients.

Guar fibers and simethicone: a winning synergy for the treatment of IBS. An observational comparative study of irritable bowel symptoms

BACKGROUND: Irritable bowel syndrome (IBS) affects a substantial quote of adult subjects. Alternate bowel movements and flatulence are the prevalent symptoms in IBS patients. A new medical device containing partially hydrolyzed gum guar (PHGG) and simethicone is presently available also in Italy. The present preliminary experience explored its usefulness in IBS patients.METHODS: After a negative colonoscopy, IBS patients were subdivided into two groups: Group A took a two-month cycle of the MD, whereas Group B did not take the medical device (MD). However, all patients had a standard management (diet and medications). The Visual Analogue Scale (VAS) measured the perception of symptom severity (abdominal pain, distention, flatulence, constipation, diarrhea, and incomplete bowel movement). Patients were evaluated at baseline and after 4 and 8 weeks.RESULTS: This preliminary experience included 50 patients (30 females and 20 males; mean age of 45.1 years). The medical device significantly reduced abdominal pain, distension, and flatulence in comparison with standard therapy alone (P<0.001, 0.042, and <0.01, respectively) after 8 weeks. Interestingly, abdominal distension was significantly improved just after 4 weeks (P=0.031). The treatment was well tolerated.CONCLUSIONS: The current preliminary experience showed that PHGG plus simethicone may represent an effective and safe add-on option in managing IBS patients. Therefore, this MD could be considered in the IBS management, mainly concerning the pathophysiological role exerted by intestinal barrier alterations and the microbiota-host interaction.

Оцінка якості життя в дітей із поєднанням функціональної диспепсії та синдрому подразненого кишечника

The prevalence of functional gastrointestinal disorders (FGID) in children ranges from 19% to 40%, depending on age. The combination of functional dyspepsia (FD) and irritable bowel syndrome (IBS) is detected in 15-44.6% of patients with FGID. Their course is characterized by more pronounced clinical symptoms: abdominal pain, which is combined with flatulence, nausea, difficulty in defecation or diarrhea, impaired stool consistency, feeling of incomplete bowel movement and deterioration in quality of life. Purpose - to assess the quality of life in children with a combination of FD and IBS to optimize therapy. Materials and methods. The study included 44 children with a combination FD and IBS aged 6 to 18 years (the main group). The control group consisted of 30 practically healthy children of the same age. Diagnoses of FD and IBS were made on the basis of clinical symptoms according to the Rome criteria IV (2016). A survey of children and their parents was conducted using the international questionnaire PedsQL™ 4.0 (Pediatrics Quality of Life Inventory), which is one of the most popular questionnaires in the world, has proven to be a simple, reliable, sensitive method for studying the quality of life of healthy and sick children of different ages (2-17 years). The questionnaire has general scales, but there is a separate version of the PedsQL™4.0 Generic Core Scales, which describes physical, emotional, social, and role functioning. Results. It was established that indicators of physical, emotional, social and school functioning and, as a result, indicators of psychosocial functioning and the overall quality of life assessment are significantly reduced in children with combined FD and IBS compared to the control group. Conclusions. Quality of life studies are an important component of a comprehensive assessment of the overall condition of a child with comorbid FD and IBS to prevent the development of these disorders, to improve quality of life, to reduce the time and cost of assessment, and to optimize therapy. The research was carried out in accordance with the principles of the Declaration of Helsinki. The Local Ethic Committee of the institution specified in the work adopted the study protocol. Informed consent of the children’s parents was obtained for the research. No conflict of interests was declared by the authors.

Multicenter prospective study showing a high gastrointestinal symptom burden in cystic fibrosis

Background and aimsPeople with cystic fibrosis (PwCF) suffer from gastrointestinal (GI) symptoms affecting their quality of life (QOL). Despite the relevance of GI symptoms to the overall health of PwCF, a paucity of studies only have comprehensively assessed the prevalence, severity and QOL of GI symptoms in both children and adults with Cystic Fibrosis (CF). MethodsEligible participants ≥2 years of age across 26 US CF centers were followed for 4 weeks. Three validated GI electronic patient-reported outcome measures (ePROMs) with a recall period of 2 weeks and a stool-specific questionnaire were administered weekly over four weeks. Total and domain scores of ePROMs were evaluated overall and in subgroups using linear mixed-effect models. ResultsOf 402 enrolled, 58% were ≥ 18 years of age (52% male). The mean (SD) of the total score for PAC-SYM was 0.52 (0.55), for PAGI-SYM was 0.63 (0.67), and for PAC-QOL was 0.67 (0.55). For specific ePROM questions, prevalence of moderate to very severe symptoms were as follows: straining (20.3%), fullness (18.3%), incomplete bowel movements (17.1%), bloating (16.4%), distension (16.4%), abdominal pain (upper-5.1%, lower-7.5%). Comparing participants ≥18 versus <18, a higher prevalence of bloating (63.7% versus 27.3%), lower abdominal pain (39.8% vs 26.2%), stomach fullness (75.6% versus 56.2%), and abdominal distension (60.2% versus 34.9%) was found. Both age groups reported high treatment dissatisfaction as measured with PAC-QOL, mean 1.39 (95% CI: 1.30, 1.47). ConclusionGI symptoms were reported in all age ranges irrespective of gender, with higher prevalence observed amongst older and female subgroups. Dissatisfaction with GI targeted treatments were reported in a large proportion of participants despite therapy, highlighting an unmet need for clinical interventions. ClinicalTrials.govNCT03801993

Pathology of the enteral nervous system in children with anorectal malformations

Introduction. The review describes a pathology of the enteric nervous system (ENS) in patients with anorectal malformations (ARM). Functional gastrointestinal disorders in children with APM after anorectoplasty (bowel impaction, constipation and fecal incontinence) is an actual problem in pediatric surgery.Materials. Literature searches was done in Scopus, PubMed, Google Scolar and eLibrary databases.Results. Reasons of unsatisfactory outcomes after the treatment are various: underdevelopment of pelvic floor muscles, low sacral ratio, redo procedures. In recent years, a certain attention has been paid to the pathology of enteric nervous system in the structure of ARM pathologies, since the intrauterine migration of neuroblasts and formation of the intestinal neuronal network are inextricably linked with the hindgut anlage. At the same time, literature on ENS state in children with anorectal transformations is not numerous and scattered. Impairments in ENS development in patients with ARM, by different authors, ranges from 3.5 to 94%. By findings of multicenter trials, the incidence of true agangliosis (Hirschsprung’s disease) in children with ARM is low (up to 3.4%).Conclusion. ARM is a group of congenital malformations of the anorectal region. The quality of life of such patients often worsens after surgery due to functional disorders, such as incomplete bowel movements, constipation and fecal incontinence. Further researches are needed to identify changes in ENS in patients with anorectal malformations in order to correct management tactics and improve their quality of life after surgery.

Diarrhea-predominant irritable bowel syndrome of spleen deficiency and damp excess treated with fire needling therapy with filiform needle and acupoint application therapy: a randomized controlled trial

Diarrhea-predominant irritable bowel syndrome of spleen deficiency and damp excess treated with fire needling therapy with filiform needle and acupoint application therapy: a randomized controlled trial

A novel digital approach to describe real world outcomes among patients with constipation

Understanding day-to-day variations in symptoms and medication management can be important in describing patient centered outcomes for people with constipation. Patient Generated Health Data (PGHD) from digital devices is a potential solution, but its utility as a tool for describing experiences of people with frequent constipation is unknown. We conducted a virtual, 16-week prospective study of individuals with frequent constipation from an online wellness platform that connects mobile consumer digital devices including wearable monitors capable of passively collecting steps, sleep, and heart rate data. Participants wore a Fitbit monitoring device for the study duration and were administered daily and monthly surveys assessing constipation symptom severity and medication usage. A set of 38 predetermined day-level behavioral activity metrics were computed from minute-level data streams for steps, sleep and heart rate. Mixed effects regression models were used to compare activity metrics between constipation status (irregular or constipated vs. regular day), medication use (medication day vs. non-medication day) and the interaction of medication day with irregular or constipation days, as well as to model likelihood to treat with constipation medications based on daily self-reported symptom severity. Correction for multiple comparisons was performed with the Benjamini–Hochberg procedure for false discovery rate. This study analyzed 1540 enrolled participants with completed daily surveys (mean age 36.6 sd 10.0, 72.8% female, 88.8% Caucasian). Of those, 1293 completed all monthly surveys and 756 had sufficient Fitbit data density for analysis of activity metrics. At a daily-level, 22 of the 38 activity metrics were significantly associated with bowel movement or medication treatment patterns for constipation. Participants were measured to have fewer steps on irregular days compared to regular days (−200 steps, 95% CI [−280, −120]), longer periods of inactivity on constipated days (9.1 min, 95% CI [5.2, 12.9]), reduced total sleep time on irregular and constipated days (−2.4 min, 95% CI [−4.3, −0.4] and −4.0 min, 95% CI [−6.5, −1.4], respectively). Participants reported greater severity of symptoms for bloating, hard stool, difficulty passing, and painful bowel movements on irregular, constipation and medication days compared to regular days with no medication. Interaction analysis of medication days with irregular or constipation days observed small increases in severity compared to non-medication days. Participants were 4.3% (95% CI 3.2, 5.3) more likely to treat with medication on constipated days versus regular. No significant increase in likelihood was observed for irregular days. Daily likelihood to treat increased for each 1-point change in symptom severity of bloating (2.4%, 95% CI [2.0, 2.7]), inability to pass (2.2%, 95% CI [1.4, 3.0]) and incomplete bowel movements (1.3%, 95% CI [0.9, 1.7]). This is the first large scale virtual prospective study describing the association between passively collected PGHD and constipation symptoms and severity at a day-to-day granularity level. Constipation status, irregular or constipated, was associated with a number of activity metrics in steps and sleep, and likelihood to treat with medication increased with increasing severity for a number of constipation symptoms. Given the small magnitude of effect, further research is needed to understand the clinical relevance of these results. PGHD may be useful as a tool for describing real world patient centered experiences for people with constipation.

Vliv synbiotika ColonFit na symptomy pacientů se syndromem dráždivého tračníku, funkční zácpou a funkčním průjmem

Background: Supplementary dietary fiber and probiotics may improve bowel symptoms due to changes in microbiome and fermentation. The aim of the study was the evaluation of symbiotic with psyllium, ColonFit, in patients with functional colonic diseases. Patients and Methods: A prospective observational study in patients with irritable bowel syndrome, functional constipation and functional diarrhea for a 4-week intake of ColonFit 10 g daily. The type and severity of bowel symptoms (scale 1–5), number and consistency of stool and quality of life features were analyzed in subgroups according to dominant initial symptoms. Results: Complete data were available from 110 patients (mean age 49.9 ± 15.3 years, 58.2% females). Constipation related symptoms were predominant in 46 (41.8%) patients, diarrhea in 28 (25.5%) and mixed type in the rest. The symptoms in constipation predominant group were more severe than in others. The significant change in softening of stool consistency (from 1.9 to 3.8 in Bristol stool scale; p &lt; 0.001), an increase in spontaneous bowel movements (from 3.1 to 5.6× weekly; p = 0,001) and reduction of incomplete bowel movements of 40% and abdominal pain of 42% were observed in constipated patients. The reduction in a number of bowel movement per week (from 17.8 to 13.6; p = 0.001) and improvement of abdominal cramps by 27% and reduction of dietary limitations by 30% were recorded in diarrhea subgroup. The beneficial effect lasted for a two-week follow up after the discontinuation of ColonFit use. Conclusion: The ColonFit use was most beneficial in constipated patients. The improvement of several symptoms was observed in other subtypes of irritable bowel syndrome without any worsening of troubles. The use of the combination of psyllium, inulin and probiotics may offer an effective alternative for the management of functional bowel diseases.

The Effectiveness of Synbiotic Preparation Containing Lactobacillus and Bifidobacterium Probiotic Strains and Short Chain Fructooligosaccharides in Patients with Diarrhea Predominant Irritable Bowel Syndrome-A Randomized Double-Blind, Placebo-Controlled Study.

The purpose of the randomized double-blind placebo-controlled trial was to assess the effectiveness of synbiotic preparation containing probiotic Lactobacillus rhamnosus FloraActive™ 19070-2, Lactobacillus acidophilus DSMZ 32418, Bifidobacterium lactis DSMZ 32269, Bifidobacterium longum DSMZ 32946, Bifidobacterium bifidum DSMZ 32403 and fructooligosaccharides in adult patients with diarrhea-dominant IBS (IBS-D). The study included eighty patients with moderate and severe IBS-D who were randomized to receive synbiotics or placebo for eight weeks. Finally, a total of sixty-eight patients finished the study. The primary endpoints included the assessment of the symptoms’ severity with IBS symptom severity scale (IBS-SSS), an improvement of IBS global symptoms with Global Improvement Scale (IBS-GIS) and adequate relief of symptoms after four and eight weeks of therapy. Secondary endpoints, which were collected by telephone interviewers three times a week included the assessment of individual IBS symptoms and adverse events. Synbiotic treatment in comparison to placebo significantly improved IBS-GIS (p = 0.043), and IBS-SSS score inducing a decrease in the total IBS-SSS (p = 0.042) and in domain-specific scores related to flatulence (p = 0.028) and bowel habit (p = 0.028) after four and eight weeks. Patients treated with synbiotics reported in weekly observations a significant amelioration in a feeling of incomplete bowel movements, flatulence, pain, stool pressure and diarrheal stools compared to those receiving placebo. There were no differences in adverse events between both groups. Concluding, the multi-strain synbiotic preparation was associated with a significant improvement in symptoms in IBS-D patients and was well-tolerated. These results suggest that the use of synbiotics offers a benefit for IBS-D patients. [Clinicaltrials.gov NCT04206410 registered 20 December 2019].

Visceral Mobilization and Functional Constipation in Stroke Survivors: A Randomized, Controlled, Double-Blind, Clinical Trial

IntroductionChronic functional constipation is common among stroke survivors. Osteopathy is an effective form of treatment as it acts on the structures surrounding the bowels that may have lost their normal capacity of resilience. The aim of the present study was to evaluate the effect of visceral mobilization on symptoms of functional constipation and static balance in stroke survivors.Materials and methodsThirty stroke survivors met the eligibility criteria and were randomly allocated to a group physical therapy and visceral manipulation or a group physical therapy. Both groups were submitted to conventional physical therapy. The group physical therapy and visceral manipulation was also submitted to visceral mobilization (sphincter inhibition and mobilization of the large intestine), whereas the group physical therapy was submitted to a sham procedure (superficial touching over the intestines). Evaluations were conducted prior to the intervention, immediately after the first intervention session and one week after the end of the five sessions. At each evaluation, the static balance was analyzed using a computerized plantar pressure sensor. Moreover, an intestinal symptoms rating scale was administered during the pre-intervention evaluation, and one week after the end of the intervention.ResultsSignificant improvements were found in intestinal symptoms (frequency of bowel movements, abdominal pain/discomfort, difficulty eliminating stools, sensation of intestinal swelling or distention, difficulty eliminating gas, sensation of incomplete bowel movement and, anal pain during bowel movement) and static balance (anteroposterior sway: F = 82.06, p = 0.0001; velocity of anteroposterior sway: F = 17.6, p = 0.001; and velocity of mediolateral sway: F = 4.41, p = 0.01).ConclusionVisceral mobilization can be part of a neurologic rehabilitation program to improve symptoms of constipation and static balance in stroke survivors.

Irritable bowel syndrome with constipation: issues of pathogenesis, diagnostics and treatment

Issues related to the diagnosis and treatment of irritable bowel syndrome occupy one of the central places in gastroenterology, due to the fact that in recent years there has been a significant increase in the incidence of this syndrome, its long-term recurrent, often lifelong course, leading to a decrease in the performance of patients, despite good quality, and a significant cost to the health care system. Irritable bowel syndrome, despite its functional nature, occurs quite often - from 14-50% of the adult population according to population epidemiological studies, and the ratio of women to men is from 2: 1 to 4:1. In the structure of gastroenterological pathology, this disease accounts for 40-70% of all cases of seeking medical help. Irritable bowel syndrome is a complex of functional disorders of the distal intestines, lasting more than 3 months and accompanied by abdominal pain that disappears after a bowel movement, flatulence, a feeling of incomplete bowel movement, changes in the frequency and consistency of stools. Factors in the pathogenesis of irritable bowel syndrome are dysfunction of mental activity with changes in autonomic and humoral functions; visceral hypersensitivity and impaired intestinal motility, past intestinal infection; endocrine disorders; food allergies, sedentary lifestyle; genetic predisposition. Endothelial dysfunction has recently played an important role in the onset of irritable bowel syndrome. The most famous among the factors of vascular endothelium today are the powerful vasoconstrictor endothelin-1 and the vasodilator - nitric oxide. The study investigated the level of vasoconstrictor endothelin-1 and vasodilator of nitric oxide in patients with irritable bowel syndrome with constipation. It was found that such patients have severe endothelial dysfunction, which manifests itself in an increase in the level of endothelin-1 (р˂0,01), a decrease in the level of nitric oxide (р˂0,01). The data obtained indicate the role of dysfunction of the vascular endothelium in the pathogenesis of irritable bowel syndrome with constipation. An inverse correlation was found between the content of endothelin-1 and nitric oxide (p˂0.01), which indicates an increase in the activity of vasoconstrictor mechanisms with a simultaneous decrease in vasodilation factors. The effectiveness of complex therapy in the group of patients in whom folic acid and zincteral were used as part of complex therapy in improving the clinical picture of the disease (complete relief of dyspeptic syndrome and a significant decrease in the severity of pain, constipation and asthenic syndromes), restoration of vascular endothelial function (significant decrease in the level of endothelin-1 and an increase in the level of nitric oxide) in comparison with the group of patients in the treatment of which only basic therapy was used.

Impact of treatment for fecal incontinence on constipation symptoms

Defecatory symptoms, such as a sense of incomplete emptying and straining with bowel movements, are paradoxically present in women with fecal incontinence. Treatments for fecal incontinence, such as loperamide and biofeedback, can worsen or improve defecatory symptoms, respectively. The primary aim of this study was to compare changes in constipation symptoms in women undergoing treatment for fecal incontinence with education only, loperamide, anal muscle exercises with biofeedback or both loperamide and biofeedback. Our secondary aim was to compare changes in constipation symptoms among responders and nonresponders to fecal incontinence treatment. This was a planned secondary analysis of a randomized controlled trial comparing 2 first-line therapies for fecal incontinence in a 2× 2 factorial design. Women with at least monthly fecal incontinence and normal stool consistency were randomized to 4 groups: (1) oral placebo plus education only, (2) oral loperamide plus education only, (3) placebo plus anorectal manometry-assisted biofeedback, and (4) loperamide plus biofeedback. Defecatory symptoms were measured using the Patient Assessment of Constipation Symptoms questionnaire at baseline, 12 weeks, and 24 weeks. The Patient Assessment of Constipation Symptoms consists of 12 items that contribute to a global score and 3 subscales: stool characteristics/symptoms (hardness of stool, size of stool, straining, inability to pass stool), rectal symptoms (burning, pain, bleeding, incomplete bowel movement), and abdominal symptoms (discomfort, pain, bloating, cramps). Scores for each subscale as well as the global score range from 0 (no symptoms) to 4 (maximum score), with negative change scores representing improvement in defecatory symptoms. Responders to fecal incontinence treatment were defined as women with a minimally important clinical improvement of ≥5 points on the St Mark's (Vaizey) scale between baseline and 24 weeks. Intent-to-treat analysis was performed using a longitudinal mixed model, controlling for baseline scores, to estimate changes in Patient Assessment of Constipation Symptoms scores from baseline through 24 weeks. At 24 weeks, there were small changes in Patient Assessment of Constipation Symptoms global scores in all 4 groups: oral placebo plus education (-0.3; 95% confidence interval, -0.5 to -0.1), loperamide plus education (-0.1, 95% confidence interval, -0.3 to0.0), oral placebo plus biofeedback (-0.3, 95% confidence interval, -0.4 to -0.2), and loperamide plus biofeedback (-0.3, 95% confidence interval, -0.4 to -0.2). No differences were observed in change in Patient Assessment of Constipation Symptoms scores between women randomized to placebo plus education and those randomized to loperamide plus education (P= .17) or placebo plus biofeedback (P= .82). Change in Patient Assessment of Constipation Symptoms scores in women randomized to combination loperamide plus biofeedback therapy was not different from that of women randomized to treatment with loperamide or biofeedback alone. Responders had greater improvement in Patient Assessment of Constipation Symptoms scores than nonresponders (-0.4; 95% confidence interval, -0.5 to -0.3 vs -0.2; 95% confidence interval, -0.3 to -0.0, P < .01, mean difference, 0.2, 95% confidence interval, 0.1-0.4). Change in constipation symptoms following treatment of fecal incontinence in women are small and are not significantly different between groups. Loperamide treatment for fecal incontinence does not worsen constipation symptoms among women with normal consistency stool. Women with clinically significant improvement in fecal incontinence symptoms report greater improvement in constipation symptoms.

Correlation of Pelvic Organ Prolapse Quantification Technique with Pelvic Floor Dysfunction Symptoms

Introduction: Assessment of POP by POP-Q gives anatomical site-specific measurement, which helps in surgery, follow-up and reduces inter-observer variation. The Pelvic Floor Distress Inventory (PFDI) is condition-specific health-related quality of life questionnaires for women with pelvic floor disorders.&#x0D; Objective: To assess pelvic organ prolapse by POP-Q technique and to correlate pelvic floor distress inventory questionnaire with POP-Q segments. Methodology A prospective study was done from March 2014 to February 2015 after ethical approval from IRC, B.P. Koirala Institute of Health Sciences. All patients with pelvic organ prolapse were included after informed verbal consent. The patients were then asked questions as in pelvic floor distress inventory questionnaire (PFDI) and noted in performa. The patients were then examined by POP-Q technique and noted. The informations were entered in the MS excel chart and statistical analysis done using SPSS 11.5.&#x0D; Results: There were 72 patients enrolled. The mean age of patients was 53.65 years. Majority of patients were found to have stage 4 prolapse (43.1%). POP-Q examination showed majority of patients had anterior and apical compartment defect. Correlation between POP-Q points and urinary symptoms showed significant relation with points in anterior compartment, genital hiatus and perineal bodies. Correlation with POP-Q points with colorectal symptoms showed involvement of genital hiatus significantly with strain stool and incomplete bowel movement. Correlation with pelvic distress symptoms with POP-Q sites showed significant relation with bulging, push up vagina for urination and defecation.&#x0D; Conclusion: POP-Q site specific points showed significant correlation with symptoms from Pelvic Floor Distress Inventry (PFDI) questionnaires.

Overlap between irritable bowel syndrome and functional dyspepsia including subtype analyses.

Coexistent gastrointestinal symptom profiles and prevalence or associated factors for the overlap between each functional dyspepsia (FD) and irritable bowel syndrome (IBS) group remain unclear. Thus, the aim of the present study was to evaluate the clinicodemographic features of FD, IBS, and IBS-FD overlap and assess the risk factors thereof, including subtype and genetic polymorphisms for IBS-FD. Consecutive patients were enrolled from the outpatient Gastroenterology clinics of Bundang Seoul National University Hospitals in Korea. All gastrointestinal symptoms occurring at least once per week in the previous 3months were recorded. Diagnostic criteria of functional gastrointestinal disorders were based on the Rome III criteria. Risk factors including genetic polymorphisms of 5-HTTLPR and ADRA2A 1291G alleles and CCK-1R intron 779T>C were assessed using a multivariate logistic regression model. A total of 632 subjects (278 control subjects, 308 FD, 156 IBS, and 110 who met the criteria for both FD and IBS) were included in this study. Patients with IBS-FD overlap had more severe symptoms (such as bloating, nausea, vomiting, hard or lumpy stools, defecation straining, and a feeling of incomplete bowel movement) and higher depression scores compared with non-overlap patients. Single/divorced or widowed marital status, nausea, bloating, and a feeling of incomplete emptying after bowel movements were independent risk factors for IBS-FD overlap among IBS patients. In contrast, young age, depression, bloating, and postprandial distress syndrome were positively associated with IBS-FD overlap among FD patients. 5-HTTLPR L/L was a risk factor for the co-occurrence of IBS-C among FD patients (OR: 12.47; 95% CI: 2.00-77.75; P=0.007). Bloating was a risk factor for IBS-FD overlap. Patients with postprandial distress syndrome have a higher risk of coexisting IBS, particularly constipation-dominant IBS.

Opioid-induced Constipation

Opioid-induced constipation (OIC) often occurs in patients administered opioids for chronic noncancer pain. Patients commonly experience hard, infrequent, and incomplete bowel movements with bloating and straining, which may impact pain management and quality of life. Over-the-counter laxatives are the first line of treatment, but their clinical value can be limited. Prescription medications that directly target the underlying bowel mechanism responsible for OIC (methylnaltrexone and naloxegol) and a secretagogue (lubiprostone) have demonstrated efficacy, safety, and tolerability in clinical trials. Awareness of OIC and individualized treatment may provide a sound strategy for care in this patient population.