Management Of Chronic Constipation Research Articles

The Diagnosis and Management of Chronic Constipation in Italy: Results from a Survey Conducted among Italian Gastroenterologists.

Background: Chronic constipation (CC) is one of the most common disorders of gut-brain interaction (DGBI). The management of CC requires specific skills due to its complex and multifactorial pathophysiology and its multistep treatment. The aims of this study were to evaluate the availability and the use of diagnostic tools for CC in Italy and the therapeutic management of CC by Italian gastroenterologists (GEs). Methods: A survey was conducted during the 28th meeting of the Italian Federation of Digestive Disease Societies (FISMAD; Rome, Italy, 11-14 May 2022). The survey explored the presence of a clinic dedicated to DGBIs, the availability and the use of specific diagnostic tools, the routine use of digital rectal examination (DRE), and the therapeutic approach to CC by Italian GEs. Results: The survey was taken by 236 GEs. The most significant results were that 42% of respondents had a clinic dedicated to DGBI in their institute; DRE was regularly performed by 56.8% of GEs when evaluating a CC patient; young GEs (≤40 years) performed DRE less frequently than older ones (p < 0.001); anorectal manometry was available to 44.3% of GEs; balloon expulsion test (BET) was available to 19.1% of GEs; GEs with a clinic dedicated to DGBI had more frequent access to anorectal physiology testing (p < 0.001); diet and lifestyle advice were the most frequently prescribed treatments; and fiber and macrogol were the second and third most prescribed treatments, respectively. Conclusions: The survey provides an interesting picture of CC management by Italian GEs. The results are in line with previous data collected about 10 years ago among Italian GEs ("CHRO.CO.DI.T.E study"); DRE is still rarely performed by Italian GEs (particularly by young GEs). The availability of anorectal physiology testing is still limited, and BET, which could be easily performed in everyday clinical settings, is rarely performed. Lifestyle suggestions, macrogol and fiber are the preferred treatment, as recommended by all guidelines. These results will be useful to identify as yet unmet educational needs and critical issues to improve CC management.

Malone Antegrade Continence Enema Procedure in the Management of Chronic Constipation.

Malone Antegrade Continence Enema Procedure in the Management of Chronic Constipation.

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Evaluation and Management of Chronic Constipation.

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Evaluation and Management of Chronic Constipation.

High fiber diet versus polyethylene glycol in management of chronic constipation in children with cerebral palsy: A randomized controlled trial.

Constipation is one of the most common gastrointestinal symptoms in patients with cerebral palsy. This study was conducted with the aim to compare the efficacy of a high fiber diet and polyethylene glycol in the management of chronic constipation in children with cerebral palsy. An open-label randomized controlled trial was conducted in the Department of Pediatrics of a tertiary care hospital in Northern India among cerebral palsy children aged 1-6 years having chronic constipation. Seventy children were enrolled in the study (35 in each group). Group A children received high fiber diet as per the diet chart prepared by the dietician. Group B received polyethylene glycol (0.5-1 g/kg/day) for a period of three months. At the end of four weeks and three months, all children were assessed for clinical improvement and both groups were compared in terms of stool frequency, consistency of stool, fecal incontinence, palpation of hard stool per abdomen, blood in stool, pain on defecation and overall satisfactory outcome. Satisfactory outcome was defined as defecation > two times weekly, soft stool, no pain on defecation, no palpation of hard stool on abdominal examination, no fecal incontinence, and no blood in stools. Children were also assessed for any adverse effects. Baseline parameters and GMFCS were comparable in the two groups. Both group patients showed significant improvement in symptoms of constipation at the end of four weeks and three months compared to baseline. However, there was no significant difference between the two groups in terms of satisfactory outcome and parameters like frequency of stool, consistency of stool, palpation of hard stool, fecal incontinence, and blood in stools. A high fiber diet can be considered a good alternative to polyethylene glycol for the management of chronic constipation in children with cerebral palsy.

Gender differences in the association between dietary protein intake and constipation: findings from NHANES.

Dietary factors play a crucial role in the development and management of chronic constipation, yet the relationship between dietary protein intake and constipation remains underexplored. This study aims to investigate the association between dietary protein intake and the prevalence of constipation among American adults, with a focus on potential gender differences, using large-scale national data. Data from 14,048 participants aged 20 and above (7,072 men and 6,976 women) from the National Health and Nutrition Examination Survey (NHANES) 2005-2010 were analyzed. The Bristol Stool Form Scale's types 1 (separate hard lumps, resembling nuts) and 2 (sausage-shaped, but lumpy) were used to define constipation. A 24-h dietary recall technique was used to measure dietary protein intake. After controlling for covariates, the association between protein consumption and constipation risk was examined using multivariable logistic regression, smooth curve fitting, and testing for gender interaction effects. We then further determined the threshold effect between dietary protein intake and constipation risk. Constipation was present in 7.49% of people overall, with a higher proportion among women (10.19%) than among males (4.82%). In men, higher protein intake was significantly associated with a lower rate of constipation. However, in women, higher protein intake correlated with an increased risk of constipation, and the interaction between gender was significant (P for interaction = 0.0298). These results were corroborated by smooth curve fits, which also demonstrated a dose-response effect. Further threshold effect analysis showed that the turning points of dietary protein intake differed between male and female participants (119.42 gm/day for men; 40.79 gm/day for women). The association between dietary protein intake and constipation was different in different genders with threshold effect. For men, moderately increasing protein intake could be beneficial, while for women, exceeding a certain level may increase the risk of constipation. These insights are crucial for guiding dietary protein recommendations for different genders and have significant clinical implications.

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.

Management of Chronic Constipation: A Comprehensive Review.

Traditionally, the treatment of chronic constipation has focused on lifestyle modification, dietary guidance and therapy, and osmotic and stimulant laxatives. Recently, several drugs with new mechanisms of action have been introduced as treatments for chronic constipation. In Japan, polyethylene glycol and lactulose can now be administered under insurance coverage. The number of treatment options for constipation has increased dramatically. First, lifestyle modifications and dietary therapies must be implemented. If constipation does not improve sufficiently, specialized functional tests are performed to diagnose physiological subgroups. If functional tests are not available, patients are classified as having the "decreased frequency of defecation" type or the "difficult defecation" type based on the patient's symptoms, with treatment applied according to each type. Medical therapy includes osmotic laxatives, secretagogues, bile acid transporter inhibitors, probiotics, prokinetics, and Kampo medicines. The temporary use of stimulant laxatives, suppositories, enemas, and digital evacuation is also recommended. The usefulness of biofeedback is yet to be determined.

Comparative Evaluation of Lactulose and Bisacodyl in the Management of Chronic Constipation: Efficacy, Safety, and Patient Preferences

Comparative Evaluation of Lactulose and Bisacodyl in the Management of Chronic Constipation: Efficacy, Safety, and Patient Preferences

DIAGNOSIS AND MANAGEMENT OF CHRONIC IDIOPATHIC CONSTIPATION: A NARRATIVE REVIEW FROM A BRAZILIAN EXPERT TASK FORCE.

Chronic idiopathic constipation (CIC) is a condition that widely affects the global population, represents relevant healthcare resource utilization and costs, and impacts the individual's well-being. To review the consensus of expert societies and published guidelines on the diagnosis and treatment of CIC in adults, seeking to assist reasoning and decision-making for medical management of patients with CIC and provide a practical reference material. A Brazilian medical task force searched the scientific literature in the following electronic databases: MEDLINE/PubMed, SciELO, EMBASE and Cochrane, using the following descriptors: chronic constipation, diagnosis, management of chronic constipation. In addition, a review of articles on the mechanism of action, safety, and efficacy of therapeutic options available in Brazil was carried out. The diagnostic approach and the understanding of the pathophysiology present in CIC are essential items to indicate the appropriate therapy and to understand the ecosystem of the patient's needs. CIC is a common condition in adults, occurring more frequently in the elderly and in women. Proper management is defined by detailed medical history and physical examination, together with appropriate therapeutics, regardless pharmacological or not, and depending on the best moment of indication. This way, the impact on quality of life is also optimized.

Understanding the user: Patients' perception, needs, and concerns of health apps for chronic constipation.

ObjectiveChronic constipation is a prevalent gastrointestinal disorder that requires long-term management and treatment adherence. With increasing smartphone usage, health app adoption represents an opportunity to incorporate personalized, patient-led care into chronic constipation management. Despite the number of apps available targeting patients with constipation, studies have not yet examined user needs and barriers towards successful app adoption and sustained usage. Accordingly, the current study explored user perception, needs, and concerns of health apps in patients with chronic constipation.MethodsFifteen participants with chronic constipation (age range = 28–79 years, 10 females) in Singapore completed a 60 min semi-structured qualitative interview exploring participant's experiences with and attitudes towards chronic constipation and health apps. Participants also completed two questionnaires regarding their constipation symptoms and general technology usage. Interviews were audio-recorded, transcribed verbatim, and coded using NVivo.ResultsFour themes and 10 sub-themes were identified using inductive thematic analysis. Themes and sub-themes cover importance of patient identity, disease-based expectations of health apps, barriers towards adoption and sustained usage of health apps, necessary conditions when adopting health apps (including perception of supportive benefits, clear understanding of app intention, personalized technology, and trusted sources), and push factor expectations which includes creative engagement and incentivization embedded within the app.ConclusionThe findings captured barriers and key elements necessary for successful health app adoption and continued usage by patients with chronic constipation. Identified elements that matter to patients can provide app developers with user-focused insights and recommendations to develop effective health apps that sustain user engagement.

World Gastroenterology Organisation Global Guidelines: Diet and the Gut.

World Gastroenterology Organisation Global Guidelines: Diet and the Gut.

478-P: Effect of Nonpharmacological Management of Chronic Constipation in Diabetic Patients

Background: Chronic constipation is highly prevalent in diabetic patients. The treatment of chronic constipation in general patients is mainly lifestyle modification and pharmacological therapy. The efficacy of non-pharmacological treatment, i.e., behavioral therapy to improve lifestyle and defecation habits, for chronic constipation in diabetic patients is not well known. This study aimed to determine the efficacy of non-pharmacological management for chronic constipation in diabetic patients. Methods: We conducted a questionnaire on defecation for diabetic patients aged 20 to 75 years at Asama General Hospital outpatient clinic. Patients diagnosed with chronic constipation according to Rome IV criteria were randomly assigned to two groups. The intervention group instructed behavior therapy to improve constipation. Specifically, we provided guidance on defecation behavior, exercise, water and dietary fiber intake, and guidance on a defecation diary recording daily defecation status. The other group received usual medical care as a control group. The questionnaire was conducted again at the next outpatient clinic. Results: Eighty of 545 diabetic patients (14.7%) had chronic constipation. The average age of constipated patients was 59.3 years, frequency of defecation 3.7 times/week, stool form (Bristol Stool Form Scale) 2.8, straining during defecations 78,8% and sensation of incomplete evacuation of defecations 42.5%. After the intervention, there was a significant increase in the frequency of defecation (4.8 vs. 3.9 times/week, P=0.008) and improvement in constipation symptoms (P=0.018) in the intervention group compared to the control group. In addition, stool form and straining during defecations were significantly improved before and after comparison within the intervention group (P &amp;lt;0.05). Conclusion: Our findings suggest that non-pharmacological management, including behavioral therapy for chronic constipation in diabetic patients, was effective. Disclosure E. Nishimori: None. M. Naka: None.

1616 Unusual Baby Bump: Hidden Pregnancy in the Setting of Chronic Opioid-Induced Pseudo-Obstruction

INTRODUCTION: Opioid addiction and abuse have become a serious public health problem in the United States. The most common gastrointestinal adverse effect is dysmotility and decreased peristalsis, manifesting as constipation. We present an extreme case of a young woman with chronic constipation in the setting of opioid abuse. Imaging obtained during her diagnostic workup revealed unexpected findings and further highlight the consequences of the opioid crisis in the United States. CASE DESCRIPTION/METHODS: A 26-year-old woman with known opioid-induced chronic constipation (OIC) presents to an outside emergency department with abdominal pain, distention, and leakage of yellow-brown fluid from the anus and vagina. She had been admitted multiple times over the course of the past year for management of chronic pseudo-obstruction. Outside abdominal computed tomography (CT) revealed a diffusely dilated colon with large amounts of stool. Incidentally, an advanced intrauterine pregnancy was identified on imaging. The patient was unaware of the pregnancy. Ultrasound exam was consistent with a gestational age of 32 weeks and 6 days complicated by oligohydramnios and cord prolapse. The patient underwent emergent cesarean delivery without immediate complications. Flexible sigmoidoscopy was performed following delivery. Extensive amounts of solid stool were removed with digital disimpaction and copious lavage. During hospitalization, the patient was counseled regarding opioid abuse, management of chronic constipation, and scheduled for outpatient follow-up. DISCUSSION: The opioid epidemic in the United States has reached epic proportions, with drastic consequences on public health. OIC is the most frequent and prevalent adverse effect among opioid users. While conventional and new laxatives have been shown to be effective for OIC, focus should be shifted towards awareness and prevention of opioid abuse. Another important note to be made is the importance of history taking on a patient with multiple hospitalizations with similar presentations. While she did have an extraordinary stool burden that did require manual disimpaction, the patient was also found to be in her third trimester of pregnancy on CT imaging. Fortunately, no harm occurred to the patient or child, however obtaining the proper history and diagnostic work-up could have helped limit any potential injury that might have resulted.

Current State of Neuromodulation for Constipation and Fecal Incontinence in Children: A Systematic Review.

Neuromodulation is the application of electrical stimulation on nerve fibers to modulate the neuronal activity. Its use for chronic constipation and fecal incontinence has increased in popularity over the past few years. Invasive and noninvasive techniques are currently available. We reviewed the current literature on the application of the neuromodulation techniques in the management of chronic constipation and fecal incontinence in children. A search of Healthcare Database Advanced Search, Embase, Medline, and Cochrane database was performed in accordance with PRISMA guideline. Terms used in the search included neuromodulation, nerve stimulation, fecal/fecal incontinence, incontinence, constipation, children, and pediatric/pediatric. Two-hundred forty-one papers were screened. Fourteen papers were included for the systematic review: seven were selected for the ISNM (implantable sacral nerve modulation) technique, one for the transcutaneous tibial nerve stimulation), one for the transcutaneous sacral nerve modulation), and five for the transcutaneous interferential sacral nerve stimulation. Results showed an overall improvement in constipation symptoms in 79 to 85.7% of patients, resolution of symptoms in 40%, reduced use of ACE stoma/transanal irrigation system in 12.5 to 38.4%, and improvement in incontinence symptoms in 75%. High complication rate was reported (17-50%) in the ISNM group. No complications were reported in the non-invasive group. Neuromodulation is a promising tool in the management of constipation refractory to medical treatment and fecal incontinence in children. Noninvasive techniques provide good results with no complications. A longer term follow-up will provide more information regarding patient compliance and sustainability of benefits of these new techniques.

VI. Management of Chronic Constipation, Treatment Options of Stimulant Laxatives for Chronic Functional Constipation

VI. Management of Chronic Constipation, Treatment Options of Stimulant Laxatives for Chronic Functional Constipation

Constipation

This review presents an overview of the management of constipation. The review addresses the diagnosis of primary and secondary forms and then discusses in greater detail the investigative workup and modern management of chronic constipation (primary). The review addresses what simple and more advanced investigations are relevant for determining pathophysiology and gives an overview of treatment options, including pharmacologic, behavioral, and surgical approaches for thus defined subgroups of patients (evacuation disorder, slow transit constipation). This review contains 3 figures, 6 tables, and 89 references.

Constipation

This review presents an overview of the management of constipation. The review addresses the diagnosis of primary and secondary forms and then discusses in greater detail the investigative workup and modern management of chronic constipation (primary). The review addresses what simple and more advanced investigations are relevant for determining pathophysiology and gives an overview of treatment options, including pharmacologic, behavioral, and surgical approaches for thus defined subgroups of patients (evacuation disorder, slow transit constipation). This review contains 3 figures, 6 tables, and 89 references.

Diagnosis and treatment of constipation: a clinical update based on the Rome IV criteria

The aim of this study was to evaluate the published professional association guidelines regarding the current diagnosis and treatment of functional intestinal constipation in adults and to compare those guidelines with the authors’ experience to standardize actions that aid clinical reasoning and decision-making for medical professionals. A literature search was conducted in the Medline/PubMed, Scielo, EMBASE and Cochrane online databases using the following terms: chronic constipation, diagnosis, management of chronic constipation, Roma IV and surgical treatment. Conclusively, chronic intestinal constipation is a common condition in adults and occurs most frequently in the elderly and in women. Establishing a precise diagnosis of the physiopathology of functional chronic constipation is complex and requires many functional tests in refractory cases. An understanding of intestinal motility and the defecatory process is critical for the appropriate management of chronic functional intestinal constipation, with surgery reserved for cases in which pharmacologic intervention has failed. The information contained in this review article is subject to the critical evaluation of the medical specialist responsible for determining the action plan to be followed within the context of the conditions and clinical status of each individual patient.

Novel perspectives in management of chronic constipation

Novel perspectives in management of chronic constipation

Management of chronic constipation in adults.

Chronic constipation (CC) is an extremely common condition with an estimated prevalence of up to 24%. Most patients with CC should be treated in primary care. Changes in lifestyle, including increased intake of dietary fibre, fluid, and exercise, should be attempted in most patients. Osmotic or stimulant laxatives are indicated if there are insufficient effects of lifestyle changes. Prokinetics and secretagogues should be restricted to those not responding to basic treatment. Anorectal physiology tests and assessment of colorectal transit time are indicated if medical treatment fails or if symptoms indicate severely obstructed defecation. If symptoms indicate an underlying structural disorder, barium or magnetic resonance evacuation proctography is indicated. Biofeedback therapy is effective in patients with dyssynergic defecation. In patients with other evacuation disorders, rectally administered laxatives or transanal irrigation should be attempted. Surgery is restricted to the minority of CC patients with very severe symptoms not responding to conservative treatment.