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Management of Conditions and Symptoms
Published in Amy J. Litterini, Christopher M. Wilson, Physical Activity and Rehabilitation in Life-threatening Illness, 2021
Amy J. Litterini, Christopher M. Wilson
Unresolved or untreated chronic constipation can lead to fecal impaction and bowel obstruction. For the appropriate patient, and with communication with the medical provider, light abdominal massage may be a beneficial modality to consider for individuals with chronic constipation. Instruction in abdominal massage, particularly for individuals with Parkinson’s disease, has shown to be beneficial.84 Rectal suppositories and oil retention enemas may be successful in mild cases, and in severe cases, manual digital disimpaction (under the order of a physician and within the scope of nursing practice) can potentially address fecal impaction while the source is being evaluated to prevent recurrence. In patients with a suspected bowel obstruction, urgent medical intervention should be recommended and/or provided. For patients still wishing for intensive medical intervention in the presence of a life-threatening illness, strategies such as corticosteroids to relieve the obstruction can often be effective prior to the consideration for surgical intervention.85
Fluid balance and continence care
Published in Barbara Smith, Linda Field, Nursing Care, 2019
If the faeces are thought to be impacted in the colon or rectum, an enema may be prescribed. This involves the administration of liquid designed to soften and move the faeces so they can be evacuated. The enema tube is inserted directly into the rectum and the contents expelled. Usually the patient is asked to retain the enema for as long as they can, as this helps to ensure better evacuation of faeces. If the patient is severely constipated, they may require several enemas. If constipation is opioid induced then a peripheral opioid-receptor antagonist such as methylnaltrexone can be given, usually to patients receiving palliative care (Rogers, 2012). Finally, a serotonin agent, prucalopride, approved by the National Institute for Health and Clinical Excellence (NICE), can be given to women with chronic constipation due to poor gut motility. It is only recommended for women who have been unable to find relief after using two laxatives from different classes at the highest tolerated dose for at least six months (NICE, 2010, cited in Rogers, 2012). These new and emerging treatments can help to fill an important void for many patients, particularly those suffering with chronic constipation (Rogers, 2012).
Williams–Beuren Syndrome
Published in Merlin G. Butler, F. John Meaney, Genetics of Developmental Disabilities, 2019
Hui Zhang, Barbara Pober, Cheryl Klaiman, Robert Schultz
Gastrointestinal problems are common in both children and adults with WBS. Young infants are frequently colicky and have feeding difficulties (71%); these may contribute to failure to thrive in some of the WBS infants (7). Gastroesophageal reflux and constipation occur in almost half of the infants (7) and many WBS infants and young children experience textured food intolerance. Constipation can continue to be a problem throughout childhood while in the adult WBS population, the most frequent gastrointestinal problems are constipation, abdominal pain, and diverticular diseases (16). Chronic constipation can be complicated by rectal prolapse, hemorroids, and increases the risk of diverticulosis and diverticulitis; therefore, it requires aggressive ongoing medical management. Celiac disease may be another contributing factor to gastrointestinal problems in WBS. Biopsy-proven celiac disease has been reported in 6 of 63 WBS children all of whom were treated successfully with a gluten free diet (34).
Safety of elobixibat and lubiprostone in Japanese patients with chronic constipation: a retrospective cohort study
Published in Expert Opinion on Drug Safety, 2021
Nobuhiro Ooba, Yoshinori Takahashi, Marina Nagamura, Masao Takahashi, Makoto Ushida, Eiji Kawakami, Masaomi Kimura, Tsugumichi Sato, Junichi Tokuyoshi, Choichiro Miyazaki, Mitsuaki Shimada
Among the laxatives used to treat constipation [7–11], magnesium and stimulant laxatives are widely used in Japan [12]. Recently, novel drugs for chronic constipation have been introduced. Lubiprostone was approved in 2012, and it stimulates chloride secretion via the activation of type-2 chloride channels in the gastrointestinal tract [13]. Elobixibat, which inhibits the uptake of bile acids, was approved in 2018 [14]. Lubiprostone has been marketed in some countries, including the United States, whereas elobixibat is authorized only in Japan as of March 2020. In a retrospective cohort study comparing users of elobixibat and lubiprostone [15], the incidence of nausea in users of lubiprostone 48 μg was 3.4 times higher than that in users of elobixibat 10 mg. The incidence of adverse events caused by elobixibat (9%) was significantly lower than that caused by lubiprostone (15%) with a daily dose of 24 μg. However, as this was a single-center study with an observation period of 2 weeks, the generalizability of the findings may be limited.
Chronic constipation is negatively associated with colonic diverticula
Published in Scandinavian Journal of Gastroenterology, 2021
Akira Higashimori, Masami Nakatani, Kagami Jinnai, Daiyu Kin, Natsumi Maeda, Yoshihiro Nakamura, Atsushi Hashimoto, Kenichi Morimoto, Eiji Sasaki, Takashi Fukuda, Toshio Watanabe, Yasuhiro Fujiwara
A total of 1014 patients were included. Colonic diverticula were found in 423 patients (42%), including 233 with right-sided diverticula (55%), 56 with left-sided diverticula (13%), and 134 with bilateral diverticula (32%) (Figure 1). Of the patients with diverticulosis, 140 (33%) and 283 (67%) patients had few (1 or 2) and many (≥3) diverticula, respectively (Supplementary Table 2). Chronic constipation was observed in 284 patients (28%) (Table 1). The prevalence of colonic diverticula increased with age (Figure 2(A)). The proportion of right-sided diverticula was higher in younger patients than in older patients. The number of diverticula present (regardless of the diverticula type) increased with age, but this trend was stronger in left-sided and bilateral diverticula (Figure 2(B) and Supplementary Table 1).
Risk Factors for Constipation in Adults: A Cross-Sectional Study
Published in Journal of the American College of Nutrition, 2020
Gamze Yurtdaş, Nilüfer Acar-Tek, Gamze Akbulut, Özge Cemali, Neslihan Arslan, Ayfer Beyaz Coşkun, Fatmanur Humeyra Zengin
Constipation is a common problem in adults, and its prevalence varies according to diagnostic criteria (3, 19, 20). In this study, the prevalence of constipation was found to be 16.6% in a Turkish population (Table 1). However, in another Turkish study, the constipation prevalence was 8.3%, according to ROMA II criteria (4, 21). In a systematic review and meta-analysis, it was reported that the worldwide prevalence of chronic constipation, according to self-reported questionnaires or specific symptom-based criteria, was 14% (6). In South America, the prevalence was 18%, in northern and southern Europe, 16%, and in the Middle East and South Asia, the constipation prevalence was 14% and 11%, respectively (6). Constipation rates in different countries may be influenced by societal, cultural and socio-economic characteristics, as well as subjective data recall and acquisition by individuals. In this study, we determined the prevalence of constipation in our cohort was similar to the prevalence of constipation across the world.