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Evaluation of Constipation and Surgical Adjuncts
Published in Marc A. Levitt, Pediatric Colorectal Surgery, 2023
Patients with functional constipation can either be managed with medical management or surgical intervention. Medical management should start with optimizing laxative therapy or a trial of rectal enemas. For a patient with a long-standing history of functional constipation who has failed medical management (laxatives and/or rectal enemas), the physician should start with a contrast enema to evaluate for the degree of colonic dilation as well as any redundancy.
Gastrointestinal Disease
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Justine Turner, Sally Schwartz
Key points in the management of functional constipation include disimpaction, regular maintenance laxative treatment, adequate follow-up, and adequate treatment duration. Given expected improvement over 6–12 months for the majority of children, early specialist medical or surgical consultation should be considered when standard therapy is failing. The evidence-based recommendations support the notion that dietary or lifestyle interventions alone will not successfully treat constipation.
The Clinical Application of 5-HT Agonists and Antagonists in Gastrointestinal Disease
Published in T.S. Gaginella, J.J. Galligan, SEROTONIN and GASTROINTESTINAL FUNCTION, 2020
Timothy P. Roarty, Richard W. McCallum
Gomme and Verlinden, in an open trial of cisapride (10 mg t.i.d. for up to 16 weeks), evaluated 19 sedentary patients with chronic constipation.81 Cisapride increased stool frequency (P < 0.005) and normalized consistency in 90% of stools, with this effect appearing to persist for up to six weeks after withdrawal of the cisapride. Muller-Lissner, et al. followed 126 patients with chronic constipation for 16 weeks who received cisapride (20 mg b.i.d.) or placebo.82 Cisapride increased stool frequency in both laxative and non-laxative users. Verheyen, et al. evaluated a similar group of 48 patients with functional constipation over 19 weeks.83 Patients were treated with cisapride (5 or 10 mg t.i.d.) or placebo in a random, double-blind manner. No difference was found between the two doses, with significantly increased stool frequency in both by approximately 70% after 12 weeks. However, it was interesting that placebo also increased defecation frequency by 43% after 12 weeks.
Clinical value of positive BET and pelvic floor dyssynergia in Chinese patients with functional defecation disorder
Published in Scandinavian Journal of Gastroenterology, 2022
Ya Jiang, Yan Wang, Yurong Tang, Lin Lin
Functional constipation (FC) is a common disease impairing patients’ well-being worldwide but some individuals are dissatisfied with their therapy, which is probably related to not targeting the underlying pathophysiology. Functional defecation disorder (FDD) is an important but under-recognized subtype of FC, referring to the paradoxical contraction and/or inadequate relaxation of the pelvic floor muscles during attempted defecation [1], which affects nearly one half of constipated patients [2]. FDD impairs patients’ mental health and quality of life (QOL) much more than other constipation subtypes [3]. There are three FDD phenotypes based on high resolution anorectal manometry (HR-ARM): high anal sphincter pressure during defecation, inadequate propulsive force, and hybrid of both disturbance [4]. Understanding different pathophysiological mechanisms might help patients be better treated so it’s essential to identify FDD. HR-ARM and balloon expulsion test (BET) are pivotal in investigation of anorectal disorders [5] and more relevant with treatment outcomes [6].
Comparison of the effects of colonic electrical stimulation and prucalopride on gastrointestinal transit and defecation in a canine model of constipation
Published in Scandinavian Journal of Gastroenterology, 2021
Shuo Chen, Liang Liu, Yanmei Li, Hailong Li, Xizhen Sun, Dan Zhu, Qiao Meng, Shukun Yao, Shiyu Du
Functional constipation is a common disorder of gastrointestinal motility, characterized by infrequent bowel movements, straining defecation, a feeling of incomplete emptying and hard stools. Slow transit constipation (STC) is one type of functional constipation that accounts for a large proportion of cases and is characterized by a prolonged delay in the passage of stool and abnormal propagation activity through the colon [1]. STC treatment usually relies on drugs and lifestyle changes. Some refractory STC patients are unresponsive to routine therapy and require surgery, such as colectomy [2]. However, surgical treatment is more traumatic and has the possibility of postoperative complications and recurrence. Currently, there is still no ideal method to effectively treat refractory STC, and new therapies to accelerate colonic transit with minimal invasion are urgently needed.
Physiotherapist management of a patient with spastic perineal syndrome and subsequent constipation: a case report
Published in Physiotherapy Theory and Practice, 2021
Shankar Ganesh, Mritunjay Kumar
Isolated defecatory dysfunction can occur in 25% of the persons suffering from constipation (Lembo and Camilleri, 2003). In the normal state, the anorectal angle is maintained by the tonic contraction of the puborectalis muscle and the anal sphincter is closed. During normal defecation smooth muscle relaxation of the anal canal (Sorensen, Lorentzen, Petersen, and Christiansen, 1991) occurs along with the relaxation of puborectalis muscle, straightening out the anorectal angle. In dyssynergic type of constipation, there is a paradoxical contraction of pelvic floor muscles (i.e. puborectalis muscle and external anal sphincter) leading to the significantly impaired ability to expel stool during attempts to defecate (Dailianas et al., 2000). These patients have a functional outlet obstruction related to the neuromuscular dysfunction of the defecation unit and are addressed by other names in the literature such as anismus, pelvic floor dyssynergia, obstructive defecation, paradoxical puborectalis contraction, pelvic outlet obstruction, and spastic pelvic floor or perineal syndrome. In this study, we have used the term dyssynergic defecation (DD) to refer to constipation that occurs as a result of pelvic floor dysfunction. The term functional constipation (FC) has been used where the cause of constipation could not be identified.