Constipation

2018 ◽  
Author(s):  
Satish Keshav ◽  
Alexandra Kent
Keyword(s):  
Irritable Bowel Syndrome ◽  
Pelvic Floor ◽  
Chronic Constipation ◽  
Secondary Care ◽  
Pelvic Floor Dysfunction ◽  
The Elderly ◽  
Normal Pattern ◽  
Normal Frequency ◽  
Slow Transit ◽  
Irritable Bowel

Patients and doctors often define constipation differently. The normal frequency of defaecation is once every 3 days to three times per day, and constipation may be defined as abnormally infrequent defaecation. A change in the normal pattern and frequency for the particular patient is pertinent. There are numerous causes of constipation, and most can be encountered in both primary and secondary care. In patients with chronic constipation without an evident cause, irritable bowel syndrome (IBS) is the cause in 59%, pelvic floor dysfunction in 25%, slow transit in 13%, and a combination of pelvic floor dysfunction and slow transit in 3%. Constipation affects twice as many women as men, with a higher prevalence in pregnant women. Prevalence is also greater in the elderly, affecting ~20% in the community.

scholarly journals Chronic constipation - the role of clinical assessment and colorectal physiologic tests to obtain an etiologic diagnosis

2008 ◽  
Vol 45 (1) ◽  
pp. 50-57 ◽  
Author(s):  
Antônio Lacerda-Filho ◽  
Marcílio José Rodrigues Lima ◽  
Marisa Fonseca Magalhães ◽  
Rodrigo de Almeida Paiva ◽  
José Renan da Cunha-Melo
Keyword(s):  
Irritable Bowel Syndrome ◽  
Differential Diagnosis ◽  
Pelvic Floor ◽  
Clinical Assessment ◽  
Chronic Constipation ◽  
Pelvic Floor Dysfunction ◽  
Fecal Impaction ◽  
Clinical Parameters ◽  
Irritable Bowel ◽  
Etiologic Diagnosis

BACKGROUND: Diagnosis of subtypes of chronic constipation has been considered difficult to achieve even in specialized centers. Although colorectal physiologic tests have brought an important contribution, it remains unclear in which patients these tests should be indicated for. AIMS: This study aims to establish a differential diagnosis for chronic constipation cases using clinical assessment and physiologic tests and to identify clinical parameters that could predict which patients need physiologic tests. METHODS: One hundred and seventy nine patients (83% females; mean age, 45) with chronic constipation according to Rome II criteria were initially treated by dietary advice and functional reeducation and those unresponsive (110 or 61.5%) were submitted to colonic transit time, defecography, anorectal manometry and electromyography, as needed. RESULTS: A differential diagnosis was achieved in 63.6% of patients tested. However, 61.5% of 179 patients with chronic constipation (69 with no need to tests and 40 with normal tests) have etiologic diagnosis established only on clinical basis. Irritable bowel syndrome (32%), pelvic floor dysfunction (29%) and functional constipation due to faulty diet and life style habits (22%) were the main causes of chronic constipation. Alternating constipation and nausea/vomiting were symptoms significantly related to the diagnosis of irritable bowel syndrome; younger age, larger intervals between bowel movements, occurrence of fecal impaction and necessity of enema were related to the diagnosis of non-chagasic megacolon and digital assistance to evacuate and large rectocele or spastic pelvic floor on rectal exam were associated to pelvic floor dysfunction. Patients with long-standing constipation, fecal impaction, abdominal pain not eased after defecation, necessity for enemas, digital assistance and evidence of rectocele tended to be in need for physiologic tests to define the cause of chronic constipation. CONCLUSIONS: The etiologic diagnosis of chronic constipation can be achieved in most of patients on a clinical basis and some symptoms may be significantly related to specific diagnoses. Indications for physiologic tests should be based on specific clinical parameters.

Female Pelvic Pain: Assessment

2020 ◽  
Author(s):  
Mario Castellanos ◽  
Louise P King
Keyword(s):  
Irritable Bowel Syndrome ◽  
Pelvic Floor ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Visceral Pain ◽  
Pelvic Floor Dysfunction ◽  
Pudendal Neuralgia ◽  
Somatic Pain ◽  
Irritable Bowel ◽  
Over Time

Chronic pelvic pain (CPP) in women is responsible for greater than 10% of referrals to gynecologists. A majority of them will remain undiagnosed or inadequately treated. Over time, CPP may lead to a syndrome that results in disability, loss of employment, and discord within relationships. This review discusses how to achieve a comprehensive assessment of CPP from a variety of causes. This review contains 13 figures, 5 tables and 60 references Key Words: dysmenorrhea, dyspareunia, endometriosis, interstitial cystitis, irritable bowel syndrome, pelvic floor dysfunction, pelvic pain, pudendal neuralgia, somatic pain, visceral pain

Female Pelvic Pain: Assessment

2018 ◽  
Author(s):  
Mario Castellanos ◽  
Louise P King
Keyword(s):  
Irritable Bowel Syndrome ◽  
Pelvic Floor ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Visceral Pain ◽  
Pelvic Floor Dysfunction ◽  
Pudendal Neuralgia ◽  
Somatic Pain ◽  
Irritable Bowel ◽  
Over Time

Chronic pelvic pain (CPP) in women is responsible for greater than 10% of referrals to gynecologists. A majority of them will remain undiagnosed or inadequately treated. Over time, CPP may lead to a syndrome that results in disability, loss of employment, and discord within relationships. This review discusses how to achieve a comprehensive assessment of CPP from a variety of causes. This review contains 12 figures, 2 tables and 57 references Key Words: dysmenorrhea, dyspareunia, endometriosis, interstitial cystitis, irritable bowel syndrome, pelvic floor dysfunction, pelvic pain, pudendal neuralgia, somatic pain, visceral pain

scholarly journals EFFICACY AND SAFETY OF INTESTINAL SECRETAGOGUES FOR CHRONIC CONSTIPATION: A SYSTEMATIC REVIEW AND META-ANALYSIS

2018 ◽  
Vol 55 (suppl 1) ◽  
pp. 2-12 ◽  
Author(s):  
Juan Sebastian LASA ◽  
María Josefina ALTAMIRANO ◽  
Luis Florez BRACHO ◽  
Silvina PAZ ◽  
Ignacio ZUBIAURRE
Keyword(s):  
Irritable Bowel Syndrome ◽  
Chronic Constipation ◽  
Meta Analysis ◽  
Efficacy And Safety ◽  
Spontaneous Bowel Movement ◽  
Intention To Treat ◽  
Mesh Terms ◽  
Bowel Movements ◽  
Irritable Bowel ◽  
Therapeutic Alternatives

ABSTRACT BACKGROUND: Intestinal secretagogues have been tested for the treatment of chronic constipation and constipation-predominant irritable bowel syndrome. The class-effect of these type of drugs has not been studied. OBJECTIVE: To determine the efficacy and safety of intestinal secretagogues for the treatment of chronic constipation and constipation-predominant irritable bowel syndrome. METHODS: A computer-based search of papers from 1966 to September 2017 was performed. Search strategy consisted of the following MESH terms: intestinal secretagogues OR linaclotide OR lubiprostone OR plecanatide OR tenapanor OR chloride channel AND chronic constipation OR irritable bowel syndrome. Data were extracted as intention-to-treat analyses. A random-effects model was used to give a more conservative estimate of the effect of individual therapies, allowing for any heterogeneity among studies. Outcome measures were described as Relative Risk of achieving an improvement in the symptom under consideration. RESULTS: Database Search yielded 520 bibliographic citations: 16 trials were included for analysis, which enrolled 7658 patients. Twelve trials assessed the efficacy of intestinal secretagogues for chronic constipation. These were better than placebo at achieving an increase in the number of complete spontaneous bowel movements per week [RR 1.87 (1.24-2.83)], at achieving three or more spontaneous bowel movements per week [RR 1.56 (1.31-1.85)] and at inducing spontaneous bowel movement after medication intake [RR 1.49 (1.07-2.06)]. Similar results were observed when assessing the efficacy of intestinal secretagogues on constipation-predominant irritable bowel syndrome based on the results of six trials. CONCLUSION: Intestinal secretagogues are useful and safe therapeutic alternatives for the treatment of constipation-related syndromes.

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