A treatment for constipation is especially relevant for consumers that suffer on a regular basis or cannot bear attendant symptoms. For the overall health it is important to have a regular bowel movement. If a healthy diet, lots of exercise and common "cures" such as prunes and fluids require several days to take effect and sometimes don't work at all, it might be necessary to take a laxative to restore regularity. It sometimes might be necessary to visit the doctor to diagnose the cause of constipation. Diagnosis If warning signs exist, the doctor should be consulted. Numerous hormonal disturbances, metabolic disorders and various drugs can cause constipation. Metabolic disorders include diabetes mellitus, an under-active thyroid, reduced potassium or increased calcium levels in the blood. Drugs that can cause constipation include antihypertensive agents, cardiac drugs, iron tablets, antidepressants, hypnotics and diuretics. If these causes can all be ruled out, so-called functional disturbances of spontaneous intestinal motility are generally responsible in 80 to 90 percent of cases. Read more [...]

Constipation is a commonly encountered medical condition in the United States for which many patients initiate self-treatment. One reason constipation continues to be a frequent problem in this country is lack of adequate dietary fiber. Another unfortunate problem is that many people have misconceptions about normal bowel function, and think that daily bowel movements are required for health and well being. Others believe that the lack of a daily bowel movement contributes to the accumulation of toxic substances or is associated with various somatic complaints. These misconceptions often lead to the inappropriate use of laxatives by the general public. Constipation does not have a single, generally agreed upon definition. When using the term, the lay public or health care professional may be referring to several difficult-to-quantify variables: bowel movement frequency, stool size or consistency, and such symptoms as the sensation of incomplete defecation. Stool frequency is most often used to describe constipation; however, the frequency of bowel movements used to define constipation is not Read more [...]

Constipation is defined as the difficulty of passing stools, incomplete passage, or infrequent passage of hard stools. It can be further defined as having less than three stools per week for women and five for men despite a high residual diet, or a period greater than 3 d without a bowel movement. It can be caused by gastrointestinal disorders, metabolic and endocrine disorders, pregnancy, neurogenic and psychogenic problems, or it could be drug induced. Laxative Mechanisms of Action Laxatives promote bowel evacuation by decreasing water and electrolyte absorption, increasing intraluminal osmolarity, or increasing hydrostatic pressure in the gut. Chronic use of laxatives, particularly stimulants, may lead to laxative dependency. Laxative dependency, in turn, may result in fluid and electrolyte imbalances, steatorrhea, osteomalacia, and vitamin and mineral deficiencies. Known as laxative abuse syndrome (LAS), it is difficult to diagnose. Laxative abuse syndrome is often seen in women with anorexia nervosa, depression, and personality disorders and also in elderly patients with quasimedical concerns Read more [...]

There are many excellent reviews of the surgical treatment of rectal prolapse, but there are few that have specifically addressed the issue of constipation in rectal prolapse patients. It is worth remembering that almost every patient with a rectal prolapse has some abnormality of bowel function. Whether the abnormality of bowel function is the cause of the prolapse or whether the functional bowel abnormality is a consequence of the prolapse is difficult to say. Constipation in Rectal Prolapse Etiology Rectal prolapse is considered by most authorities to be a true intussusception of the rectum through the pelvic floor and sphincters. Video-proctographic studies clearly demonstrate the apex of a rectal prolapse descending through the ampulla of the rectum and through the puborectalis swing to appear inside the anal canal and subsequently on the perineum as a rectal prolapse. Intussusception It is unknown whether an intussusception subsequently develops into a full-thickness rectal prolapse. Studies on the long-term natural history of intussusception indicate that some patients do ultimately Read more [...]

IBS — Irritable Bowel Syndrome Diagnosis and Definition Irritable bowel syndrome (IBS) is a common chronic intestinal disorder characterized by abdominal discomfort and altered bowel habits. These symptoms occur in the absence of "structural or biochemical abnormalities." It is estimated that up to 20% of the population of the United States has symptoms suggestive of IBS. Multiple comorbidities, the high cost of medical utilization, and diminished productivity and quality of life all may be found in association with irritable bowel syndrome. Despite extensive research, there is no specific test that can diagnose this condition. In clinical practice, a diagnosis of IBS is accomplished after performing a careful medical history, including a system assessment using established diagnostic criteria, a complete physical examination, and limited laboratory testing. A flexible sigmoidoscopy or colonoscopy is often suggested; the choice of these evaluations depends on the age and risk factors of the individual patient. The clinician must carefully assess the patient for any signs and symptoms of organic Read more [...]

Constipation is commonly defined as the paucity of bowel movements. However, patients may have constipation regardless of the number of bowel movements in a unit of time. The inability to satisfactorily evacuate one's colon and rectum can be manifested by different degrees of abdominal discomfort associated with "normal" bowel habits, infrequent stools, or even overflow diarrhea. In addition, many other abdominal complaints are related to constipation, including pain syndromes, bloating, fullness, and even heartburn and dyspepsia. It is not unusual for patients referred for constipation to present to the specialist having had at least one (and possibly multiple) full anatomic evaluation(s) of the bowel, including computed tomography (CT) scans, contrast studies, and colonoscopies. The reported results of these studies are usually normal, except for varying degrees of diverticulosis coli. Usually, a careful history suffices to reveal the underlying problem. Issues to be addressed in the history include bowel habits, frequency of bowel movements, ease or difficulty with evacuation, chronicity, Read more [...]

Constipation is a common and subjective symptom that can be related to a multitude of factors, including, dietary, psychological, cultural, anatomic, and functional aspects. In addition, constipation is still surrounded by misconceptions and taboos that hamper an objective evaluation and encourage self-medication that is not always innocuous to the patient. The definition of constipation varies tremendously among both patients and physicians. When adults not seeking health care were asked to define constipation, their most frequent definitions included "straining" (52%), "hard stools" (44%), "infrequent stools" (32%), as well as terms such as "abdominal discomfort" and "sense of incomplete evacuation." According to Ruben, 62% of the general population believes that a daily bowel movement is a sign of good health; they may report constipation if they fail to achieve a daily bowel movement or even if they fail to achieve a bowel movement at their usual time each day. Definitions used by physicians include (1) unspecific self-reported symptoms, (2) stool frequency of less than three bowel movements Read more [...]

Lifestyle Dietary Fiber In clinical practice, it is commonly accepted that fiber therapy and stool-bulking agents are the main therapeutic agents of choice in the initial management of primary constipation. Several clinical trials have been performed on the effects of fiber therapy and constipation. Meta-analyses of these trials have had discordant conclusions. In one study, a total of seven double-blind, placebo-controlled trials were analyzed; five of the studies resulted in improvement in overall symptoms, an increase in fecal weight and frequency, and decreased transit time. However, another meta-analysis reviewed 13 clinical trials, and only four found beneficial results. Moreover, the improvements noted were in several nonspecific outcomes, such as ease of stool passage and frequency of satisfaction with bowel movements, and no significant improvement was noted in the more specific symptoms such as stool frequency, abdominal pain, and bloating. Reviews of fiber therapy have pointed out that the most common reason for failure of fiber treatment is noncompliance. In an ongoing prospective Read more [...]

Functional constipation is defined by the Rome II Coordinated Committees as a group of functional disorders that present with resistant, difficult, infrequent, or seemingly incomplete defecation. Previous definitions have included a regular occurrence (in more than 25% of defecations) of excessive straining, lumpy or hard stools, a sense of incomplete evacuation, a sensation of anorectal obstruction or blockage, or less than three bowel movements per week over at least 12 consecutive weeks in the preceding 2 years. Such disorders may be congenital, as in Hirschsprung's disease, or acquired later in life as a result of lifestyle or behavior, infection, or because of anatomic or physiologic abnormalities (Figure: Algorithm describing etiologies of various acquired constipation). The causes of constipation, even after an exhaustive evaluation, often remain unclear and, in many cases, multifactorial. This chapter discusses the etiology of acquired constipation. Lifestyle Diet Western-style societies have the highest incidence of constipation as compared to less developed societies. Dietary Read more [...]

Constipation is among the most common gastrointestinal disorders. It is so prevalent, in fact, that it has been considered endemic in the elderly population. In the United States alone, more than 3 million prescriptions are written for cathartics yearly and over $800 million is spent for over-the-counter (OTC) laxatives. It is clear that constipation represents a major public health problem. Despite its significant impact, the etiology of constipation remains largely unknown. The variety of symptoms and risk factors associated with constipation suggest that its etiology is likely to be multifactorial. Although epidemiologic studies cannot establish etiologic relationships, consistent epidemiologic distributions may suggest potential causative risk factors. The more uniform the epidemiologic pattern, the more likely an environmental agent(s) may be contributing to its etiology. Elucidation of the epidemiology of constipation, therefore, is helpful both in suggesting potential etiologic risk factors and in identifying populations that are at highest risk of developing this condition. Once high-risk Read more [...]