Constipation

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Constipation is "Infrequent or difficult evacuation of feces. These symptoms are associated with a variety of causes, including low dietary fiber intake, emotional or nervous disturbances, systemic and structural disorders, drug-induced aggravation, and infections."[1]

Classification

Constipation may be classified by colonic transit time testing. The oralanal transit time the amount of time required for radiopaque markers to transit from the mouth to colon. Normal is less expelling more than 80% of markers within 67 hours[2] to 72[3] hours.

Slow-transit constipation

Slow-transit constipation is associated with hard stools.[4] In a case series of women whose oralanal transit times were over 5 days, subjects averaged one bowel movement per week.[5]

Slow-transit constipation may be associated with delayed gastric emptying in 60%[6] to 75%[7] of patients.

Slow-transit constipation may be associated with other signs of autonomic dysfunction[7]

Normal-transit constipation

Patients with normal-transit constipation may have more psychological distress.[8][9]

Treatment

Dietary fiber is the principle treatment.[3] Osmotic laxatives, such as polyethylene glycol (PEG)[10][11], may also be used.

Patients with slow-transit constipation may be less likely to respond to dietary fiber.[2] Although not compared to nonsurgical therapy in randomized controlled trials, various surgeries to reduce colonic time have been used.[12]

Investigational treatments

Prucalopride is an agonist of 5-hydroxytryptamine4 cell surface receptors that may treat severe chronic constipation.[13]

Methylnaltrexone is an antagonist of opioid mu cell surface receptors and may treat constipation due to opioid analgesics.[14]

Treatments to avoid

Sodium phosphate, by enema[15] or especially by mouth[16], can lead to metabolic and renal problems such as hypovolemia, hypernatremia, hyperphosphatemia, and phosphate nephropathy.

References

  1. Anonymous (2015), Constipation (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. 2.0 2.1 Voderholzer WA, Schatke W, Mühldorfer BE, Klauser AG, Birkner B, Müller-Lissner SA (January 1997). "Clinical response to dietary fiber treatment of chronic constipation". Am. J. Gastroenterol. 92 (1): 95–8. PMID 8995945[e]
  3. 3.0 3.1 Lembo A, Camilleri M (October 2003). "Chronic constipation". N. Engl. J. Med. 349 (14): 1360–8. DOI:10.1056/NEJMra020995. PMID 14523145. Research Blogging.
  4. Degen LP, Phillips SF (July 1996). "How well does stool form reflect colonic transit?". Gut 39 (1): 109–13. PMID 8881820. PMC 1383242[e]
  5. Preston DM, Lennard-Jones JE (January 1986). "Severe chronic constipation of young women: 'idiopathic slow transit constipation'". Gut 27 (1): 41–8. PMID 3949236. PMC 1433176[e]
  6. van der Sijp JR, Kamm MA, Nightingale JM, et al (May 1993). "Disturbed gastric and small bowel transit in severe idiopathic constipation". Dig. Dis. Sci. 38 (5): 837–44. PMID 8482182[e]
  7. 7.0 7.1 Altomare DF, Portincasa P, Rinaldi M, et al (February 1999). "Slow-transit constipation: solitary symptom of a systemic gastrointestinal disease". Dis. Colon Rectum 42 (2): 231–40. PMID 10211501[e]
  8. Ashraf W, Park F, Lof J, Quigley EM (January 1996). "An examination of the reliability of reported stool frequency in the diagnosis of idiopathic constipation". Am. J. Gastroenterol. 91 (1): 26–32. PMID 8561138[e]
  9. Wald A, Hinds JP, Caruana BJ (October 1989). "Psychological and physiological characteristics of patients with severe idiopathic constipation". Gastroenterology 97 (4): 932–7. PMID 2777045[e]
  10. Lee-Robichaud H, Thomas K, Morgan J, Nelson RL (2010). "Lactulose versus Polyethylene Glycol for Chronic Constipation.". Cochrane Database Syst Rev 7: CD007570. DOI:10.1002/14651858.CD007570.pub2. PMID 20614462. Research Blogging.
  11. Dipalma JA, Cleveland MV, McGowan J, Herrera JL (July 2007). "A randomized, multicenter, placebo-controlled trial of polyethylene glycol laxative for chronic treatment of chronic constipation". Am. J. Gastroenterol. 102 (7): 1436–41. DOI:10.1111/j.1572-0241.2007.01199.x. PMID 17403074. Research Blogging.
  12. Peng HY, Xu AZ (December 2006). "Colonic exclusion and combined therapy for refractory constipation". World J. Gastroenterol. 12 (48): 7864–8. PMID 17203535[e]
  13. Camilleri M, Kerstens R, Rykx A, Vandeplassche L (May 2008). "A placebo-controlled trial of prucalopride for severe chronic constipation". N. Engl. J. Med. 358 (22): 2344–54. DOI:10.1056/NEJMoa0800670. PMID 18509121. Research Blogging.
  14. Thomas J, Karver S, Cooney GA, et al (May 2008). "Methylnaltrexone for opioid-induced constipation in advanced illness". N. Engl. J. Med. 358 (22): 2332–43. DOI:10.1056/NEJMoa0707377. PMID 18509120. Research Blogging.
  15. Mendoza J, Legido J, Rubio S, Gisbert JP (July 2007). "Systematic review: the adverse effects of sodium phosphate enema". Aliment. Pharmacol. Ther. 26 (1): 9–20. DOI:10.1111/j.1365-2036.2007.03354.x. PMID 17555417. Research Blogging.
  16. Steinman TI, Samir AE, Cornell LD (August 2008). "Case records of the Massachusetts General Hospital. Case 27-2008. A 64-year-old man with abdominal pain, nausea, and an elevated level of serum creatinine". N. Engl. J. Med. 359 (9): 951–60. DOI:10.1056/NEJMcpc0804600. PMID 18753652. Research Blogging.