Chronic constipation is a very common clinical problem with its prevalence of up to 14% in the general population. It is not a life-threatening disease, but since patient's satisfaction to the treatment is known to be as low as 50%, chronic constipation still remains a clinically challenging problem. Fortunately, many new treatments have been introduced or are to be introduced in the near future. This article will review the basic concepts and the results of recent studies on the new treatments for chronic constipation.
Chloride Channel Agonists/therapeutic use ; Chronic Disease ; Constipation/*drug therapy/epidemiology ; Humans ; Laxatives/*therapeutic use ; Polyethylene Glycols/therapeutic use ; Prevalence ; Probiotics/therapeutic use ; Serotonin 5-HT4 Receptor Agonists/therapeutic use

While constipation is a common symptom in Korea, there are no existing treatment guidelines. Although constipation may occur as a result of organic cause, there is no obstructive mucosal or structural cause in the vast majority of patients with constipation. The present paper deals with only the management of functional constipation: lifestyle changes; bulking agents and stool softeners; osmotic agents; stimulant laxatives; prokinetics; biofeedback and surgical treatments. Exercise and dietary fiber are helpful in some patients with constipation. Laxatives including bulking agents, stool softeners, osmotic agents, and stimulant laxatives have been found to be more effective than placebo at relieving symptoms of constipation. New enterokinetic agents that affect peristalsis through selective interaction with 5-hydroxytryptamine-4 receptors can be effective in patients with constipation who cannot get adequate relief from current laxatives. Biofeedback can relieve symptoms in selected patients with pelvic floor dyssynergia. Surgical treatments can be helpful in some patients with refractory constipation.
Biofeedback, Psychology ; Cathartics/therapeutic use ; Constipation/surgery/*therapy ; Dietary Fiber/therapeutic use ; Electric Stimulation Therapy ; Exercise Therapy ; Health Behavior ; Humans ; Laxatives/therapeutic use ; Serotonin 5-HT4 Receptor Antagonists/therapeutic use ; Surface-Active Agents/therapeutic use

PURPOSE: This study was done to identify effects of carbonated water intake on constipation in elders who have experienced a cerebrovascular accident (CVA) and are bed-ridden. METHODS: Forty elderly patients with CVA were randomly assigned to one of two groups in a double-blind study. Patients in the experimental group drank carbonated water and those in the control group drank tap water for two weeks. Six patients dropped out during the study period. Data were analyzed by repeated measured ANCOVA and the covariance was the dose of laxatives used for the two weeks. RESULTS: Frequency of defecation increased significantly and symptoms of constipation decreased significantly for patients in the experimental group. CONCLUSION: The study results suggest that the intake of carbonated water is an effective method for the intervention of constipation in elderly patients with CVA.
Aged ; Analysis of Variance ; Carbonates/*therapeutic use ; Constipation/complications/*drug therapy ; Double-Blind Method ; Female ; Humans ; Laxatives/therapeutic use ; Male ; Middle Aged ; Stroke/*complications

Traditional symptom-based therapies of irritable bowel syndrome (IBS) are directed at the relief of individual IBS symptoms, but they are often of limited efficacy in addressing the entire symptom complex. Combinations of drugs to target bothersome symptoms are suggested as the first-line pharmacologic treatment. Increasing knowledge of the pathophysiology and molecular mechanisms of IBS has resulted in the development of several new therapeutic approaches. Thirteen consensus statements for the treatment of IBS were developed using the modified Delphi approach. Exclusion diets have modest efficacy in improving symptoms in some IBS patients. Symptom-based therapies with dietary fiber, bulking agents, laxatives, antispasmodics and laxatives are effective in the improvement of some individual symptoms, e.g. dietary fiber and bulking agents for constipation, laxatives for constipation, antispasmodics for abdominal pain and discomfort, antidiarrheals for diarrhea. 5HT3 receptor antagonists and 5HT4 receptor agonists are effective in the relief of global IBS symptoms and individual symptoms such as abdominal pain and abnormal bowel habits. A short term course of nonabsorbable antibiotics may improve global IBS symptoms, particularly in patients with diarrhea- predominant IBS. Some probiotics appear to have the potential benefit in improving global IBS symptoms. Selective C-2 chloride channel activator is more effective than placebo at relieving global IBS symptoms in patients with constipation-predominant IBS. Both tricyclic antidepressants and selective serotonin reuptake inhibitors are equally effective in relieving global IBS symptoms, and have some benefits in treating abdominal pain. Certain types of psychologic therapy may be effective in improving global symptoms in some IBS patients. Further studies are strongly needed to develop better treatment strategies for Korean patients with IBS.
Anti-Infective Agents/therapeutic use ; Antidepressive Agents/therapeutic use ; Antidiarrheals/therapeutic use ; Dietary Fiber/therapeutic use ; Humans ; Irritable Bowel Syndrome/*therapy ; Laxatives/therapeutic use ; Parasympatholytics/therapeutic use ; Probiotics/therapeutic use ; Serotonin 5-HT4 Receptor Agonists/therapeutic use ; Serotonin Antagonists/therapeutic use

The purpose of this study was to investigate the prevalence, clinical characteristics, and management of functional constipation at pediatric gastroenterology clinics. A prospective survey using the Rome III criteria was distributed to a group of parents of children with a constipation history and its control group in May 2008. The mean prevalence of constipation was 6.4%, which was similar to those in other countries. Statistically significant variables for children without constipation were that more children had a body mass index of below the 10th percentile even though they received more mother's care and ate balanced meals compared to the constipation group. Meanwhile, the constipation group frequently showed a history of constipation in infancy, picky-eating, lack of exercise, and retentive posturing. When analyzed with the Rome III criteria, the children showed greater than 60% rate of hard stools, painful stools, a history of large fecal mass in rectum, and its disappearance of constipation symptoms after passing a large stool. Our study found different approaches amongst pediatric gastroenterologists like rectal examinations, disimpaction, or drug treatment. Several factors addressed in our study can provide better guidelines for clinicians treating constipation and its future research.
Adolescent ; Body Mass Index ; Child ; Child, Preschool ; Constipation/*diagnosis/drug therapy/epidemiology ; Female ; Hospitals ; Humans ; Infant ; Laxatives/therapeutic use ; Male ; Prevalence ; Prospective Studies ; Rectum/physiopathology ; Severity of Illness Index

Colorectal fecaloma is hardening of feces into lumps of varying size that is much harder in consistency than a fecal impaction. Complications of colorectal fecaloma include ulceration, bleeding, perforation and obstruction of the colon. Most fecalomas are successfully removed by conservative treatment with laxatives, enemas and rectal evacuation to relieve fecal impaction. When conservative treatments have failed, a surgical intervention may be needed. Herein, we report a case of 4.7 cm sized sigmoid fecaloma showing no response to conservative treatments that was successfully removed by endoscopic fragmentation with Coca-Cola injection instead of surgery.
Adult ; Cola/*chemistry ; Colon, Sigmoid ; Colonoscopy ; Fecal Impaction/*drug therapy ; Female ; Humans ; Laxatives/*therapeutic use ; Radiography, Abdominal ; Tomography, X-Ray Computed

Constipation is a digestive symptom that is frequently seen in clinical practice. Its prevalence has been reported to be 2% to 20%, depending on geographical region. Despite the rapid development of medical science, systematic studies on constipation have been rarely conducted in Korea. Recently, guidelines on the diagnosis and treatment of functional gastrointestinal disorders, including constipation, were proposed by The Korean Society of Neurogastroenterology and Motility. These guidelines are expected to reflect the current situation regarding treatment of constipation in Korea. In this paper, practical constipation treatment methods that are in current use will be reviewed with reference to these recent guidelines.
*Behavior Therapy ; Constipation/diagnosis/epidemiology/physiopathology/*therapy ; Defecation/*drug effects ; Dietary Fiber/*administration & dosage ; Humans ; Laxatives/*therapeutic use ; Practice Guidelines as Topic ; Prevalence ; Republic of Korea/epidemiology ; *Risk Reduction Behavior ; Treatment Outcome

INTRODUCTIONConstipation is a common poststroke complication. This study was designed to document the incidence and clinical course of poststroke constipation in a rehabilitation ward, as well as identify the factors independently associated with the condition.

METHODSThis retrospective study involved patients who were admitted to the rehabilitation ward of our institute due to an acute stroke between 1 August 2010 and 31 July 2011. The main outcome measured was the incidence of poststroke constipation, defined as the use of laxative after stroke, fulfilment of the Rome II diagnostic criteria for functional constipation and/or stool impaction. The variables examined were basic demographic data, presence of impairment, degree of disability (evaluated using the Barthel index), walking ability, medications taken and medical complications.

RESULTSOut of the 155 patients who met the inclusion criteria, 123 (79.4%) had poststroke constipation. All 123 patients used oral laxatives; 56 received additional rectal medications and 13 discontinued their use of laxatives at discharge. Patients with poststroke constipation were more likely to have major medical complications (p = 0.04). Those who used rectal medications had a higher risk of major medical complications than those who used only oral laxatives (p < 0.01). Infratentorial lesions were an independent predictor of poststroke constipation (p = 0.003). More severe disability increased the severity of constipation, as indicated by the use of rectal medication.

CONCLUSIONPoststroke constipation is a common complication during inpatient rehabilitation. Healthcare providers should be aware of the incidence of poststroke constipation. Further studies are required to establish standard guidelines for screening and managing bowel function in patients with stroke.

Age Distribution ; Aged ; Aged, 80 and over ; Cohort Studies ; Constipation ; drug therapy ; epidemiology ; etiology ; Female ; Follow-Up Studies ; Humans ; Incidence ; Laxatives ; therapeutic use ; Male ; Middle Aged ; Rehabilitation Centers ; Retrospective Studies ; Risk Assessment ; Severity of Illness Index ; Sex Distribution ; Singapore ; Stroke ; complications ; diagnosis ; Stroke Rehabilitation ; Treatment Outcome