• Humans
• Obesity/epidemiology

• parkinson’s disease
• dysphagia
• nausea
• bloating
• constipation

• Humans
• Constipation/diagnosis
• Constipation/etiology
• Constipation/therapy
• Gastrointestinal Diseases/diagnosis
• Gastrointestinal Diseases/etiology
• Gastrointestinal Diseases/therapy
• Levodopa/pharmacology
• Parkinson Disease/complications
• Parkinson Disease/diagnosis
• Parkinson Disease/drug therapy

• Humans
• Defecation
• Retrospective Studies
• Manometry/methods
• Constipation/diagnosis
• Constipation/therapy
• Biofeedback, Psychology/methods
• Anal Canal

• Humans
• Parkinson Disease/complications
• Parkinson Disease/epidemiology
• Parkinson Disease/diagnosis
• Constipation/diagnosis
• Constipation/epidemiology
• Constipation/etiology
• Prevalence
• Cognitive Dysfunction/complications

• Constipation/diagnosis
• Constipation/therapy
• Humans
• Quality of Life
• Rectum
• Sensation
• Transcutaneous Electric Nerve Stimulation

• Constipation
• Herbal medicines
• Laxative
• Medicinal effects
• Non-pharmacological
• Pharmacological

• anorectal manometry
• colonic transit
• constipation
• dyssynergic defecation
• gastrointestinal disorders
• motility
• slow transit constipation

• Biofeedback
• Functional constipation
• High quality care
• Pelvic floor dysfunction
• Self-rating anxiety scale
• Self-rating depression scale

Chronic constipation is the disturbances of intestinal motility which is a challenge in primary healthcare around the world. In this study, Court-type Thai traditional massage and Senokot, treatments were assessed and compared in terms of their efficacy in relieving constipation. Forty subjects diagnosed with constipation were recruited and randomized into the massage group and drug group. For 7 days, Thai traditional abdominal massage was provided regularly for the patients in the massage group, while the drug group was subjected to Senokot treatment only. The Bristol stool chart scale and demographics questionnaire were used as instruments. As a result, both court type Thai traditional massage and Senokot are effective in relieving constipation. However, although both treatment options can increase the frequency of defecations and the sensation of complete evacuation, the court type Thai traditional massage seems to be better since it leads to normal defecations rather than watery or entirely liquid defecations with no solid pieces (p < 0.05). This randomized controlled trial suggested that Thai traditional abdominal massage can be used as an optional public health treatment for constipation.

• Thai traditional massage
• abdominal massage
• constipation
• randomized controlled trial

• Anorectal function
• Constipation
• Digital rectal examination
• Fecal incontinence
• Translumbosacral anorectal magnetic stimulation

• Anal Canal/physiopathology
• Constipation/diagnosis
• Constipation/physiopathology
• Constipation/psychology
• Defecography
• Diagnostic Techniques, Digestive System
• Fecal Incontinence/diagnosis
• Fecal Incontinence/physiopathology
• Fecal Incontinence/psychology
• Humans
• Magnetic Resonance Imaging
• Magnetics
• Manometry/methods
• Medical Records
• Pudendal Nerve/physiopathology
• Quality of Life
• Reaction Time
• Rectum/physiopathology
• Ultrasonography

• Colonic inertia
• Descending perineum syndrome
• Dyssynergia
• Evacuation disorder
• Slow transit constipation

• Adult
• Case-Control Studies
• Constipation/blood
• Constipation/drug therapy
• Constipation/physiopathology
• Enzyme-Linked Immunosorbent Assay/methods
• Fasting/blood
• Fasting/physiology
• Female
• Guanylyl Cyclase C Agonists/therapeutic use
• Humans
• Irritable Bowel Syndrome/blood
• Irritable Bowel Syndrome/complications
• Irritable Bowel Syndrome/drug therapy
• Irritable Bowel Syndrome/physiopathology
• Male
• Middle Aged
• Natriuretic Peptides/metabolism
• Natriuretic Peptides/therapeutic use
• Nucleotides, Cyclic/metabolism
• Peptides/therapeutic use
• Protein Precursors/metabolism
• Receptors, Atrial Natriuretic Factor/metabolism

• chronic idiopathic constipation
• guanylate cyclase C
• irritable bowel syndrome-constipation
• linaclotide
• plecanatide
• uroguanylin

• Gastrointestinal Diseases/diagnosis
• Gastrointestinal Diseases/etiology
• Gastrointestinal Diseases/therapy
• Humans
• Receptors, Guanylate Cyclase-Coupled/physiology

• P30 CA056036 NCI NIH HHS
• R01 CA206026 NCI NIH HHS
• R01 DK092179 NIDDK NIH HHS
• R01 CA204481 NCI NIH HHS
• Targeted Diagnostics & Therapeutics, Inc.
• National Cancer Institute
• National Institute of Diabetes and Digestive and Kidney Diseases
• Synergy Pharmaceuticals

Dyssynergic defecation (DD) is present in approximately 30% of patients with idiopathic chronic constipation (CC). Diagnostic criteria for DD require objective testing such as anorectal manometry (ARM); yet, ARM remains a limited resource in Canada. The aim of this study is to determine the predictability of DD in patients with CC using a standardized self-reported symptom questionnaire.

In this study, 166 consecutive English-speaking patients with CC who were referred for ARM completed a symptom questionnaire. DD was diagnosed if pelvic floor dyssynergy was demonstrated by ARM and balloon expulsion time was more than one minute. Likelihood ratios (LRs) were calculated for individual symptoms and prespecified symptom combinations. Likelihood ratios greater than five or less than 0.2 were considered significant. A recursive partitioning tree was used to find the symptoms best able to predict DD.

No single constipation symptom was sufficient to predict a diagnosis of DD. Patients who reported sometimes feeling an urge to defecate and a prolonged straining duration of greater than five minutes were more likely to have DD (LR = 7.74). In patients who reported straining often or always and had a short straining duration of less than two minutes, the diagnosis of DD was less likely (LR = 0.04). The recursive partitioning tree analysis similarly identified a sense of urge with a prolonged straining duration as predictor for DD, as well as an incomplete evacuation as another potential predictor.

Questions regarding need to strain, duration of straining, urge to defecate, and incomplete evacuation are useful to predict the presence of DD in patients with CC. These questions will enable clinicians to make a clinical diagnosis of DD to guide treatment.

• Anorectal manometry
• Chronic constipation
• Dyssynergic defecation

Constipation is one of the most frequently reported gastrointestinal (GI) disorders that negatively impacts quality of life and is associated with a significant economic burden to the patients and society. Traditional treatments including lifestyle modification and laxatives are often ineffective in the more severe forms of constipation and over the long term. New medications targeting at intestinal chloride channels and colonic serotonin receptors have been demonstrated effective in recent years. Emerging agents focusing on improving intestinal secretion and/or colonic motility have been shown effective in animal models and even in clinical trials. Recognization of the role of cystic fibrosis transmembrane regulator (CFTR) and calcium-activated chloride channels (CaCCs) in intestine fluid secretion and motility modulation makes CFTR and CaCCs promising molecule targets for anti-constipation therapy. Although there are multiple choices for constipation treatment, there is still a recognized need for new medications in anti-constipation therapy. The present review covers the discovery of luminally acting agents for constipation treatment described in both patents (2011–present) and scientific literatures.

• activators
• chloride channels
• constipation
• fluid secretion
• intestinal motility

• Abdominal discomfort
• Adultos
• Adults
• Atención Primaria
• Clinical practice guide
• Digestive Diseases
• Enfermedades digestivas
• Estreñimiento funcional
• Functional constipation
• Guía de práctica clínica
• Irritable bowel syndrome
• Molestia abdominal
• Primary Care
• Roma IV
• Rome IV
• Síndrome del intestino irritable

• Adult
• Algorithms
• Constipation/complications
• Constipation/diagnosis
• Constipation/therapy
• Continuity of Patient Care
• Humans
• Irritable Bowel Syndrome/complications
• Irritable Bowel Syndrome/diagnosis
• Irritable Bowel Syndrome/therapy

• biofeedback
• descending perineum syndrome
• dyssynergic defecation
• increased perineal descent
• obstructive defecation syndrome
• paradoxical puborectalis contraction

• Abdominal discomfort
• Adultos
• Adults
• Atención Primaria
• Clinical practice guide
• Digestive Diseases
• Enfermedades digestivas
• Estreñimiento funcional
• Functional constipation
• Guía de práctica clínica
• Irritable bowel syndrome
• Molestia abdominal
• Primary Care
• Roma IV
• Rome IV
• Síndrome del intestino irritable

Although chronic constipation is a common symptom, to date no international consensus has been reached regarding its definition. The aims of this study were (1) to investigate defecation habits and (2) to examine the prevalence of constipation using the Japanese Society of Internal Medicine (JSIM) and the Rome III criteria using an online survey.

An online questionnaire composed of items on the frequency, interval, form of defecation, the management, and self-recognition of constipation (reference standard of constipation) was created. A total of 5155 valid responses were received. In addition, constipation symptoms were evaluated through a survey using the JSIM and the Rome III criteria.

In the internet survey, 28.4% of the respondents considered themselves to be constipated. Stratified by sex, significantly more females (37.5%) than males (19.1%) considered themselves to be constipated (P < 0.001). The prevalence of constipation among the respondents was 28.0% using the Rome III, but only 10.1% using the JSIM. The diagnostic accuracy was 73.2% for the Rome III and 78.1% for the JSIM, while the diagnostic specificity was 81.1% for the Rome III and 97.5% for the JSIM. However, the diagnostic sensitivities for both measures were low, at 52.2% and 29.2% for the Rome III and the JSIM, respectively.

The online survey developed for this study was able to provide clarification regarding defecation patterns. The results also suggest a discrepancy between the self-recognized prevalence of constipation in Japan and prevalence of constipation based on the JSIM criteria.

• Constipation
• Prevalence
• Recognition

Dyssynergic defecation is common and affects up to one half of patients with chronic constipation. This acquired behavioral problem is due to the inability to coordinate the abdominal and pelvic floor muscles to evacuate stools. A detailed history, prospective stool diaries, and a careful digital rectal examination will not only identify the nature of bowel dysfunction, but also raise the index of suspicion for this evacuation disorder. Anorectal physiology tests and balloon expulsion test are essential for a diagnosis. Newer techniques such as high-resolution manometry and magnetic resonance defecography can provide mechanistic insights. Recently, randomized controlled trials have shown that biofeedback therapy is more effective than laxatives and other modalities, both in the short term and long term, without side effects. Also, symptom improvements correlated with changes in underlying pathophysiology. Biofeedback therapy has been recommended as the first-line of treatment for dyssynergic defecation. Here, we provide an overview of the burden of illness and pathophysiology of dyssynergic defecation, and how to diagnose and treat this condition with biofeedback therapy.

• Constipation
• Defecation
• Laxatives

• adverse events
• clozapine
• constipation
• meta-analysis
• systematic review
• treatment-resistant schizophrenia

• Antipsychotic Agents/adverse effects
• Clozapine/adverse effects
• Constipation/chemically induced
• Constipation/epidemiology
• Humans
• Odds Ratio
• Prevalence
• Schizophrenia/complications
• Schizophrenia/drug therapy
• Serotonin Antagonists/adverse effects

• MC_PC_13065 Medical Research Council
• MR/L003988/1 Medical Research Council
• MR/L011794/1 Medical Research Council

Although a range of guidelines for the diagnosis and treatment of chronic constipation has been carried out, there was very little information about the understanding on constipation. The aim of the present study was to estimate the understanding of constipation symptoms and the diagnosis and management of constipation by clinical physicians in China.

Participants were physicians and researchers in the field of gastroenterology in China who were scheduled to attend the National Conference on gastrointestinal motility(Constipation). Based on the recommendation of the Rome Foundation Board, the self-reported questionnaire was constructed.

Although most of the opinions on symptoms of constipation were consistent, there were still some differences. Opinions on the Bristol stool form during constipation were discordant, 34% of the doctors thought that it was type 1 and type 2, while 46%of the doctors suggested that type 3 should also be considered constipation. There was no significant difference between them(P = 0.05); We investigated the interpretation on the duration of defecation prolonged, 27% of the doctors suggested it should be longer than 10 minutes, 22% of the doctors suggested it should be longer than 20 minutes, and other 22% of the doctors suggested it should be time of defecation became longer compared to previously bowel habits, there was no significant difference among them(P = 0.38).Only 36% of the doctors thought that psychotherapy was most important in the treatment of severe constipation, while 37% of the doctors thought that medication treatment was most important in the treatment of severe constipation, there was no significant difference between them(P = 0.895).

We were able to obtain valuable information about current views on symptoms of constipation and the diagnosis and treatment of constipation among Chinese doctors. Although most of the opinions were consistent there were still some differences. This study indicated that in practice in China there was a need for further study on the role of constipation symptoms and there may also be a need for better establishment of consensus guidelines for constipation.

• China/epidemiology
• Constipation/diagnosis
• Constipation/epidemiology
• Constipation/therapy
• Defecation
• Disease Management
• Gastrointestinal Motility
• Humans
• Physicians

• Colonic transit time
• Constipation
• Difficult defecation
• Dyschezia
• Irritable bowel syndrome with constipation

Diarrhea is one of the most common complications following colectomy in patients with slow transit constipation (STC). Early postoperative diarrhea is usually treated with opioid agonists; however, to date, published data on the management of persistent diarrhea after colectomy for STC are scarce. Here, we report a case of severe diarrhea after a total colectomy with ileorectal anastomosis. One year after the surgery, the patient presented with persistent diarrhea. Treatment with a long-acting somatostatin analogue, lanreotide Autogel, was initiated. One month after the first injection of lanreotide Autogel the diarrhea was resolved. The patient's stool transit was markedly improved (type 4 or type 5 according to the Bristol Stool Chart compared to type 7 before the treatment), positively affecting the patient's quality of life (mean score of 2.1 on the Irritable Bowel Syndrome Quality of Life questionnaire compared to 3.9 before the treatment). This case report describes a successful use of lanreotide Autogel in a patient with persistent diarrhea after a total colectomy.

• Abdominal Pain/drug therapy
• Abdominal Pain/physiopathology
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Chronic Disease
• Constipation/drug therapy
• Constipation/physiopathology
• Double-Blind Method
• Female
• Gastrointestinal Agents/administration & dosage
• Gastrointestinal Agents/adverse effects
• Gastrointestinal Agents/therapeutic use
• Humans
• Male
• Middle Aged
• Peptides/administration & dosage
• Peptides/adverse effects
• Peptides/therapeutic use
• Treatment Outcome
• Young Adult

• Rome II criteria
• Rome III criteria
• constipation
• diagnosis
• questionnaires

• Clinical review
• Constipation
• Evidence-based medicine

Constipation severity is often defined by symptoms including feelings of complete evacuation, straining, stool frequency and consistency. These descriptors are mostly obtained in the absence of laxative use. For many constipated patients laxative usage is ubiquitous and long standing. Our aim was to determine the impact of laxative use upon the stereotypic constipation descriptors.

Patients with confirmed slow transit constipation completed 3-week stool diaries, detailing stool frequency and form, straining, laxative use and pain and bloating scores. Each diary day was classified as being under laxative affect (laxative affected days) or not (laxative unaffected days). Unconditional logistic regression was used to assess the affects of laxatives on constipation symptoms.

Ninety four patients with scintigraphically confirmed slow transit constipation were enrolled in the study. These patients reported a stool frequency of 5.6 ± 4.3 bowel motions/week, only 21 patients reported <3 bowel motions/week. Similarly, 21 patients reported a predominant hard stool at defecation. The majority (90%) of patients reported regular straining. A regular feeling of complete evacuation was reported in just 7 patients. Daily pain and/or bloating were reported by 92% of patients. When compared with laxative unaffected days, on the laxative affected days patients had a higher stool frequency (OR 2.23; P <0.001) and were more likely to report loose stools (OR 1.64; P <0.009). Laxatives did not increase the number of bowel actions associated with a feeling of complete evacuation. Laxative use had no affect upon straining, pain or bloating scores

The reporting of frequent and loose stools with abdominal pain and/or bloating is common in patients with slow transit constipation. While laxative use is a significant contributor to altering stool frequency and form, laxatives have no apparent affect on pain or bloating or upon a patients feeling of complete evacuation. These factors need to be taken into account when using constipation symptoms to define this population.

AIM: To determine whether distinct symptom groupings exist in a constipated population and whether such grouping might correlate with quantifiable pathophysiological measures of colonic dysfunction.

METHODS: One hundred and ninety-one patients presenting to a Gastroenterology clinic with constipation and 32 constipated patients responding to a newspaper advertisement completed a 53-item, wide-ranging self-report questionnaire. One hundred of these patients had colonic transit measured scintigraphically. Factor analysis determined whether constipation-related symptoms grouped into distinct aspects of symptomatology. Cluster analysis was used to determine whether individual patients naturally group into distinct subtypes.

RESULTS: Cluster analysis yielded a 4 cluster solution with the presence or absence of pain and laxative unresponsiveness providing the main descriptors. Amongst all clusters there was a considerable proportion of patients with demonstrable delayed colon transit, irritable bowel syndrome positive criteria and regular stool frequency. The majority of patients with these characteristics also reported regular laxative use.

CONCLUSION: Factor analysis identified four constipation subgroups, based on severity and laxative unresponsiveness, in a constipated population. However, clear stratification into clinically identifiable groups remains imprecise.

• Factor analysis
• Constipation
• Symptoms
• Clusters
• Laxatives