Constipation Help Relief In Minutes

Nature's Quick Constipation Cure

The First Step-by-step Plan To Cure Constipation Using A Combination Of Unique All-natural Remedies. This plan uses a strategically organized and ordered combination of the safest and most effective natural remedies for constipation. Everything used in this plan is from natures garden. No use of harmful laxatives. People who have used these swear they work Better than over-the-counter laxatives! Every strategy is carefully researched for safety and effectiveness. Each remedy builds on the last while helping out the next. The plan takes into account human physiology, anatomy, nutrition, metabolic needs and deficiencies while using specific dietary remedies and the almost always neglected but extremely powerful, mechanical remedies. All of these have been carefully planned and refined to provide you the most powerful, synergistic constipation relief plan that will relieve you of even the most stubborn of constipation episodes within as quick as 15 minutes and less than 24 Hours. Read more...

Natures Quick Constipation Cure Overview


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Children with Constipation Colonic Hypomotility

In these children, colon motility is significantly reduced. The basis of the bowel management program in these patients is to teach parents to clean the child's colon once a day with a suppository, an enema, or colonic irrigation. No special diet or medications are necessary. The fact that these children suffer from constipation (hypomotility) is helpful, as it helps them remain clean between enemas. The real challenge is to find an enema capable of completely cleaning the colon. Definitive evidence that the colon is truly empty following an enema requires a plain abdominal radiograph. Soiling episodes or accidents occur when there is incomplete bowel cleaning and feces that progressively accumulates.


BUCKBEAN was used in the Outer Hebrides, at least on South Uist. They took the root, cleaned it and boiled it in water all day until the juice was dark and thick. This was strained, and a teaspoonful given to the patient it was even given to calves for the same complaint (Shaw), though the dose must have been increased. SCAMMONY is a Near Eastern plant, and a drastic purgative. Its gum resin, or the dried, milky juice is collected, and often put with colocynth and calomel, to be used for constipation, worms or dropsy (Lindley). How did it become an ingredient in a Cambridgeshire folk remedy for constipation (Porter. 1969). BLADDER SENNA is, of course, a laxative, but Sir John Hill's warning has to be heeded - some


RASPBERRY leaves, in one form or another, constituted a Dorset remedy for constipation (Dacombe). There was an ancient use of VIOLETS as a laxative. Gerard prescribed a syrup intended to FLAX seeds, better known as LINSEED, are laxative (Schauenberg & Paris), and have always been used, both as food and as medicine. CASTOR OIL is too well known for further comment. But one of the most extraordinary laxatives in the Middle Ages were the very poisonous seeds of CORN COCKLE. Archaeologists have found them, some crushed as if in an apothecary's mortar, in cesspits of the 13th and 14th centuries (Platt). Hill was still recommending them in the 18th century CAMOMILE tea, that great stand-by for almost any ailment, is used as a laxative, too (V G Hatfield. 1994). A very odd way to tackle the problem comes from Alabama - you had to boil YARROW and thicken it with meal, and then apply it to the stomach (R B Browne). But the best known of all laxatives is the Cascara Sagrada, the bark of the...

Chronic Constipation

FI can occur in patients affected by chronic constipation as a consequence of stool retention in the rectum, resulting in overflow incontinence. Chronic fecal retention determines a significantly decreased anorectal sensation. On the other hand, constipation can be caused by excessive consumption of drugs, including antidiarrheals, narcotics, calcium-channel blockers, antidepressants, and other psychotropic agents. Finally, particularly in the older subjects, dehydration and insufficient fiber and fluid intake cause chronic constipation. Overflow FI is particularly frequent in institutionalized patients. It can require manual disimpaction, stool softeners, laxatives, enemas, or suppositories 22 . Accurate diagnosis of constipation-FI sequence is determinant to avoid planning incorrect or excessive treatment. Physical examination, anorectal manometry and electrophysiology, endoanal ultrasound, contrast defecography, and radiologic transit time evaluation can contribute to the...

The gastrointestinal system

Taste often alters very early in pregnancy. The whole intestinal tract has decreased motility during the first two trimesters, with increased absorption of water and salt, tending to increase constipation. Heartburn is common from the increased intragastric pressure. Hepatic synthesis of albumin, plasma globulin and fibrinogen increases, the latter two sufficiently to give increased plasma concentrations despite the increase in plasma volume. Total hepatic synthesis of globulin increases under oestrogen stimulation, so the hormone-binding globulins rise. There is decreased hepatic extraction of circulating amino acids.

Physical Examination 231

The urologist will be better able to make use of modern diagnostic tools and management algorithms in a purposeful manner once the urologic history and physical examination are complete. They should not be bypassed. A prospective controlled study addressing the predictive value of abdominal examination in the diagnosis of abdominal aortic aneurysm, for instance, reported a negative predictive value higher than 90 for aneurysms of 4 cm and a positive predictive value over 80 for those larger than 5 cm (Vendatasubramaniam et al. 2004). Another group (van den Berg et al. 1999) compared the detection of groin hernia by different diagnostic tools and physical examination. Interestingly, physical examination achieved a sensitivity of 75 and a specificity of 96 . In patients with acute abdominal pain (Bohner et al. 1998), the variables with the highest sensitivity for bowel obstruction were distended abdomen, decreased bowel sounds, history of constipation, previous abdominal surgery,...

Gender Ethnicracial And Life Span Considerations

Approximately one to two out of four patients with allergic purpura have GU symptoms such as dysuria and hematuria. Other symptoms include headaches fever peripheral edema and skin lesions accompanied by pruritus, paresthesia, and angioedema (swelling of the skin, mucous membranes, or organs). Other patients describe severe GI symptoms (spasm, colic, constipation, bloody vomitus, bloody stools) and joint pain.

Problems with Measurement

Some work around definition and classification has been done in the paediatric population in which there is again confusing terminology. There have been several attempts to standardise the definition of functional faecal incontinence in childhood, which accounts for more than 90 of cases 5, 6 The term encopresis is commonly used for paediatric faecal incontinence however, there is variability about its definition in the literature. In 1994, a classic set of criteria was defined for encopresis (with or without symptoms of constipation) 7 . The criteria included two or more faecal incontinence episodes per week in children older than 4 years. The Rome II consensus group also defined criteria for nonretentive faecal incontinence of once per week or more for at least 3 months in a child older than 4 years 6, 8 . However, these two definitions exclude faecal incontinence secondary to constipation and faecal retention, which account for a significant proportion of cases 5, 6, 9 . In 2004, a...

Primary Nursing Diagnosis

Encourage the patient to urinate, but avoid catheterization and the use of suppositories. Postoperatively, a bulk laxative or stool softener is often prescribed on the day of the surgery. Intramuscular injections of analgesics are given to control pain. Assess the perirectal area hourly for bleeding for the first 12 to 24 hours postoperatively. When open fistula wounds are left, as in a fistulotomy, the anal canal may be packed lightly with oxidized cellulose. PATIENT TEACHING. Teach the patient how to keep the perianal area clean teach the female patient to wipe the perineal area from front-to-back after a bowel movement in order to prevent genitourinary infection. Teach the patient about the need for a high-fiber diet that helps prevent hard stools and constipation. Explain how constipation can lead to straining that increases pressure at the incision site. Unless the patient is on fluid restriction, encourage him or her to drink at least 3 L of fluid a day.

Discharge And Home Healthcare Guidelines

Explain the need to remain on a diet that will not cause physical trauma or irritation to the perirectal area. A diet high in fiber and fluids will help soften the stools, and bulk laxatives can help prevent straining. Emphasize to the patient the need to avoid spicy foods and hot peppers to decrease irritation to the perirectal area upon defecation.

Anorexia Nervosa DRG Categr 428

Weight is lost three ways in this condition by restricting food intake, by excessive exercise, or by purging either with laxatives or by vomiting. Initially, patients receive attention and praise for their extreme self-control over food intake, but as the illness progresses, this attention is replaced by worry and efforts to monitor the patient's food intake. The increased negative attention and attempts at control of the patient serve to reinforce the patient's need for control and contribute to the progression of the illness. Adverse consequences of anorexia nervosa include possible atrophy of the cardiac muscle and cardiac dysrhythmias, alteration in thyroid metabolism, and estrogen deficiencies (those with long-standing estrogen deficiencies may develop osteoporosis). Refeeding may lead to slowed peristalsis, constipation, bloating, and fluid retention. Mortality rates are as high as 10 to 20 , and only half of people with anorexia nervosa recover completely.

Multiple Endocrine Neoplasia Type 2 Syndromes

It may be transmitted as an autosomal dominant trait or as a sporadic entity and is characterized by ganglioneuromas of the tarsal plates and the anterior third of the tongue and lips and a marfanoid habitus. Ganglioneuromas that occur in the alimentary tract may be associated with constipation, diarrhea, and megacolon. The marfanoid characteristics include long limbs, hyperextensible joints, scoliosis, and anterior chest deformities, but not the ectopic lens or cardiovascular abnormalities seen in Marfan's syndrome (92).

Common symptoms in pregnancy

Constipation complicates approximately one-third of pregnancies usually decreasing in severity with advancing gestation. It is thought to be related in part to poor dietary fibre intake and reduction in gut motility caused by rising levels of progesterone. Diet modification with bran and wheat fibre supplementation helps, as well as increasing daily fluid intake. Heartburn is also a common symptom in pregnancy, but unlike constipation, occurs more frequently as the pregnancy progresses. It is estimated to complicate one-fifth of pregnancies in the first trimester rising to three quarters by the third trimester. It is due to the increasing pressure caused by the enlarging uterus combined with the hormonal changes that lead to gastro-oesophageal reflux. It is important to distinguish this symptom from the epigastric pain associated with pre-eclampsia which will usually be associated with hypertension and proteinuria. Symptoms can be improved by simple lifestyle modifications such as...

Congenital Risk Factors Anorectal Anomalies

Anorectal anomalies affect 1 3-5,000 newborn babies 11 , most frequently associated with rectourethral fistula in boys and rectovestibular fistula in girls, but which range from low (covered anus) to complex malformations, including persistent cloaca in girls, associated with varying degrees of sacral dysgenesis 12 . The more complex the malformation, the more poorly developed are the levators and external sphincter. Irrespective of adequacy of surgical treatment in terms of anatomical correction, all those born with anorectal anomalies have an abnormal continence mechanism, which in addition to underdeveloped striated musculature includes loss of anal canal sensitivity (and thus faecal continence) and disturbed hindgut motility resulting in a dilated rectum and overflow incontinence 13-15 . Thus, up to 30 of all those born with low defects suffer faecal incontinence, constipation and inability to control flatus, and up to 85 of those with high malformations report social disability...

Hirschsprungs Disease

Up to 50 of children following surgical treatment of Hirschsprung's disease (which affects 1 5,000 live births) suffer constipation or faecal incontinence 20 , although by adulthood, most have reasonable function 21, 22 . Physiologically, such disturbances may reside in loss of colonic length, a dysmotile residual colon with increased high-amplitude propagating contractile activity (HAPCs) resulting in rapid stool delivery to the neorectum, and rectal pressures exceeding external anal sphincter pressure, compounded by surgical interventions to relax the internal sphincter and disimpact the rectum, whereas loss of normal urge rectal sensation and failure of internal sphincter relaxation facilitate persistent constipation.

Central Nervous System Cerebrovascular Accidents

Faecal incontinence may affect up to 40 of subjects immediately following a stroke, with a frequency of up to 15 of those who survive 3 years. It is associated with a higher mortality and greater likelihood of need for long-term (institutional) care (exceeding dementia as a reason for requesting nursing home placement). In the immediate poststroke period, incontinence has been shown to be associated with female gender, a history of previous stroke, and comorbidity of other disabling diseases, especially diabetes mellitus and hypertension. The cerebral lesions in those with incontinence are significantly more often a haemorrhage, larger in size, and more often involved the cerebral cortex than those without faecal incontinence 26 . The pathophysiology of urinary incontinence following a stroke has been categorised into three main mechanisms disruption of neuromicturition pathways, stroke-related cognitive and language deficits and concurrent neuropathy and medication use. Presumably,...

Californian Buckthorn

(Rhamnus purshiana) Famous for its product, the Cascara Sagrada, the sacred bark that is the best known of all laxatives, no matter under what name it is marketed (see Weiner). The name cascara sagrada was given by the Spanish pioneers, who took notice that the Californian Indians (Schenk & Gifford Spier) used the bark infusion as a physic. There is also a brown dye to be obtained from the bark. In some parts of California in the early days, the scriptural term Shittim Bark was applied to this. It was said locally to be the Shittim wood of which the Hebrew ark was made (Maddox). It was used by the Californian Indians for toothache the root was heated as hot as could be borne, put in the mouth against the aching tooth, and tightly gripped between the teeth (Powers).

Direct Health Care Costs

Direct health care costs also include expenditure on pharmaceutical drugs, which in patients with fecal incontinence are antidiarrheal and laxatives. These drugs do not have a high unit cost, their impact on the total cost of the disorder being < 10 (5.4 according to Deutekom et al. 5 and 3.9 according to Ratto et al. 6 ).

System Reconstructive Procedures

The primary cause of cystoceles and rectoceles is a weakened vaginal wall. Factors that contribute to this loss of pelvic muscle tone are repeated pregnancies, especially those spaced close together, congenital weaknesses, and unrepaired childbirth lacerations. Obesity, advanced age, chronic cough, constipation, forceps deliveries, and occupations that involve much standing and lifting are also contributing factors. Lack of estrogen after menopause frequently aggravates the condition. Patients with a rectocele have a history of constipation, hemorrhoids, pressure sensations, low back pain, difficulty with intravaginal intercourse, and difficulty controlling and evacuating the bowel. Symptoms may be worse when standing and lifting and are relieved somewhat when lying down. Obstetric history often reveals a forceps delivery. Some report that they are able to

Bladder Rupture Postaugmentation

Undergo augmentation are neurologically impaired therefore, lower abdominal sensation is diminished and signs and symptoms may be nonspecific. Patients may complain of nausea, vomiting, fever, obstipation, gross hematuria, and oliguria physical examination demonstrates a distended rigid abdomen with positive peritoneal signs.

Patient Preparation and Positioning

Bowel preparation is not routinely performed but a clear liquid diet is advised for the day prior to the procedure and a Dulcolax suppository is given on the day prior to surgery. One gram of cefazolin (Ancef) is administered preoperatively. In the obese patient or the individual with a history of deep venous thrombosis, 5000 U of heparin are administered subcutaneously 2 h prior to the procedure and continued on a 12-h basis postoperatively. At the outset of the procedure, just prior to any skin incision, 30 mg of ketorolac (Toradol) is given intravenously.

Storage Sites Plasma Proteins

Diarrhea is an unpleasant physiological effect of toxicant ingestion. It is important to understand the factors and mechanisms responsible for the effect in order to better understand the toxic response and how treatment can be devised. Diarrhea is the frequent evacuation of watery feces. The term is derived from Late Latin diarrhoea and Greek diarrhoia, from diarrhein, which means to flow through. Food poisoning, laxatives, and alcohol ingestion can cause acute diarrhea, but it is usually caused by an acute infection with bacteria such as Salmonella, Staphylococcus aureus, and Escherichia coli. Acute diarrhea is usually self-limiting in infants and the major concern to influence the prognosis is prevention of dehydration. Travelers' diarrhea is very common and affects up to half of those traveling to developing areas of the world. Decreases in solute absorption can result from overeating, deficiencies in gut enzymes or bile flow, or ingestion of poorly absorbed ions such as...

Genetic Considerations

Determine a history of risk factors, with a particular focus on medications. Establish a history of anorexia, nausea, vomiting, constipation, polyuria, or polydipsia. Ask about muscular weakness or digital and perioral paresthesia (tingling) and muscle cramps. Ask family members if the patient has manifested personality changes.

Pharmacologic Highlights

Other Drugs Zoledronate (Zometa) Inhibits bone resorption and Is used for hypercalcemia of malignancy. Bulk laxatives and stool softeners loop rather than thiazide diuretics glucocorticoids such as prednisone (inhibit serum calcium by inhibiting cytokine release, inhibiting intestinal calcium absorption, and increasing urinary calcium excretion). Encourage sufficient fluid intake. Encourage ambulation as soon as possible and as frequently as allowed, being sure to handle the patient carefully to prevent fractures. Reposition bedridden patients frequently, and encourage range-of-motion exercises to promote circulation and prevent urinary stasis, as well as calcium loss from bone. Choose fluids containing sodium, unless con-traindicated. Discourage a high intake of calcium-rich foods and fluids, and provide adequate bulk in the diet to help prevent constipation. If confusion or other mental symptoms occur, institute safety precautions as necessary. Orient the patient frequently, and...

Intussusception Introduction

Intussusception is a telescoping of one section of the bowel into another section which results in obstruction to passage of the intestinal contents and inflammation and decreased blood flow to the parts of the intestinal walls that are pressing against one another. If left untreated, eventual necrosis, perforation, and peritonitis occurs. It occurs in infants most commonly between 3 to 12 months of age or in children 12 to 24 months of age. The actual cause is unknown but risk for the condition increased in children with Meckel's diverticulum, celiac disease, cystic fibrosis, diarrhea, or constipation. Surgical correction is indicated if the obstruction of the involved segment cannot be reduced manually or by hydrostatic pressure or if bowel becomes necrotic.

Clinical Features Lassa fever

These diseases have an insidious onset of malaise, fever, general myalgia and anorexia. Lumbar pain, epigastric pain, retro-orbital pain, often with photophobia, and constipation occur commonly. Nausea and vomiting frequently occur. Temperature is high, reaching 40 C or above. Unlike LCM and Lassa fever, AHF and BHF do not usually lead to respiratory symptoms and sore throat. On physical examination patients appear toxic. Conjunctivitis, erythema of the face, neck and thorax are prominent. Petechiae may be observed in the axillae by the 4th or 5th days of the illness. There may be a pharyngeal enanthem, but pharyngitis is uncommon. Relative bradycardia is

Recommendations for Followup of Patients with ABS Implants

Basal pressure with the ABS opened by the patient represents residual anal pressure. When low, it is indicative of a wide anal opening and easy defecation, whereas high residual pressure could account for postoperative dyschezia. ence a rapid closure quicker than that specified for the ABS (approximately 7 min normally), which may also be responsible for dyschezia. Anal manometry can also be used to check whether the patient is manipulating the device correctly. Pumping quality, which needs to be slow to be efficient, and that of the resulting anal opening can be evaluated on a screen image for the patient's benefit, as during biofeedback sessions.

Indications and Contraindications for the ABS

In cases of neurogenic or neurologic fecal incontinence, it is essential to take into account possible associated dyschezia and excessive perineal descent. The ABS creates an obstacle to rectal evacuation, which can sometimes cause considerable evacuation difficulties. Continence restoration should not be achieved to the detriment of evacuation capacities. However, an objective assessment of the state of pre-operative transit is not always easy. Patients have often modified their diet to avoid difficulties or have had recourse to antidiarrheic treatments. Rectal prolapse or a history of surgical cure for prolapse should be carefully considered before implantation of an ABS insofar as these conditions are indicative of disturbances in the defecation process.

Clinical Features of Infection

Abrupt onset of fever, chills, headache, retro-orbital pain, photophobia, myalgia and generalized malaise. Abdominal pain occurs in about 20 of patients and a rash is relatively uncommon (< 10 ). Other symptoms include diarrhea or constipation and loss of appetite for tobacco. A diphasic or even triphasic febrile pattern has been observed, usually lasting 5 10 days. Severe forms of the disease involving infection of the central nervous system or hemorrhagic fever, or even both, have been infrequently observed, nearly always in children under 12. At least three such cases have proved to be fatal. Although congenital infection with CTFV does appear to occur, the risks of abortion and congenital defects remain uncertain.

Multiplesystem Atrophy

The parkinsonian features are usually unresponsive to levodopa therapy. There may be gait and limb ataxia, orthostatic hypotension, erectile dysfunction, constipation, and decreased sweating. Whereas multiple-system atrophy is a distinct neuropathological entity, the consensus diagnostic criteria depend on specific clinical features. Pathologically, glial cytoplasmic inclusions and degeneration are found throughout the basal ganglia, substantia nigra, brainstem autonomic nuclei, and Purkinje cells of the cerebellum.

DRG Category 182 Mean LOS 43 days Description Medical Esophagitis

I rritable bowel syndrome (IBS), sometimes called spastic colon, is the most common digestive disorder in the United States. with a prevalence as high as 10 to 20 in the population. It is a poorly understood syndrome of diarrhea, constipation, flatus, and abdominal pain that causes a great deal of stress and embarrassment to its victims. People often suffer with it for years before seeking medical attention. Although people with IBS have a gastrointestinal (GI) tract that appears normal, colonic smooth muscle function is often abnormal. The autonomic nervous system, which innervates the large bowel, fails to provide the normal contractions interspaced with relaxations that propel stool smoothly forward. Excessive spasm and peristalsis lead to constipation or diarrhea, or both. Generally patients with IBS have either diarrhea- or constipation-predominant syndrome. Although complications are unusual, they include diverticulitis, colon cancer, and chronic

Invited Commentary

SNS is now a confirmed therapy option in fecal incontinence. Its use in other bowel dysfunctions, such as outlet obstruction and slow-transit constipation, are under evaluation. Complex pelvic floor deficits arise as new targets of chronic stimulation. Urinary and fecal incontinence are often combined symptoms in patients older than 50 years (women 9 and men 6 ) 12 . Other authors found a double incontinence in up to 25 of patients 13,14 . For those patients, SNS is a promising therapy option because no other surgical treatment is similarly effective for both forms of incontinence. In the future, the challenge will be to assess pelvic floor disorders and select patients who may benefit from SNS. To do this, an interdisciplinary approach, as that found in pelvic-floor centers, is warranted. Additionally, by concentrating the treatment of SNS in such centers, the success and cost-effectiveness of the procedure will be guaranteed.

Clinical Manifestations

Prior to surgery for MTC, patients with MEN-2 should be evaluated for an unrecognized pheochromocytoma. If diagnosed, the pheochromocytoma should be surgically removed prior to the total thyroidectomy since there is a substantial risk to the surgical patient with an undiagnosed pheochromocytoma. Individuals with hyperparathyroidism in MEN-2a usually have an asymptomatic elevation of serum calcium (like hypercalcemia hyperparathyroidism in MEN-1), but may present with symptoms of hypercalcemia (polyuria, polydipsia, constipation, nephrolithiasis, or abdominal pain).

Management of Hypercalcemia Based on Severity

Hypercalcemia in the moderate range may be associated with symptoms such as polyuria, polydipsia, anorexia, constipation, and various degrees of obtundation. In this setting, it is prudent to embark upon a more aggressive approach to the hypercalcemia as described below. The therapy, however, has to be adapted to the actual level of the serum Ca and is not ordinarily as vigorous as it is when the serum Ca is much higher.

Parkinsons Disease and Parkinsonian Syndromes

The majority of patients with PD or parkinsonian syndromes-in particular, multiple system atrophy (MSA)-complains of gastrointestinal and pelvic organ dysfunction. Stocchi et al 26 reported a similar occurrence of altered bowel frequency and defecation in PD and MSA patients. Gastrointestinal symptoms in PD include gastroparesis and constipation as a result of decreased bowel movement frequency and defecation difficulty. In all patients, these disorders became manifest or worsened after the onset of neurologic symptoms. The most striking features of bowel dysfunction in PD patients were constipation and difficulty in expulsion 27 . The prevalence of constipation in PD patients is high more than 50 suffer from moderate to severe constipation 27, 28 . PD patients are reported to have prolonged colorectal transit time and paradoxical contraction of the PR muscle on defecation 29, 30 . Difficulty in defecation is a very common symptom in PD, occurring in 67-94 of patients constipation is...

Fecal Incontinence in Myopathies

Constipation and diarrhea are frequent in most muscular dystrophies these clinical features have been particularly investigated in Duchenne's dystrophy, where colonic transit time is commonly increased 92 . Altered motility of the small and large intestines has been described in other muscular dystrophies 93 . Atrophy and fibrosis of the intestinal smooth muscles possibly reflect the diffuse muscle-dystrophic process. Chronic constipation from immobility is believed to contribute to bowel dysfunctions, which include abdominal pain, distension, and vomiting. Acute gastric dilation, gastric perforation, and, rarely, peritonitis may occur 94 .

Clinical Features

The signs and symptoms are similar regardless of the etiology of the hypercalcemia. The most common symptoms of hypercalcemia are neurologic, renal, and gastrointestinal. The neurologic symptoms include weakness, lethargy, depression, and even coma in severe cases. Renal effects include polyuria from hypercalciuria-induced nephrogenic diabetes insipidus, decreased glomerular filtration rate (GFR), hyperchloremic acidosis, nephrocalcinosis, and stones. The gastrointestinal symptoms may include nausea, vomiting, constipation, and anorexia.

Prevalence and Epidemiology

In an early study, Feldman and Schiller reported that faecal incontinence occurred in 20 of 136 unselect-ed diabetic outpatients referred to a tertiary centre 1 . About half of the diabetic patients with diarrhoea had faecal incontinence when specifically asked. Interestingly, 10 of the cohort claimed to have had episodes of faecal incontinence without chronic diarrhoea. The prevalence of disordered defecation appears to be less prevalent among patients with diabetes attending secondary referral centres 5, 6 , where constipation has been reported in about 20 and faecal incontinence in about 9 6 . There is little information about the prevalence of disordered defecation in diabetic patients managed in the community by primary care physicians, although faecal incontinence is a common problem in the community, with a prevalence of 2-15 7 . Whereas age, gender, physical incapacity, and impaired general health have been established as risk factors for faecal incontinence in community...

Clinical Assessment

Teritis or infectious colitis, may overwhelm the sphincter mechanism and lead to incontinence. Thus, patients with severe diarrhoea who pass large amounts of liquid motion require investigation and treatment of their diarrhoea before any specific investigations of anorectal function, because in many cases, the incontinence will cease to be a problem if the diarrhoea is treated satisfactorily. Faecal incontinence associated with faecal impaction and overflow incontinence is well described 53 . Incomplete emptying of the rectum can lead to overflow incontinence, as liquid stool passes by the inspissated faecal mass. An association between constipation and faecal incontinence has been reported. This may be caused by pelvic nerve damage in this group of patients 54 . For this reason, it is important not to miss faecal impaction with overflow and identify specific neurological causes of incontinence. It is also important to identify obstetric trauma, because this can be treated surgically....

Overflow Incontinence

Fecal impaction with overflow incontinence may occur in patients of all ages but is disproportionately seen in those with dementia, psychosis, and the elderly, especially those who are institutionalized. This diagnosis should always be considered in a clinical setting in which there is frequent or constant seepage of liquid stools. Diagnosis is confirmed by a digital rectal examination (if the impaction is in the low rectum) or by an abdominal X-ray that demonstrates fecal loading in a patient who is incontinent of diarrheal stools (Fig. 1). Treatment consists of disimpaction, thorough colon cleansing, and a bowel-retraining regimen, together with periodic bowel emptying depending upon clinical circumstances (see below). The latter is critically important because of the high recurrence rate in patients without appropriate follow-up measures 19 . There is no indication for diagnostic anorectal studies in such patients.

Minor Soiling with Normal Bowel Habits

Present with minor soiling or seepage in the presence of normal bowel habits. This does not involve incontinence of solid stool but, rather, spotting of underclothes by persistent soiling of the perianal area. Digital anorectal examination often suggests decreased anal canal tone at rest, strong voluntary contraction of the external anal sphincter and pub-orectalis muscle, and absence of fecal impaction, mucosal, or hemorrhoidal prolapse and other perianal conditions that can produce minor soiling. This clinical scenario is consistent with isolated weakness or dysfunction of the internal anal sphincter. A history of lateral internal sphincterotomy, i.e., for anal fissure, should alert the physician to this diagnosis, but in most patients, internal anal sphincter dysfunction is idiopathic and appears to be associated with aging- related fibrosis 20 . The use of a simple anal cotton plug as an absorbent barrier can often alleviate this embarrassing problem (see below). Formal...

Reservoir Incontinence

This clinical situation is generally identified by clinical history and examination. If a treatable cause of reduced colorectal storage capacity such as ulcerative colitis is not present, treatment strategies should incorporate reduction of stool volume by decreasing dietary fiber and alteration of stool delivery with antidiarrheal agents such as loperamide and diphe-noxylate with atropine 21 . Evacuation of the colon once or twice per week with oral laxatives prevents stool buildup in these patients.

Incontinence in Persons with Dementia or Psychiatric Illness

Analysis of possible causative or contributing factors and attempts to correct them. These include simplifying access to toilets, using clothing that is easily undone, creating a secure and familiar environment, preventing constipation, and avoiding medications that can cause diarrhea 15, 25, 26 .

Treatment of Hypocalcemia

Although most individuals with disorders of blood calcium concentration are asymptomatic, sometimes serum calcium measurement is indicated. Individuals should be screened for hypercalcemia in the setting of nephrocalcinosis and nephrolithiasis, with evidence of osteopenia at sites of predominantly cortical bone, as well as for signs and symptoms suggesting hypercalcemia. Although these are uncommon or nonspecific, they include band keratopathy, anorexia, constipation and abdominal pain, possibly peptic ulcer disease, and pancreatitis, as well as a variety of nonspecific neuropsychiatry symptoms. It seems reasonable to monitor serum calcium periodically in patients taking calcium or vitamin D supplements and in persons taking medications that can potentially alter blood calcium concentrations.

Role of Smooth Visceral Motility Disorders

It has been demonstrated that women with lower urinary tract dysfunction suffer more frequently from bowel disorders than does the general female population 3,4 . There are important correlations between irritable bowel syndrome and postpartum anal incontinence. UI is the greatest risk factor for FI, followed by loss of ability to perform daily activities, tube feeding, physical restraints, diarrhea, dementia, impaired vision, and constipation 77 . Various papers have demonstrated that detrusor overactivity is associated more frequently with anal incontinence with respect to SUI 3 , and this is true particularly for women who complain of anal urgency and anal urge incontinence. Soligo et al. 8 found that women with anal urge incontinence showed a higher score for UI on the visual analog scale (VAS) and a higher frequency of urodynamic detrusor overactivity with respect to women with passive anal incontinence. This subgroup also complained of concomitant disorders of colonic motility....

Which Pediatric Patients have True Fecal Incontinence

When the constipation is properly treated, soiling frequently disappears. Thus, approximately 40 of all children with anorectal malformations have voluntary bowel movements and no soiling. In other words, they behave like normal children. Children with good bowel control still may suffer from temporary episodes of fecal incontinence, especially when they experience severe diarrhea. Once diagnosis of the specific anorectal defect is established, functional prognosis can be predicted. If the child's defect is of a type associated with good prognosis-such as a vestibular fistula, perineal fistula, rectal atresia, rectourethral bulbar fistula, or imperforate anus with no fistula-the child can be expected to have voluntary bowel movements by the age of 3 years. These children will still need supervision to avoid fecal impaction, constipation, and soiling. Patients with fecal incontinence and a tendency toward constipation cannot be treated with laxatives...

Determining Laxative Requirement in a Disimpacted Patient

Once the patient has been disimpacted, an arbitrary amount of laxative is started, usually a senna derivative. The initial amount is based on information the parent gives about previous response to laxatives and the subjective evaluation of the megasigmoid on the contrast enema. The empiric dose is given, and the patient is observed for the next 24 h. If the patient does not have a bowel movement in the 24 h after receiving the laxative, it means the laxative dose was not enough and must be increased. An enema is also required to remove the stool produced during the previous 24 h. Stool in these extremely constipated The routine of increasing the amount of laxatives and giving an enema, if needed, is continued every night until the child has a voluntary bowel movement and completely empties the colon. The day that the patient has a bowel movement (which is usually with diarrhea), a radiograph should confirm that the bowel movement was effective, meaning that the patient completely...

Rectosigmoid Resection

For the last 14 years, we have been performing a sig-moid resection to treat select patients with severe constipation 15, 16 . The very dilated megarec-tosigmoid is resected, and the descending colon is anastomosed to the rectum. In a recent review of patients with anorectal malformations, 315 suffered from severe constipation, were fecally continent, but required significant laxative doses to empty their colon. Of these, 53 underwent a sigmoid resection. The degree of improvement varied. Following sigmoid resection, 10 of patients no longer required laxatives, had daily bowel movements, and no longer soiled 30 decreased their laxative requirement by 80 and the remaining 60 decreased their laxative requirement by 40 . These patients must be followed closely because the condition is not cured by the operation. The remaining rectum is most likely abnormal, and without careful observation and treatment of constipation, the colon can redilate. A possible alternative could be to resect the...

General therapeutic measures

All incontinent women benefit from simple measures such as the provision of suitable incontinence pads and pants. Those with a high fluid intake should be advised to restrict their drinking to a litre a day, particularly if frequency of micturition is a problem. Caffeine-containing drinks (such as teas, coffee and cola) and alcohol are irritant to the bladder and act as diuretics, so should be avoided, if possible. Anything which increases intra-abdominal pressure will aggravate incontinence, so patients with a chronic cough should be advised to give up smoking, and constipation should be treated appropriately. Pelvic floor exercises may be particularly helpful in the puerperium or after pelvic surgery. For younger, more active women who have not yet completed their family, a device or sponge tampon may be used during strenuous activity such as sport. Oestrogen replacement therapy for postmenopausal women is often beneficial as it improves quality of life as well as helps with the...

Pathophysiological and Behavioral Aspects

Longitudinal studies of relationship of fecal incontinence to functional gastrointestinal disorders Prevent anatomic defects leading to surgery by modifying behaviors (e.g., straining or hard stools) Randomized controlled trial of laxative regimens in pediatric fecal incontinence Compare enemas with oral laxatives in pediatric fecal incontinence Compare enemas with toilet training in functional nonretentive fecal soiling

Pituitary causes of secondary amenorrhoea

During Months Pregnancy

Most patients show a fall in prolactin levels within a few days of commencing bromocriptine therapy and a reduction of tumour volume within 6 weeks. Side effects can be troublesome (nausea, vomiting, headache, postural hypotension) and are minimized by commencing the therapy at night for the first 3 days of treatment and taking the tablets in the middle of a mouthful of food. Longer term side effects include Raynauds, constipation, and psychiatric changes - especially aggression, which can occur at the start of treatment.

Temporary causes of urinary incontinence

Lower urinary tract infections (cystitis or urethritis) may uncommonly cause incontinence of urine which is temporary and will resolve once treatment with the appropriate antibiotics has been employed. Diuretics, especially in the elderly, may also be responsible for urgency, frequency and incontinence. In older people, anything which limits their independence may cause urge incontinence where only urgency existed before. This applies particularly to immobility, and if an older person is unable to reach the toilet in a short space of time, she may become incontinent. Thus, the provision of appropriate facilities and adequate lighting can alleviate the problem. Faecal impaction may cause urinary incontinence or retention of urine which will resolve once suitable laxatives or enemas have been effective.

Management of puerperium

Minor problems tiredness, backache, constipation, piles, headache. Intermediate perineal pain, breast problems, tearfulness depression. Major hypertension, vaginal discharge, abnormal bleeding, stitch breakdown, voiding difficulties incontinence, urinary infection, side effects of epidural. Minor problems tiredness, backache, constipation, piles, headache. Intermediate perineal pain, breast problems, tearfulness depression. Major hypertension, vaginal discharge, abnormal bleeding, stitch breakdown, voiding difficulties incontinence, urinary infection, side effects of epidural.

Clinical presentation

Most of the clinical features of pheochromocytoma result from metabolic and hemodynamic actions of norepinephrine and epinephrine secreted by the tumor (1,5,13). Hypertension is the most common clinical sign. Headache, excessive truncal sweating, and palpitations are the most common symptoms. Although pallor is found only in a small number of patients, the presence of this sign is highly suspicious for pheochromocytoma and, together with hypertension and excessive sweating, provides a high probability of the diagnosis. Some patients may also suffer from anxiety, unusual nervousness, constipation, low energy level, and exhaustion after attacks (Table 1). Differential diagnoses include panic and anxiety syndromes, hypernoradrenergic hypertension, supraventricular tachycardia, baroreflex failure, postural tachycardia syndrome, cluster or migraine headache, hypertensive encephalopathy, hypoglycemia, carcinoid tumor, adrenomedullary hyperplasia, and hyperthyroidism. Pheochromocytomas must...

Balloon Expulsion Test

A balloon expulsion test can identify impaired evacuation in patients with fecal seepage or in those with fecal impaction and overflow. Most normal subjects can expel a balloon containing 50 ml water 56 or a silicon-filled artificial stool from the rectum in less than a minute 79 . In general, most patients with fecal incontinence have little or no difficulty with evacuation. But patients with fecal seepage 46, 50 and many elderly subjects with fecal incontinence secondary to fecal impaction demonstrate impaired evacuation. In these selected patients, a balloon expulsion test 53, 56, 58 may help to identify dyssynergia and facilitate appropriate therapy.

Laparoscopic Radical Nephrectomy

Patients receive 15 mg of ketorlac (Toradol) IV q6h as requested, for 36 h, as well as an oral narcotic if necessary. Diet is resumed immediately with clear fluids and advanced as tolerated. The patient is ambulated on the first postoperative day. Discharge is routinely planned for the evening of postoperative day 1 or the morning of postoperative day 2. Parenteral antibiotics are stopped on postoperative day 1. The patient is discharged on oral narcotics as needed. Of note, it is not uncommon for these patients to develop some constipation postoperatively as such, use of a Dulcolax suppository as needed and sending the patient home on a stool softener (e.g., Colace one tablet twice a day) is recommended.

Repair of Third and Fourthdegree Perineal Lacerations Introduction

Data from the obstetrical literature show that about 0.4-3.7 of all vaginal deliveries result in a third- or fourth-degree perineal laceration 1, 2 . Rarely, the reported incidence can go as high as 20-39 3, 4 . When a third- or fourth-degree perineal laceration occurs during vaginal delivery, the standard repair is to approximate the torn ends of the anal sphincter using two to six interrupted mattress or figure-of-eight stitches and close the vaginal and perineal tissues in layers. Postpartum, the patient is typically put on a soft diet and given a stool softener for 7-10 days. This method of repair is described in the latest edition of Williams Obstetrics 5 , the newest edition of Gabbe et al. 6 , and numerous other obstetrical textbooks.

Place of the ABS at the Time of the Sacral Nerve Stimulation SNS

Excessive perineal descent severe constipation irradiated perineum perineal sepsis Crohn's disease anal coitus results. Among 27 patients tested in our institution between December 2001 and April 2004,15 were successfully treated with permanent SNS (mean follow-up 15 9 months). We compared these patients in a case-control study to 15 patients treated with an ABS. Both groups were similar regarding age, gender, incontinence severity, and conservative treatment failure. Preoperative manometric studies were similar in both groups. A standardized questionnaire including incontinence (CCS) and constipation Knowles-Eccersley-Scott-Symptom (KESS) scoring systems and the SF-36 quality of life scale was answered by each patient. Results of the study showed that quality of life evaluation was similar in both groups, whereas incontinence and constipation scores were significantly different (Table 4). As expected, greater improvement in continence is obtained after ABS implantation but with a...

Endometriosisassociated pain symptoms

Severe dysmenorrhoea, deep dyspareunia, chronic pelvic pain, ovulation pain, cyclical or perimenstrual symptoms - often bowel or bladder related, causing dyschezia or dysuria - with or without abnormal bleeding, and chronic fatigue have all been associated with endometrio-sis. However, the predictive value of any one symptom or set of symptoms is uncertain as each can have other causes, and many affected women are asymptomatic. There is little correlation between disease stage and the type, nature and severity of pain symptoms, perhaps because the current classification systems are inadequate. However, endometriomas and DIE are clearly associated with severe pain, although some affected women are pain free in the case of DIE, symptom severity is related to the depth of infiltration. Typical peritoneal lesions probably cause pain as symptoms are relieved by surgery whether this applies to subtle lesions remains unclear. The suggested causes for the pain include peritoneal inflammation,...

Postoperative Urinary Retention

Bladder that then becomes overdistended, with resultant detrusor dysfunction that can lead both acute and chronic retention. In some patients, especially those undergoing pelvic surgery, there is a risk of direct neurological damage as a cause of abnormal detrusor function. Other causes of postoperative UR include immobility, constipation, pain, local edema and preexisting BOO.

Proctological Procedures General Introduction

Fecal Incontinence

Patients with rectocele may have associated physiological abnormalities, including chronic constipation and incontinence. Incontinence aetiology is variable but includes rectoanal intussusception, complete rectal prolapse, sphincter disruption and atrophy 42 . There are a number of surgical approaches to correcting the defect, including the transvaginal, transanal and transperineal approaches.

Suprasphincteric Dysfunction

The aetiology of rectal hyposensitivity is unclear, although there is limited evidence to support the role of pelvic nerve injury and abnormal toilet behaviour 25 . More frequently, it is associated with diseases such as altered mental conditions (i.e. dementia stroke encephalopathy) and sensory neuropathy (i.e. diabetes spina bifida meningocele) 31-34 . Rectal hyposensitivity is more often related to constipation, but it can also be the cause of passive incontinence. Despite a normal or borderline sphincter function, blunted anorectal sensation with impaired EAS contraction during the sampling reflex may result in soiling 35 . This is what typically happens in institutionalised elderly people in whom reduced rectal sensation and poor rectal motility often determine faecal impaction with overflow incontinence secondary to continuous elicitation of the anorectal reflex. Overall, high conscious rectal sensory threshold is probably the primary cause of incontinence in about one third of...

Rectal Evacuatory Disorder

Childhood constipation is a common problem, affecting around 9 of children under 18 years 239 . In children without anorectal anomalies, functional faecal retention, because of fear of painful defecation or other reasons, may also result in faecal impaction and encopresis or overflow soiling 25, 145 . Treatment requires disimpaction, and education focused on alleviating phobias and feelings of guilt by reinforcing self-esteem and incorporating disciplined toileting behaviour 25 . Failure to retrain such children may result in progressive dilatation of the rectum (megarectum), leading to chronic impaction, and in a proportion, symptoms may progress into adulthood 240, 241 . Although a considerable body of literature is available regarding impaction-related incontinence at both ends of the age spectrum (i.e. paediatrics adolescents and geriatrics), there is a relative paucity of information in adults that addresses the concept that rectal evacuatory dysfunction may be an independent...

Fecal Incontinence in Peripheral Neuropathies

Diabetes mellitus is the most common cause of polyneuropathy in developed countries. Diabetic neuropathy is a chronic symmetrical sensorimotor polyneuropathy that usually begins after years of hyperglycemia and is frequently associated with autonomic neuropathy and bowel, bladder, and sexual dysfunction. Severe diabetic autonomic neuropathy (DAN) is almost always associated with insulin-dependent diabetes. Symptoms of autonomic involvement include impairment of sweating and of vascular reflexes, constipation, nocturnal diarrhea and fecal incontinence, atonic bladder, sexual impotence, and occasionally postural hypotension. The pathogenetic mechanism of the constipation is uncertain, but autonomic neuropathy causing parasympathetic denervation is likely to be implicated. Diarrhea typically occurs at night or after meals, is a more troublesome complication of diabetes, and may be an isolated symptom of autonomic dysfunction. It is usually chronic, but it is intermittent and alternates...

Multiple Sclerosis Myelopathies and Spinal Cord Injury

Multiple sclerosis (MS) is a progressive neurologic disease that results from multiple demyelinating lesions within the CNS and that shows a variety of clinical presentations and courses determined by the location and number of the same lesions. Bladder and bowel dysfunction is the third most important discomfort in MS patients after spasticity and fatigue 33, 34 . Genitourinary dysfunctions in MS patients frequently occur due to the spinal involvement, with an incidence of 78 35-38 . Bowel-related disorders in MS patients are very common. The prevalence of bowel dysfunction, fecal incontinence, and or constipation is reported to be between 52 and 66 39-41 . Hinds et al. 42 found that 51 of 280 MS patients experienced fecal incontinence it occurred at least weekly in 25 . The authors also demonstrated a strong correlation between fecal incontinence and the duration of MS and degree of disability 42 . Conversely, Chia et al. 39 found no correlation between the presence of bowel...

Celiac Plexus Neurolysis

The majority of pancreatic cancer patients have pain (68,69), therefore pain control and quality of life are of paramount importance in this unfortunate group of patients with limited life expectancy. Opioid administration is frequently necessary, however side effects such as constipation, nausea, vomiting, and drowsiness may limit dosing and effect. CPN, where the celiac plexus is ablated with a neurolytic agent, has additionally been offered to pancreatic cancer patients for pain control. Typically, alcohol or phenol have been injected into the celiac plexus in hopes of interrupting visceral afferent pain transmission. Traditionally, this has been performed via direct injection of the celiac plexus at the time of attempted resection, or per-cutaneously under fluoroscopic guidance by trained anesthesiologists using vertebral landmarks. Randomized studies have reported improved pain scores following CPN with both techniques, although opioid use is still generally necessary (70-72).


Ask the patient to describe the kind of pain and the precise location. Determine if the pain is exacerbated by sitting or coughing. Ask if the patient has experienced rectal itching or pain with sitting, coughing, or defecating. Elicit a history of signs of infection such as fever, chills, nausea, vomiting, malaise, or myalgia. Ask the patient if she or he has experienced constipation, which is a common symptom because of the patient's attempts to avoid pain by preventing defecation.

Antenatal education

Meat can lead to permanent neurological and visual problems in the newborn if the mother contracts the infection during pregnancy. (Salmonella food poisoning has not been shown to have adverse fetal effects.) To reduce the risk, pregnant women should be advised to thoroughly wash all fruits and vegetables before eating and to cook well all meats including ready-prepared chilled meats. Written information from the Food Standards Agency - 'Eating While you are Pregnant' can also be helpful. Women who have not had a baby with spina bifida, should be advised to take folic acid, 400 mg day, from pre-conception until 12 weeks of gestation to reduce the chance of fetal neural tube defects (NTDs). A recent study has failed to show the efficacy of this strategy in analysing population incidence of NTD. This is suggested to relate to inadequate pre-conceptual taking of folate and or poor compliance. Suggestions of adding folate to certain foods, for example, flour to ensure population...

Spina Bifida

Neurological defects in patients with spinal lesions may affect one or more of these components, resulting in different types of defecation disorders faecal incontinence, chronic constipation or both 17 . The external sphincter is often paralysed, so that upon internal sphincter relaxation, soiling is inevitable 18 , and delayed colonic transit together with lack of rectal contraction in response to distension compound the problem.

Spinal Cord Injury

The influence of spinal cord injury on continence is complex, being dependent upon the level and completeness of the injury as well as time since the event. The majority of patients suffer with constipation, but faecal incontinence is experienced by 75 , with up to one third having accidents at least monthly 36 . In the acute phase (spinal shock), complete cord severance leads to permanent loss of all voluntary and sensory function and a temporary loss of reflex functions in all segments below the lesion. There is loss of facilitation from above and loss of inhibitory reflexes from below the lesion. The termination of spinal shock, up to 4 weeks following injury, is heralded by a return and then exaggeration of reflex activity. Supraconal lesions are associated with delayed proximal colonic transit (loss of sympathetic activity compounded by muscle weakness and being bedridden), but with exaggerated rectal contractions and anal relaxation in response to relatively low rectal...


Sion analysis interestingly demonstrated rates of faecal incontinence to be higher in women than in men, but that the difference did not reach statistical significance 42 . Among the elderly, faecal incontinence can be broadly categorised as overflow incontinence, reservoir incontinence and rectosphincteric incontinence. Faecal incontinence among nursing home residents is associated with multiple factors urinary incontinence, impaired ability to perform activities of daily living, tube feeding, the use of physical restraints, diarrhoea, poor vision and constipation impaction.


It used to be a Highland remedy for all kinds of stomach pains, and herbalists still give the leaf decoction for stomach disorders, loss of appetite and the like (Schauenberg & Paris), an interesting usage, for the Kwakiutl Indians of the Pacific north-west of America use the water from the boiled roots for some kind of stomach trouble, briefly translated as when the pit of our stomach is sick (Boas). Even stomach ulcers were treated, in Scotland, successfully apparently, with infusions from this plant (Beith). They even used it for constipation on South Uist. They took the root, cleaned it and boiled it in water all day until the juice was dark and thick. It was strained, and a teaspoonful given to the patient it was even given to calves for the same complaint (Shaw), though the dose must have been increased.

The elderly

There is a decrease in intestinal motility (Bitar and Patil, 2004) and mucosal immune function (Fujihashi and McGhee, 2004) with aging. Fecal impaction may result from loss of smooth muscle contractility, but it is not clear if prolonged exposure of pathogens to intestinal epithelium is a risk factor for pathogen infection. However, studies have found that the elderly are at greater risk of infection from the senescence of gut-related immune tissues (Fujihashi and McGhee, 2004).

Bulimia Nervosa

People with bulimia nervosa may also engage in recurrent inappropriate compensatory behavior to prevent weight gain. This behavior includes self-induced vomiting misuse of laxatives, diuretics, enemas, or other medications fasting or excessive exercise. To be classified as having bulimia nervosa, binge eating and inappropriate compensatory behavior must occur, on average, two times per week for three months (Hughes & colleagues, 2001). People with bulimia nervosa evaluate themselves based on their body weight and shape. The health consequences of bulimia nervosa are Constipation


Encopresis affects 3 to 7 of school-age children and is much more common in boys than girls. Encopresis with constipation and overflow incontinence is the most common type. This type starts when children withhold bowel movements because of previously painful bowel movements, fear of the toilet, or not wanting to stop what they are doing to use the bathroom. Over time, this results in the loss of the urge to defecate and constipation. An overflow of liquid bowel occurs, resulting in soiling of clothing. The child generally doesn't experience the urge to defecate and does not intend to soil. When the child must defecate, the feces are often large and painful to pass. Once this cycle is established, children continue to withhold feces to avoid further painful elimination, and parental attention may reinforce this behavior.


Treatment for retentive encopresis is usually multimodal, including medical, dietary, and behavioral interventions. The goal of treatment is to establish regular bowel habits, and effectiveness rates are between 55 and 82 . Medical intervention (enemas or laxatives) to relieve constipation is the typical first step, followed by the use of laxatives or stool softeners and increasing dietary fiber to foster regular bowel movements. To establish regular toileting times the child sits on the toilet twice daily for at least 10 minutes (usually 20 minutes after breakfast and dinner to take advantage of the natural colon reflex after eating). Behavioral interventions include the use of positive reinforcement for appropriate toileting and clean clothing along with overcorrection for soiling (i.e., the child cleans himself and his clothing after soiling). Intentional or nonreten-tive encopresis may require individual or family therapy to resolve the problems that lead to encopresis. Controlled...


For assessment of fecal incontinence, digital palpation, manometry (balloon or vector manometry), and measurement of pudendal nerve motor latency are used. In manometry, pressure at rest and pressure at contraction are quantified in a station-pull-through technique. A low pressure at rest is due to functional impairment of the internal sphincter, and a low pressure at contraction is due to impairment of the external sphincter muscle. However, even modern vector manometry cannot provide precise definition of localization and extent of sphincter defects 13 . PNTML is prolonged in patients with idiopath-ic fecal incontinence. Pudendal latency is increased in patients with long-standing constipation, per-ineal descent, or, generally, pelvic floor disorders. However, with all of these methods, structural defects cannot be assessed 13 . Diagnosis of sphincter defects is important because patients may be helped by surgery that aims to restore integrity to the sphincter ring. The prime role...

Patient Selection

Only major contraindications to the sphincter replacement procedures are very severe chronic bowel diseases causing intractable defecation dysfunctions (severe diarrhea as well as severe constipation) and coexistence of rectal prolapse, intussusception, rectocele, or enterocele.

Chronic Diarrhea

- Excess of medications (laxatives, antacids, prostaglandins, nonsteroidal anti-inflammatory drugs) For FI associated with mild chronic diarrhea or mild chronic constipation, bulking agents of either natural (psyllium, gum arabic, methyl cellulose) or synthetic (calcium polycarbophil) fibers should be considered as first-line treatment. Moreover, a daily fiber supplementation for 1 month has been demonstrated to significantly reduce FI 10 . effective in reducing urgency, stool frequency, and central nervous system (CNS) adverse events (it does not cross the blood-brain barrier) 11-13 . However, caution must be used in dosage to avoid undesirable constipation. Only a few studies have been directed toward evaluating the benefits of loperamide in FI patients 14-16 . Diphenoxylate and difenoxin are opioids with antiperistaltic action, but they cross the blood-brain barrier, causing mild euphoria if taken in excess, requiring atropine. No effects on anal pressures have been demonstrated....


To the boil, is taken in wineglassful doses three times a day to cope with dropsical and glandular complaints (Hatfield). Another decoction of half an ounce of the leaves to a pint of water, is to be taken to relieve constipation and diseases of the liver and spleen, the latter figuring in Gerard's quite enthusiastic catalogue of the virtues.

Postoperative Care

To ensure adequate healing and patient comfort, postoperative care should focus on pain management and avoidance of constipation. Opioid analgesics in the early postoperative period are usually required and are typically administered via epidural catheter or patient-controlled analgesia (PCA). When the patient begins oral analgesics, we routinely supplement with acetaminophen and nonsteroidal anti-inflammatory drugs to minimize opioid requirements. High-fiber diets, supplement bulking agents, and large quantities of liquids should be standard for all patients. In addition, daily use of a mild laxative or tap water enema serves to counteract the constipating effects of narcotic use and alleviate pain with defecation. In an era where diverting ostomies are not routinely performed in conjunction with sphinc-teroplasty, it is crucial that patients are instructed on how to take the appropriate measures to avoid damage to the sphincter repair that may result from excessive straining and...


In patients who have a combination of incontinence and constipation, it is better not to perform a DGP, as it can aggravate the constipation component. When patients are incontinent for diarrhea, it is important to treat the diarrhea first. Probably, the incontinence will be solved, and if this fails, better results are seen after DGP. Anal region sensibility can be tested for touch, pain, or temperature or with electrical stimuli in the anus. Rectal sensibility can be tested with an inflatable balloon. This allows the possibility of determining whether the patient must be instructed to empty the bowel at regular times of the day. Lack of sensation can lead to stasis in the rectum after DGP and cause scy-bala that cannot be removed. The best indication for DGP is the patient with severe trauma that cannot be treated with other methods 14 .

Management Options

The resins such as cholestyramine and colestipol bind bile acids in the intestine, inducing interruption of their circulation to the liver via the portal vein and therefore enhancing excretion. This process promotes greater synthesis of bile acids by the liver using circulating cholesterol. However, the resins also promote VLDL synthesis by the liver and may cause a worsening of hypertriglyceridemia. The most common side effects of the resins include abdominal bloating, borbo-rygmi, and constipation. In addition, these drugs tend to bind to other compounds besides bile acids and to inhibit their absorption. Therefore, they should not be administered with other medications (26). Finally, resins also inhibit the absorption of fat because of the unavailability of bile acids and may induce a deficiency of fat-soluble vitamins in the long term.


In the literature, several series have been published that indicate success rates from 45 to 80 14, 18-21 . Not everyone does well after this operation, however, and many complications have been reported 17 . The most common problems are infections, constipation, and insufficient contraction of the gra-cilis. Infections can be minor, such as skin infections or infections around the anus, which can be treated with antibiotics. The more severe infections involve the implanted material and make explantation necessary. Constipation is seldom due to a too-tight wrap around the anus, but this is seen in about 16 of cases. The solution is often a laxative or retrograde cleaning of the bowel. Insufficient contraction of the gracilis can be caused by electrical or muscular problems. Distinction between the two is simple Because the muscle still has its own innervation, the patient can be asked to voluntarily contract the gracilis. When there is no contraction, the problem is muscu


The sweet chestnut, commonly known as the European chestnut, is native to western Asia. The Greeks encountered it in Persia and introduced it to southern Europe, and the Romans brought it to Gaul and Britain. Cooks ground the starchy nut to flour, and mixed it with wheat flour from which they made bread, a practice still found in medieval Europe, especially in times of famine. Boiled or roasted, chestnuts, classified as warm and dry by physicians, were considered nutritious but hard to digest, causing wind and constipation. Then as now chestnuts were recommended for stuffing chickens, ducks, and geese.

Anatomy and Function

Despite the reported success of gluteoplasty for fecal incontinence, graciloplasty is more frequently performed, for reasons that include ease of harvest, anterior approach, and patient positioning 7-22 . Minimal donor-site morbidity can be achieved via endoscopic harvest or through minimal-access incisions 22 . Disadvantages of the gracilis flap include early muscle fatigue, difficulty training them to contract (which is accomplished via thigh adduction), incomplete rectum wrap, inability to generate a high squeeze pressure, and frequent constipation due to distortion of the anorectal angle. The gracilis may, in fact, serve as a static sling with some contractile properties, whereas the gluteus can generate significant sustained squeeze pressures and add considerable bulk to the perirectal space.

Future Directions

The indications for SNS have been expanded beyond the field of fecal incontinence to slow-transit constipation and outlet obstruction. Preliminary data indicate that it may be beneficial 51 and that this benefit is unlikely to be a placebo effect 52 . Based on these findings, a prospective multicenter trial is ongoing. Not only is the effect of SNS on functional disorders of the colorectum and anus of interest, in the future, its interaction with the anterior and middle compartment of the pelvis and pelvic floor will be important to identify further conditions in which SNS can be of clinical value.


The most common presenting symptoms of hypercalcemia are nonspecific and include fatigue, anorexia, nausea, and constipation. Through the induction of an osmotic diuresis and inhibition of antidiuretic hormone activity, hypercalcemia also causes polyuria and progressive dehydration. Not uncommonly, patients are found to have acute or chronic renal insufficiency at the time of presentation. Neurologic symptoms such as weakness, lethargy, and disorientation may progress into seizures, coma, and even death if treatment is delayed. Symptom severity depends upon the degree of hypercalcemia and the rate at which it develops.


In the past, haloperidol (Haldol) was the treatment of choice for childhood psychosis. Its efficacy is well established, although it has a high incidence of extrapyramidal side effects (a constellation of medication side effects causing odd muscular reactions caused by the antipsychoptic's action on dopamine receptors includes acute dystonia, akasthisia, akine-sia, and Parkinsonian side effects). Therefore, the atypical antipsychotics including olanzapine (Zyprexa), risperidone (Risperdal), ziprasidone (Geodon), queti-apine fumarate (Seroquel), and clozapine (Clozaril) are prescribed more often because their side effect profile is better than other antipsychotic agents (Brown & Sammons, 2002). Adverse side effects include sedation, weight gain, and anticholinergic effects (e.g., dry eyes, mouth, and or throat constipation). Clozapine is associated with severe and possibly fatal side effects including potentially fatal cardiac complications (Brown & Sammons, 1998).

Symptoms and Signs

Typically, patients complain of prolapse, mucus discharge, bleeding and either incontinence or constipation. The diagnosis of full-thickness rectal prolapse, although suggested by the history, needs to be confirmed on examination to rule out partial-thickness rectal prolapse, prolapsing haemorrhoids and the like. Ideally, the patient should be placed on a toilet or commode and encouraged to bear down in order to demonstrate the prolapse, as embarrassment and fear of soiling often prevents demonstration of the prolapse in the consultation room. Incontinence should be specified, as mucus or minor soiling from the surface of the prolapsing rectum is often reported as faecal incontinence.


Clinical manifestations can be grouped into four categories (1) Asymptomatic carriers, in which the cyst can be passed via stools, but the individual is free of symptoms. (2) Nondysenteric colitis, in which the individual has nonspecific symptoms such as intermittent diarrhea, constipation, and abdominal pain. Cysts can be found in stools and trophozoites can be seen during diarrhea. (3) Dysentery, with symptoms of bloody diarrhea, mucus, low-grade fever, and colonic perforation with peritonitis. (4) Amebic liver abscesses, in which there is fever, pain in the right upper quadrant of the abdomen or the right lower chest, and the liver is enlarged, tender, and jaundiced. Metronidazole and chloroquine are effective drug treatments for E. histolytica.

Red Deadnettle

Irish remedy, and there is one from East Anglia for piles, when the plant was infused in white wine for an hour. A wineglassful would be taken two or three times a day (V G Hatfield. 1994). The rest of the medicinal uses are taken from the earlier herbalists. For example, from the 15th century, to heal wounds full of blood. Stamp red nettle in a mortar with red vinegar ( ), and lay on the wound and it shall do away the blood and cleanse the wound (Dawson. 1934). This is in fact an old remedy for stopping the effusion of blood (Pratt), and Hill, in the 18th century, was recommending such a cure. There was a recipe for boils in Reliquae Antiquae (14th century), and Gerard recommended it for the King's Evil, which is scrofula, and also as a poultice for wens and hard swellings. Another of Lupton's suggestions was for constipation, using red deadnettles (and mallows). The plants had to be boiled in water, and then the party was advised to .sit close over the same, and receive the fume...

Ribwort Plantain

Ribwort is mentioned as a Highland remedy for boils and bruises (Grant), and in the west of Ireland, for a lump (Gregory. 1925). A leaf tea is used for bronchitis or asthma (Conway), and as a gargle it soothes sore throats (Schauenberg & Paris). A record from South Uist shows that the leaves were applied to relieve sore feet (Shaw). The seeds, left in water for two hours to swell, are a mild purgative (Fluck), and a cold decoction of the plant was a Russian folk remedy for constipation (Kourennoff), but a leaf infusion was used in Norfolk for just the opposite effect - to cure diarrhoea (V G Hatfield). A similar preparation has been used for conjunctivitis, as an eyewash (Wickham). In earlier times, e.g., the Anglo-Saxon version of Apuleius, this plant was prescribed for bite of snake, for a quartan agus, and for uselessness of the ears. As far as the snakebite remedy is concerned, it should be noted that Ribwort was given for hydrophobia in Ireland (Denham). Perhaps the most...

Etoposide Vepesid

Examples of inhibitors of chromatin function derived from flowering plants (Fig. 80) are etoposide (lignan) and alkaloids camptothecin, Vinca alkaloids, and 7 epitaxol. The rhizome of Podophyllum peltatum L. (May apple, Berberidaceae) has been used to remove warts and to relieve the bowels from costiveness since very early times. It contains podophyllo-toxin, a cytotoxic lignan from which etoposide (Vepesid ), which is used to treat lung cancer, lymphomas, and leukemias on account of its ability to inhibit the activity of

Bowel Confinement

Another approach that has been used to improve surgical outcome is bowel confinement. Many obstetricians routinely order a soft diet and a stool softener for women who had an anal sphincter repair, whereas others prefer a laxative or a constipating agent. These regimens are intended to lessen tension on the sutures during bowel movement and allow the torn ends of the anal sphincter to heal together. However, there are very little data that show whether bowel confinement affects the outcome of anal sphincter repair. A study from Dublin randomized 105 patients who had a third-degree perineal laceration to either 3 days of codeine followed by 4 days of laxative or 7 days of laxative 37 . After 3 months, the median incontinence score was similar between the two groups Wexner incontinence score 1 20 (range 0-8) vs. 0 20 (range 0-9), p 0.096 .


(Convolvulus scammonia) An Asian species, whose gum resin, or the dried milky juice, is a drastic purgative (Pomet), and has been known as such since ancient times. The drug is collected in Asia Minor, chiefly around Smyrna, and often put with colocynth and calomel, to be used for constipation, worm cases and dropsy (Lindley), even for rheumatic pains (Porter. 1969). But however did it become an ingredient in a Cambridgeshire folk remedy for constipation, unless it reached the folk level via Academe

Chronic pelvic pain

The role of endometriosis in chronic pelvic pain remains controversial and difficult to quantify. In this chapter the management protocols for chronic pelvic pain are outlined and it is extremely important that patients who have endometriosis-related chronic pelvic pain are recognized as suffering with irritable bowel syndrome. The use of the holistic approach to these patients can be extremely effective in relieving some of their pelvic pain and improving their quality of life. This relates to improved diet, fluid intake, avoidance of constipation and exercise. There is also increasing evidence that self-management courses can be very effective in helping these women cope with their long-term problems of pain.

Diarrhea Loose Stools

Breach mild sphincter dysfunctions that are subclinical because of underlying constipation or simply normal firm stool. Identification and treatment of acute diarrhea in the elderly who are especially prone to Clostridium difficile infections or who are more susceptible to bacterial diarrheas because of gastric achlorhydria caused by disease or use of medications such as proton pump inhibitors is too extensive to review comprehensively here 13 . Additional causes of loose stools in the elderly include microscopic colitis (diagnosed only by colonic biopsies), bile-salt-induced diarrheas occurring after cholecystectomy, bacterial overgrowth syndromes 22 , and diar-rheagenic medications. Normalizing stool delivery by treating specific disorders with the use of antidiar-rheal agents such as loperamide often ameliorates fecal incontinence 21 . Adequate doses and timing are important, i.e., 2-4 mg 30 min before meals or prior to social occasions to avoid accidents outside the home. The...


The pathogenesis of diarrhea in patients with diabetes is poorly understood and probably multifactorial. It may be caused by disturbances directly related to diabetes (primary causes) or to late complications (secondary causes). Among primary causes, visceral neuropathy is a key factor but other factors probably contribute as well. Functional changes such as accelerated transit time and decreased intestinal tone might be associated with enhanced cholinergic and decreased P-adrenergic receptor activities (65). Neuroendocrine peptide dysfuntions might also be involved. El-Salhy and Spangeus (66) have shown that in diabetic mice antral VIP and galanin levels are increased, whereas colonic PYY concentrations are decreased. These particular anomalies in enteric peptide profile would favor the development of diarrhea, whereas other anomalies in peptide levels could favor constipation. Diabetic diarrhea was first recognized in 1936 by Bargen et al. (73) (Table 2). The diarrhea is watery,...

Fecal Incontinence

Fecal incontinence is a challenging clinical condition particularly in elderly diabetics. It has been estimated that upto one-fifth of patients with diabetes have fecal incontinence, although prevalences depend on criteria of incontinence applied. The incidence of fecal incontinence in diabetics appears to correlate with duration of the disease (90). Incontinence is probably multifactorial and involves age-related changes, diabetic neuropathy, multimorbidity, and polymedication (91). However, instability of the internal sphincter probably plays a major role in incontinent diabetics (92). Another important cause is fecal impaction (93).

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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