Constipation definition

Psychotherapy focused on reducing the influence of the CNS on the gut has been studied. Cognitive behavioral therapy (CBT), dynamic psychotherapy, relaxation therapy, and hypnotherapy have been reported to be effective in some patients. However, CBT and relaxation therapy do not appear to be better than standard approaches.18 Biofeedback may provide relief in cases of severe constipation, but definitive evidence is lacking.16 Psychotherapy interventions provide relief from pain and diarrhea but not constipation.19... 

CDC Case Definition An illness caused by S. typhi that is often characterized by insidious onset of sustained fever, headache, malaise, anorexia, relative bradycardia, constipation or diarrhea, and nonproductive cough. However, many mild and atypical infections occur. Carriage of S. typhi may be prolonged. Laboratory criteria for diagnosis is isolation of S. typhi from blood, stool, or other clinical specimen. 

An excellent brief article on buprenorphine treatment has been provided by Taikato et al. (2005), which notes the common possible side-effects (headaches, nausea and vomiting, sweating, constipation, etc.) and drug interactions. The limited central depressant effect of buprenorphine may be compounded by alcohol and antidepressants, while the metabolism of buprenorphine can be enhanced by anticonvulsants, with therefore possibly reduced efficacy. There have been some case reports of liver toxicity from buprenorphine that is reversible if the medication is stopped (Herve et al. 2004), and often clinical guidelines will recommend that liver function tests are included in buprenorphine treatment, as they definitely should be with naltrexone. 

Although there is no one definition for constipation, it is usually described as infrequent defecation, which is often accompanied by straining as well as the passage of hard, uncomfortable stool. 

In a retrospective review, 33 mentally retarded patients were evaluated adverse effects were mild and transient, constipation being the most common (n = 10) (12). There were no significant cardiovascular adverse effects and no seizures no patient discontinued treatment because of agranulocytosis. Small sample sizes, short durations of treatment, and lack of controls in these studies preclude definite conclusions. 

The safety and efficacy of oral cyclodextrin itraconazole (5 mg/kg/day) as antifungal prophylaxis has been assessed in an open trial in 103 neutropenic children (median age 5 years range 0-15 years) (53). Prophylaxis was started at least 7 days before the onset of neutropenia and continued until neutrophil recovery. Of the 103 patients, only 47 completed the course of prophylaxis 27 withdrew because of poor compliance, 19 because of adverse events, and 10 for other reasons. Serious adverse events (other than death) occurred in 21 patients, including convulsions (n = 7), suspected drug interactions (n = 6), abdominal pain (n — 4), and constipation n — 4). The most common adverse events considered definitely or possibly related to itraconazole were vomiting (n = 12), abnormal liver function (n — 5), and abdominal pain (n = 3). Tolerabihty of the study medication at end-point was rated as good (55%), moderate (11%), poor (17%), or unacceptable (17%). There were no unexpected problems of safety or tolerability. 

Constipation is the infrequent or difficult evacuation of faeces. There is no exact definition, but it is a reduction in normal stool frequency accompanied by hardening of stools. Constipation that is not secondary to underlying disease or caused by factors such as side-effects of drugs or laxative abuse is known as simple or functional constipation and may be self-treated with advice from a pharmacist. 

Normal people pass at least three stools per week. Some of the definitions of constipation used in clinical studies include (a) less than three stools per week for women and five stools per week for men despite a high-residue diet, or a period of more than 3 days without a bowel movement (b) straining at stool greater than 25% of the time and/or two or fewer stools per week or (c) straining at defecation and less than one stool daily with minimal effort. These varying definitions demonstrate the difficulty in characterizing this problem. 

Alosetron was withdrawn from the U.S. market in 2000 due to serious adverse effects including severe constipation and ischemic colitis that did not appear in the initial clinical trials. Its use is now limited to an FDA-approved restricted use program in lower initial doses, and requires extensive postmarketing surveillance. Results of these trials are necessary to definitively determine alosetron s true safety profile, especially with regard to its association with or causation of fatal ischemic colitis. 

Careful definition of symptoms with elimination/treatmerrt of physical causes, e.g infections, cardiovascular disease, constipation. 

Melanosis coli is observed in 12-31% of unselected constipated patients. A causal relationship between melanosis coli and use of anthraquinone laxatives has been shown in animals and humans. Sennosides produce melanosis coli after 4—13 mo of use, which disappears 5-11 mo after cessation of sennoside use. Melanosis coli begins abruptly at the ileocolonic junction and may extend to the dentate line. The intensity is highest in the cecum and becomes less intense in the aboral direction, and may increase again in the rectum, with a prevalence of 1-8% on proctoscopy. The pigment has not been definitively identified, but it is probably lipofuscin. Even if melanosis coli cannot be seen... 

In this particular instance, the (+) and (-) isomers both should get attached to the definitive receptors actually responsible for the suppression of the cough reflex. In fact, the prevailing (+) form (isomer) bears a steric relationship which essentially precludes being attached to the definitive receptors particularly associated in the various therapeutic activities, such as analgesic, constipative, addictive, and other properties displayed by the corresponding (-) form (isomer). 

Precautions A definite carcinogen (causes cancer). An animal teratogen (abnormal fetus development). Moderately toxic to humans by swallowing. Various effects on the body by swallowing include liver changes, respiratory effects, and constipation. An eye irritant. 

The patient with acute intermittent porphyria suffers a severe acute abdominal pain not definitely localized and without rigidity or tenderness of the abdominal wall. Moderate fever and leukocytosis develop. If the physician is not aware of the porphyria, he is likely to be confused and suspect appendicitis, renal or biliary colics, pancreatitis, perforated ulcer, acute bowel obstruction or another common cause of abdominal pain. The differential diagnosis of porphyria and bowel obstruction is further complicated because the attacks of porphyria hepatica are often associated with severe constipation. Abdominal X-rays of porphyric patients show colonic distension. The pathogenesis of the abdominal symptoms is not known. They could result either from a direct effect of porphobilinogen or porphyrin on the intestinal mucosa or be the consequence of an increased excitability of the autonomic system. 

In addition, numerous definitions and categories are in use for nonneurogenic bladder-sphincter dysfunction, blaming either the bladder or the urethral sphincter for the various clinical expressions of nonneurogenic bladder sphincter-dysfunction. In this chapter not only the whole spectrum of nonneurogenic bladder-sphincter dysfunction will be described, but how dysfunction is embedded into the disease complex UTI-renal damage will be shown. Furthermore, the associations and the causal relationship to VUR, UTI, renal damage and constipation will be discussed and the various clinical manifestations will be elucidated. 

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