ReviewA Gap in Our Understanding: Chronic Constipation and Its Comorbid Conditions
Section snippets
Pathophysiologic Mechanisms
Chronic constipation, as defined by the Rome III criteria, specifies a minimum 6-month history of symptoms to establish chronicity. The hallmark symptoms include straining, a sense of incomplete evacuation, bowel movement infrequency, and hard stool consistency.3 Of these constipation-defining symptoms, hard stool, straining, and the associated increase in intra-abdominal pressure may be etiologically important in clinical sequelae, such as hemorrhoids, anal fissures, and possibly rectal
Methods
In Medline, a master search set comprised of the subject headings constipation and chronic constipation between the years 1980 and 2007 was created. Subject headings were selected and/or text queries were created for each of the following clinical concepts: hemorrhoids, anal fissures, fissure in ano, anal ulcer, rectal prolapse, stercoral ulcers, rectal ulcers, intestinal volvulus, fecal impaction, obstipation, obstruction, colonic pseudo-obstruction, gastric outlet obstruction, intestinal
Results
Relatively few publications were found in the literature dealing with the association of constipation and various search terms, supporting our initial impression that this area is largely unexplored. Given the limited data, we have confined our review to more commonly discussed anorectal, colonic, and urologic disorders. In the following discussion, each comorbidity is evaluated individually in the context of the currently proposed pathophysiology, specific to the disorder.
Conclusions
The evidence of a cause-and-effect relationship between constipation and comorbid diseases is inferred from association studies and knowledge of the mechanical effects of constipation. However, in some cases there are confounding factors that may predispose to both constipation and comorbid diseases. For example, disruption of the enteric nervous system can lead to motility disorders, with secondary reduction in bowel movement frequency and colonic dilatation. Furthermore, lifestyle factors
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Total Fasting and Dehydration in the Operating Room: How Can Surgeons Survive and Thrive?
2021, Journal of Surgical EducationCitation Excerpt :Constipation was another commonly reported symptom of dehydration. Although often overlooked, constipation can negatively impact sense of well-being and lead to complications such as hemorrhoids, fissures, and diverticulosis.21 Dry mouth, which was commonly reported, can impact dental health by increasing the risk of oral infections and dental carries as well as acceleration of tooth demineralization.22
Rethinking What We Know About Hemorrhoids
2019, Clinical Gastroenterology and HepatologyCitation Excerpt :Ever since work by Burkitt and Graham-Stewart12–14 in the 1970s, hemorrhoids have been considered to be caused by a low-fiber diet and constipation. The current belief is that constipation leads to chronic straining and hard stools, resulting in degeneration of the supportive tissue in the anal canal and distal displacement of anal cushions.15 However, hemorrhoids and constipation have different epidemiologic features including age, sex, ethnicity, and socioeconomic status, casting doubt on constipation as a risk factor.10
Clinical practice guidelines for the management of constipation in adults. Part 1: Definition, aetiology and clinical manifestations
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The authors disclose the following: C.L.B. and K.L.L. are employees of Takeda Pharmaceuticals North America, Inc, Medical & Scientific Affairs. N.J.T. is a consultant to Johnson & Johnson Pharmaceutical R&D, Pfizer, Procter & Gamble, Theravance, Inc, Lexicon Genetics, Inc, Astellas Pharma US, Inc, Pharma Frontiers, Ltd, Callisto Pharmaceuticals, Astra Zeneca, Addex Pharma, Ferring Pharma, and Salix; and received research support from Novartis, Takeda, GlaxoSmithKline, Dynogen, and Tioga.