THE 2002 OFFICIAL PATIENT’S SOURCEBOOK
on
CONSTIPATION
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
ii
ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The 2002 Official Patient’s Sourcebook on Constipation: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83265-X 1. Constipation-Popular works. I. Title.
iii
Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail:
[email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this sourcebook.
iv
Dedication To the healthcare professionals dedicating their time and efforts to the study of constipation.
Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to the study of constipation. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.
v
About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
vi
About ICON Health Publications In addition to constipation, Official Patient’s Sourcebooks are available for the following related topics: ·
The Official Patient's Sourcebook on Appendicitis
·
The Official Patient's Sourcebook on Autoimmune Hepatitis
·
The Official Patient's Sourcebook on Bacteria and Foorborne Illness
·
The Official Patient's Sourcebook on Barrett's Esophagus
·
The Official Patient's Sourcebook on Celiac Disease
·
The Official Patient's Sourcebook on Cirrhosis of the Liver
·
The Official Patient's Sourcebook on Crohn Disease
·
The Official Patient's Sourcebook on Cyclic Vomiting Syndrome
·
The Official Patient's Sourcebook on Diarrhea
·
The Official Patient's Sourcebook on Diverticular Disease
·
The Official Patient's Sourcebook on Fecal Incontinence
·
The Official Patient's Sourcebook on Gallstones
·
The Official Patient's Sourcebook on Gas
·
The Official Patient's Sourcebook on Gastritis
·
The Official Patient's Sourcebook on Gastroparesis
·
The Official Patient's Sourcebook on Hemolytic Uremic Syndrome
·
The Official Patient's Sourcebook on Hemorrhoids
·
The Official Patient's Sourcebook on Hepatitis a
·
The Official Patient's Sourcebook on Hepatitis B
·
The Official Patient's Sourcebook on Hepatitis C
·
The Official Patient's Sourcebook on Hiatal Hernia
·
The Official Patient's Sourcebook on Hirschsprung
·
The Official Patient's Sourcebook on Indigestion
·
The Official Patient's Sourcebook on Inguinal Hernia
·
The Official Patient's Sourcebook on Intestinal Pseudo-obstruction
·
The Official Patient's Sourcebook on Irritable Bowel Syndrome
·
The Official Patient's Sourcebook on Lactose Intolerance
·
The Official Patient's Sourcebook on Ménétrier
·
The Official Patient's Sourcebook on Pancreatitis
·
The Official Patient's Sourcebook on Peptic Ulcer
·
The Official Patient's Sourcebook on Porphyria
·
The Official Patient's Sourcebook on Primary Biliary Cirrhosis
·
The Official Patient's Sourcebook on Primary Sclerosing Cholangitis
·
The Official Patient's Sourcebook on Proctitis
·
The Official Patient's Sourcebook on Rapid Gastric Emptying
vii
·
The Official Patient's Sourcebook on Short Bowel Syndrome
·
The Official Patient's Sourcebook on Ulcerative Colitis
·
The Official Patient's Sourcebook on Whipple Disease
·
The Official Patient's Sourcebook on Wilson's Disease
·
The Official Patient's Sourcebook on Zollinger-ellison Syndrome
To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
Contents
ix
Table of Contents INTRODUCTION...................................................................................... 1 Overview ....................................................................................................................................... 1 Organization ................................................................................................................................. 3 Scope.............................................................................................................................................. 3 Moving Forward............................................................................................................................ 4 PART I: THE ESSENTIALS ............................................................................................................. 7
CHAPTER 1. THE ESSENTIALS ON CONSTIPATION: GUIDELINES.......... 9 Overview ....................................................................................................................................... 9 What Is Constipation?................................................................................................................. 11 Who Gets Constipated? ............................................................................................................... 11 What Causes Constipation? ........................................................................................................ 12 Common Causes of Constipation................................................................................................. 12 Diseases That Cause Constipation .............................................................................................. 15 Diagnostic Testing ...................................................................................................................... 16 How Is Constipation Treated?..................................................................................................... 19 Can Constipation Be Serious?..................................................................................................... 21 Points to Remember..................................................................................................................... 22 Additional Resources................................................................................................................... 22 More Guideline Sources .............................................................................................................. 23 Vocabulary Builder...................................................................................................................... 39
CHAPTER 2. SEEKING GUIDANCE ....................................................... 45 Overview ..................................................................................................................................... 45 Associations and Constipation .................................................................................................... 45 Finding More Associations ......................................................................................................... 50 Finding Doctors........................................................................................................................... 52 Selecting Your Doctor ................................................................................................................. 53 Working with Your Doctor ......................................................................................................... 54 Broader Health-Related Resources .............................................................................................. 55 Vocabulary Builder...................................................................................................................... 55
CHAPTER 3. CLINICAL TRIALS AND CONSTIPATION .......................... 57 Overview ..................................................................................................................................... 57 Recent Trials on Constipation ..................................................................................................... 60 Benefits and Risks........................................................................................................................ 62 Keeping Current on Clinical Trials ............................................................................................. 65 General References....................................................................................................................... 66 Vocabulary Builder...................................................................................................................... 67 PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL ........................... 69
CHAPTER 4. STUDIES ON CONSTIPATION ........................................... 71 Overview ..................................................................................................................................... 71 The Combined Health Information Database .............................................................................. 71 Federally-Funded Research on Constipation ............................................................................... 80 E-Journals: PubMed Central ....................................................................................................... 93 The National Library of Medicine: PubMed................................................................................ 93 Vocabulary Builder.................................................................................................................... 103
CHAPTER 5. PATENTS ON CONSTIPATION ........................................ 111 Overview ................................................................................................................................... 111
x
Contents Patents on Constipation ............................................................................................................ 112 Patent Applications on Constipation ........................................................................................ 116 Keeping Current ........................................................................................................................ 116 Vocabulary Builder.................................................................................................................... 117
CHAPTER 6. BOOKS ON CONSTIPATION............................................ 119 Overview ................................................................................................................................... 119 Book Summaries: Federal Agencies ........................................................................................... 119 Book Summaries: Online Booksellers ........................................................................................ 125 The National Library of Medicine Book Index........................................................................... 130 Chapters on Constipation .......................................................................................................... 133 Directories ................................................................................................................................. 142 General Home References .......................................................................................................... 143 Vocabulary Builder.................................................................................................................... 144
CHAPTER 7. MULTIMEDIA ON CONSTIPATION ................................. 149 Overview ................................................................................................................................... 149 Video Recordings....................................................................................................................... 149 Bibliography: Multimedia on Constipation............................................................................... 154 Vocabulary Builder.................................................................................................................... 156
CHAPTER 8. PERIODICALS AND NEWS ON CONSTIPATION .............. 157 Overview ................................................................................................................................... 157 News Services & Press Releases ................................................................................................ 157 Newsletters on Constipation ..................................................................................................... 160 Newsletter Articles .................................................................................................................... 161 Academic Periodicals covering Constipation ............................................................................ 169 Vocabulary Builder.................................................................................................................... 170
CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES ................... 173 Overview ................................................................................................................................... 173 NIH Guidelines ......................................................................................................................... 173 NIH Databases .......................................................................................................................... 174 Other Commercial Databases .................................................................................................... 190 The Genome Project and Constipation ...................................................................................... 191 Specialized References ............................................................................................................... 195 Vocabulary Builder.................................................................................................................... 196
CHAPTER 10. DISSERTATIONS ON CONSTIPATION ........................... 197 Overview ................................................................................................................................... 197 Dissertations on Constipation ................................................................................................... 197 Keeping Current ........................................................................................................................ 198 PART III. APPENDICES .............................................................................................................. 199
APPENDIX A. RESEARCHING YOUR MEDICATIONS.......................... 201 Overview ................................................................................................................................... 201 Your Medications: The Basics ................................................................................................... 202 Learning More about Your Medications ................................................................................... 203 Commercial Databases............................................................................................................... 205 Contraindications and Interactions (Hidden Dangers)............................................................. 219 A Final Warning ....................................................................................................................... 220 General References..................................................................................................................... 220 Vocabulary Builder.................................................................................................................... 221
APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ................... 227 Overview ................................................................................................................................... 227 What Is CAM? .......................................................................................................................... 227
Contents
xi
What Are the Domains of Alternative Medicine? ..................................................................... 228 Can Alternatives Affect My Treatment?................................................................................... 231 Finding CAM References on Constipation ............................................................................... 232 Additional Web Resources......................................................................................................... 244 General References..................................................................................................................... 293
APPENDIX C. RESEARCHING NUTRITION ......................................... 295 Overview ................................................................................................................................... 295 Food and Nutrition: General Principles .................................................................................... 296 Finding Studies on Constipation............................................................................................... 300 Federal Resources on Nutrition................................................................................................. 303 Additional Web Resources......................................................................................................... 304 Vocabulary Builder.................................................................................................................... 328
APPENDIX D. FINDING MEDICAL LIBRARIES.................................... 331 Overview ................................................................................................................................... 331 Preparation ................................................................................................................................ 331 Finding a Local Medical Library ............................................................................................... 332 Medical Libraries Open to the Public ........................................................................................ 332
APPENDIX E. CONSTIPATION IN CHILDREN ..................................... 339 Overview ................................................................................................................................... 339 For More Information................................................................................................................ 340 ONLINE GLOSSARIES ............................................................................................................... 343 Online Dictionary Directories................................................................................................... 347 CONSTIPATION GLOSSARY ................................................................................................... 349 General Dictionaries and Glossaries ......................................................................................... 375 INDEX.............................................................................................................................................. 377
Introduction
1
INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don’t know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3
Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2
2
Constipation
Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor’s offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The 2002 Official Patient’s Sourcebook on Constipation has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to constipation, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on constipation. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on constipation should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on appropriate
Introduction
3
options is always up to the patient in consultation with their physician and healthcare providers.
Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching constipation (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to constipation. It also gives you sources of information that can help you find a doctor in your local area specializing in diagnosing and treating constipation. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with constipation. Part II moves on to advanced research dedicated to constipation. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on constipation. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with constipation or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with constipation. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with constipation.
Scope While this sourcebook covers constipation, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that constipation is often considered a synonym or a condition closely related to the following: ·
Costive Bowel
·
Locked Bowels
4
Constipation
In addition to synonyms and related conditions, physicians may refer to constipation using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world’s illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for constipation:4 ·
564.0 constipation
·
564.00 constipation, unspecified
·
564.01 slow transit constipation
·
564.02 outlet dysfunction constipation
·
564.09 other constipation
·
564.7 megacolon, other than hirschsprung's
·
564.8 other specified functional disorders of intestine (includes atony of colon)
·
751.3 hirschsprung's disease and other congenital functional disorders of colon
For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to constipation. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.
Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses and conditions. Some are written by patients or their family members. These generally take a layperson’s approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful.
4 This list is based on the official version of the World Health Organization’s 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”
Introduction
5
As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. Why “Internet age”? All too often, patients with constipation will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with constipation is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of constipation, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors
7
PART I: THE ESSENTIALS
ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on constipation. The essentials of a symptom typically include the definition or description of the symptom, a discussion of who it affects, the diseases that are associated with a given symptom, tests or diagnostic procedures that might be specific to the symptom, and treatments for the symptom. Your doctor or healthcare provider may have already explained the essentials of constipation to you or even given you a pamphlet or brochure describing constipation. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.
Guidelines
CHAPTER 1. GUIDELINES
THE
ESSENTIALS
ON
9
CONSTIPATION:
Overview Official agencies, as well as federally-funded institutions supported by national grants, frequently publish a variety of guidelines on constipation. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on constipation can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on constipation. Originally founded in 1887, the NIH is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.
5
Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.
10 Constipation
There is no guarantee that any one Institute will have a guideline on a specific condition or disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare conditions and disorders. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with constipation and associated conditions: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
Among these, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is particularly noteworthy. The NIDDK’s mission is to conduct and support research on many of the most serious diseases affecting public health.6 The Institute supports much of the clinical research on the diseases of internal medicine and related subspecialty fields as well as many basic science disciplines. The NIDDK’s Division of Intramural Research encompasses the broad spectrum of metabolic diseases such as diabetes, inborn errors of metabolism, endocrine disorders, mineral metabolism, digestive diseases, nutrition, urology and renal disease, and hematology. Basic research studies include biochemistry, nutrition, pathology, histochemistry, chemistry, physical, chemical, and molecular biology, pharmacology, and toxicology. NIDDK extramural research is organized into divisions of program areas: ·
Division of Diabetes, Endocrinology, and Metabolic Diseases
·
Division of Digestive Diseases and Nutrition
·
Division of Kidney, Urologic, and Hematologic Diseases
The Division of Extramural Activities provides administrative support and overall coordination. A fifth division, the Division of Nutrition Research Coordination, coordinates government nutrition research efforts. The This paragraph has been adapted from the NIDDK: http://www.niddk.nih.gov/welcome/mission.htm. “Adapted” signifies that a passage is reproduced exactly or slightly edited for this book. 6
Guidelines 11
Institute supports basic and clinical research through investigator-initiated grants, program project and center grants, and career development and training awards. The Institute also supports research and development projects and large-scale clinical trials through contracts. The following patient guideline was recently published by the NIDDK on constipation.
What Is Constipation?7 Constipation is passage of small amounts of hard, dry bowel movements, usually fewer than three times a week. People who are constipated may find it difficult and painful to have a bowel movement. Other symptoms of constipation include feeling bloated, uncomfortable, and sluggish. Many people think they are constipated when, in fact, their bowel movements are regular. For example, some people believe they are constipated, or irregular, if they do not have a bowel movement every day. However, there is no right number of daily or weekly bowel movements. Normal may be three times a day or three times a week depending on the person. In addition, some people naturally have firmer stools than others. At one time or another almost everyone gets constipated. Poor diet and lack of exercise are usually the causes. In most cases, constipation is temporary and not serious. Understanding causes, prevention, and treatment will help most people find relief.
Who Gets Constipated? According to the 1991 National Health Interview Survey, about 4 1/2 million people in the United States say they are constipated most or all of the time. Those reporting constipation most often are women, children, and adults age 65 and over. Pregnant women also complain of constipation, and it is a common problem following childbirth or surgery. Constipation is the most common gastrointestinal complaint in the United States, resulting in about 2 million annual visits to the doctor. However, most people treat themselves without seeking medical help, as is evident from the $725 million Americans spend on laxatives each year.
Adapted from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): http://www.niddk.nih.gov/health/digest/pubs/const/const.htm. 7
12 Constipation
What Causes Constipation? To understand constipation, it helps to know how the colon (large intestine) works. As food moves through it, the colon absorbs water while forming waste products, or stool. Muscle contractions in the colon push the stool toward the rectum. By the time stool reaches the rectum, it is solid because most of the water has been absorbed.
The hard and dry stools of constipation occur when the colon absorbs too much water. This happens because the colon’s muscle contractions are slow or sluggish, causing the stool to move through the colon too slowly.
Common Causes of Constipation The most common causes of constipation include: ·
Not enough fiber in diet
·
Not enough liquids
·
Lack of exercise
·
Medications
·
Irritable bowel syndrome
·
Changes in life or routine such as pregnancy, older age, and travel
·
Abuse of laxatives
Guidelines 13
·
Ignoring the urge to have a bowel movement
·
Specific diseases such as multiple sclerosis and lupus
·
Problems with the colon and rectum
·
Problems with intestinal function (Chronic idiopathic constipation)
Diet The most common cause of constipation is a diet low in fiber found in vegetables, fruits, and whole grains and high in fats found in cheese, eggs, and meats. People who eat plenty of high-fiber foods are less likely to become constipated. Fiber--soluble and insoluble--is the part of fruits, vegetables, and grains that the body cannot digest. Soluble fiber dissolves easily in water and takes on a soft, gel-like texture in the intestines. Insoluble fiber passes almost unchanged through the intestines. The bulk and soft texture of fiber help prevent hard, dry stools that are difficult to pass. On average, Americans eat about 5 to 20 grams of fiber daily, short of the 20 to 35 grams recommended by the American Dietetic Association. Both children and adults eat too many refined and processed foods in which the natural fiber is removed. A low-fiber diet also plays a key role in constipation among older adults. They often lack interest in eating and may choose fast foods low in fiber. In addition, loss of teeth may force older people to eat soft foods that are processed and low in fiber.
Not Enough Liquids Liquids like water and juice add fluid to the colon and bulk to stools, making bowel movements softer and easier to pass. People who have problems with constipation should drink enough of these liquids every day, about eight 8ounce glasses. Other liquids, like coffee and soft drinks, that contain caffeine seem to have a dehydrating effect.
14 Constipation
Lack of Exercise Lack of exercise can lead to constipation, although doctors do not know precisely why. For example, constipation often occurs after an accident or during an illness when one must stay in bed and cannot exercise.
Medications Pain medications (especially narcotics), antacids that contain aluminum, antispasmodics, antidepressants, iron supplements, diuretics, and anticonvulsants for epilepsy can slow passage of bowel movements. Irritable Bowel Syndrome (IBS) Some people with IBS, also known as spastic colon, have spasms in the colon that affect bowel movements. Constipation and diarrhea often alternate, and abdominal cramping, gassiness, and bloating are other common complaints. Although IBS can produce lifelong symptoms, it is not a life-threatening condition. It often worsens with stress, but there is no specific cause or anything unusual that the doctor can see in the colon.
Changes in Life or Routine During pregnancy, women may be constipated because of hormonal changes or because the heavy uterus compresses the intestine. Aging may also affect bowel regularity because a slower metabolism results in less intestinal activity and muscle tone. In addition, people often become constipated when traveling because their normal diet and daily routines are disrupted.
Abuse of Laxatives Myths about constipation have led to a serious abuse of laxatives. This is common among older adults who are preoccupied with having a daily bowel movement. Laxatives usually are not necessary and can be habit-forming. The colon begins to rely on laxatives to bring on bowel movements. Over time, laxatives can damage nerve cells in the colon and interfere with the colon’s
Guidelines 15
natural ability to contract. For the same reason, regular use of enemas can also lead to a loss of normal bowel function.
Ignoring the Urge to Have a Bowel Movement People who ignore the urge to have a bowel movement may eventually stop feeling the urge, which can lead to constipation. Some people delay having a bowel movement because they do not want to use toilets outside the home. Others ignore the urge because of emotional stress or because they are too busy. Children may postpone having a bowel movement because of stressful toilet training or because they do not want to interrupt their play.
Specific Diseases Diseases that cause constipation include neurological disorders, metabolic and endocrine disorders, and systemic conditions that affect organ systems. These disorders can slow the movement of stool through the colon, rectum, or anus.
Diseases That Cause Constipation Neurological disorders that may cause constipation include: ·
Multiple sclerosis
·
Parkinson’s disease
·
Chronic idiopathic intestinal pseudo-obstruction
·
Stroke
·
Spinal cord injuries
Metabolic and endocrine conditions include: ·
Diabetes
·
Underactive or overactive thyroid gland
·
Uremia
Systemic disorders include: ·
Amyloidosis
16 Constipation
·
Lupus
·
Scleroderma
Problems with the Colon and Rectum Intestinal obstruction, scar tissue (adhesions), diverticulosis, tumors, colorectal stricture, Hirschsprung’s disease, or cancer can compress, squeeze, or narrow the intestine and rectum and cause constipation.
Problems with Constipation)
Intestinal
Function
(Chronic
Idiopathic
Also known as functional constipation, chronic idiopathic (of unknown origin) constipation is rare. However, some people are chronically constipated and do not respond to standard treatment. This chronic constipation may be related to multiple problems with hormonal control or with nerves and muscles in the colon, rectum, or anus. Functional constipation occurs in both children and adults and is most common in women. Colonic inertia and delayed transit are two types of functional constipation caused by decreased muscle activity in the colon. These syndromes may affect the entire colon or may be confined to the left or lower (sigmoid) colon. Functional constipation that stems from abnormalities in the structure of the anus and rectum is known as anorectal dysfunction, or anismus. These abnormalities result in an inability to relax the rectal and anal muscles that allow stool to exit.
Diagnostic Testing Most people do not need extensive testing and can be treated with changes in diet and exercise. For example, in young people with mild symptoms, a medical history and physical examination may be all the doctor needs to suggest successful treatment. The tests the doctor performs depends on the duration and severity of the constipation, the person’s age, and whether there is blood in stools, recent changes in bowel movements, or weight loss.
Guidelines 17
Medical History The doctor may ask a patient to describe his or her constipation, including duration of symptoms, frequency of bowel movements, consistency of stools, presence of blood in the stool, and toilet habits (how often and where one has bowel movements). Recording eating habits, medication, and level of physical activity or exercise also helps the doctor determine the cause of constipation.
Physical Examination A physical exam may include a digital rectal exam with a gloved, lubricated finger to evaluate the tone of the muscle that closes off the anus (anal sphincter) and to detect tenderness, obstruction, or blood. In some cases, blood and thyroid tests may be necessary. Extensive testing usually is reserved for people with severe symptoms, for those with sudden changes in number and consistency of bowel movements or blood in the stool, and for older adults. Because of an increased risk of colorectal cancer in older adults, the doctor may use these tests to rule out a diagnosis of cancer: ·
Barium enema x-ray
·
Sigmoidoscopy or colonoscopy
·
Colorectal transit study
·
Anorectal function tests.
Barium Enema X-Ray A barium enema x-ray involves viewing the rectum, colon, and lower part of the small intestine to locate any problems. This part of the digestive tract is known as the bowel. This test may show intestinal obstruction and Hirschsprung’s disease, a lack of nerves within the colon. The night before the test, bowel cleansing, also called bowel prep, is necessary to clear the lower digestive tract. The patient drinks 8 ounces of a special liquid every 15 minutes for about 4 hours. This liquid flushes out the bowel. A clean bowel is important, because even a small amount of stool in the colon can hide details and result in an inaccurate exam.
18 Constipation
Because the colon does not show up well on an x-ray, the doctor fills the organs with a barium enema, a chalky liquid to make the area visible. Once the mixture coats the organs, x-rays are taken that reveal their shape and condition. The patient may feel some abdominal cramping when the barium fills the colon, but usually feels little discomfort after the procedure. Stools may be a whitish color for a few days after the exam.
Sigmoidoscopy or Colonoscopy An examination of the rectum and lower colon (sigmoid) is called a sigmoidoscopy. An examination of the rectum and entire colon is called a colonoscopy. The night before a sigmoidoscopy, the patient usually has a liquid dinner and takes an enema in the early morning. A light breakfast and a cleansing enema an hour before the test may also be necessary. To perform a sigmoidoscopy, the doctor uses a long, flexible tube with a light on the end called a sigmoidoscope to view the rectum and lower colon. First, the doctor examines the rectum with a gloved, lubricated finger. Then, the sigmoidoscope is inserted through the anus into the rectum and lower colon. The procedure may cause a mild sensation of wanting to move the bowels and abdominal pressure. Sometimes the doctor fills the organs with air to get a better view. The air may cause mild cramping. To perform a colonoscopy, the doctor uses a flexible tube with a light on the end called a colonoscope to view the entire colon. This tube is longer than a sigmoidoscope. The same bowel cleansing used for the barium x-ray is needed to clear the bowel of waste. The patient is lightly sedated before the exam. During the exam, the patient lies on his or her side and the doctor inserts the tube through the anus and rectum into the colon. If an abnormality is seen, the doctor can use the colonoscope to remove a small piece of tissue for examination (biopsy). The patient may feel gassy and bloated after the procedure.
Colorectal Transit Study This test, reserved for those with chronic constipation, shows how well food moves through the colon. The patient swallows capsules containing small markers, which are visible on x-ray. The movement of the markers through the colon is monitored with abdominal x-rays taken several times 3 to 7 days
Guidelines 19
after the capsule is swallowed. The patient follows a high-fiber diet during the course of this test. Anorectal Function Tests These tests diagnose constipation caused by abnormal functioning of the anus or rectum (anorectal function). Anorectal manometry evaluates anal sphincter muscle function. A catheter or air-filled balloon inserted into the anus is slowly pulled back through the sphincter muscle to measure muscle tone and contractions. Defecography is an x-ray of the anorectal area that evaluates completeness of stool elimination, identifies anorectal abnormalities, and evaluates rectal muscle contractions and relaxation. During the exam, the doctor fills the rectum with a soft paste that is the same consistency as stool. The patient sits on a toilet positioned inside an x-ray machine and then relaxes and squeezes the anus and expels the solution. The doctor studies the x-rays for anorectal problems that occurred while the patient emptied the paste.
How Is Constipation Treated? Although treatment depends on the cause, severity, and duration, in most cases dietary and lifestyle changes will help relieve symptoms and help prevent constipation.
Diet A diet with enough fiber (20 to 35 grams each day) helps form soft, bulky stool. A doctor or dietitian can help plan an appropriate diet. High-fiber foods include beans; whole grains and bran cereals; fresh fruits; and vegetables such as asparagus, brussels sprouts, cabbage, and carrots. For people prone to constipation, limiting foods that have little or no fiber such as ice cream, cheese, meat, and processed foods is also important.
Lifestyle Changes Other changes that can help treat and prevent constipation include drinking enough water and other liquids such as fruit and vegetable juices and clear soup, engaging in daily exercise, and reserving enough time to have a bowel
20 Constipation
movement. In addition, the urge to have a bowel movement should not be ignored.
Laxatives Most people who are mildly constipated do not need laxatives. However, for those who have made lifestyle changes and are still constipated, doctors may recommend laxatives or enemas for a limited time. These treatments can help retrain a chronically sluggish bowel. For children, short-term treatment with laxatives, along with retraining to establish regular bowel habits, also helps prevent constipation. A doctor should determine when a patient needs a laxative and which form is best. Laxatives taken by mouth are available in liquid, tablet, gum, powder, and granule forms. They work in various ways: ·
Bulk-forming laxatives generally are considered the safest but can interfere with absorption of some medicines. These laxatives, also known as fiber supplements, are taken with water. They absorb water in the intestine and make the stool softer. Brand names include Metamucil®, Citrucel®, Konsyl®, and Serutan®.
·
Stimulants cause rhythmic muscle contractions in the intestines. Brand names include Correctol®, Dulcolax®, Purge®, Feen-A-Mint®, and Senokot®. Studies suggest that phenolphthalein, an ingredient in some stimulant laxatives, might increase a person’s risk for cancer. The Food and Drug Administration has proposed a ban on all over-the-counter products containing phenolphthalein. Most laxative makers have replaced or plan to replace phenolphthalein with a safer ingredient.
·
Stool softeners provide moisture to the stool and prevent dehydration. These laxatives are often recommended after childbirth or surgery. Products include Colace®, Dialose®, and Surfak®.
·
Lubricants grease the stool enabling it to move through the intestine more easily. Mineral oil is the most common lubricant.
·
Saline laxatives act like a sponge to draw water into the colon for easier passage of stool. Laxatives in this group include Milk of Magnesia®, Citrate of Magnesia®, and Haley’s M-O®.
People who are dependent on laxatives need to slowly stop using the medications. A doctor can assist in this process. In most people, this restores the colon’s natural ability to contract.
Guidelines 21
Other Treatment Treatment may be directed at a specific cause. For example, the doctor may recommend discontinuing medication or performing surgery to correct an anorectal problem such as rectal prolapse. People with chronic constipation caused by anorectal dysfunction can use biofeedback to retrain the muscles that control release of bowel movements. Biofeedback involves using a sensor to monitor muscle activity that at the same time can be displayed on a computer screen allowing for an accurate assessment of body functions. A health care professional uses this information to help the patient learn how to use these muscles. Surgical removal of the colon may be an option for people with severe symptoms caused by colonic inertia. However, the benefits of this surgery must be weighed against possible complications, which include abdominal pain and diarrhea.
Can Constipation Be Serious? Sometimes constipation can lead to complications. These complications include hemorrhoids caused by straining to have a bowel movement or anal fissures (tears in the skin around the anus) caused when hard stool stretches the sphincter muscle. As a result, rectal bleeding may occur that appears as bright red streaks on the surface of the stool. Treatment for hemorrhoids may include warm tub baths, ice packs, and application of a cream to the affected area. Treatment for anal fissure may include stretching the sphincter muscle or surgical removal of tissue or skin in the affected area. Sometimes straining causes a small amount of intestinal lining to push out from the anal opening. This condition is known as rectal prolapse and may lead to secretion of mucus from the anus. Usually, eliminating the cause of the prolapse such as straining or coughing is the only treatment necessary. Severe or chronic prolapse requires surgery to strengthen and tighten the anal sphincter muscle or to repair the prolapsed lining. Constipation may also cause hard stool to pack the intestine and rectum so tightly that the normal pushing action of the colon is not enough to expel the stool. This condition, called fecal impaction, occurs most often in children and older adults. An impaction can be softened with mineral oil taken by mouth and an enema. After softening the impaction, the doctor may break up and remove part of the hardened stool by inserting one or two fingers in the anus.
22 Constipation
Points to Remember ·
Constipation affects almost everyone at one time or another.
·
Many people think they are constipated when, in fact, their bowel movements are regular.
·
The most common causes of constipation are poor diet and lack of exercise.
·
Additional causes of constipation include medications, irritable bowel syndrome, abuse of laxatives, and specific diseases.
·
A medical history and physical examination may be the only diagnostic tests needed before the doctor suggests treatment.
In most cases, following these simple tips will help relieve symptoms and prevent recurrence of constipation: ·
Eat a well-balanced, high-fiber diet that includes beans, bran, whole grains, fresh fruits, and vegetables.
·
Drink plenty of liquids.
·
Exercise regularly.
·
Set aside time after breakfast or dinner for undisturbed visits to the toilet.
·
Do not ignore the urge to have a bowel movement.
·
Understand that normal bowel habits vary.
·
Whenever a significant or prolonged change in bowel habits occurs, check with a doctor.
Most people with mild constipation do not need laxatives. However, doctors may recommend laxatives for a limited time for people with chronic constipation.
Additional Resources For more information, contact: International Foundation for Functional Gastrointestinal Disorders P.O. Box 17864 Milwaukee, WI 53217 (414) 964-1799
Guidelines 23
Intestinal Disease Foundation 1323 Forbes Avenue, Suite 200 Pittsburgh, PA 15219 (412) 261-5888 National Digestive Diseases Information Clearinghouse 2 Information Way Bethesda, MD 20892-3570 E-mail: National Digestive Diseases Information Clearinghouse
More Guideline Sources The guideline above on constipation is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to constipation. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with constipation. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following as being relevant to constipation: ·
Guides On Constipation Constipation http://www.nlm.nih.gov/medlineplus/constipation.html
24 Constipation
·
Other Guides Diverticulosis http://www.nlm.nih.gov/medlineplus/tutorials/diverticulosisloade r.html First trimester pregnancy http://www.nlm.nih.gov/medlineplus/ency/article/000887.htm Tumor http://www.nlm.nih.gov/medlineplus/ency/article/001310.htm Encopresis http://www.nlm.nih.gov/medlineplus/ency/article/001570.htm Fecal impaction http://www.nlm.nih.gov/medlineplus/ency/article/000230.htm Cancer http://www.nlm.nih.gov/medlineplus/ency/article/001289.htm
Within the health topic page dedicated to constipation, the following was recently recommended to patients: ·
General/Overviews Constipation Source: American Gastroenterological Association http://www.gastro.org/public/constipation.html Constipation: Keeping Your Bowels Moving Smoothly Source: American Academy of Family Physicians http://familydoctor.org/healthfacts/037/
·
Diagnosis/Symptoms Abdominal Pain, Acute: Self-Care Flowcharts Source: American Academy of Family Physicians http://familydoctor.org/flowcharts/527.html Abdominal Pain, Chronic: Self-Care Flowcharts Source: American Academy of Family Physicians http://familydoctor.org/flowcharts/528.html
Guidelines 25
Colonoscopy http://www.nlm.nih.gov/medlineplus/tutorials/colonoscopyloader. html Colonoscopy Source: National Digestive Diseases Information Clearinghouse http://www.niddk.nih.gov/health/digest/pubs/diagtest/colo.htm Elimination Problems in Infants and Children: Self-Care Flowcharts Source: American Academy of Family Physicians http://familydoctor.org/flowcharts/533.html Elimination Problems: Self-Care Flowcharts Source: American Academy of Family Physicians http://familydoctor.org/flowcharts/532.html Flexible Sigmoidoscopy Source: National Digestive Diseases Information Clearinghouse http://www.niddk.nih.gov/health/digest/pubs/diagtest/sigmo.htm Radiography-Lower GI Tract Source: American College of Radiology, Radiological Society of North America http://www.radiologyinfo.org/content/lower_gi.htm ·
Treatment Why Am I Constipated? Source: img src='/medlineplus/images/easyread.gif' width='79' height='17' border=0 alt='Easy-to-Read'> (National Digestive Diseases Information Clearinghouse http://www.niddk.nih.gov/health/digest/pubs/whyconst/whycon st.htm
·
Nutrition Fiber: How To Increase the Amount in Your Diet Source: American Academy of Family Physicians http://familydoctor.org/handouts/099.html
·
Specific Conditions/Aspects PDQ-Supportive Care-Patients: Constipation, Impaction, and Bowel Obstruction Source: National Cancer Institute http://www.cancer.gov/cancer_information/doc_pdq.aspx?viewid= AC1316AC-A144-405E-87EF-3914EE0917A2
26 Constipation
Stool Soiling in Children (Encopresis) Source: American Academy of Family Physicians http://familydoctor.org/handouts/166.html ·
Children Are Your Bowels Moving? Source: Nemours Foundation http://kidshealth.org/kid/stay_healthy/body/bowel.html Constipation in Children Source: National Digestive Diseases Information Clearinghouse http://www.niddk.nih.gov/health/digest/summary/conchild/inde x.htm
·
From the National Institutes of Health Constipation Source: National Digestive Diseases Information Clearinghouse http://www.niddk.nih.gov/health/digest/pubs/const/const.htm
·
Organizations American Gastroenterological Association http://www.gastro.org/index.html American Society of Colon and Rectal Surgeons http://www.fascrs.org/ascrs-home.html National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov/
If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.
Guidelines 27
The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on constipation and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·
Gastrointestinal Tract in Scleroderma Source: Danvers, MA: Scleroderma Foundation. 1999. 6 p. Contact: Available from Scleroderma Foundation. 12 Kent Way, Suite 101, Byfield, MA 01922. (800) 722-4673 or (978) 463-5843. Fax (978) 4635809. E-mail:
[email protected]. Website: www.scleroderma.org. Price: Single copy $1.00. Summary: This pamphlet provides people who have scleroderma with information on its gastrointestinal tract manifestations. The pamphlet focuses on manifestations involving the mouth, esophagus, stomach, and small intestine and large intestines. People who have scleroderma may experience dry mouth, which may lead to impairment of early digestion and occurrence of dental caries and periodontitis. Involvement of the esophagus may cause heartburn, difficulty with swallowing, and aspiration. Stomach involvement occurs in only 10 percent of patients, but it can be associated with bloating, satiety, abdominal pain, nausea, and vomiting. Involvement of the small intestine may cause nausea, vomiting, bloating, diarrhea, and malabsorption, while muscle impairment of the large intestine may result in constipation, bloating, and diarrhea. The pamphlet also includes a glossary of terms. 1 figure.
·
Acute Intermittent Porphyria (AIP) Source: Houston, TX: American Porphyria Foundation. 199x. 8 p. Contact: Available from American Porphyria Foundation. P.O. Box 22712, Houston, TX 77227-2712. (713) 266-9617. Fax (713) 871-1788. Website: www.enterprise.net/apf/. Price: Single copy free to members only ($30.00 membership fee); online version available for $5.00 access fee. Summary: This brochure for health professionals and people with acute intermittent porphyria (AIP) discusses the clinical features, diagnosis, and treatment of this rare inherited disease. Signs and symptoms usually
28 Constipation
occur intermittently and include abdominal pain, constipation, muscle weakness, arm and leg pain, insomnia, emotional difficulties, rapid pulse, and high blood pressure. Factors that may precipitate or exacerbate an attack are drugs such as barbiturates and sulfonamides, hormones, nutrition, environmental chemicals, alcoholic beverages, stress, and fatigue. Various blood and urine tests are central to the diagnosis, and initial treatment consists of stopping the patient from taking harmful drugs and providing a high intake of carbohydrates. Drugs that may be used to treat AIP include hematin and heme arginate, administered intravenously. Prognosis is usually good if the disease is recognized and treated before severe nerve damage has occurred. The brochure concludes with a list of general recommendations for people whose blood tests show low levels of porphobilinogen deaminase. ·
Hemorrhoids: Steps to Finding Relief Source: San Bruno, CA: StayWell Company. 1999. [2 p.]. Contact: Available from StayWell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 2444512. E-mail:
[email protected]. Website: www.staywell.com. Price: $17.95 for pack of 50; plus shipping and handling. Summary: This patient education brochure describes hemorrhoids and their treatment. Written in nontechnical language, the brochure first defines hemorrhoids as cushions of swollen veins in the anal canal. Hemorrhoids are a very common problem and can affect all kinds of people, including those who sit for long periods, pregnant women, and others. Symptoms of hemorrhoids can include pain, itching, irritation, burning, and bleeding of the rectal area. Constipation (dry, hard to pass stool) is a major cause of hemorrhoids. Other causes include heavy lifting, lack of exercise, too much strenuous exercise, chronic cough, and poor bowel habits (such as sitting on the toilet for long periods of time). Diagnosis is important to rule out more serious diseases and will include the patient's medical history and some diagnostic tests, such as sigmoidoscopy. Most treatment plans focus on steps that the patient can follow at home, including sitz baths, nonprescription medications, and good bowel habits. The brochure reminds readers that steps to ease constipation include increasing fluid intake and undertaking regular exercise. One section of the brochure illustrates and describes the physiology of the anal canal and the types of hemorrhoids that can occur (external or internal). The last page of the brochure summarizes the recommendations for increasing dietary fiber. The brochure is illustrated with full color line drawings. 6 figures.
Guidelines 29
·
Guide to Controlling Irritable Bowel Syndrome Source: San Bruno, CA: StayWell Company. 1999. 7 p. Contact: Available from Staywell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 2444512. Price: $1.25 per copy; plus shipping and handling. Summary: This brochure offers a user friendly approach to understanding and coping with irritable bowel syndrome (IBS). The brochures stresses the importance of consulting a doctor for diagnosis, because symptoms similar to those of IBS can sometimes be caused by other more serious bowel conditions. IBS is the digestive tract's abnormal reaction to the stresses and strains of daily life, as well as to the routine activity of processing food. The brochure reviews normal digestion, including the role of the esophagus, stomach, small intestine, colon, sigmoid colon, and rectum. The symptoms of abdominal pain, constipation, and diarrhea are typical in patients with IBS. With IBS, the natural motility of the bowel muscle is disrupted; motility is the rhythmic wave like motion the bowel makes to move body waste along. Tension, eating, smoking, and alcohol all can alter normal motility. Treatment programs can include medication, changes in the diet, and lifestyle modifications to reduce stress (including exercise, biofeedback meditation, and counseling or support groups). The brochure stresses that continued medical followup is essential to monitor the success of the treatment program. Each concept in the brochure is illustrated with cartoon type line drawings featuring patients and a group of elf characters who are shown as the inner workings of the digestive tract.
·
Hemorrhoid Book: A Look at Hemorrhoids, How They're Treated and How You Can Prevent Them from Coming Back. [Folleto de las Hemorroides: Information Sobre las Hemorroides: Tratamiento y Prevencion] Source: San Bruno, CA: StayWell Company. 1999. 15 p. Contact: Available from Staywell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 2444512. Price: $1.25 per copy; plus shipping and handling. Summary: This patient education brochure describes hemorrhoids and problems that can occur with swollen hemorrhoids. Written in nontechnical language, the brochure first defines hemorrhoids as normal cushions of tissue that swell gently to aid in the process of elimination (defecation). Hemorrhoids become a problem only when they swell too much, at which point they may cause pain, itching, irritation, burning, and bleeding. The primary cause is a low fiber diet, leading to
30 Constipation
constipation and straining on the toilet. Other causes include a sedentary lifestyle, too much strenuous exercise, pressure on the rectum from pregnancy or from standing a lot, regulating bowel habits by the clock, and medications that cause diarrhea or constipation. Because symptoms of hemorrhoids can mimic symptoms of a more serious disease such as colorectal cancer, prompt evaluation and diagnosis is important. Once the doctor confirms a diagnosis of bleeding or swollen hemorrhoids, treatment options can be explored. For many people, a change in diet and level of activity is the only treatment that may be needed. For others, treatment at the doctor's office or surgery may be necessary. Maintaining a healthy, high fiber diet, which relieves constipation and eases the digestive process, is the best way to prevent bleeding or swollen hemorrhoids. The brochure describes and illustrates external and internal hemorrhoids, and other anal problems, including fissures and fistulae. Treatment options reviewed include injection therapy, infrared coagulation, banding, cryosurgery, laser therapy, and hemorrhoidectomy (surgical removal of the hemorrhoids). The brochure is illustrated with full color line drawings and is available in English or Spanish. 27 figures. ·
Diverticular Disease Source: Fort Worth, TX: Konsyl Pharmaceuticals, Inc. 1998. [2 p.]. Contact: Available from Konsyl Pharmaceuticals, Inc. 4200 South Hulen Street, Suite 513, Fort Worth, TX 76109-4912. (800) 356-6795 or (817) 7638011. Fax (817) 731-9389. Website: www.konsyl.com. Price: Single copy free. Summary: This brochure provides basic information about diverticular disease, a condition in which balloonlike sacs or pouches develop in the walls of the colon (large intestine). Diverticulosis is a term indicating that the pouches are present, but there may be no symptoms. Diverticulitis, means that some of the pouches are irritated or infected; the resulting symptoms can include pain and fever. The brochure investigates why the colon is a problem site and outlines strategies to avoid excess pressure on the colon (primarily those that avoid constipation). The author emphasizes the use of fiber supplements, such as Konsyl (the manufacturer of which is the producer of this brochure). The brochure also lists good dietary habits: eating at regular intervals; chewing food well; drinking plenty of water, milk, and fruit and vegetable juices; exercising daily; and being sensitive to bowel function (especially avoiding straining). The brochure is illustrated with full color drawings and photographs. 3 figures.
Guidelines 31
·
Constipation Source: Fort Worth, TX: Konsyl Pharmaceuticals, Inc. 1998. [2 p.]. Contact: Available from Konsyl Pharmaceuticals, Inc. 4200 South Hulen Street, Suite 513, Fort Worth, TX 76109-4912. (800) 356-6795 or (817) 7638011. Fax (817) 731-9389. Website: www.konsyl.com. Price: Single copy free. Summary: This brochure provides basic information about constipation, a symptom and side effect of many diseases. Among Western populations, the range for 'normal' bowel evacuation is as often as two times a day to once every two days. However, as a generalization, five stools weekly may be considered normal. Also considered constipation are straining at the toilet, incomplete evacuation, or stools that are too small or too hard. The four major causes of constipation are lack of adequate water intake, lack of adequate fiber intake, lack of adequate exercise, and use of prescription or over the counter drugs that tend to cause constipation as a side effect. Constipation may also be a problem during pregnancy and among the elderly. The brochure recommends a physical examination and appropriate diagnostic tests to indicate the cause of constipation, then outlines a regimen for modifying diet and lifestyle to address constipation problems. The author discusses the use of fiber supplements, such as Konsyl (the manufacturer of which is the producer of this brochure). The brochure is illustrated with full color drawings and photographs. 1 table. 4 figures.
·
Constipation: Getting Relief Source: San Bruno, CA: StayWell Company. 1998. [2 p.]. Contact: Available from StayWell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 2444512. E-mail:
[email protected]. Website: www.staywell.com. Price: $17.95 for pack of 50; plus shipping and handling. Summary: This patient education brochure describes constipation and its treatment. Written in nontechnical language, the brochure first defines constipation as bowel movements that occur less often than usual or the need to strain to pass hard, dry stool. Symptoms of constipation include a feeling of fullness in the rectum, bloating and gas, feeling the urge but being unable to pass stool, abdominal pain and cramping, and nausea. One of the main causes of constipation is a diet that is too low in dietary fiber and water. Other causes can include travel (and changes in diet and bowel habits), pregnancy, too little exercise, misuse of laxatives, side effects of certain medications, systemic diseases (diabetes or hyperthyroidism, for example), and ignoring the urge to have a bowel
32 Constipation
movement. Diagnosis will include the patient's medical history and some diagnostic tests such as sigmoidoscopy and barium enema. Most treatment plans focus on increasing dietary fiber, getting regular exercise, and avoiding chronic laxative use. One section of the brochure illustrates and describes the physiology of normal bowel movements and what happens in constipation. The last page of the brochure summarizes the recommendations for increasing dietary fiber. The brochure is illustrated with full color line drawings. 7 figures. ·
International Foundation for Functional Gastrointestinal Disorders: Who We Are Source: Milwaukee, WI: International Foundation for Functional Gastrointestinal Disorders. 1997. 2 p. Contact: Available from International Foundation for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864, Milwaukee, WI 53217. (888) 964-2001 or (414) 964-1799. Fax (414) 964-7176. E-mail:
[email protected]. Website: www.iffgd.org. Price: Single copy free. Summary: The International Foundation for Functional Gastrointestinal Disorders (formerly the International Foundation for Bowel Dysfunction) is a nonprofit organization formed to address the issues surrounding life with bowel dysfunction. Functional gastrointestinal (GI) disorders include irritable bowel syndrome (IBS), incontinence, diarrhea, constipation, pelvic floor pain, anorectal pain, abdominal bloating or pain, esophageal disorders, gastroduodenal disorders, and biliary disorders. This brief brochure reviews the objectives and activities of the IFFGD, which offers educational services to affected people and works with the health and care provider community to research and share information. The brochure includes the names and locations of the organization's board of directors and advisory board.
·
Taking Care of Irritable Bowel Syndrome Source: Santa Cruz, CA: ETR Associates. 1997. 4 p. Contact: Available from ETR Associates. P.O. Box 1830, Santa Cruz, CA 95061-1830. (800) 321-4407. Price: $16.00 for 50 copies. Summary: This patient education brochure explains the basics of living with irritable bowel syndrome (IBS). The brochure encourages readers to check with their health care provider for assistance in dealing with the discomfort and inconvenience of recurrent and chronic cramps, gas, bloating, diarrhea, or constipation. The brochure discusses causes of IBS, the physiology of normal digestion, how to discover individual triggers of symptoms, common dietary triggers of IBS symptoms (caffeine; dairy
Guidelines 33
products; chocolate; alcohol; and acidic, fatty, or spicy foods), how to manage symptoms, the role of medications, and how to learn to manage stress (a common trigger of IBS symptoms). The brochure emphasizes the role of exercise and nutrition in managing IBS. The brochure also lists symptoms for which a health care provider should be consulted, including blood in the stool, continuous abdominal pain and fever, and when symptoms interfere with normal activities. The brochure concludes with a brief list of references and the contact information for the National Digestive Diseases Information Clearinghouse. 1 figure. 3 references. (AA-M). ·
Taking Care of Constipation Source: Santa Cruz, CA: ETR Associates. 1997. 4 p. Contact: Available from ETR Associates. P.O. Box 1830, Santa Cruz, CA 95061-1830. (800) 321-4407. Price: $16.00 for 50 copies. Summary: This patient education brochure explains the basics of constipation and its treatment. Constipation is defined as hard, dry or painful bowel movements or less than 3 bowel movements per week. The brochure briefly describes the causes of constipation, and stresses three simple actions to prevent problems: get regular exercise, drink plenty of fluids, and eat enough fiber. The brochure explains each of these three steps in detail, and then describes how to make changes in one's diet without striving for perfection. One sidebar lists the most common causes of constipation. Another sidebar notes the recommended amounts of fiber (including USDA, American Dietetic Association, and National Cancer Institute guidelines), the role of fiber in the diets of people who are trying to lose weight, and the use of fiber supplements. The brochure concludes with a list of symptoms for which a health care provider should be consulted. (AA-M).
·
Chronic Intestinal Pseudo-Obstruction: A Guide for Parents-Caretakers Source: North Andover, MA: American Pseudo-Obstruction and Hirschsprung's Disease Society, Inc. 1997. 4 p. Contact: Available from American Pseudo-Obstruction and Hirschsprung's Disease Society, Inc. 158 Pleasant Street, North Andover, MA 01845. (978) 685-4477. Fax (978) 685-4488. E-mail:
[email protected]. Price: Single copy free. Summary: This brochure provides basic information for parents and other caregivers of children with chronic intestinal pseudo-obstruction (CIP) and other forms of chronic gastrointestinal (GI) motility disorder. GI motility refers to the muscle contractions within the walls of the
34 Constipation
digestive tract and the movement of food within the digestive system. Written in question and answer format, the brochure addresses the causes of GI motility disorders, the definition and cause of CIP, the incidence and diagnosis of CIP, treatment options, enteral feeding, parenteral feeding, and the impact of CIP on the child's development and lifespan. In pseudo-obstruction, the symptoms are not caused by a surgically correctable tumor, or twist or ulcer in the bowel, but rather by a problem having to do with the strength or coordination of the contractions that move along contents within the bowel. Children with CIP often complain of poor appetite, nausea, vomiting, heartburn, abdominal pain, and constipation. As a result, normal growth and development may be affected. One treatment option, enteral feedings, consists of predigested liquid diets which may be administered in a variety of ways, including nasogastric tubes, gastrostomy, or jejunostomy. Another option is total parenteral nutrition (TPN), in which a nutritional solution is infused via an intravenous access. The brochure concludes with a brief description of the American Pseudo-obstruction and Hirschsprung's Disease Society (APHS), a group that offers support and information through parent networking, publications, and educational activities. ·
Pediatric Gastrointestinal Motility Disorders in the 90's: Clinical Aspects, Supportive Management and Therapeutic Care. Symposium, March 25-27, 1993 Source: Medford, MA: American Pseudo-Obstruction and Hirschsprung's Disease Society, Inc. (APHS). 1993. (videocassette series). Contact: Available from APHS. 158 Pleasant Street, North Andover, MA 01845-2797. (508) 685-4477. Fax (508) 685-4488. E-mail:
[email protected]. Price: $149.99 including shipping and handling. Summary: These materials comprise presentations from a conference on pediatric gastrointestinal motility disorders, held in March 1993. The conference focused on the clinical aspects, supportive management, and therapeutic care for these disorders. The series of videotapes and the written materials include 2.5 days of presentations, covering the following topics: visceral pain in children, intestinal pseudo-obstruction, chest pain in children, the diagnosis and management of children with feeding disorders, the pathogenesis of Hirschsprung's disease, autonomic function testing in gastrointestinal motility disorders, nursing perspectives on caring for the chronically ill child, transitioning children from hospital to home care, legal issues, the parents' perspective, making the doctor-patient relationship work, educational settings, gastroesophageal reflux disease, nutritional assessment, psychosocial
Guidelines 35
issues, constipation in childhood, gastrointestinal motility disorders in children with neuromuscular diseases, and biofeedback training. The conference was sponsored by the American Pseudo-obstruction and Hirschsprung's Disease Society (APHS), the former North American Pediatric Pseudo-obstruction Society, Inc. (NAPPS; now part of APHS), the Emory University School of Medicine Department of Pediatrics, Egleston Children's Hospital, and Scottish Rite Children's Medical Center. Some of the presentations include references. ·
Diabetes Patient Education Manual Source: Gaithersburg, MD: Aspen Publishers. 2000. 378 p. Contact: Available from Aspen Publishers, Inc. 200 Orchard Ridge Drive, Gaithersburg, MD 20878. (800) 234-1660. Fax (800) 901-9075. E-mail:
[email protected]. Website: www.aspenpub.com. Price: $159.00 plus shipping and handling. Order number 12757. ISBN: 0834212757. Summary: This manual serves as a comprehensive source of patient education materials for the diabetes patient. Chapter one, created especially for the professional, addresses the issue of effective patient education. Topics include conducting an educational needs assessment, using various teaching plans and strategies, and creating effective materials. The topics in the following chapters are presented in the form of a collection of large print, easy to read handouts. Each topic is presented at third and sixth grade literacy levels and in both English and Spanish. In addition to these low literacy materials, the manual includes patient education materials created by diabetes professionals from around the United States. Chapter two provides an overview of diabetes and its treatment. Chapter three discusses blood sugar control, focusing on self monitoring of blood glucose, hypoglycemia, hyperglycemia, and ketones. Chapter four presents meal planning guidelines and provides worksheets and planning forms. Chapter five explains the use of insulin; oral diabetes medications such as sulfonylureas, biguanides, alpha glucosidase inhibitors, thiazolidinediones, and meglitinides; and other medications that may increase or decrease blood glucose levels. Chapter six discusses the importance of exercise in diabetes management and offers guidelines for creating an individualized exercise program. Chapter seven describes diabetes related complications, including heart and circulation, foot, skin, eye, nerve, dental, and kidney problems. Other topics include stress management, women's sexual health, and the prevention and treatment of constipation. Chapter eight addresses issues related to special situations, including sick days, pregnancy, travel,
36 Constipation
surgery, and driving. Many chapters also include practitioner reference materials. The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “constipation” or synonyms. The following was recently posted: ·
Idiopathic constipation and soiling in children. Source: University of Michigan Health System.; 1997 September; 5 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1011&sSearch_string=constipation
·
Management of constipation. Source: University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core.; 1996 (revised 1998 Jun); 49 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 0543&sSearch_string=constipation
Healthfinder™ Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·
Age Page - Constipation Summary: This pamphlet discusses the causes and treatment of constipation in the elderly. The role of diet and the misuse of laxatives and enemas are also addressed. Several self-help remedies are suggested. Source: National Institute on Aging, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=32
Guidelines 37
·
Constipation in Children Summary: Although constipation is usually harmless, it can be a sign or cause of a more serious problem. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=2696
·
Constipation: A Guide for Patients Summary: A general overview about constipation and the methods used to treat constipation, written especially for patients . Source: Educational Institution--Follow the Resource URL for More Information http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=4082
·
Irritable Bowel Syndrome in Children Summary: Irritable bowel syndrome (IBS) is a digestive disorder that causes abdominal pain, bloating, gas, diarrhea, and constipation--or some combination of these problems. Source: National Institute of Environmental Health Sciences, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6514
·
Sigmoidoscopy Summary: Basic information about sigmoidoscopy -- a medical procedure that allows a physician to look at the inside of the large intestine to determine the cause of diarrhea, abdominal pain and constipation, Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=4977
38 Constipation
The NIH Search Utility After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to constipation. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific conditions or disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.
PEDBASE Similar to NORD, PEDBASE covers relatively rare disorders, limited mainly to pediatric conditions. PEDBASE was designed by Dr. Alan Gandy. To access the database, which is more oriented to researchers than patients, you can view the current list of conditions covered at the following Web site: http://www.icondata.com/health/pedbase/pedlynx.htm.
Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
·
drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html
·
Family Village: http://www.familyvillage.wisc.edu/specific.htm
·
Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
·
Med Help International: http://www.medhelp.org/HealthTopics/A.html
·
Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
Guidelines 39
·
Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
·
WebMDÒHealth: http://my.webmd.com/health_topics
Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Adhesions: Pathological processes consisting of the union of the opposing surfaces of a wound. [NIH] Aluminum: A metallic element that has the atomic number 13, atomic symbol Al, and atomic weight 26.98. [NIH] Anorectal: Pertaining to the anus and rectum or to the junction region between the two. [EU] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Anus: The distal or terminal orifice of the alimentary canal. [EU] Aspiration: The act of inhaling. [EU] Autonomic: Self-controlling; functionally independent. [EU] Barium: An element of the alkaline earth group of metals. It has an atomic symbol Ba, atomic number 56, and atomic weight 138. All of its acid-soluble salts are poisonous. [NIH] Baths: The immersion or washing of the body or any of its parts in water or other medium for cleansing or medical treatment. It includes bathing for personal hygiene as well as for medical purposes with the addition of therapeutic agents, such as alkalines, antiseptics, oil, etc. [NIH] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU]
40 Constipation
Catheter: A tubular, flexible, surgical instrument for withdrawing fluids from (or introducing fluids into) a cavity of the body, especially one for introduction into the bladder through the urethra for the withdraw of urine. [EU]
Chronic: Persisting over a long period of time. [EU] Coagulation: 1. the process of clot formation. 2. in colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. in surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Colonoscopy: Endoscopic examination, therapy or surgery of the luminal surface of the colon. [NIH] Constipation: Infrequent or difficult evacuation of the faeces. [EU] Cryosurgery: The use of freezing as a special surgical technique to destroy or excise tissue. [NIH] Defecation: The normal process of elimination of fecal material from the rectum. [NIH] Defecography: Radiographic examination of the process of defecation after the instillation of a contrast media into the rectum. [NIH] Dehydration: The condition that results from excessive loss of body water. Called also anhydration, deaquation and hypohydration. [EU] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Diverticulitis: Inflammation of a diverticulum, especially inflammation related to colonic diverticula, which may undergo perforation with abscess formation. Sometimes called left-sided or L-sides appendicitis. [EU] Encopresis: Incontinence of feces not due to organic defect or illness. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Enema: A clyster or injection; a liquid injected or to be injected into the rectum. [EU] Evacuation: An emptying, as of the bowels. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Fats: One of the three main classes of foods and a source of energy in the body. Fats help the body use some vitamins and keep the skin healthy. They
Guidelines 41
also serve as energy stores for the body. In food, there are two types of fats: saturated and unsaturated. [NIH] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Gastroduodenal: Pertaining to or communicating with the stomach and duodenum, as a gastroduodenal fistula. [EU] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Gastrostomy: Creation of an artificial external opening into the stomach for nutritional support or gastrointestinal compression. [NIH] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Granule: A small pill made from sucrose. [EU] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH] Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [NIH] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hyperthyroidism: 1. excessive functional activity of the thyroid gland. 2. the abnormal condition resulting from hyperthyroidism marked by increased metabolic rate, enlargement of the thyroid gland, rapid heart rate, high blood pressure, and various secondary symptoms. [EU] Idiopathic: Of the nature of an idiopathy; self-originated; of unknown causation. [EU]
42 Constipation
Incontinence: Inability to control excretory functions, as defecation (faecal i.) or urination (urinary i.). [EU] Inertia: Inactivity, inability to move spontaneously. [EU] Insomnia: Inability to sleep; abnormal wakefulness. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Jejunostomy: Surgical formation of an opening through the abdominal wall into the jejunum, usually for enteral hyperalimentation. [NIH] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH]
Malabsorption: Impaired intestinal absorption of nutrients. [EU] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Motility: The ability to move spontaneously. [EU] Mucus: The free slime of the mucous membranes, composed of secretion of the glands, along with various inorganic salts, desquamated cells, and leucocytes. [EU] Narcotic: 1. pertaining to or producing narcosis. 2. an agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Neuromuscular: Pertaining to muscles and nerves. [EU] Oral: Pertaining to the mouth, taken through or applied in the mouth, as an oral medication or an oral thermometer. [EU] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH]
Guidelines 43
Phenolphthalein: An acid-base indicator which is colorless in acid solution, but turns pink to red as the solution becomes alkaline. It is used medicinally as a cathartic. [NIH] Porphyria: A pathological state in man and some lower animals that is often due to genetic factors, is characterized by abnormalities of porphyrin metabolism, and results in the excretion of large quantities of porphyrins in the urine and in extreme sensitivity to light. [EU] Prolapse: 1. the falling down, or sinking, of a part or viscus; procidentia. 2. to undergo such displacement. [EU] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Reflux: A backward or return flow. [EU] Saline: Salty; of the nature of a salt; containing a salt or salts. [EU] Sclerosis: A induration, or hardening; especially hardening of a part from inflammation and in diseases of the interstitial substance. The term is used chiefly for such a hardening of the nervous system due to hyperplasia of the connective tissue or to designate hardening of the blood vessels. [EU] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Sedentary: 1. sitting habitually; of inactive habits. 2. pertaining to a sitting posture. [EU] Sigmoid: 1. shaped like the letter S or the letter C. 2. the sigmoid colon. [EU] Sigmoidoscopy: Endoscopic examination, therapy or surgery of the sigmoid flexure. [NIH] Spastic: 1. of the nature of or characterized by spasms. 2. hypertonic, so that the muscles are stiff and the movements awkward. 3. a person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU]
44 Constipation
Stimulant: 1. producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. an agent or remedy that produces stimulation. [EU] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Tears: The fluid secreted by the lacrimal glands. This fluid moistens the conjunctiva and cornea. [NIH] Tone: 1. the normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. a particular quality of sound or of voice. 3. to make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Ulcer: A break in the skin; a deep sore. People with diabetes may get ulcers from minor scrapes on the feet or legs, from cuts that heal slowly, or from the rubbing of shoes that do not fit well. Ulcers can become infected. [NIH] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Uterus: The hollow muscular organ in female mammals in which the fertilized ovum normally becomes embedded and in which the developing embryo and fetus is nourished. In the nongravid human, it is a pear-shaped structure; about 3 inches in length, consisting of a body, fundus, isthmus, and cervix. Its cavity opens into the vagina below, and into the uterine tube on either side at the cornu. It is supported by direct attachment to the vagina and by indirect attachment to various other nearby pelvic structures. Called also metra. [EU] Veins: The vessels carrying blood toward the heart. [NIH]
Seeking Guidance 45
CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with constipation. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.8 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with constipation. The chapter ends with a discussion on how to find a doctor that is right for you.
Associations and Constipation As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of a condition or disorder can be as taxing as the physical side.9 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 9 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 8
46 Constipation
condition can all influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. In addition to associations or groups that your doctor might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your insurance provider to find out if the cost will be covered): ·
American Society of Adults with Pseudo-obstruction, Inc Address: American Society of Adults with Pseudo-obstruction, Inc. 19 Carroll Road, Woburn, MA 01801-6161 Telephone: (781) 935-9776 Fax: (781) 933-4151 Email:
[email protected] Background: The American Society of Adults with Pseudo-obstruction (ASAP) is an international not-for-profit organization that functions as an information resource center for people affected by Chronic Intestinal Pseudo-obstruction (CIP) and other digestive and motility disorders, their families, and physicians. Intestinal Pseudo-obstruction is a digestive disorder characterized by vomiting, constipation, and pain without evidence of obstruction. Established in 1991, the organization also provides information on other digestive motility disorders and conditions common to people with CIP. In addition, the Society offers networking services such as a young adult networking line for affected individuals from 12 to 25 years of age and distributes a list of physicians who have experience with the diagnosis and treatment of Intestinal Pseudo-obstruction. The organization also periodically distributes questionnaires to members for the purpose of collecting information. This information is then compiled and later published. The organization also offers additional educational materials including booklets, pamphlets, videos, and the 'ASAP Digest,' a bulletin that updates members about society activities or new medical developments in the field of motility disorders.
·
American Society of Colon and Rectal Surgeons Address: American Society of Colon and Rectal Surgeons 85 West Algonquin Road, Suite 550, Arlington Heights, IL 60005
Seeking Guidance 47
Telephone: (847) 290-9184 Toll-free: (888) 964-2001 Fax: (847) 290-9203 Email:
[email protected] Web Site: http://www.fascrs.org Background: The American Society of Colon and Rectal Surgeons (ASCRS) is a medical professional society representing more than 1,000 board certified colon and rectal surgeons and other surgeons. The Society's membership is dedicated to advancing and promoting the science and practice of the treatment of individuals with diseases and disorders affecting the colon, rectum, and anus. The Society's Standards Task Force is committed to developing practice parameters for the treatment of colon and rectal diseases and disorders including ambulatory anorectal surgery, treatment of hemorrhoids, management of anal fissure, treatment of rectal carcinoma, and detection of colorectal neoplasms. The Society's web site provides links to such practice parameters as well as to core subject updates on such topics as colonic volvulus, ostomies and stomal therapy, familial adenomatous polyposis, and colon and rectal cancer. The Society also publishes the 'Washington Report,' which offers updates on current federal legislative and regulatory actions, and provides professional publications including the 'ASCRS Newsletter' and the Society's official journal entitled 'Diseases of the Colon and Rectum.' The ASCRS also provides an email discussion group (listserv) for the benefit of ASCRS members and fellows in colon and rectal surgery. The primary purpose of the listserv is to provide a forum for the informal discussion of clinical cases and other issues of general interest to the colon and rectal surgeon community. The Society's web site also provides information on the Collaborative Group of the Americas on Inherited Colorectal Cancer. The Group was established in 1995 to improve understanding of the basic science of inherited colorectal cancer and the clinical management of affected families. Its broad aims are to promote education of physicians, allied health care professionals, patients, and their families; provide linkage to clinical and chemoprevention trials; promote the integration of molecular and clinical research at local and national levels; and serve as a resource for developing similar genetic registers. The American Society of Colon and Rectal Surgeons also provides patient information on a variety of topics including anal abscess/fistula, anal fissure, anal warts, bowel incontinence, colonoscopy, colorectal cancer, constipation, Crohn's disease, diverticular disease, irritable bowel syndrome, ostomy, rectal prolapse, and ulcerative colitis.
48 Constipation
·
Canadian Multiple Endocrine Neoplasia Type 1, Ltd Address: Telephone: (306) 892-2080 Fax: (306) 892-2080 Email:
[email protected] Background: Canadian Multiple Endocrine Neoplasia Type 1, Ltd. is an international nonprofit organization dedicated to helping others with Multiple Endocrine Neoplasia Type 1 and assisting their family members. Familial Multiple Endocrine Neoplasia Type 1 (FMEN1) is a rare genetic disorder characterized by overactivity of certain endocrine glands (e.g., pituitary, parathyroid gland, and pancreatic islet cells) and excessive production of certain hormones. A variety of symptoms and physical findings may result such as abnormally increased levels of calcium in the blood (hypercalcemia), generalized fatigue, weakness, muscle and/or bone pain, constipation and/or other digestive abnormalities, and/or additional symptoms. Established in 1996, the organization, which is affiliated with Voice of the Handicapped, is committed to collecting and distributing current information on the disease; educating the medical community about FMEN1; and providing networking services that enable affected individuals to exchange information, resources, and support.
·
International Foundation for Functional Gastrointestinal Disorders Address: International Foundation for Functional Gastrointestinal Disorders P.O. Box 17864, Milwaukee, WI 53217 Telephone: (414) 964-1799 Toll-free: (888) 964-2001 Fax: (414) 964-7176 Email:
[email protected] Web Site: http://www.iffgd.or Background: The International Foundation for Functional Gastrointestinal Disorders (IFFGD) is a nonprofit educational and research organization dedicated to addressing the issues affecting individuals with functional gastrointestinal (GI) disorders. These disorders include irritable bowel syndrome (IBS), incontinence, diarrhea, constipation, pelvic floor pain, anorectal pain, abdominal bloating or pain, esophageal disorders, gastroduodenal disorders, and biliary disorders. Founded in 1990 and consisting of approximately 20,000 members, IFFGD offers support to affected individuals and their families. The Foundation also works with the medical, health care, and research
Seeking Guidance 49
communities to increase awareness of these disorders and to promote research efforts to improve diagnosis and treatment. Educational materials include a quarterly newsletter entitled 'Participate' and several fact sheets on various gastrointestinal disorders and their treatment alternatives. IFFGD also distributes a 'Personal Daily Diary' that is designed to help individuals with gastrointestinal disorders gain a more complete understanding of their condition through the regular recording of important details. Relevant area(s) of interest: Constipation, Diarrhea, Irritable Bowel Syndrome ·
Intestinal Disease Foundation Address: Intestinal Disease Foundation 1323 Forbes Avenue, Suite 200, Pittsburgh, PA 15219 Telephone: (412) 261-5888 Toll-free: (888) 964-2001 Fax: (412) 471-272 Background: The Intestinal Disease Foundation (IDF) is an international not- for-profit organization dedicated to providing information, assistance, and mutual support to individuals with chronic intestinal illnesses including irritable bowel syndrome, diverticular disease, ulcerative colitis, Crohn's disease, and short-bowel syndrome. Established in 1986 and consisting of 1,400 members in the United States and abroad, IDF promotes healing by encouraging individuals to assume an active role in their own treatment through a positive mental attitude founded on shared experiences. This is facilitated by a telephone network of individuals with intestinal illnesses who provide support, encouragement, and information. The Foundation publishes a quarterly newsletter entitled 'Intestinal Fortitude' as well as a variety of informational brochures and educational materials on chronic intestinal diseases and conditions. Relevant area(s) of interest: Diarrhea, Diverticular Disease, Irritable Bowel Syndrome, Lactose Intolerance, Proctitis, Short Bowel Syndrome
·
Irritable Bowel Information and Support Association of Australia,Inc Address: Irritable Bowel Information and Support Association of Australia, Inc. PO Box 5044, Manly, Queensland, 4179, Australia Telephone: 07 3893 1131 Toll-free: 1300 651131 Fax: 07 3396 4436 Email:
[email protected] 50 Constipation
Web Site: http://www.powerup.com.au/~ibi Background: The Irritable Bowel Information and Support Association of Australia, Inc. (IBIS) is a support group consisting of individuals affected by irritable bowel syndrome (IBS) and their family members. IBS is a chronic noninflammatory condition characterized by abdominal pain and irregular bowel movements including constipation, diarrhea, or both, in the absence of any demonstrable disease. The Irritable Bowel Information and Support Association of Australia includes members from throughout Australia and New Zealand, many of whom belong to IBIS regional support groups that conduct regular meetings with guest speakers. The Association is also dedicated to cooperating with the medical profession when appropriate to supply information necessary for IBS research and disseminating information to members and the general public. IBIS members receive regularly updated listings of publications on IBS and a quarterly newsletter that includes articles on the care and control of IBS, meeting listings, and research updates. The Association also has a web site on the Internet. Relevant area(s) of interest: Irritable Bowel Syndrome
Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for patient associations.
The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about constipation. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.
DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database
Seeking Guidance 51
comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “constipation” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.
The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “constipation”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “constipation” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with constipation. You should check back periodically with this database since it is updated every 3 months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific conditions and diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option called “Organizational Database (ODB)” and type “constipation” (or a synonym) in the search box.
Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other
52 Constipation
healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective.
Finding Doctors One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with constipation must go through the process of selecting a physician. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:10 ·
If you are in a managed care plan, check the plan’s list of doctors first.
·
Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals.
·
Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide.
·
Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide.
Additional steps you can take to locate doctors include the following: ·
Check with the associations listed earlier in this chapter.
·
Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors.
·
The American Board of Medical Specialties can tell you if your doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at http://www.abms.org/newsearch.asp.11 You can also contact the ABMS by phone at 1-866-ASK-ABMS.
This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified. 10 11
Seeking Guidance 53
·
You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA’s Web site: http://www.amaassn.org/aps/amahg.htm.
If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare conditions and diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.
Selecting Your Doctor12 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your health insurance plan and if he or she is taking new patients. If the doctor is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen physician. During the first visit you will have the opportunity to evaluate your doctor and to find out if you feel comfortable with him or her. Ask yourself, did the doctor: ·
Give me a chance to ask questions about constipation?
·
Really listen to my questions?
·
Answer in terms I understood?
·
Show respect for me?
·
Ask me questions?
·
Make me feel comfortable?
·
Address the health problem(s) I came with?
·
Ask me my preferences about different kinds of treatments for constipation?
·
Spend enough time with me?
12 This
section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
54 Constipation
Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.
Working with Your Doctor13 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·
You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.
·
It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.
·
Bring a “health history” list with you (and keep it up to date).
·
Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.
·
Tell your doctor about any natural or alternative medicines you are taking.
·
Bring other medical information, such as x-ray films, test results, and medical records.
·
Ask questions. If you don’t, your doctor will assume that you understood everything that was said.
·
Write down your questions before your visit. List the most important ones first to make sure that they are addressed.
·
Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.
·
Ask your doctor to draw pictures if you think that this would help you understand.
·
Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.
This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
13
Seeking Guidance 55
·
Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.
·
Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.
·
After leaving the doctor’s office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.
By following these steps, you will enhance the relationship you will have with your physician.
Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:14 ·
Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html
·
Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html
·
Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html
Vocabulary Builder The following vocabulary builder provides definitions of words used in this chapter that have not been defined in previous chapters: Abscess: A localized collection of pus caused by suppuration buried in tissues, organs, or confined spaces. [EU] You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
14
56 Constipation
Carcinoma: A malignant new growth made up of epithelial cells tending to infiltrate the surrounding tissues and give rise to metastases. [EU] Colitis: Inflammation of the colon. [EU] Hypercalcemia: Abnormally high level of calcium in the blood. [NIH] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Parathyroid: 1. situated beside the thyroid gland. 2. one of the parathyroid glands. 3. a sterile preparation of the water-soluble principle(s) of the parathyroid glands, ad-ministered parenterally as an antihypocalcaemic, especially in the treatment of acute hypoparathyroidism with tetany. [EU] Proctitis: Inflammation of the rectum. [EU] Warts: Benign epidermal proliferations or tumors; some are viral in origin. [NIH]
Clinical Trials 57
CHAPTER 3. CLINICAL TRIALS AND CONSTIPATION Overview Very few medical conditions have a single treatment. The basic treatment guidelines that your physician has discussed with you, or those that you have found using the techniques discussed in Chapter 1, may provide you with all that you will require. For some patients, current treatments can be enhanced with new or innovative techniques currently under investigation. In this chapter, we will describe how clinical trials work and show you how to keep informed of trials concerning constipation.
What Is a Clinical Trial?15 Clinical trials involve the participation of people in medical research. Most medical research begins with studies in test tubes and on animals. Treatments that show promise in these early studies may then be tried with people. The only sure way to find out whether a new treatment is safe, effective, and better than other treatments for constipation is to try it on patients in a clinical trial.
The discussion in this chapter has been adapted from the NIH and the NEI: www.nei.nih.gov/netrials/ctivr.htm.
15
58 Constipation
What Kinds of Clinical Trials Are There? Clinical trials are carried out in three phases: ·
Phase I. Researchers first conduct Phase I trials with small numbers of patients and healthy volunteers. If the new treatment is a medication, researchers also try to determine how much of it can be given safely.
·
Phase II. Researchers conduct Phase II trials in small numbers of patients to find out the effect of a new treatment on constipation.
·
Phase III. Finally, researchers conduct Phase III trials to find out how new treatments for constipation compare with standard treatments already being used. Phase III trials also help to determine if new treatments have any side effects. These trials--which may involve hundreds, perhaps thousands, of people--can also compare new treatments with no treatment. How Is a Clinical Trial Conducted?
Various organizations support clinical trials at medical centers, hospitals, universities, and doctors’ offices across the United States. The “principal investigator” is the researcher in charge of the study at each facility participating in the clinical trial. Most clinical trial researchers are medical doctors, academic researchers, and specialists. The “clinic coordinator” knows all about how the study works and makes all the arrangements for your visits. All doctors and researchers who take part in the study on constipation carefully follow a detailed treatment plan called a protocol. This plan fully explains how the doctors will treat you in the study. The “protocol” ensures that all patients are treated in the same way, no matter where they receive care. Clinical trials are controlled. This means that researchers compare the effects of the new treatment with those of the standard treatment. In some cases, when no standard treatment exists, the new treatment is compared with no treatment. Patients who receive the new treatment are in the treatment group. Patients who receive a standard treatment or no treatment are in the “control” group. In some clinical trials, patients in the treatment group get a new medication while those in the control group get a placebo. A placebo is a harmless substance, a “dummy” pill, that has no effect on constipation. In other clinical trials, where a new surgery or device (not a medicine) is being tested, patients in the control group may receive a “sham treatment.” This
Clinical Trials 59
treatment, like a placebo, has no effect on constipation and does not harm patients. Researchers assign patients “randomly” to the treatment or control group. This is like flipping a coin to decide which patients are in each group. If you choose to participate in a clinical trial, you will not know which group you will be appointed to. The chance of any patient getting the new treatment is about 50 percent. You cannot request to receive the new treatment instead of the placebo or sham treatment. Often, you will not know until the study is over whether you have been in the treatment group or the control group. This is called a “masked” study. In some trials, neither doctors nor patients know who is getting which treatment. This is called a “double masked” study. These types of trials help to ensure that the perceptions of the patients or doctors will not affect the study results. Natural History Studies Unlike clinical trials in which patient volunteers may receive new treatments, natural history studies provide important information to researchers on how constipation develops over time. A natural history study follows patient volunteers to see how factors such as age, sex, race, or family history might make some people more or less at risk for constipation. A natural history study may also tell researchers if diet, lifestyle, or occupation affects how a disease or disorder develops and progresses. Results from these studies provide information that helps answer questions such as: How fast will a condition or disorder usually progress? How bad will the condition become? Will treatment be needed? What Is Expected of Patients in a Clinical Trial? Not everyone can take part in a clinical trial for a specific condition or disorder. Each study enrolls patients with certain features or eligibility criteria. These criteria may include the type and stage of a condition or disorder, as well as, the age and previous treatment history of the patient. You or your doctor can contact the sponsoring organization to find out more about specific clinical trials and their eligibility criteria. If you are interested in joining a clinical trial, your doctor must contact one of the trial’s investigators and provide details about your diagnosis and medical history. If you participate in a clinical trial, you may be required to have a number of medical tests. You may also need to take medications and/or undergo
60 Constipation
surgery. Depending upon the treatment and the examination procedure, you may be required to receive inpatient hospital care. Or, you may have to return to the medical facility for follow-up examinations. These exams help find out how well the treatment is working. Follow-up studies can take months or years. However, the success of the clinical trial often depends on learning what happens to patients over a long period of time. Only patients who continue to return for follow-up examinations can provide this important long-term information.
Recent Trials on Constipation The National Institutes of Health and other organizations sponsor trials on various conditions and disorders. Because funding for research goes to the medical areas that show promising research opportunities, it is not possible for the NIH or others to sponsor clinical trials for every disease and disorder at all times. The following lists recent trials dedicated to constipation.16 If the trial listed by the NIH is still recruiting, you may be eligible. If it is no longer recruiting or has been completed, then you can contact the sponsors to learn more about the study and, if published, the results. Further information on the trial is available at the Web site indicated. Please note that some trials may no longer be recruiting patients or are otherwise closed. Before contacting sponsors of a clinical trial, consult with your physician who can help you determine if you might benefit from participation. ·
Constipation in Pediatric Cancer Patients Receiving Vinca Alkaloids or Narcotics Condition(s): Constipation; Neoplasms Study Status: This study is currently recruiting patients. Sponsor(s): Warren G Magnuson Clinical Center (CC) Purpose - Excerpt: This study will evaluate a questionnaire for measuring constipation in children with cancer. The questionnaire used in this study (Constipation Assessment Scale) reliably predicts the presence and severity of constipation in adult patients, but has not been tested in children. The answers to the questionnaire will be used to determine the child's level of constipation and to plan and provide appropriate care. Patients up to 21 years of age who are enrolled in National Cancer Institute trials and are taking weekly vinca alkaloids or narcotics twice a day or more may be eligible for this study. On admission to the study, participants will undergo the following procedures: - The child (or the child's parent) will be interviewed about the child's bowel habits. - The
16
These are listed at www.ClinicalTrials.gov.
Clinical Trials 61
results of the child's most recent physical examination related to bowel function will be obtained from the medical record for review. - A registered dietitian will interview the child or parent about the child's eating habits. During the study, participants will undergo the following procedures: - A registered nurse will interview the child or parent about the child's bowel movements. This will be done every other day for hospitalized children and three times a week (by phone) for outpatients. The child or parent will complete a daily diary of bowel movements. - A registered dietitian will evaluate the child's nutritional status periodically (by phone). Children who are not constipated when they enter the study will receive a stool softener every day to prevent constipation. Children who become constipated during the study will be treated as needed. Patients will be followed for 7 days after the last dose of vinca alkaloid or narcotic for a maximum of 6 weeks. Study Type: Observational Contact(s): Maryland; Warren G. Magnuson Clinical Center (CC), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800-411-1222
[email protected]; TTY 1-866-411-1010 Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00032682;jsessionid=4333404 4C0B6F70022041351B631D444 ·
Treatment of Functional Bowel Disorders Condition(s): Irritable Bowel Syndrome; Constipation; Abdominal Pain; Functional Colonic Diseases Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Purpose - Excerpt: The primary purpose for this study is to compare clinical treatments for patients with functional bowel disorders (irritable bowel syndrome, abdominal pain, painful constipation) in women. We also plan to: 1) determine what clinical features (medical or psychological) determine which patients will improve to these treatments, and 2) understand if there are any physiological features that relate to improvement in symptoms and response to the treatments. We will compare a psychological treatment (cognitive-behavioral therapy CBT) with education/attention placebo, and an antidepressant drug (desipramine) with a pill placebo. This is the first large-scale study designed to determine the therapeutic effects of these methods, and to also determine interactions among physiologic measures, psychologic
62 Constipation
and sociodemographic factors, severity of symptoms, and therapeutic improvement including quality of life. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00006157;jsessionid=4333404 4C0B6F70022041351B631D444
Benefits and Risks17 What Are the Benefits of Participating in a Clinical Trial? If you are interested in a clinical trial, it is important to realize that your participation can bring many benefits to you and society at large: ·
A new treatment could be more effective than the current treatment for constipation. Although only half of the participants in a clinical trial receive the experimental treatment, if the new treatment is proved to be more effective and safer than the current treatment, then those patients who did not receive the new treatment during the clinical trial may be among the first to benefit from it when the study is over.
·
If the treatment is effective, then it may improve health or prevent diseases or disorders.
·
Clinical trial patients receive the highest quality of medical care. Experts watch them closely during the study and may continue to follow them after the study is over.
·
People who take part in trials contribute to scientific discoveries that may help other people with constipation. In cases where certain conditions or disorders run in families, your participation may lead to better care or prevention for your family members.
This section has been adapted from ClinicalTrials.gov, a service of the National Institutes of Health: http://www.clinicaltrials.gov/ct/gui/c/a1r/info/whatis?JServSessionIdzone_ct=9jmun6f2 91. 17
Clinical Trials 63
The Informed Consent Once you agree to take part in a clinical trial, you will be asked to sign an “informed consent.” This document explains a clinical trial’s risks and benefits, the researcher’s expectations of you, and your rights as a patient. What Are the Risks? Clinical trials may involve risks as well as benefits. Whether or not a new treatment will work cannot be known ahead of time. There is always a chance that a new treatment may not work better than a standard treatment. There is also the possibility that it may be harmful. The treatment you receive may cause side effects that are serious enough to require medical attention. How Is Patient Safety Protected? Clinical trials can raise fears of the unknown. Understanding the safeguards that protect patients can ease some of these fears. Before a clinical trial begins, researchers must get approval from their hospital’s Institutional Review Board (IRB), an advisory group that makes sure a clinical trial is designed to protect patient safety. During a clinical trial, doctors will closely watch you to see if the treatment is working and if you are experiencing any side effects. All the results are carefully recorded and reviewed. In many cases, experts from the Data and Safety Monitoring Committee carefully monitor each clinical trial and can recommend that a study be stopped at any time. You will only be asked to take part in a clinical trial as a volunteer giving informed consent.
What Are a Patient’s Rights in a Clinical Trial? If you are eligible for a clinical trial, you will be given information to help you decide whether or not you want to participate. As a patient, you have the right to: ·
Information on all known risks and benefits of the treatments in the study.
·
Know how the researchers plan to carry out the study, for how long, and where.
·
Know what is expected of you.
64 Constipation
·
Know any costs involved for you or your insurance provider.
·
Know before any of your medical or personal information is shared with other researchers involved in the clinical trial.
·
Talk openly with doctors and ask any questions.
After you join a clinical trial, you have the right to: ·
Leave the study at any time. Participation is strictly voluntary. However, you should not enroll if you do not plan to complete the study.
·
Receive any new information about the new treatment.
·
Continue to ask questions and get answers.
·
Maintain your privacy. Your name will not appear in any reports based on the study.
·
Know whether you participated in the treatment group or the control group (once the study has been completed).
What about Costs? In some clinical trials, the research facility pays for treatment costs and other associated expenses. You or your insurance provider may have to pay for costs that are considered standard care. These things may include inpatient hospital care, laboratory and other tests, and medical procedures. You also may need to pay for travel between your home and the clinic. You should find out about costs before committing to participation in the trial. If you have health insurance, find out exactly what it will cover. If you don’t have health insurance, or if your insurance company will not cover your costs, talk to the clinic staff about other options for covering the cost of your care. What Should You Ask before Deciding to Join a Clinical Trial? Questions you should ask when thinking about joining a clinical trial include the following: ·
What is the purpose of the clinical trial?
·
What are the standard treatments for constipation? Why do researchers think the new treatment may be better? What is likely to happen to me with or without the new treatment?
Clinical Trials 65
·
What tests and treatments will I need? Will I need surgery? Medication? Hospitalization?
·
How long will the treatment last? How often will I have to come back for follow-up exams?
·
What are the treatment’s possible benefits to my condition? What are the short- and long-term risks? What are the possible side effects?
·
Will the treatment be uncomfortable? Will it make me feel sick? If so, for how long?
·
How will my health be monitored?
·
Where will I need to go for the clinical trial? How will I get there?
·
How much will it cost to be in the study? What costs are covered by the study? How much will my health insurance cover?
·
Will I be able to see my own doctor? Who will be in charge of my care?
·
Will taking part in the study affect my daily life? Do I have time to participate?
·
How do I feel about taking part in a clinical trial? Are there family members or friends who may benefit from my contributions to new medical knowledge?
Keeping Current on Clinical Trials Various government agencies maintain databases on trials. The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide patients, family members, and physicians with current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to their Web site (www.clinicaltrials.gov) and search by “constipation” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The
66 Constipation
following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: ·
For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/
·
For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html
·
For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm
General References The following references describe clinical trials and experimental medical research. They have been selected to ensure that they are likely to be available from your local or online bookseller or university medical library. These references are usually written for healthcare professionals, so you may consider consulting with a librarian or bookseller who might recommend a particular reference. The following includes some of the most readily available references (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
A Guide to Patient Recruitment : Today’s Best Practices & Proven Strategies by Diana L. Anderson; Paperback - 350 pages (2001), CenterWatch, Inc.; ISBN: 1930624115; http://www.amazon.com/exec/obidos/ASIN/1930624115/icongroupinterna
·
A Step-By-Step Guide to Clinical Trials by Marilyn Mulay, R.N., M.S., OCN; Spiral-bound - 143 pages Spiral edition (2001), Jones & Bartlett Pub; ISBN: 0763715697; http://www.amazon.com/exec/obidos/ASIN/0763715697/icongroupinterna
·
The CenterWatch Directory of Drugs in Clinical Trials by CenterWatch; Paperback - 656 pages (2000), CenterWatch, Inc.; ISBN: 0967302935; http://www.amazon.com/exec/obidos/ASIN/0967302935/icongroupinterna
·
The Complete Guide to Informed Consent in Clinical Trials by Terry Hartnett (Editor); Paperback - 164 pages (2000), PharmSource Information Services, Inc.; ISBN: 0970153309; http://www.amazon.com/exec/obidos/ASIN/0970153309/icongroupinterna
Clinical Trials 67
·
Dictionary for Clinical Trials by Simon Day; Paperback - 228 pages (1999), John Wiley & Sons; ISBN: 0471985961; http://www.amazon.com/exec/obidos/ASIN/0471985961/icongroupinterna
·
Extending Medicare Reimbursement in Clinical Trials by Institute of Medicine Staff (Editor), et al; Paperback 1st edition (2000), National Academy Press; ISBN: 0309068886; http://www.amazon.com/exec/obidos/ASIN/0309068886/icongroupinterna
·
Handbook of Clinical Trials by Marcus Flather (Editor); Paperback (2001), Remedica Pub Ltd; ISBN: 1901346293; http://www.amazon.com/exec/obidos/ASIN/1901346293/icongroupinterna
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Alkaloid: One of a large group of nitrogenous basis substances found in plants. They are usually very bitter and many are pharmacologically active. Examples are atropine, caffeine, coniine, morphine, nicotine, quinine, strychnine. The term is also applied to synthetic substances (artificial a's) which have structures similar to plant alkaloids, such as procaine. [EU] Desipramine: A tricyclic dibenzazepine compound that potentiates neurotransmission. Desipramine selectively blocks reuptake of norepinephrine from the neural synapse, and also appears to impair serotonin transport. This compound also possesses minor anticholingeric activity, through its affinity to muscarinic receptors. [NIH] Outpatients: Persons who receive ambulatory care at an outpatient department or clinic without room and board being provided. [NIH]
69
PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL
ABOUT PART II In Part II, we introduce you to additional resources and advanced research on constipation. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on constipation. In Part II, as in Part I, our objective is not to interpret the latest advances on constipation or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with constipation is suggested.
Studies 71
CHAPTER 4. STUDIES ON CONSTIPATION Overview Every year, academic studies are published on constipation or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on constipation. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on constipation and teach you how to keep current on new studies as they are published or undertaken by the scientific community.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and constipation, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the
72 Constipation
format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “constipation” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·
Systemic Amyloidosis and the Gastrointestinal Tract Source: Gastroenterology Clinics of North America. 27(3): 595-614. September 1998. Summary: This journal article provides health professionals with information on gastrointestinal involvement in systemic amyloidosis. This disease, of which there are five main types, is not a single disease but results from a variety of different diseases. Gastrointestinal manifestations are commonly reported in systemic amyloidosis. Each type of amyloid has its own unique gastrointestinal manifestations. The disease affects every part of the gastrointestinal tract from the mouth to the anus. Oral amyloidosis can produce various symptoms, including toothache, paresthesia, bony swelling, pathologic fractures, soft nodular mucosal lesions, and macroglossia. Patients who have esophageal involvement usually present with dysphagia and symptoms of esophageal reflux. Gastric involvement usually causes gastroparesis, epigastric pain, gastric outlet obstruction, gastric amyloid tumors, peptic ulceration, hematemesis, and melena. Diarrhea, constipation, malabsorption, pseudo-obstruction, bleeding, and vascular insufficiency are common if the small intestine is affected by amyloid deposition. Colonic amyloid can present with many of these same problems. Amyloidosis can also affect the liver and pancreas. The definitive diagnosis of amyloidosis is made through tissue biopsy. Amyloid has a characteristic roentographic and endoscopic appearance. An uncommon but serious complication of long-term inflammatory bowel disease is acquired systemic amyloidosis. This type of amyloidosis is similar to that associated with certain other chronic inflammatory diseases. There are now some effective ways of treating patients with this type of amyloidosis. Familial Mediterranean fever-associated amyloidosis is a genetically transmitted disease. Although the gastrointestinal tract is a site of amyloid deposition early in the course of familial Mediterranean fever amyloidosis, it is not clear when amyloidosis of the gastrointestinal tract becomes clinically overt. Treatments for amyloidosis include
Studies 73
chemotherapy for AL amyloidosis, colchicine for AA amyloidosis, and liver transplantation for familial amyloid neuropathy. 2 figures, 1 table, and 82 references. ·
Acupuncture for Gastrointestinal and Hepatobiliary Disorders Source: Journal of Alternative and Complementary Medicine: Research on Paradigm, Practice and Policy. 5(1): 27-45. 1999. Summary: This journal article provides an overview of the basic scientific data regarding the effects of acupuncture on gastrointestinal (GI) function, areas of clinical application, and promising directions for future research. Extensive research in both animal models and human subjects supports the effect of acupuncture on the physiology of the GI tract, including acid secretion, motility, neurohormonal changes, and changes in sensory thresholds. Much of the neuroanatomic pathway of these effects has been identified in animal models. A large body of clinical evidence supports the effectiveness of acupuncture for suppressing nausea associated with chemotherapy, postoperative state, and pregnancy. Prospective randomized controlled trials have shown the efficacy of acupuncture for analgesia for endoscopic procedures, including colonoscopy and upper endoscopy. Acupuncture also has been used for a variety of other conditions, including postoperative ileus, achalasia, peptic ulcer disease, functional bowel disease, diarrhea, constipation, inflammatory bowel disease, expulsion of gallstones and biliary ascariasis, and pain associated with pancreatitis. Although there are few randomized clinical trials, the author concludes that the welldocumented effects of acupuncture on the physiology of the GI tract and its extensive history of successful clinical use makes this a promising modality that warrants further study. The article has 3 figures and 117 references. (AA-M).
·
Dealing with Irregularity: Constipation, Diarrhea, Excessive Gas and Foul-Smelling Gas Source: Digestive Health and Nutrition. 3(1): 16-20. January-February 2001. Contact: Available from American Gastroenterological Association. 7910 Woodmont Avenue, 7th Floor, Bethesda, MD 20814. (877) DHN-4YOU or (301) 654-2055, ext. 650. E-mail:
[email protected]. Summary: This article offers strategies for dealing with problems of bowel irregularity, including constipation, diarrhea, excessive gas, and foul-smelling gas. The author notes that bowel habits vary greatly among individuals, so each person's perception of whether there even is a
74 Constipation
problem and how to deal with it best is different. The author stresses that too little fiber and liquid in the diet are by far the most common reasons for constipation among people living in western cultures. The fiber found in foods such as fruits, grains, and vegetables adds bulk to the stool, making it easier to move through the colon (large intestine). Liquids add both bulk and fluid to the stool. Exercise helps prevent constipation by maintaining energy levels and promoting intestinal activity. A number of pain medications; antidepressants; antacids that contain aluminum; diuretics; and antiinflammatory and antiseizure medications are some of the many medications that can contribute to constipation. Changes in routines can also cause irregularity. The author explores the role of aging as a cause of constipation. Laxatives are an effective remedy for constipation, but they should be used with caution. As with constipation, diarrhea means different things to different people. Bacterial and viral infections are the most common causes of acute diarrhea; food intolerance is another frequent cause of both diarrhea and gas. Regardless of the cause, diarrhea usually lasts only a few days and ends on its own without the need for medical attention. The author reviews the concerns regarding dehydration, which can be a consequence of diarrhea, particularly in children and in the elderly. Gas comes from two sources: swallowed air and the breakdown of certain undigested foods in the large intestine. Simple ways of reducing the gas from swallowed air include eating and drinking more slowly, not chewing gum, and having dentures properly fitted. For episodes of excessive or smelly intestinal gas, the use of a food diary may help identify the offending items. The author concludes by reiterating the importance of adequate fiber and fluid intake. The websites of four information resource organizations are listed. ·
'It's Not All in Your Head': Irritable Bowel Syndrome Source: AJN. American Journal of Nursing. 101(1): 26-34. January 2001. Contact: Available from Lippincott Williams and Wilkins. AJN, P.O. Box 50480, Boulder, CO 80322-0480. (800) 627-0484 or (303) 604-1464. Summary: This continuing education article reviews the nursing care for patients with irritable bowel syndrome (IBS). The authors note that it is now believed that IBS has a basis in visceral hypersensitivity (of the bowel wall) and abnormal gut motor function, possibly caused by anomalies in the gut brain connection. The syndrome is neither life threatening nor associated with the development of gastrointestinal diseases such as cancer, but IBS accounts for a significant number of medical visits and prescribed medications, as well as lost work time and reduced productivity. The syndrome tends to manifest with either
Studies 75
diarrhea or constipation or with an alternating pattern of the two. Other common symptoms include mucus in the stool, a sensation of incomplete evacuation, looser or more frequent stools with pain, and relief of abdominal pain after defecation. It has been postulated that there are differences related to sex in motility patterns, symptom and psychological profiles, pain sensitivity, and access to health care. No one factor appears to be responsible for the symptoms in all patients with IBS. Diet, stressful events, and psychological distress may also exacerbate symptoms in vulnerable patients. Diagnosis of IBS occurs by exclusion; there is no biologic marker. Therapy usually focuses on the patient's predominant symptoms and can include patient education and reassurance, nonpharmacologic interventions, and pharmacologic (drug) interventions. One sidebar explores the connection between emotional (sexual) abuse and IBS, notably assessing the effect of self blame and self silencing. A posttest for receiving continuing education credits is appended to the article. 3 figures. 1 table. 50 references. ·
Management of the Irritable Bowel Syndrome Source: Gastroenterology. 120(3): 652-668. February 2001. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452. Website: www.gastrojournal.org. Summary: Irritable bowel syndrome (IBS) is the most common disorder diagnosed by gastroenterologists and one of the more common ones encountered in general practice. This article reviews the management of IBS, focusing on the definitions, epidemiology, and pathophysiology as a means of understanding strategies for optimal management; the natural history and 'safety' of the disorder that justifies a conservation and reassuring approach to patients; and consideration of conventional and newer treatments of IBS. The overall prevalence rate is similar (approximately 10 percent) in most industrialized countries; the illness has a large economic impact on health care use and indirect costs, chiefly through absenteeism. IBS is a biopsychosocial disorder in which 3 major mechanisms interact: psychosocial factors, altered motility, and heightened sensory function of the intestine. Subtle inflammatory changes suggest a role for inflammation, especially after infectious enteritis, but this has not yet resulted in changes in the approach to patient treatment. Treatment of patients is based on positive diagnosis of the symptom complex, limited exclusion of underlying organic disease, and institution of a therapeutic trial. If patient symptoms are intractable, further investigations are needed to exclude specific motility (movement) or other disorders. Symptoms tend to fluctuate over time; treatment is
76 Constipation
often restricted to times when patients experience symptoms. Symptomatic treatment includes supplementing fiber to achieve a total intake of up to 30 grams in those with constipation, those taking loperamide or other opioids for diarrhea, and those taking low dose antidepressants or infrequently using antispasmodics for pain. Older conventional therapies do not address pain in IBS. Behavioral psychotherapy and hynotherapy are also being evaluated. Novel approaches include alosetron; a 5 HT3 antagonist, tegaserod, a partial 5 HT4 agonist, K opioid agonists, and neurokinin antagonists to address the remaining challenging symptoms of pain, constipation, and bloating. The author concludes that understanding the brain gut connection is the key to the eventual development of effective therapies for IBS. 7 figures. 7 tables. 176 references. ·
Meta-Analysis of Smooth Muscle Relaxants in the Treatment of Irritable Bowel Syndrome Source: Alimentary Pharmacology and Therapeutics. 15(3): 355-361. March 2001. Contact: Available from Alimentary Pharmacology and Therapeutics. Blackwell Science Ltd., Osney Mead, Oxford OX2 OEL, UK. +44(0)1865 206206. Fax +44(0)1865 721205. E-mail:
[email protected]. Website: www.blackwell-science.com. Summary: This review article updates previous overviews of placebo controlled double blind trials assessing the efficacy and tolerance of smooth muscle relaxants used to treat irritable bowel syndrome (IBS). A total of 23 randomized clinical trials were selected for meta analyses of their efficacy and tolerance. Six drugs were analyzed: cimetropium bromide (five trials), hyoscine butyl bromide (three trials), mebeverine (five trials), otilium bromide (four trials), pinaverium bromide (two trials), and trimebutine (four trials). The total number of patients included was 1,888, of which 945 received an active drug and 943 a placebo. The mean percentage of patients with global improvement was 38 percent in the placebo group (n = 925) and 56 percent in the myorelaxant group (n = 927). The percentage of patients with pain improvement was 41 percent in the placebo group (n = 568) and 53 percent in the myorelaxant group (n = 567). There was no significant difference for adverse events. The authors conclude that myorelaxants are superior to placebo in the management of IBS. These drugs showed significant efficacy on the global assessment despite a high placebo effect (38 percent global improvement), with a range of difference from 31 percent for cimetropium to 11 percent for hyoscin. The efficacy was also significant and in the same range for pain relief, as well as for abdominal
Studies 77
distension relief, although lower. There was no significant difference for transit abnormalities, diarrhea, or constipation. 4 figures. 1 table. 37 references. ·
What You Can Do to Prevent and Treat Constipation Source: Guide to Women's Health. 12, 14. April 2001. Contact: Available from Springhouse Corporation. 1111 Bethlehem Pike, P.O. Box 908, Springhouse, PA 19477. (215) 646-8700. Fax (215) 540-0668. Summary: This fact sheet reviews strategies that readers can follow to prevent and treat constipation. Most cases of constipation are temporary and not serious. Poor diet and lack of exercise are usually to blame, and in most cases, simple dietary and lifestyle changes will relieve symptoms and help prevent constipation from recurring. A diet with enough fiber (20 to 35 grams each day) helps form soft, bulky stool. Good sources of fiber include beans, whole grains and bran cereals, fresh fruits, and vegetables such as asparagus, brussels sprouts, cabbage, and carrots. Other changes that can help treat and prevent constipation include: drinking enough water and other liquids; engaging in daily exercise; reserving enough time to have a bowel movement; and not ignoring the urge to have a bowel movement. Health care providers may recommend laxatives or enemas for a limited time in patients who have a slow response to these lifestyle changes. The fact sheet outlines different types of laxatives, including bulk forming laxatives, stimulants, stool softeners, and saline laxatives. For chronic constipation or constipation caused by problems such as rectal prolapse, anorectal dysfunction, or colonic inertia, surgical options may be recommended by the health care provider. One sidebar lists the common causes of constipation.
·
Slow Transit Constipation Source: Gastroenterology Clinics of North America. 30(1): 77-95. March 2001. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32821-9816. (800) 654-2452. Summary: This article reviews slow transit constipation, a clinical syndrome characterized by intractable constipation poorly responsive to dietary fiber and laxatives. Other gastrointestinal manifestations include abdominal pain, bloating, malaise, nausea, anorectal symptoms suggestive of difficult fecal expulsion, and delayed colonic transit without megacolon. Extragastrointestinal symptoms in this syndrome include painful or irregular menses, hesitancy in initiating micturition (urination), and somatic symptoms such as cold hands or blackout. The
78 Constipation
authors briefly discuss terminology and stress that slow transit constipation is the term used to define a disorder of colonic motor function, and is generally used for patients with delayed colonic transit but no underlying systemic disorder or pelvic floor dysfunction that explains their symptoms. The authors discuss epidemiology, pathophysiology, histology, clinical features, differential diagnosis, radiopaque marker diagnostic methods, scintigraphic techniques, medical treatments, surgical treatment, and the special situation of colonic dysfunction after spinal cord injury. The authors note that the disorder spans a spectrum of variable severity, ranging from patients who have relatively mild delays in transit but who are otherwise indistinguishable from irritable bowel syndrome patients at one extreme, to patients with colonic inertia or chronic megacolon at the other extreme. Potential mechanisms for impaired colonic propulsion include fewer colonic HAPCs (high amplitude propagated contractions) or a reduced colonic contractile response to a meal. The treatment is primarily medical; surgery is reserved for patients with severe disease or colonic inertia. 3 figures. 1 table. 85 references. ·
Surgical Treatment of Constipation and Fecal Incontinence Source: Gastroenterology Clinics of North America. 30(1): 131-166. March 2001. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32821-9816. (800) 654-2452. Summary: This lengthy article reviews the surgical treatment of constipation and fecal incontinence. The authors emphasize that success in the management of constipation depends on an accurate determination of the cause. Because there are many extracolonic causes that can produce constipation, a detailed clinical history should be taken. Before physiologic investigation, patients must discontinue the use of medications that may cause or exacerbate their symptoms. A proper diet should be maintained, and patients must be supervised by a dietitian or a physician for a minimum of 3 to 6 months before any extensive physiologic evaluation is undertaken and before any surgery is considered. Diagnostic tests may include anorectal examination, colonic transit study, proctography and cinedefecography, electromyography, manometry, small bowel transit study, Minnesota Multiphasic Personality Inventory, and rectal biopsy. Surgery for constipation is reserved for a highly select group of patients; the authors review the indications for patients with pelvic outlet obstruction, with colonic inertia (slow transit throughout the colon), and with combined outlet obstruction and colonic inertia. The authors then discuss fecal
Studies 79
incontinence, noting that obstetric injury (during childbirth) is a major cause and one amenable to surgical correction. Diagnostic tests can include physical examination, manometry, electromyography, pudendal nerve terminal motor latency, anal ultrasonography, and magnetic resonance imaging (MRI). The treatment of fecal incontinence should always be directed to the cause; many individuals can be managed adequately by noninvasive means. Surgical treatment can include sphincter repair, muscle transplant, the use of synthetic material, and diversion (the creation of a stoma). 4 figures. 9 tables. 297 references. ·
Review of the Causes of Lower Gastrointestinal Tract Bleeding in Children Source: Gastroenterology Nursing. 24(2): 77-83. March-April 2001. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (410) 528-8555. Summary: Bleeding may occur anywhere along the gastrointestinal (GI) tract, which covers a large surface area and is highly vascularized. Pediatric patients who present with blood in their stools (bowel movements) are a special challenge for the health care team. Seeing blood in the child's stools, the caregiver and child may become extremely anxious, fearing a devastating diagnosis. This article reviews the causes of lower GI tract bleeding in children. The differential diagnosis of this symptoms in infants and children includes numerous possibilities ranging from benign disorders, which require little or no treatment at all, to serious diseases that require immediate intervention. A complete history, including progression, duration, frequency, and severity of symptoms, is essential in assessing GI bleeding. Associated symptoms that help define the diagnosis include vomiting, diarrhea, constipation, abdominal pain, anorexia (lack of appetite), rash, joint pain or swelling, weight loss, fever, irritability, history of GI bleeding, or history of hematological or immunological disorders. Constipation with fissure (a tear in the anus) formation is the most common cause for rectal bleeding in toddlers and school age children. Infection is one of the more common causes of bleeding from the lower GI tract; infections can be due to Salmonella, Shigella, Campylobacter jejuni; Yersinia enterocolitica, Escherichia coli, Clostridium difficile, or Entamoeba histolytica. Other causes include swallowed blood, hemorrhoids, inflammatory bowel disease (IBD), intussusception (a portion of the bowel turns in on itself, creating an obstruction), polyps, lymphonodular hyperplasia, Meckel's diverticulum, allergic colitis, Henoch Schonlein purpura, hemolytic uremic syndrome (HUS), enterocolitis, child sexual abuse, and Munchausen syndrome by proxy.
80 Constipation
·
Therapy of Constipation Source: Alimentary Pharmacology and Therapeutics. 15(6): 749-763. June 2001. Contact: Available from Alimentary Pharmacology and Therapeutics. Blackwell Science Ltd., Osney Mead, Oxford OX2 OEL, UK. +44(0)1865 206206. Fax +44(0)1865 721205. E-mail:
[email protected]. Website: www.blackwell-science.com. Summary: Constipation is a common symptom that may be idiopathic (of unknown cause) or due to various identifiable disease processes. This article reviews the current recommendations for treating constipation. Laxatives are agents that add bulk to intestinal contents, that retain water within the bowel lumen by virtue of osmotic effects, or that stimulate intestinal secretion or motility, thereby increasing the frequency and ease of defecation. Drugs which improve constipation by stimulating gastrointestinal motility (movement) by direct actions on the enteric nervous system are under development. Mineral oil is a lubricating agent that facilitates defecation by altering stool consistency and by forming a slippery layer around fecal pellets. Other modalities used to treat constipation include biofeedback and surgery. Laxatives and lavage (cleaning) solutions are also used for colon preparation and evaluation of the bowels after toxic ingestions. Most patients with constipation will try to treat this condition themselves before seeking medical attention. Therefore, it is important for the health care provider to obtain a good history of the treatments that have been tried previously in addition to trying to develop a good understanding of exactly what problems the patient is having with defecation. A detailed physical examination, including a thorough rectal examination is also important. 3 tables. 133 references.
Federally-Funded Research on Constipation The U.S. Government supports a variety of research studies relating to constipation and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.18 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable 18 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
Studies 81
database of federally-funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to constipation and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally-funded studies use animals or simulated models to explore constipation and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for constipation: ·
Project Title: Biofeedback for Fecal Incontinence and Constipation Principal Investigator & Institution: Whitehead, William E.; Medicine; University of North Carolina Chapel Hill Box 2688, 910 Raleigh Rd Chapel Hill, Nc 27515 Timing: Fiscal Year 2000; Project Start 0-SEP-1999; Project End 0-NOV2004 Summary: There is no text on file for this abstract. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
·
Project Title: Improving of Care by Reversal of Opioid Constipation Principal Investigator & Institution: Yuan, Chun-Su; Anesthesia and Critical Care; University of Chicago 5801 S Ellis Ave Chicago, Il 60637 Timing: Fiscal Year 2000; Project Start 8-FEB-2000; Project End 1-JAN2004 Summary: Morphine and other opioids are widely used analgesics in advanced cancer patients, and constipation is the most common treatment-associated side effect of opioid pain medications. Conventional measures for opioid-induced constipation are often insufficient, and constipation becomes a limiting factor in opioid use and opioid dose in these patients. A significant number of hospice patients receiving chronic opioids for pain would rather endure their pain than face the severe incapacitating constipation that opioids cause. Thus, opioid-induced constipation, a symptom secondary to the treatment, has a significant negative impact on the quality of life of these terminal patients. Palliative care and end of life management practices have received insufficient attention in the past, and the need to enhance palliative care of dying
82 Constipation
patients has become apparent in this country. In this proposed project, the efficacy of a novel peripheral opioid receptor antagonist, methylnaltrexone, in the treatment of chronic opioid-induced constipation, will be evaluated. Specific Aim 1 and 2 studies will utilize a clinical pharmacology approach (Phase II/III trials) to evaluate the efficacy and dose-response of intravenous and oral methylnaltrexone in reversing chronic opioid-induced gut motility changes and constipation in methadone addicts and patients with advanced malignant conditions. These trials will be randomized, double-blind, placebo-controlled studies. In these studies, the oral-cecal transit time will be measured using the lactulose hydrogen breath test, and positive laxation response and opioid analgesic effect will be evaluated. In addition, subjective visual analog scale (VAS) scores for constipation, stool frequency and consistency, and "overall well being" will be recorded. Pharmacokinetic data will also be collected. In these studies, mechanisms underlying opioid gastrointestinal pharmacology in humans, an issue that has not been addressed before, will be investigated, since translation of data from previous animal experiments to humans may be problematic due to differences in the physiology of the opioid systems. Bringing methylnaltrexone, the first selective peripheral opioid receptor antagonist, to clinical application will be a significant advance in palliative care. Successful completion of this project will lead to a number of future studies in which other applications of methylnaltrexone, as well as its mechanisms of action of both opioids and their antagonism in humans, can be explored. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Novel Therapy and Measure of Opioid-Induced Constipation Principal Investigator & Institution: Liu, Maywin; St. Joseph Medical Center (Towson, Md) 7620 York Rd Towson, Md 21204 Timing: Fiscal Year 2000; Project Start 9-SEP-1999; Project End 1-AUG2004 Summary: Dr. Maywin Liu, Assistant Professor of Anesthesia at the University of Pennsylvania Medical Center, is applying for a Mentored Patient-Oriented Research Career Development Grant. Dr. Liu is committed to an academic career in clinical research, examining the mechanisms and adverse effects of opioids. This proposal will allow Dr. Liu to expand from her previous training in experimental pain research to clinically-based research to become an independent, funded academic investigator. Pain affects up to 80 percent of cancer patients. Many patients can obtain adequate relief with the proper use of opioids,
Studies 83
however, opioid-related adverse effects often substantially limit pain therapy. Side effects of opioids are difficult to treat as the same receptors responsible for production of analgesia are believed to be responsible for producing the side effects. Constipation is the most common opioidinduced side effect occurring in up to 85 percent of patients. Constipation appears to be chiefly a peripheral effect arising from stimulation of the opioid receptors of the gastrointestinal tract. In our first study, we will evaluate the efficacy of methyl-naltrexone, a peripherally-selective opioid antagonist, for the treatment of opioid-induced constipation in cancer patients. In a double-blind, placebo-controlled, randomized trial, subjects will receive either placebo or active drug for 3 weeks after baseline data is obtained. Efficacy will be assessed using changes in bowel frequency, oral-cecal transit time, and constipation-related symptoms. Constipation has objective, i.e., bowel frequency, and subjective components, e.g., abdominal pain, difficulty passing stool. Although difficult to measure, constipation-related symptoms are usually the primary concern to patients. Assessing for both bowel frequency and subjective symptoms will result in a more appropriate measurement scale. No scale combining both the clinical signs and subjective symptoms of constipation currently exists. As a result, we have developed the Constipation Measurement Scale (CMS) to assess both the symptoms and clinical signs. In this proposal, we will test the reliability, validity, and responsiveness of the CMS. Using a case-control design, patients who respond "yes" to the question "are you constipated?" and age-matched controls who answer "no" will be asked to complete the CMS daily for one week. Total scores of the CMS and subscores of each part will be correlated to the screening question to assess validity. Comparison of daily response will assess the reliability. Patients who are constipated will be treated with lactulose and asked to continue the daily CMS during this time. Pre- and posttreatment scores will be compared to assess for responsiveness of the scale. These studies will serve as a foundation for future studies examining the role of adverse effects of treatment on pain control. In addition, the mechanisms of opioid adverse effects and analgesia will be further explored with the use of methyl-naltrexone, e.g., contribution of peripheral opioid receptors to analgesia and peripheral vs. central mechanisms of other side effects. The methodologic techniques and research skills developed through formal training and conducting the clinical trials will serve as a foundation for pursuing related research questions as Dr. Liu matures into a fully independent academic clinical investigator. In addition, the study will provide important information about the appropriate treatment of opioid-induced constipation which will have an immediate relevance to the care of the cancer patient. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
84 Constipation
·
Project Title: Oral R108512 for Constipation in Children Principal Investigator & Institution: Winter, Harland S.; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2000; Project Start 1-FEB-1978; Project End 0-NOV2002 Summary: This study is to determine the pharmacokinetics of a new drug for the treatment of constipation in children. The purpose of the study is to determine the preliminary safety and efficacy of a single dose of 0.03 mg/kg prucalopride (R108512) in pediatric subjects aged 12 years with functional fecal retention. This dose corresponds to an adult dose of 1.52.0 mg of prucalopride. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
·
Project Title: Pyridostigmine for Constipation in Patients w/an Autonomic Neuropathy Principal Investigator & Institution: Bharucha, Adil E.; Mayo Clinic Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2000 Summary: Patients with an autonomic neuropathy frequently have severe constipation unresponsive to our current therapeutic armementarium. We recently demonstrated that i.v. neostigmine increases colonic contractility and transit in healthy volunteers; neostigmine also increased colonic tone and improved symptoms in one patient with autonomic neuropathy and intractable constipation. Pyridostigmine is an acetylcholinesterase inhibitor with higher bioavailability than neostigmine. Hypotheses- 1) In patients with slow transit constipation due to an autonomic neuropathy resulting from diabetes, pure autonomic failure, an immune-mediated process or multiple system atrophy, the acetylcholinesterase inhibitor pyridostigmine is safe, well tolerated, will improve colonic transit and satisfaction with bowel habits, 2) The effect of intravenous neostigmine on colonic tone during a motility study will predict treatment success with pyridostigmine. Aims - To assess the safety, tolerability, effect on symptoms, colonic transit and satisfaction with bowel movements of pyridostigmine in patients with constipation due to an autonomic neuropathy, and to determine if neostigmine's effects on the colonic pressure-volume relationship during a motility study predict the therapeutic response to pyridostigmine. Methods - Open-label, phase II pilot study of an escalating dose of pyridostigmine (60 mg t.i.d. to 180 mg t.i.d) in 10 patients with an autonomic neuropathy and constipation. A two-week run-in single-blind placebo phase will be followed by a 6-week
Studies 85
single-blind treatment phase. Standard clinical assessments and a radionuclide whole-gut transit study will be performed at the beginning and end of the study. The effect of i.v. neostigmine on colonic tone and compliance will be assessed prior to the therapeutic trial. Primary endpoints are the effect of pyridostigmine on colonic transit and patient reported satisfaction with bowel movements during the last 2 weeks of the treatment period. Secondary endpoints are derived from the Rome Criteria for constipation (number of stools/week, stool consistency, frequency of straining and incomplete evacuation) and the proximal colonic emptying rate. A total of 10 patients in this pilot study should provide sufficient information to estimate the response magnitude and variability of the quantitative primary response variable, colonic transit. Significance - A successful therapeutic response in >6/10 patients in this pilot study will lead to an placebo-controlled study of pyridostigmine in a similar patient population and perhaps other patient groups with constipation due to an autonomic neuropathy. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: R108512 Constipation or IBS
and
GI/Colonic
Transit
in
Functional
Principal Investigator & Institution: Camilleri, Michael L.; Professor of Medicine and Physiology; Mayo Clinic Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2000; Project Start 1-DEC-1976; Project End 0-NOV2004 Summary: The hypothesis is that R108512 dose dependently accelerates colonic transit in patients with functional constipation or constipationpredominant irritable bowel syndrome. The specific aim of this study is to measure gastric, small bowel, and colonic transit in 40 patients with functional constipation or constipation-predominant irritable bowel syndrome randomized to placebo, 0.5, 2.0, or 4.0 mg per day as a single dose of R108512. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Treatment of Early Childhood Constipation and Encopresis Principal Investigator & Institution: Cox, Daniel J.; Psychiatric Medicine; University of Virginia Charlottesville Box 400195 Charlottesville, Va 22904 Timing: Fiscal Year 2000; Project Start 1-APR-1992; Project End 9-AUG2001
86 Constipation
Summary: Pediatric constipation and encopresis typically develop in infancy or the toddler years and are treated by Primary Care Physicians (PCPs). This condition can be relatively treatment resistant and can culminate in devastating psychosocial consequences if it persists into school years. However, treatment literature of this condition typically involves older children (6 or more years of age), who have an extensive history of treatment failure, have associated behavioral problems, and are treated at specialty clinics. Consequently, available studies bear an unknown relationship to routine clinical care by PCPs of young children. Additionally, there are little developmental data on this symptom pattern. Building on the investigator's current research with children 6-15 years, a descriptive study to evaluate the mechanisms of constipation and encopresis in early childhood (ages 2-6), and treatment efficacy by PCPs is proposed. This study will evaluate patients immediately before and two months following routine care by their PCP. This evaluation will include physical, psychological and behavioral variables to test a proposed bio-psycho-behavioral model of constipation-encopresis. Patients who do not respond to this initial intervention will then enter an experimental study, and be randomly assigned to either continued care by their PCP or referred to a specialty clinic where they will receive intensive laxative therapy or intensive laxative therapy plus behavior therapy (enhanced toilet training). This latter 3 (pre-post-12 month follow up) x 3 (treatment groups) study will allow a test of a model concerning the development, maintenance and treatment- responsiveness of early childhood constipation and encopresis, as well as allow an assessment with the relative cost-effectiveness of these three modes of treatment. Not only will this research represent the first prospective description and evaluation of PCP routine care, but it also represents the first experimental treatment outcome study of early childhood constipation encopresis. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Bladder and Bowel Control Using Neuroprosthetic Devices Principal Investigator & Institution: Creasy, Graham; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2000 Summary: Electrical stimulators resembling pacemakers were designed to improve bladder emptying following spinal cord injury, by stimulating the nerve roots at the base of the spine. This causes contraction of the bladder and has been shown in about 90% of the patients on whom it has been used to improve bladder emptying and
Studies 87
reduce urine infection. It can also improve continence. This project will document these results accurately in the United States. The stimulator also causes contraction of the rectum and most of the patients in whom it has been used report a reduction in constipation. Techniques for more selective stimulation of the bladder and bowel have been developed by the investigators at CWRU. This project provides an opportunity for evaluating the functional benefit to be gained in human subjects for these techniques. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Infectivity of Cyclospora Cayetanesis in Human Volunteers Principal Investigator & Institution: Moe, Christine J.; University of North Carolina Chapel Hill Box 2688, 910 Raleigh Rd Chapel Hill, Nc 27515 Timing: Fiscal Year 2000; Project Start 1-OCT-1974; Project End 0-NOV2002 Summary: The purpose of this research study is to determine the amount of Cyclospora which causes infection and to describe the characteristics and duration of the the infection. Cyclospora is a parasite that causes diarrhea and other gastrointestinal symptoms such as nausea, vomiting, diarrhea, muscle aches or constipation that lasts for many days if not treated. It is found in food and water and is spread through low levels of stool contamination of fresh produce and in drinking water. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
·
Project Title: Multicenter Trial of Functional Bowel Disorders Principal Investigator & Institution: Drossman, Douglas A.; Medicine; University of North Carolina Chapel Hill Box 2688, 910 Raleigh Rd Chapel Hill, Nc 27515 Timing: Fiscal Year 2000; Project Start 0-SEP-1995; Project End 1-AUG2002 Summary: The primary aim of this study is to compare the efficacies of clinical treatments for the group of chronic, painful functional bowel disorders (FBD) that predominantly affect women. Secondary aims include 1) determination of demographic, psychosocial, physiologic and symptomatic predictors of clinical improvement and 2) analysis of significant relationships among physiologic markers of FBD, psychosocial status, symptoms and treatment effects. The Principal Investigator and his colleagues propose to compare cognitive-behavioral psychological treatment with antidepressant drug therapy (desipramine) and education/attention placebo in over 300 women. Interrelationships
88 Constipation
between psychological and physiological factors on the development, clinical expression and treatment of FBD have long been recognized, but this is the first large-scale study designed both to isolate therapeutic effects, and to investigate interactions among physiologic measures, psychologic and sociodemographic factors, severity of symptoms, and therapeutic improvement including quality of life. In the proposed plan of research, at least 300 female patients (aged 18- 65) with FBD (irritable bowel syndrome, painful constipation and/or functional abdominal pain) will be enrolled in clinics at UNC-Chapel Hill and Toronto, Canada. A severity index will determine recruitment into the group of moderate FBD (200 patients) and severe FBD (100 patients). Each group will be randomized into the three treatment arms (cognitive- behavioral treatment, desipramine, and education/attention placebo), treated over a 12-week period, and followed for one year. Outcome measures will include symptoms (standardized abdominal pain, stool form, and frequency) using diary cards, daily functional status (Sickness Impact Profile), depression (HAM-D), and psychological distress (SCL-90), physiological measures (enhanced rectal motility and visceralsensation), and health care use. Multivariate statistical methods with a hierarchical design will be applied to the data to assure maintenance of statistical power over multiple tests of overlapping groups. The results of this study may significantly improve an understanding of this complicated syndrome that lowers the quality of life and economic productivity of large numbers of women. The clinical impact of the study, in providing physicians with scientific evidence of the efficacy of treatments of FBD that are commonly used in practice, may be significant. This study may provide clinicians with predictors of success among types of FBD patients and types of therapy that will improve symptoms and quality of life and reduce the health care costs associated with this common syndrome, while improving patient-physician satisfaction. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Defecation
Neuromuscular
Condition
Therapy-Dyssynergic
Principal Investigator & Institution: Rao, Satish S.; Internal Medicine; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2000; Project Start 1-SEP-2000; Project End 0-JUN2005 Summary: Constipation affects 4 million Americans, predominantly women and the elderly. Its pathophysiology is incompletely understood and its treatment is unsatisfactory. Laxative-dependent, and unable to accomplish natures' call, many resort to desperate treatments. About 50
Studies 89
percent of patients with constipation exhibit uncoordinated or dyssynergic defecation. Uncontrolled studies suggest that biofeedback therapy may improve symptoms in these patients. But, whether the improvement is due to the behavioral intervention or a consequence of excess attention is not known. Biofeedback therapy is labor-intensive, expensive and only available in a few centers. In order to treat the many patients in the community, a home-based, self-training program is essential. Our proposal addresses three objectives; 1) to determine the efficacy of biofeedback therapy by performing a randomized controlled study in patients with dyssynergic defecation. After diagnostic evaluation with colon transit study, anorectal manometry and stool diaries, 90 patients will be randomized to receive standard treatment consisting of diet, habit-training and laxatives or biofeedback therapy consisting of neuromuscular conditioning or sham feedback therapy. Short-term (3 month) and long-term (12 month) assessments of anorectal physiology-defecation index, anal relaxation, fecom expulsion time and colon transit time and symptomatology-bowel satisfaction score, straining effort, laxative consumption score and stool form and consistency will be performed. 2) To investigate the efficacy of hometraining versus office-based biofeedback therapy and if it is cost-effective, 100 patients will be randomized to receive either home-training using a hand-held portable device and a silicon probe or biofeedback therapy for 3 months. Anorectal physiology and symptoms will be assessed and actuarial costs of each treatment will be compared. 3) For a condition that is entwined with psyche there is no information on quality of life or psychosocial function. We wish to investigate these parameters with validated instruments, SF-36 and SCL-90-R in 90 patients, before and after treatment and compare this with two controlled groups. This may provide impetus for new treatments such as psychotherapy. This first controlled study will determine the efficacy and scientific basis for a safe and alternative therapy for difficult defecation, provide new information that could facilitate home self-training and assess the impact of treatment on anorectal physiology, symptoms, quality of life and psychosocial aspects. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Opioids with Reduced Potential for Tolerance Principal Investigator & Institution: Thatcher, Linn N.; Pharmaceutical Sciences; University of Maryland Balt Prof School Professional Schools Baltimore, Md 21201 Timing: Fiscal Year 2002; Project Start 1-NOV-2002
90 Constipation
Summary: The treatment for the pain associated with terminal cancer remains poorly treated. Although opioids, such as morphine,, can trat the pain, chronic treatment with morphine leads to severe constipation. The goal of this research is to develop novel opioids which will treat severe pain, without leading to constipation. The approach to be used consists of developing opioids with a profile of mu agonism and delta antagonism, a profile shown to reduce the development of tolerance to the antinociceptiv4 effects of mu agonists. Thus the ever increasing dose of opioid will not b required, leading to lower levels of constipation. The current hypotheses is that the aromatic ring of the indolomorphinans and benzylidene-type delta selective opioids leads to a profile of low delta efficience. Thus, if a suitably placed aromatic ring is introduced into the structure of the orvinols (a class of opioids known to bind with high affinity to both mu and delta receptors), a profile of potent mu agonism and delta antagonism will result. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Perillyl Alcohol (NSC 641066) Daily in Metastatic Breast Cancer Principal Investigator & Institution: Bailey, Howard H.; Assistant Professor of Medicine; University of Wisconsin Madison 500 Lincoln Dr Madison, Wi 53706 Timing: Fiscal Year 2000; Project Start 1-DEC-1994; Project End 0-NOV2004 Summary: Perillyl alcohol, a major component of lavender plant extract, is an oral monoterpene, which has antitumor properties in animal mammary cancer models. The drug's mechanism of action has not been fully elucidated, but appears to be distinct from that of cytotoxic chemotherapy, and may be related to modification of cellular growth factors or growth factor receptors. Primary toxicities from animal studies included gastrointestinal (emesis, diarrhea) and renal toxicities (rising BUN and renal lesions). The main toxicities noted in recent Phase I studies at multiple institutions were grade 1-2 gastrointestinal toxicity (nausea, vomiting, eructation, early satiety, anorexia) and fatigue. Additional toxicities observed included diarrhea, constipation, headache, increased creatinine, increased transaminases, and two cases of transient leukopenia. The dosing schedule determined from the Phase I study, and employed in this Phase II trial is 1200 mg/m2 po QID. However, since many patients in the Phase I trial tolerated a dose of 1600 mg/m2/dose without significant problem, patients experiencing minimal toxicities after Cycle 1 will be escalated to 1500 mg/m2 po QID. Forty to fifty metastatic breast cancer patients with measurable disease and no brain
Studies 91
metastases, who have failed at least one prior metastatic chemotherapy regimen will be enrolled onto this study. Toxicity data, as well as data on tumor response rate, time to treatment failure, and survival will be collected. Patients will have monthly physical exams, hematology surveys, serum chemistries, electrolytes, serum lipid profiles, and urinalyses while enrolled on the study. Hematology surveys and serum chemistries will be obtained weekly for the first cycle, then every two weeks until cycle 6, then monthly. Additional hematology surveys, serum chemistries, electrolytes, and lipid profiles will be obtained after a dose escalation. Serum and urine pharmacokinetics will be assessed on the majority of patients, over six hours, during Day 1 of Cycles 1 and 2. Pharmacokinetic assessments may continue during subsequent cycles at the investigator's discretion. The effect of perillyl alcohol on plasma TGFbeta, and tumor-cell IGF II receptors and IGF II receptor heterozygosity will also be assessed when available. Disease response will be evaluated every eight weeks, and patients will remain on study until progression, prohibitive toxicity, or consent withdrawal. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: R108512 Solution in Pediatric Subjects w/Functional Fecal Retention Principal Investigator & Institution: Blumer, Jeffrey L.; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2000 Summary: In the pediatric population, constipation is the chief complaint in about 3% of all pediatric outpatient visits; as many as 25% of referrals to pediatric gastroenterologists are for children with constipation. The majority of these children have a form of functional constipation, referred to as FFR or functional fecal retention. The primary objective of this trial is to characterize the pharmacokinetics of a single oral dose of 0.03 mg/kg prucalopride in pediatric subjects aged greater than 4 to less than 12 years with FFR. This dose corresponds to an adult dose of .15 - 2.0 mg of prucalopride. The secondary objective is to evaluate the safety and the tolerability (adverse experiences) of a single oral dose of prucalopride solution, 0.03 mg/kg, given to pediatric subjects with FFR. No efficacy will be evaluated in this trial. Pharmacokinetic studies were done on the GCRC. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
92 Constipation
·
Project Title: Synaptic Transmission in Diabetic Enteric Nervous System Principal Investigator & Institution: Lepard, Kathy J.; Physiology; Midwestern University 555 31St St Downers Grove, Il 60515 Timing: Fiscal Year 2000; Project Start 0-SEP-2000; Project End 1-AUG2002 Summary: (Applicant's abstract): Gastrointestinal (GI) disturbances are not normally life-threatening but do profoundly affect quality of life. Diabetic patients often experience a wide range of GI discomforts including heartburn, nausea, vomiting, diarrhea, constipation, fecal incontinence and abdominal pain. Many patients have abnormalities in motility arising from identifiable conditions; but over 50% of GI complaints are idiopathic and are indicative of autonomic neuropathy. Both enteric nerves in and sympathetic nerves to the GI tract undergo neuropathy in animal models of diabetes as supported by immunohistochemical, histological, and functional data. A streptozotocin-induced diabetic guinea pig model will be used to isolate and evaluate alterations in sympathetic and enteric nerve activity at the histochemical, functional and cellular level. Neuropathy of enteric neurons will be investigated immunohistochemically by quantifying enzyme and peptide content of the small intestine, functionally by recording contractions/ relaxations from circular/ longitudinal smooth muscle strips of small intestine and cellularly by recording junction potentials from smooth muscle cells. Neuropathy of sympathetic neurons will be evaluated histochemically by quantifying norepinephrine (NE) content of small intestine and cellularly by recording NE mediated inhibitory postsynaptic potentials from submucosal neurons and by evaluating presynaptic inhibition of enteric neurotransmission by NE. Experimental data will be correlated with metabolic indices (body weight, glycosylated hemoglobin and plasma glucose) to determine normal control deviations and degree of diabetic severity with the intent of identifying a threshold for GI dysfunction. By defining the individual contribution of sympathetic and enteric neuropathies to dysfunctional GI motility, targets for therapeutic intervention to improve patient quality of life will be pinpointed. Adaptations of enteric neurons to diabetes will provide insight into enteric plasticity occurring in other GI diseases such as neuronal intestinal dysplasia, achalasia, scleroderma, pyloric stenosis, idiopathic constipation, diverticular disease, Parkinson's disease, and paraneoplastic syndromes. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
Studies 93
E-Journals: PubMed Central19 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).20 Access to this growing archive of e-journals is free and unrestricted.21 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “constipation” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for constipation in the PubMed Central database: ·
Randomised crossover trial of transdermal fentanyl and sustained release oral morphine for treating chronic non-cancer pain by Laurie Allan, Helen Hays, Niels-Henrik Jensen, Bernard Le Polain de Waroux, Michiel Bolt, Royden Donald, and Eija Kalso; 2001 May 12 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=31593
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.22 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals.
Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 20 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 21 The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 22 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication. 19
94 Constipation
To generate your own bibliography of studies dealing with constipation, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “constipation” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “constipation” (hyperlinks lead to article summaries): ·
Controlled randomised trial of visual biofeedback versus muscle training without a visual display for intractable constipation. Author(s): Koutsomanis D, Lennard-Jones JE, Roy AJ, Kamm MA. Source: Gut. 1995 July; 37(1): 95-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7672690&dopt=Abstract
·
Decreased substance P levels in rectal biopsies from patients with slow transit constipation. Author(s): Tzavella K, Riepl RL, Klauser AG, Voderholzer WA, Schindlbeck NE, Muller-Lissner SA. Source: European Journal of Gastroenterology & Hepatology. 1996 December; 8(12): 1207-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8980942&dopt=Abstract
·
Diagnosis and management of irritable bowel syndrome, constipation, and diarrhea in pregnancy. Author(s): West L, Warren J, Cutts T. Source: Gastroenterology Clinics of North America. 1992 December; 21(4): 793-802. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1478735&dopt=Abstract
·
Effectiveness of acupuncture for treatment of childhood constipation. Author(s): Broide E, Pintov S, Portnoy S, Barg J, Klinowski E, Scapa E. Source: Digestive Diseases and Sciences. 2001 June; 46(6): 1270-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11414304&dopt=Abstract
·
Effects of psyllium therapy on stool characteristics, colon transit and anorectal function in chronic idiopathic constipation. Author(s): Ashraf W, Park F, Lof J, Quigley EM.
Studies 95
Source: Alimentary Pharmacology & Therapeutics. 1995 December; 9(6): 639-47. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8824651&dopt=Abstract ·
Electroacupuncture treatment for constipation due to spasmodic syndrome of the pelvic floor--a report of 36 cases. Author(s): Wang S. Source: J Tradit Chin Med. 2001 September; 21(3): 205-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11789328&dopt=Abstract
·
Electromyographic assessment of biofeedback training for fecal incontinence and chronic constipation. Author(s): Patankar SK, Ferrara A, Larach SW, Williamson PR, Perozo SE, Levy JR, Mills J. Source: Diseases of the Colon and Rectum. 1997 August; 40(8): 907-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9269806&dopt=Abstract
·
Empirically supported treatments in pediatric psychology: constipation and encopresis. Author(s): McGrath ML, Mellon MW, Murphy L. Source: Journal of Pediatric Psychology. 2000 June; 25(4): 225-54; Discussion 255-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10814690&dopt=Abstract
·
Encopresis and constipation in children. Author(s): Hatch TF. Source: Pediatric Clinics of North America. 1988 April; 35(2): 257-80. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3278282&dopt=Abstract
·
Epidemiology of constipation in elderly patients. Drug utilisation and cost-containment strategies. Author(s): Lederle FA.
96 Constipation
Source: Drugs & Aging. 1995 June; 6(6): 465-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7663066&dopt=Abstract ·
Factors determining outcome in children with chronic constipation and faecal soiling. Author(s): Loening-Baucke V. Source: Gut. 1989 July; 30(7): 999-1006. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2759495&dopt=Abstract
·
Functional colonic and anorectal disorders. Detecting and overcoming causes of constipation and fecal incontinence. Author(s): Rao SS. Source: Postgraduate Medicine. 1995 November; 98(5): 115-9, 124-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7479446&dopt=Abstract
·
Gut focused behavioural treatment (biofeedback) for constipation and faecal incontinence in multiple sclerosis. Author(s): Wiesel PH, Norton C, Roy AJ, Storrie JB, Bowers J, Kamm MA. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2000 August; 69(2): 240-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10896701&dopt=Abstract
·
How effective is nonlaxative treatment of constipation? Author(s): Klauser AG, Muller-Lissner SA. Source: Pharmacology. 1993 October; 47 Suppl 1: 256-60. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8234439&dopt=Abstract
·
How to deal with chronic constipation. A stepwise method of establishing and treating the source of the problem. Author(s): Wong PW, Kadakia S. Source: Postgraduate Medicine. 1999 November; 106(6): 199-200, 203-4, 207-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10576011&dopt=Abstract
Studies 97
·
Identification of patients likely to benefit from biofeedback for outlet obstruction constipation. Author(s): Wexner SD. Source: The British Journal of Surgery. 1999 November; 86(11): 1484. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10617365&dopt=Abstract
·
Idiopathic Constipation and Fecal Incontinence. Author(s): Krevsky B. Source: Curr Treat Options Gastroenterol. 1998 December; 1(1): 20-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11096560&dopt=Abstract
·
Idiopathic constipation: any movement? Author(s): Kamm MA. Source: Scand J Gastroenterol Suppl. 1992; 192: 106-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1439560&dopt=Abstract
·
Incontinence and constipation: pelvic floor disorders of gastrointestinal motility and urodynamics. Author(s): Floch MH, Dowd J. Source: Journal of Clinical Gastroenterology. 1998 July; 27(1): 4-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9706763&dopt=Abstract
·
Influence of senna, fibre, and fibre + senna on colonic transit in loperamide-induced constipation. Author(s): Ewe K, Ueberschaer B, Press AG. Source: Pharmacology. 1993 October; 47 Suppl 1: 242-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8234436&dopt=Abstract
·
Intestinal neuronal dysplasia. Defining a new cause for chronic constipation. Author(s): Hutson JM.
98 Constipation
Source: Aust Fam Physician. 1996 September; 25(9): 1357. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8840558&dopt=Abstract ·
Management of childhood constipation. Author(s): Beach RC. Source: Lancet. 1996 September 21; 348(9030): 766-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8813977&dopt=Abstract
·
Management of constipation and encopresis in infants and children. Author(s): Seth R, Heyman MB. Source: Gastroenterology Clinics of North America. 1994 December; 23(4): 621-36. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7698824&dopt=Abstract
·
Management of constipation. 1. High fibre diets work. Author(s): Taylor R. Source: Bmj (Clinical Research Ed.). 1990 April 21; 300(6731): 1063-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2160848&dopt=Abstract
·
Management of faecal incontinence and constipation in adults with central neurological diseases. Author(s): Wiesel PH, Norton C, Brazzelli M. Source: Cochrane Database Syst Rev. 2001; (4): Cd002115. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11687140&dopt=Abstract
·
Managing morphine-induced constipation: a controlled comparison of an Ayurvedic formulation and senna. Author(s): Ramesh PR, Kumar KS, Rajagopal MR, Balachandran P, Warrier PK. Source: Journal of Pain and Symptom Management. 1998 October; 16(4): 240-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9803051&dopt=Abstract
Studies 99
·
Mechanisms of constipation in older persons and effects of fiber compared with placebo. Author(s): Cheskin LJ, Kamal N, Crowell MD, Schuster MM, Whitehead WE. Source: Journal of the American Geriatrics Society. 1995 June; 43(6): 666-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7775727&dopt=Abstract
·
Non-surgical treatment for constipation in adults: the place of biofeedback. Author(s): Kuijpers JH, Bleijenberg G. Source: Neth J Surg. 1991; 43(6): 218-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1812414&dopt=Abstract
·
Outcome and predictors of success of biofeedback for constipation. Author(s): Gilliland R, Heymen S, Altomare DF, Park UC, Vickers D, Wexner SD. Source: The British Journal of Surgery. 1997 August; 84(8): 1123-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9278659&dopt=Abstract
·
Outlet Dysfunction Constipation. Author(s): Wald A. Source: Curr Treat Options Gastroenterol. 2001 August; 4(4): 293-297. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11469987&dopt=Abstract
·
Outlet obstruction constipation (anismus) managed by biofeedback. Author(s): Kawimbe BM, Papachrysostomou M, Binnie NR, Clare N, Smith AN. Source: Gut. 1991 October; 32(10): 1175-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1955173&dopt=Abstract
·
Patient satisfaction after biofeedback for constipation and pelvic floor dyssynergia. Author(s): Wiesel PH, Dorta G, Cuypers P, Herranz M, Kreis ME, Schnegg JF, Jornod P.
100 Constipation
Source: Swiss Medical Weekly : Official Journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology. 2001 March 24; 131(11-12): 152-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11416888&dopt=Abstract ·
Persistence of chronic constipation in children after biofeedback treatment. Author(s): Loening-Baucke V. Source: Digestive Diseases and Sciences. 1991 February; 36(2): 153-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1988258&dopt=Abstract
·
Pharmacological basis for the use of peach leaves in constipation. Author(s): Gilani AH, Aziz N, Ali SM, Saeed M. Source: Journal of Ethnopharmacology. 2000 November; 73(1-2): 87-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11025143&dopt=Abstract
·
Portable biofeedback apparatus for treatment of anal sphincter dystonia in childhood soiling and constipation. Author(s): Griffiths P, Dunn S, Evans A, Smith D, Bradnam M. Source: Journal of Medical Engineering & Technology. 1999 May-June; 23(3): 96-101. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10425608&dopt=Abstract
·
Predictive factors for short-term symptom persistence in children after emergency department evaluation for constipation. Author(s): Patel H, Law A, Gouin S. Source: Archives of Pediatrics & Adolescent Medicine. 2000 December; 154(12): 1204-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11115303&dopt=Abstract
·
Prospective study of biofeedback for treatment of constipation. Author(s): Rieger NA, Wattchow DA, Sarre RG, Saccone GT, Rich CA, Cooper SJ, Marshall VR, McCall JL. Source: Diseases of the Colon and Rectum. 1997 October; 40(10): 1143-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9336108&dopt=Abstract
Studies 101
·
Prospective, randomized trial comparing four biofeedback techniques for patients with constipation. Author(s): Heymen S, Wexner SD, Vickers D, Nogueras JJ, Weiss EG, Pikarsky AJ. Source: Diseases of the Colon and Rectum. 1999 November; 42(11): 138893. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10566525&dopt=Abstract
·
Psychological disorders in patients with evacuation disorders and constipation in a tertiary practice. Author(s): Nehra V, Bruce BK, Rath-Harvey DM, Pemberton JH, Camilleri M. Source: The American Journal of Gastroenterology. 2000 July; 95(7): 17558. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10925980&dopt=Abstract
·
Psyllium is superior to docusate sodium for treatment of chronic constipation. Author(s): McRorie JW, Daggy BP, Morel JG, Diersing PS, Miner PB, Robinson M. Source: Alimentary Pharmacology & Therapeutics. 1998 May; 12(5): 4917. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9663731&dopt=Abstract
·
Randomized controlled trial of Cassia alata Linn. for constipation. Author(s): Thamlikitkul V, Bunyapraphatsara N, Dechatiwongse T, Theerapong S, Chantrakul C, Thanaveerasuwan T, Nimitnon S, Boonroj P, Punkrut W, Gingsungneon V, et al. Source: J Med Assoc Thai. 1990 April; 73(4): 217-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2203870&dopt=Abstract
·
Review article: the therapy of constipation. Author(s): Schiller LR. Source: Alimentary Pharmacology & Therapeutics. 2001 June; 15(6): 74963. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11380313&dopt=Abstract
102 Constipation
·
Review of the treatment literature for encopresis, functional constipation, and stool-toileting refusal. Author(s): Brooks RC, Copen RM, Cox DJ, Morris J, Borowitz S, Sutphen J. Source: Annals of Behavioral Medicine : a Publication of the Society of Behavioral Medicine. 2000 Summer; 22(3): 260-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11211851&dopt=Abstract
·
Role of colonic motility in guiding therapy in patients with constipation. Author(s): Snape WJ Jr. Source: Digestive Diseases (Basel, Switzerland). 1997; 15 Suppl 1: 104-11. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9177949&dopt=Abstract
·
Role of proctography in severe constipation. Author(s): Infantino A, Masin A, Pianon P, Dodi G, Del Favero G, Pomerri F, Lise M. Source: Diseases of the Colon and Rectum. 1990 August; 33(8): 707-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2376228&dopt=Abstract
·
Safety and efficacy of a bulk laxative containing senna versus lactulose in the treatment of chronic constipation in geriatric patients. Author(s): Kinnunen O, Winblad I, Koistinen P, Salokannel J. Source: Pharmacology. 1993 October; 47 Suppl 1: 253-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8234438&dopt=Abstract
·
Short-term effects of sacral nerve stimulation for idiopathic slow transit constipation. Author(s): Malouf AJ, Wiesel PH, Nicholls T, Nicholls RJ, Kamm MA. Source: World Journal of Surgery. 2002 February; 26(2): 166-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11865344&dopt=Abstract
·
Simple electromyographic biofeedback treatment for chronic pediatric constipation/encopresis: preliminary report. Author(s): Cox DJ, Sutphen J, Borowitz S, Dickens MN, Singles J, Whitehead WE.
Studies 103
Source: Biofeedback Self Regul. 1994 March; 19(1): 41-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8167163&dopt=Abstract ·
Slow Transit Constipation. Author(s): Wald A. Source: Curr Treat Options Gastroenterol. 2002 August; 5(4): 279-283. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12095475&dopt=Abstract
·
Sociodemographic and lifestyle factors associated with constipation in an elderly Asian community. Author(s): Wong ML, Wee S, Pin CH, Gan GL, Ye HC. Source: The American Journal of Gastroenterology. 1999 May; 94(5): 128391. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10235208&dopt=Abstract
·
Surgery for constipation: a review. Author(s): Pfeifer J, Agachan F, Wexner SD. Source: Diseases of the Colon and Rectum. 1996 April; 39(4): 444-60. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8878507&dopt=Abstract
Vocabulary Builder Absenteeism: Chronic absence from work or other duty. [NIH] Acetylcholinesterase: An enzyme that catalyzes the hydrolysis of acetylcholine to choline and acetate. In the CNS, this enzyme plays a role in the function of peripheral neuromuscular junctions. EC 3.1.1.7. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH]
104 Constipation
Anorexia: Lack or loss of the appetite for food. [EU] Ascariasis: Infection by nematodes of the genus ascaris. Ingestion of infective eggs causes diarrhea and pneumonitis. Its distribution is more prevalent in areas of poor sanitation and where human feces are used for fertilizer. [NIH] Atrophy: A wasting away; a diminution in the size of a cell, tissue, organ, or part. [EU] Benign: Not malignant; not recurrent; favourable for recovery. [EU] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Campylobacter: A genus of bacteria found in the reproductive organs, intestinal tract, and oral cavity of animals and man. Some species are pathogenic. [NIH] Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Clostridium: A genus of motile or nonmotile gram-positive bacteria of the family bacillaceae. Many species have been identified with some being pathogenic. They occur in water, soil, and in the intestinal tract of humans and lower animals. [NIH] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Contractility: stimulus. [EU]
Capacity for becoming short in response to a suitable
Cyclospora: A genus of coccidian parasites in the family eimeriidae. Cyclospora cayetanensis is pathogenic in humans, probably transmitted via the fecal-oral route, and causes nausea and diarrhea. [NIH] Cytotoxic: Pertaining to or exhibiting cytotoxicity. [EU] Dentures: An appliance used as an artificial or prosthetic replacement for missing teeth and adjacent tissues. It does not include crowns, dental abutments, nor tooth, artificial. [NIH] Diverticulum: A pathological condition manifested as a pouch or sac opening from a tubular or sacular organ. [NIH] Dysphagia: Difficulty in swallowing. [EU] Dysplasia: Abnormality of development; in pathology, alteration in size, shape, and organization of adult cells. [EU] Dystonia: Disordered tonicity of muscle. [EU] Electrolyte: A substance that dissociates into ions when fused or in solution,
Studies 105
and thus becomes capable of conducting electricity; an ionic solute. [EU] Electromyography: Recording of the changes in electric potential of muscle by means of surface or needle electrodes. [NIH] Endoscopy: Visual inspection of any cavity of the body by means of an endoscope. [EU] Entamoeba: A genus of ameboid protozoa characterized by the presence of beaded chromatin on the inner surface of the nuclear membrane. Its organisms are parasitic in invertebrates and vertebrates, including humans. [NIH]
Enteritis: Inflammation of the intestine, applied chiefly to inflammation of the small intestine; see also enterocolitis. [EU] Enterocolitis: Inflammation involving both the small intestine and the colon; see also enteritis. [EU] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Epigastric: Pertaining to the epigastrium. [EU] Eructation: The act of belching, or of casting up wind from the stomach through the mouth. [EU] Escherichia: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms occur in the lower part of the intestine of warmblooded animals. The species are either nonpathogenic or opportunistic pathogens. [NIH] Ethnopharmacology: The study of the actions and properties of drugs, usually derived from medicinal plants, indigenous to a population or ethnic group. [NIH] Faecal: Pertaining to or of the nature of feces. [EU] Hematemesis: Vomiting of blood. [NIH] Hepatobiliary: Pertaining to the liver and the bile or the biliary ducts. [EU] Hydrogen: Hydrogen. The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hyperplasia: The abnormal multiplication or increase in the number of
106 Constipation
normal cells in normal arrangement in a tissue. [EU] Hypersensitivity: A state of altered reactivity in which the body reacts with an exaggerated immune response to a foreign substance. Hypersensitivity reactions are classified as immediate or delayed, types I and IV, respectively, in the Gell and Coombs classification (q.v.) of immune responses. [EU] Hysterectomy: The operation of excising the uterus, performed either through the abdominal wall (abdominal h.) or through the vagina (vaginal h.) [EU] Ileus: Obstruction of the intestines. [EU] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]
Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Lumen: The cavity or channel within a tube or tubular organ. [EU] Malaise: A vague feeling of bodily discomfort. [EU] Malignant: Tending to become progressively worse and to result in death. Having the properties of anaplasia, invasion, and metastasis; said of tumours. [EU] Megacolon: An abnormally large or dilated colon; the condition may be congenital or acquired, acute or chronic. [EU] Melena: 1. the passage of dark, pitchy, and grumous stools stained with blood pigments or with altered blood. 2. black vomit. [EU] Micturition: The passage of urine; urination. [EU] Midwifery: The practice of assisting women in childbirth. [NIH] Morphine:
The principal alkaloid in opium and the prototype opiate
Studies 107
analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Neostigmine: A cholinesterase inhibitor used in the treatment of myasthenia gravis and to reverse the effects of muscle relaxants such as gallamine and tubocurarine. Neostigmine, unlike physostigmine, does not cross the blood-brain barrier. [NIH] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A general term denoting functional disturbances and/or pathological changes in the peripheral nervous system. The etiology may be known e.g. arsenical n., diabetic n., ischemic n., traumatic n.) or unknown. Encephalopathy and myelopathy are corresponding terms relating to involvement of the brain and spinal cord, respectively. The term is also used to designate noninflammatory lesions in the peripheral nervous system, in contrast to inflammatory lesions (neuritis). [EU] Neurosurgery: A surgical specialty concerned with the treatment of diseases and disorders of the brain, spinal cord, and peripheral and sympathetic nervous system. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Pacemaker: An object or substance that influences the rate at which a certain phenomenon occurs; often used alone to indicate the natural cardiac pacemaker or an artificial cardiac pacemaker. In biochemistry, a substance whose rate of reaction sets the pace for a series of interrelated reactions. [EU] Palliative: 1. affording relief, but not cure. 2. an alleviating medicine. [EU] Pancreas: An organ behind the lower part of the stomach that is about the size of a hand. It makes insulin so that the body can use glucose (sugar) for
108 Constipation
energy. It also makes enzymes that help the body digest food. Spread all over the pancreas are areas called the islets of Langerhans. The cells in these areas each have a special purpose. The alpha cells make glucagon, which raises the level of glucose in the blood; the beta cells make insulin; the delta cells make somatostatin. There are also the PP cells and the D1 cells, about which little is known. [NIH] Pancreatitis: Inflammation (pain, tenderness) of the pancreas; it can make the pancreas stop working. It is caused by drinking too much alcohol, by disease in the gallbladder, or by a virus. [NIH] Paradoxical: Occurring at variance with the normal rule. [EU] Pathologic: 1. indicative of or caused by a morbid condition. 2. pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Pharmacokinetics: The action of drugs in the body over a period of time, including the processes of absorption, distribution, localization in tissues, biotransformation, and excretion. [EU] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Prevalence: The number of people in a given group or population who are reported to have a disease. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Proxy: A person authorized to decide or act for another person, for example, a person having durable power of attorney. [NIH] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]
Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [NIH] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid
Studies 109
hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Relaxant: 1. lessening or reducing tension. 2. an agent that lessens tension. [EU]
Salmonella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that utilizes citrate as a sole carbon source. It is pathogenic for humans, causing enteric fevers, gastroenteritis, and bacteremia. Food poisoning is the most common clinical manifestation. Organisms within this genus are separated on the basis of antigenic characteristics, sugar fermentation patterns, and bacteriophage susceptibility. [NIH] Senna: Preparations of Cassia senna L. and C. angustifolia of the Leguminosae. They contain sennosides, which are anthraquinone type cathartics and are used in many different preparations as laxatives. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Silicon: Silicon. A trace element that constitutes about 27.6% of the earth's crust in the form of silicon dioxide. It does not occur free in nature. Silicon has the atomic symbol Si, atomic number 14, and atomic weight 28.09. [NIH] Somatic: 1. pertaining to or characteristic of the soma or body. 2. pertaining to the body wall in contrast to the viscera. [EU] Stenosis: Narrowing or stricture of a duct or canal. [EU] Symptomatic: 1. pertaining to or of the nature of a symptom. 2. indicative (of a particular disease or disorder). 3. exhibiting the symptoms of a particular disease but having a different cause. 4. directed at the allying of symptoms, as symptomatic treatment. [EU] Symptomatology: 1. that branch of medicine with treats of symptoms; the systematic discussion of symptoms. 2. the combined symptoms of a disease. [EU]
Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated
110 Constipation
from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Transaminase: Aminotransferase (= a subclass of enzymes of the transferase class that catalyse the transfer of an amino group from a donor (generally an amino acid) to an acceptor (generally 2-keto acid). Most of these enzymes are pyridoxal-phosphate-proteins. [EU] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Trimebutine: Proposed spasmolytic with possible local anesthetic action used in gastrointestinal disorders. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Urodynamics: The mechanical laws of fluid dynamics as they apply to urine transport. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Withdrawal: 1. a pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) a substancespecific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Yersinia: A genus of gram-negative, facultatively anaerobic rod- to coccobacillus-shaped bacteria that occurs in a broad spectrum of habitats. [NIH]
Patents 111
CHAPTER 5. PATENTS ON CONSTIPATION Overview You can learn about innovations relating to constipation by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.23 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available to patients with constipation within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available to patients with constipation. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.
23Adapted
from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
112 Constipation
Patents on Constipation By performing a patent search focusing on constipation, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on constipation: ·
Apparatus and method for treating chronic constipation Inventor(s): Bardy; Gust H. (Seattle, WA) Assignee(s): Medtronic, Inc. (Minneapolis, MN) Patent Number: 6,238,423 Date filed: September 30, 1999 Abstract: An anticonstipation apparatus, and method, that may include using an implanted stimulus generator that may supply electrical stimuli to the muscles associated with a target portion of the patient's gut, from the esophagus to the anus, through an electrical lead and several pairs of electrodes. The electrical stimuli may be provided to nerves in the autonomic nervous system that are associated with the muscles, or the stimuli may be provided directly to the muscles themselves. The stimuli may be provided sequentially, in a proximal to caudad direction, in order to initiate, enhance or artificially produce peristalsis in the gut's target portion in a proximal to caudad direction. If the gut's target portion is in the descending colon, such stimulation may be coordinated with similar stimulation of the muscles associated with the rectum and anus. A sensor may be provided to detect when the target portion is experiencing constipation. Excerpt(s): The present invention relates generally to apparatus and methods for treating constipation in humans. More particularly, it relates to treating chronic, severe constipation by using an anticonstipation apparatus to electrically stimulate the muscles associated with the afflicted portion of the gut. This may be done by stimulating portions of the autonomic nervous system associated with those muscles, or by directly stimulating those muscles themselves. ... Constipation is a lifedisturbing problem that afflicts millions of Americans, from the very
Patents 113
young to the elderly. Although relatively rare among the young, it is a very common problem in middle age, and is a nearly ubiquitous problem in the elderly. ... Chronic constipation is a major problem for many individuals, and frequently causes extreme discomfort to the afflicted. Such discomfort may be a major obstacle to leading a normal life, and may consume an enormous amount of the afflicted person's energy and time. Web site: http://www.delphion.com/details?pn=US06238423__ ·
Use of a chemical agent for reducing the changes in waistline and the effect of constipation due to the taking of other agents Inventor(s): Salkin; Andre (134 Avenue du 14 Juillet, 76300 Sotteville les Rouen, FR) Assignee(s): none reported Patent Number: 5,948,824 Date filed: November 7, 1997 Abstract: The invention relates to the use of a chemical agent of organic origin for reducing or eliminating changes in waistline or for reducing or eliminating constipation due to the taking of other agents. A preferred agent is a polyvinylpyrrolidone or povidone. By virtue of the invention, changes in waistline are reduced or eliminated during the day, as well as constipation which can be generated by the taking of other agents such as clays. Excerpt(s): Use of a chemical agent reducing the changes in waistline and the effect of constipation due to the taking of other agents. ... According to a third aspect, the invention also relates to the use of a polyvinylpyrrolidone or povidone, in particular a soluble or insoluble cross-linked or non-cross-linked polyvinylpyrrolidone or povidone having a molecular weight between 10,000 and more than 2.8 million, for reducing the effect of constipation due to the taking of certain agents such as activated charcoal and clay. ... According to another aspect, the invention relates to a composition, such as a food or drink composition, characterised in that it contains at least one chemical agent of organic origin, preferably polyvinylpyrrolidone or povidone, in a synergetic association with another agent, clay in particular, in an amount effective for reducing or eliminating chances in waistline and constipation due to the taking of the other agent. Web site: http://www.delphion.com/details?pn=US05948824__
114 Constipation
·
Fermentation compositions having superoxide dismutating activity and an antihypertensive agent for treatment of constipation each having the superoxide dismutating activity Inventor(s): Kimura; Akihiko (Aichi, JP), Takada; Atsushi (Aichi, JP), Ishikawa; Naoto (Aichi, JP) Assignee(s): Toyo Hakko Co., Ltd. (Obu, JP) Patent Number: 5,776,756 Date filed: August 31, 1995 Abstract: The present invention provides a fermentation composition which makes use of rice brans, soybeans and sources of carbon as starting materials and which is innoxious, has a good SOD action (the action of effectively eliminating O.sub.2.sup.- which is harmful to the living body and the action of preventing diseases), and can prevent degradation of vitamin C. The invention also relates to an antihypertensive agent and constipation improver which are innoxious and have a good SOD action. The fermentation composition comprises a fermentation liquid obtained by inoculating and cultivating, under aerating and agitating conditions, bacillus natto or grass bacilli in a liquid medium,a pH of the medium is controled in the range of from 7.5 to 10 by alkaline agents, containing a rice bran, a soybean, a source of carbon and water, and filtering the resultant cultivation broth, or an evaporation residue of the fermentation liquid, vitamin C and, optionally, an extract of green tea or its evaporation residue. Excerpt(s): The present invention provides a fermentation compositions which have a good SOD action and more particularly, to fermentation compositions which comprises, at least, a specific type of fermented liquid and vitamin C. The other invention relates to an antihypertensive agent and an improver for constipation which also have a good SOD action. The compositions of the present invention have wide utility in the fields of treatment and improvement such as of various types of diseases caused by active oxygen (O.sub.2.sup.-) including diseases caused by bloodstream troubles such as myocardial infarction, cerebral apoploxy,hypertension, menstrul pain, the stiffness of the shoulders, nerve pain, lambagos, crapulence and the like, adult and internal diseases such as cancer, nephritis, hepatitis,diabetes and the like, and beauty cares and dermatoses such as spots, epherides, skin chapping, anematosis, constipation, wrinkles, atopic dermatitis and the like. ... Another object of the invention is to provide an antihypertensive agent and improver for constipation (which may hereinafter generically be referred to as antihypertensive agent etc.) which are derived from rice brans, soybeans and sources of carbon as starting materials and which are safe to the
Patents 115
health and have a good SOD action. ... The antihypertensive agent etc. have a good SOD action and exhibit a good effect caused by the SOO action. Accordingly, the antihypertensive agent and the improver for constipation according to the invention have, respectively, a good effect of inhibiting the blood pressure and a good effect on digestion. Web site: http://www.delphion.com/details?pn=US05776756__ ·
Method for treating constipation using dimethicone Inventor(s): Schmidt; Alfred (Leinpfad 2, 22301 Hamburg, DE), Upmeyer; Hans-Jurgen (Mauerkircherstr. 197, 81925 Munchen, DE) Assignee(s): none reported Patent Number: 5,418,220 Date filed: March 8, 1994 Abstract: The invention disclosed relates to the use of dimethicone as an agent for treating constipation. Excerpt(s): The invention relates to methods for treating constipation. ... Constipation means a delay in the discharge of dry and hard feces. It is caused either by a delayed passage of the stomach contents through the intestine or a disorder of the evacuation reflex. Possible reasons for the delayed passage through the intestine are dietetic factors, changes in the intestinal walls or a functional or organic disorder of the nervous system. Also, pharmaceuticals may have a constipating effect. A defect in the defecation mechanism is found in disorders of the anal channel, in the case of loss of the rectal dilation reflex or a weakness in the abdominal muscles used to apply abdominal pressure. Patients complain about symptoms such as a sensation of pressure, flatulence, and pains during the discharge of feces. ... Constipation is treated with laxatives which on the one hand soften the hard feces and on the other hand prompt defecation. Web site: http://www.delphion.com/details?pn=US05418220__
·
Bowel evacuant and method of treating constipation Inventor(s): Moss; David W. (885 Park Ave., New York, NY 10021) Assignee(s): none reported Patent Number: 4,476,121 Date filed: March 1, 1983
116 Constipation
Abstract: There is disclosed an orally administered composition useful in the treatment of constipation. The composition is a synergistic mixture of fruits, glycerine and compound senna which is efficacious at a dosage quantity far below that required of any of the ingredients when used alone. Excerpt(s): This invention relates to a composition which relieves constipation and aids in the evacuation of the contents of the lower bowel. More particularly, the invention relates to an improved composition which may be orally self administered, is pleasant tasting, storable under refrigeration for extended periods of time and fully excreatable by the body and therefore, free of drawbacks associated with many pharmaceutical preparations. ... Constipation may be defined simply, as the infrequent and difficult passage of stool. It is manifest by a significant change in frequency of evacuation and an accompanying increased difficulty in passage. There are generally two major motor disturbances leading to constipation: spasticity which is predominately characterized as an irratable bowel syndrome; and atonicity, characterized by volumnous evacuation. ... The most common form of constipation is known as an imaginery condition and is the result of a preconceived notion as to the definition of regularity. Such condition with an increased and abusive use of laxatives can lead to a secondary condition of excessive evacuation and consequent desensitization of urge and a reinforcement of the imaginary condition, whereupon the cycle repeats itself, going full circle each time. Web site: http://www.delphion.com/details?pn=US04476121__
Patent Applications on Constipation As of December 2000, U.S. patent applications are open to public viewing.24 Applications are patent requests which have yet to be granted (the process to achieve a patent can take several years).
Keeping Current In order to stay informed about patents and patent applications dealing with constipation, you can access the U.S. Patent Office archive via the Internet at no cost to you. This archive is available at the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent 24
This has been a common practice outside the United States prior to December 2000.
Patents 117
Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “constipation” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on constipation. You can also use this procedure to view pending patent applications concerning constipation. Simply go back to the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.
Vocabulary Builder Antihypertensive: An agent that reduces high blood pressure. [EU] Bacillus: A genus of bacteria of the family Bacillaceae, including large aerobic or facultatively anaerobic, spore-forming, rod-shaped cells, the great majority of which are gram-positive and motile. The genus is separated into 48 species, of which three are pathogenic, or potentially pathogenic, and the remainder are saprophytic soil forms. Many organisms historically called Bacillus are now classified in other genera. [EU] Desensitization: The prevention or reduction of immediate hypersensitivity reactions by administration of graded doses of allergen; called also hyposensitization and immunotherapy. [EU] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fermentation: An enzyme-induced chemical change in organic compounds that takes place in the absence of oxygen. The change usually results in the production of ethanol or lactic acid, and the production of energy. [NIH] Flatulence: The presence of excessive amounts of air or gases in the stomach or intestine, leading to distention of the organs. [EU] Hepatitis: Inflammation of the liver. [EU] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Infarction: 1. the formation of an infarct. 2. an infarct. [EU] Nephritis: Inflammation of the kidney; a focal or diffuse proliferative or destructive process which may involve the glomerulus, tubule, or interstitial
118 Constipation
renal tissue. [EU] Peristalsis: The wormlike movement by which the alimentary canal or other tubular organs provided with both longitudinal and circular muscle fibres propel their contents. It consists of a wave of contraction passing along the tube for variable distances. [EU] Povidone: A polyvinyl polymer of variable molecular weight; used as suspending and dispersing agent and vehicle for pharmaceuticals; also used as blood volume expander. [NIH] Reflex: 1; reflected. 2. a reflected action or movement; the sum total of any particular involuntary activity. [EU] Spasticity: A state of hypertonicity, or increase over the normal tone of a muscle, with heightened deep tendon reflexes. [EU] Synergistic: Acting together; enhancing the effect of another force or agent. [EU]
Books 119
CHAPTER 6. BOOKS ON CONSTIPATION Overview This chapter provides bibliographic book references relating to constipation. You have many options to locate books on constipation. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on constipation include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go to http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “constipation” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on constipation: ·
20 Common Problems in Gastroenterology Source: New York, NY: McGraw-Hill, Inc. 2002. 317 p.
120 Constipation
Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Website: www.bookstore.mcgrawhill.com. Price: $45.00;plus shipping and handling. ISBN: 0070220557. Summary: This text is one from a series that provides concise, practical information for health care professionals. This book focuses on the most common gastroenterological problems encountered in a primary practice setting and represents a selection of 20 clinical issues that every practitioner of primary care and general gastroenterology will encounter on a regular basis. The chapters are organized to support rapid access to the information necessary to evaluate and treat most patients with these problems. The text features three sections: general gastroenterology, gastrointestinal (GI) bleeding, and hepatic (liver) and biliary problems. Twenty chapters cover heartburn, nausea and vomiting, dysphagia (swallowing difficulties), weight loss, dyspepsia, chronic abdominal pain (functional GI disorders), acute abdominal pain, acute upper GI bleeding, acute lower GI bleeding, occult (hidden) bleeding and iron deficiency anemia, flatulence (gasiness), acute diarrhea in adults, constipation, colorectal cancer screening, anal pain, viral hepatitis, right upper quadrant pain (gallbladder disease and its complications), liver masses, abnormal liver function tests, and biliary obstruction. Each chapter includes a chapter outline for quick reference, the text itself, a diagnostic and treatment algorithm, and selected references. The text concludes with a subject index. Color photographs are provided in a special section; black and white photographs, figures, and charts illustrate the volume. ·
Pediatric Gastrointestinal Disease. 2nd ed Source: Philadelphia, PA: W.B. Saunders Company. 1999. 823 p. Contact: Available from W.B. Saunders Company. Book Order Fulfillment Department, 11830 Westline Industrial Drive, Saint Louis, MO 63146-9988. (800) 545-2522 or (314) 453-7010. Fax (800) 568-5136 or (314) 453-7095. E-mail:
[email protected]. Website: customerservice.wbsaunders.com. Price: $155.00 plus shipping and handling. ISBN: 0721674615. Summary: This medical textbook covers all facets of clinical pediatric gastrointestinal disease. The text emphasizes a clinical focus and incorporates anatomy and physiology considerations into each chapter rather than a separate section. The book is organized into distinct sections, starting with the common clinical problems and followed by organ specific diseases. General chapters on clinical problems cover chronic abdominal pain of childhood and adolescence, vomiting, diarrhea, constipation and encopresis (fecal soiling), failure to thrive, gastrointestinal hemorrhage, eating disorders and obesity, jaundice,
Books 121
ascites, caustic ingestion and foreign bodies, abdominal masses in pediatric patients, and abdominal surgical emergencies. Sections on diseases of the esophagus, stomach, and the small and large bowel (intestine) are followed by chapters reviewing the clinical facets of pediatric liver disease. Specific chapters include gastrointestinal reflux, achalasia and other motor disorders, congenital anomalies, gastric motility disorders, bezoars (a mass of food, hair or other components found in the stomach or intestine), maldigestion and malabsorption, celiac disease, short bowel syndrome, enteric parasites, Crohn's disease, ulcerative colitis, polyps, appendicitis, hernia, Hirschsprung's disease, neoplasms (cancerous and noncancerous), hepatitis, gallbladder diseases, and liver transplantation. The last two sections review diseases of the pancreas and basic nutrition in children, including pancreatitis, cystic fibrosis, nutritional assessment, parenteral (outside the digestive system, for example, intravenous nutrition) and enteral nutrition, and the management of diarrhea. Each chapter offers black and white photographs and figures and concludes with extensive references. A detailed subject index concludes the text. ·
Clinical Practice of Gastroenterology. Volume One Source: Philadelphia, PA: Current Medicine. 1999. 783 p. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 8746418 or (407) 352-3445. Website: www.wbsaunders.com. Price: $235.00 plus shipping and handling. ISBN: 0443065209 (two volume set); 0443065217 (volume 1); 0443065225 (volume 2). Summary: This lengthy textbook brings practitioners up to date on the complexities of gastroenterology practice, focusing on the essentials of patient care. This first volume includes 86 chapters in four sections: esophagus, stomach and duodenum, small bowel, and colon. Specific topics include normal esophageal physiology, gastroesophageal reflux disease (GERD), motor disorders of the esophagus, esophageal foreign bodies, esophagitis, esophageal trauma, esophageal surgery, gastric and duodenal histology and histopathology, gastroduodenal motility and motility disorders, abdominal pain, nausea and vomiting, dyspepsia (heartburn), Helicobacter pylori, gastric and duodenal ulcer, gastric cancer, gastric infection, gastric surgery, small intestine anatomy and physiology, symptoms and signs of small bowel disease, maldigestion and malabsorption, intestinal obstruction and pseudoobstruction, immunologic disorders, small intestinal malignancies (cancer), short bowel syndrome, Whipple's disease, infectious diarrhea, parasitic diseases of the small intestine, foodborne diseases of the small intestine,
122 Constipation
gastroenteritis, Crohn's disease, anatomy and physiology of the colon, irritable bowel syndrome (IBS), secretory diarrhea, constipation and fecal impaction, fecal incontinence, gas and flatulence, gastrointestinal bleeding, colitis (including ulcerative colitis), diverticulitis and diverticular hemorrhage, appendicitis, benign tumors of the colon and polyposis syndrome, malignant tumors of the colon, and anorectal disorders. The chapters include figures, algorithms, charts, graphs, radiographs, endoscopic pictures, intraoperative photographs, photomicrographs, tables, and extensive references. The volume concludes with a detailed subject index and a section of color plates. ·
Clinical Practice of Gastroenterology. Volume Two Source: Philadelphia, PA: Current Medicine. 1999. 861 p. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 8746418 or (407) 352-3445. Website: www.wbsaunders.com. Price: $235.00 plus shipping and handling. ISBN: 0443065209 (two volume set); 0443065217 (volume 1); 0443065225 (volume 2). Summary: This lengthy textbook brings practitioners up to date on the complexities of gastroenterology practice, focusing on the essentials of patient care. This second volume includes 113 chapters in five sections: liver, gallbladder and biliary tract, pancreas, pediatric gastroenterology, and special topics. Specific topics include hepatic (liver) structure and function, jaundice, viral hepatitis, alcoholic liver injury, liver tumors, parasitic diseases of the liver, Wilson's disease, hemochromatosis, the pregnancy patient with liver disease, portal hypertension, hepatic encephalopathy, fulminant hepatic failure, liver transplantation, the anatomy of the gallbladder and biliary tract, gallstones, laparoscopic cholecystectomy (gallbladder removal), cholecystitis (gallbladder infection), primary sclerosing cholangitis, biliary obstruction, pancreatic anatomy and physiology, acute pancreatitis, pancreatic fistulas and ascites (fluid accumulation), chronic pancreatitis, cancer of the pancreas, endoscopic retrograde cholangiopancreatography, esophageal atresia, gastroesophageal reflux in infants and children, achalasia and esophageal motility disorders, caustic and foreign body ingestion, vomiting, chronic abdominal pain, gastritis and peptic ulcer disease in children, malabsorption syndromes in children, inflammatory bowel disease in children and adolescents, acute appendicitis, cystic fibrosis, constipation and fecal soiling (incontinence), hepatitis in children, liver transplantation in children, failure to thrive, pediatric AIDS, the gastrointestinal manifestations of AIDS, the evaluation and management of acute upper gastrointestinal bleeding, principles of endoscopy, eating
Books 123
disorders, nutritional assessment, enteral and parenteral nutrition, gastrointestinal diseases in the elderly and in pregnancy, nosocomial infections, and the psychosocial aspects of gastroenterology (doctor patient interactions). The chapters include figures, algorithms, charts, graphs, radiographs, endoscopic pictures, intraoperative photographs, photomicrographs, tables, and extensive references. The volume concludes with a detailed subject index and a section of color plates. ·
Irritable Bowel Syndrome and the Mind-Body Brain-Gut Connection Source: Columbus, OH: Parkview Publishing. 1997. 302 p. Contact: Available from Parkview Publishing. P.O. Box 1103, Columbus, OH 43216. (888) 599-6464 or (614) 258-4848. Fax (614) 258-7272. Price: $19.95. ISBN: 0965703894. Summary: This book offers readers a guide to understanding and treating their functional gastrointestinal (GI) disorders, focusing on irritable bowel syndrome (IBS). The author emphasizes the role that individuals can play in managing their own symptoms and future. The book is framed around eight steps to positive change; eight chapters cover the GI tract and the mind-body connection; the common functional GI disorders; healing with diagnosis and education; understanding one's own symptoms and GI tract; identifying gut 'triggers'; emphasizing selfcare and wellness; taking action if symptoms persist; and managing the functional GI disorder. Specific topics include the interplay between stress, psychology and symptoms; colitis and inflammatory bowel disease (IBD); the International Foundation for Functional Gastrointestinal Disorders (IFFGD); self-tests for personal and psychological problems; the role of a history of abuse; cognitive behavioral factors; food and symptom diaries; food allergy versus food intolerance and sensitivity; inflammation and infection; the menstrual cycle; seasonal changes; nutrition; weight; exercise; the impact of alcohol, nicotine, and tobacco; the use of an elimination diet; stress, emotional, and psychological issues; chronic pain management; and managing the symptoms of chest pain, heartburn, dysphagia, dyspepsia, nausea, vomiting, aerophagia (burping and belching), abdominal bloating, rectal gas and flatulence, abdominal pain, diarrhea, constipation, bowel incontinence, and anal and rectal pain. The book includes black and white photographs, charts, and figures; a subject index concludes the volume.
·
Pediatric Clinical Gastroenterology. 4th ed Source: St. Louis, MO: Mosby-Year Book, Inc. 1995. 1065 p.
124 Constipation
Contact: Available from Mosby-Year Book, Inc. 11830 Westline Industrial Drive. St. Louis, MO 63146. (800) 426-4545 or (800) 325-4177 or (314) 8728370. Fax (314) 432-1380. Price: $100 (as of 1995). ISBN: 0815174063. Summary: This textbook of pediatric clinical gastroenterology presents 37 chapters in 5 sections: symptoms and signs; diseases of the gastrointestinal tract; diseases of the liver; diseases of the pancreas; and nutritional support. Specific topics include gastrointestinal (GI) emergencies of the neonate; intestinal obstruction; sucking and swallowing disorders; diseases of the esophagus; disorders of the stomach and duodenum; diarrheal disorders; carbohydrate intolerance; malabsorption syndrome; protein losing gastroenteropathy; immune homeostasis and the gut; inflammatory bowel diseases; constipation, fecal incontinence, and proctologic conditions; functional recurrent abdominal pain; parasitic and fungal disease of the GI tract; neonatal unconjugated hyperbilirubinemias; neonatal hepatitis; prolonged obstructive jaundice; acute and chronic viral hepatitis; bacterial, rickettsial, and parasitic infections and infestations; fulminant hepatic failure and hepatic coma; cirrhosis; portal hypertension; inborn errors of metabolism; hepatic tumors; liver transplantation; congenital anomalies and heredity disorders; cystic fibrosis; pancreatitis and pancreatic tumors; energy and nutrient requirements; infant feeding; and enteral and parenteral alimentation. Each chapter includes numerous references and a subject index concludes the volume. ·
Understanding Indigestion and Other Tummy Troubles Source: Woollahra, New South Wales, Australia: Health Books, Gore and Osment Publications. 1993. 64 p. Contact: Available from Health Books, Gore and Osment Publications, Private Box 427, 150 Queen Street, Woollahra, NSW 2025, Australia. (02) 361-5244. Fax (02) 360-7558. Price: $9.95 (as of 1995). ISBN: 187553136X. Summary: This book presents basic information on the causes and treatments of common stomach and digestive tract ailments. After an introductory section that reviews the anatomy and physiology of the gastrointestinal (GI) tract, the book features nine chapters on the following topics: indigestion; ulcers; food poisoning and other causes of upset stomachs and diarrhea; irritable bowel syndrome (IBS); inflammatory bowel disease (IBD); dealing with diverticular disease; bowel cancer; other GI problems, including hiccups, gas, hepatitis, food allergies, appendicitis, and sexually transmitted diseases of the bowel; and children's GI problems, including colic, food intolerance, gastroenteritis, reflux, celiac disease, constipation, IBS, IBD, polyps, and phantom pains. The book is written in clear, easy-to-understand
Books 125
language and focuses on practical, self-care tips for many of the disorders covered. ·
Let's Get Things Moving: Overcoming Constipation Source: Woollahra, New South Wales, Australia: Health Books, Gore and Osment Publications. 1992. 72 p. Contact: Available from Health Books, Gore and Osment Publications, Private Box 427, 150 Queen Street, Woollahra, NSW 2025, Australia. (02) 361-5244. Fax (02) 360-7558. PRICE: $9.95 (Australian). ISBN: 1875531238. Also available from National Association for Continence (formerly Help For Incontinent People). P.O. Box 8310, Spartanburg, SC 29305-8310. (800) BLADDER or (864) 579-7900. Fax (864) 579-7902. Price: $9.95 plus $2.00 shipping (as of 1996). Summary: This book on managing constipation is from a series of health books that provide straightforward, easy to understand information on a variety of health issues. Eleven chapters address the definition of constipation, its symptoms, and incidence; physiology of defecation; bowel anatomy; causes of constipation, including travel, changes in routine, food and nutrition, pain, the menstrual cycle, and pregnancy; acute and chronic constipation in children; causes of constipation in the elderly; self-help strategies; the role of fiber; slow transit constipation; obstructed defecation; pelvic floor muscles; good defecation dynamics; diagnostic tests used to confirm bowel dysfunction; and surgical options for treatment, including rubber banding, sphincterotomy, rectopexy, proctectomy, colectomy, colostomy, and ileostomy. The book concludes with a glossary of terms. Simple, sometimes humorous, line drawings illustrate many of the concepts presented.
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes & Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). The following have been recently listed with online booksellers as relating to constipation (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com):
126 Constipation
·
All You Wanted to Know About Constipation by Savitri Ramaiah; ISBN: 812072223X; http://www.amazon.com/exec/obidos/ASIN/812072223X/icongroupi nterna
·
Childhood Encopresis and Enuresis: Causes and Therapy by Charles E., Ph.D. Schaefer (1995); ISBN: 1568210736; http://www.amazon.com/exec/obidos/ASIN/1568210736/icongroupin terna
·
Conquer Constipation-The Father and Mother of All Diseases: Confidential Report by Edwin Flatto (1988); ISBN: 0935540008; http://www.amazon.com/exec/obidos/ASIN/0935540008/icongroupin terna
·
Conquering constipation : the natural guide to intestinal health by Alan Moyle; ISBN: 0722503202; http://www.amazon.com/exec/obidos/ASIN/0722503202/icongroupin terna
·
Constipation by Gary S. Ross; ISBN: 1891875000; http://www.amazon.com/exec/obidos/ASIN/1891875000/icongroupin terna
·
Constipation by Michael A. Kamm, John E. Lennard-Jones (Editor) (1994); ISBN: 1871816246; http://www.amazon.com/exec/obidos/ASIN/1871816246/icongroupin terna
·
Constipation and Anto-Rectal Insufficiency (Falk Symposium , Vol 95) by K. Ewe (Editor), et al (1997); ISBN: 0792387279; http://www.amazon.com/exec/obidos/ASIN/0792387279/icongroupin terna
·
Constipation and Fecal Incontinence and Motility Disturbances of the Gut (Progress in Pediatric Surgery, Vol 24) by J. Yokoyama, T.A. Angerpointner (Editor) (1989); ISBN: 0387508139; http://www.amazon.com/exec/obidos/ASIN/0387508139/icongroupin terna
·
Constipation and Indigestion: Prevention and Cure by L. Ramachandran (1985); ISBN: 0318363607; http://www.amazon.com/exec/obidos/ASIN/0318363607/icongroupin terna
·
Constipation Control: An Exercise Program to Achieve Regularity by Richard R. Fuller (1981); ISBN: 0682496901; http://www.amazon.com/exec/obidos/ASIN/0682496901/icongroupin terna
Books 127
·
Constipation in Childhood by Graham Clayden, Ulfur Agnaarsson (1991); ISBN: 0192620444; http://www.amazon.com/exec/obidos/ASIN/0192620444/icongroupin terna
·
Constipation, piles, and other bowel disorders by Richard Heatley; ISBN: 0443029156; http://www.amazon.com/exec/obidos/ASIN/0443029156/icongroupin terna
·
Constipation: A New Reading on the Subject by J. H. Tilden (1998); ISBN: 1564598101; http://www.amazon.com/exec/obidos/ASIN/1564598101/icongroupin terna
·
Constipation: Etiology, Evaluation and Management by Steven D. Wexner, David C.C. Bartolo (Editor); ISBN: 0750607769; http://www.amazon.com/exec/obidos/ASIN/0750607769/icongroupin terna
·
Constipation--World-Wide Afflictions: Index of New Information and Guide-Book for Consumers, Reference and Research by Brenda Yola, Dr Brandis (2002); ISBN: 0788326457; http://www.amazon.com/exec/obidos/ASIN/0788326457/icongroupin terna
·
Constipation--World-Wide Afflictions: Index of New Information and Guide-Book for Consumers, Research and Reference by Brenda Yola, Dr Brandis (2002); ISBN: 0788326449; http://www.amazon.com/exec/obidos/ASIN/0788326449/icongroupin terna
·
Definite Cure of Chronic Constipation Also Overcoming Constipation Naturally by Arnold Ehret (2002); ISBN: 0879040327; http://www.amazon.com/exec/obidos/ASIN/0879040327/icongroupin terna
·
Diarrhoea and Constipation in Geriatric Practice by Ranjit N. Ratnaike (Editor); ISBN: 0521653886; http://www.amazon.com/exec/obidos/ASIN/0521653886/icongroupin terna
·
Die Zèurcher Constipation : Texte aus der extremen Mitte des Wohlstands by Isolde Schaad; ISBN: 3857911158; http://www.amazon.com/exec/obidos/ASIN/3857911158/icongroupin terna
128 Constipation
·
Diets to help constipation by Alan Moyle; ISBN: 072250151X; http://www.amazon.com/exec/obidos/ASIN/072250151X/icongroupi nterna
·
Dr. Jensen's Guide to Better Bowel Care: A Complete Program for Tissue Cleansing Through Bowel Management by Bernard Jensen (1998); ISBN: 0895295849; http://www.amazon.com/exec/obidos/ASIN/0895295849/icongroupin terna
·
Gastrointestinal Health : A Self-Help Nutritional Program to Prevent, Cure, or Alleviate Irritable Bowel Syndrome, Ulcers, Heartburn, Gas, Constipation by Steven R. Peikin (1992); ISBN: 0060984058; http://www.amazon.com/exec/obidos/ASIN/0060984058/icongroupin terna
·
Healthy Digestion the Natural Way: Preventing and Healing Heartburn, Constipation, Gas, Diarrhea, Inflammatory Bowel and Gallbladder Diseases, Ulcers, Irritable Bowel Syndrome, and More by D. Lindsey Berkson, et al; ISBN: 0471349623; http://www.amazon.com/exec/obidos/ASIN/0471349623/icongroupin terna
·
Healthy Digestion: A Natural Approach to Relieving Indigestion, Gas, Heartburn, Constipation, Colitis & More by David Hoffmann, David Hoffman; ISBN: 1580172504; http://www.amazon.com/exec/obidos/ASIN/1580172504/icongroupin terna
·
Herbs for constipation by William Smith; ISBN: 0722503245; http://www.amazon.com/exec/obidos/ASIN/0722503245/icongroupin terna
·
Herbs for Improved Digestion: Herbal Remedies for Stomach Pain, Constipation, Ulcers, Colitis, and Other Gastrointestinal Problems by C. J. Puotinen; ISBN: 0585128405; http://www.amazon.com/exec/obidos/ASIN/0585128405/icongroupin terna
·
Herbs for Improved Digestion: Herbal Remedies for Stomach Pain, Constipation, Ulcers, Colitis, and Other Gastrointestinal Problems (Keats Good Herb g by C. J. Puotinen (1996); ISBN: 087983742X; http://www.amazon.com/exec/obidos/ASIN/087983742X/icongroupi nterna
·
Inner Hygiene: Constipation and the Pursuit of Health in Modern Society by James C. Whorton (2000); ISBN: 0195135814;
Books 129
http://www.amazon.com/exec/obidos/ASIN/0195135814/icongroupin terna ·
Laxatives: A Practical Guide by Francesco Capasso, Timothy S. Gaginella; ISBN: 3540750371; http://www.amazon.com/exec/obidos/ASIN/3540750371/icongroupin terna
·
Management of constipation by Francis Avery Jones; ISBN: 063206580X; http://www.amazon.com/exec/obidos/ASIN/063206580X/icongroupi nterna
·
Natural Relief from Constipation: Using Herbal Remedies, Diet, and Exercise to Promote Good Colon Health and Restore Balance to the Body (Good health by Donna Dimarco (1999); ISBN: 0879839589; http://www.amazon.com/exec/obidos/ASIN/0879839589/icongroupin terna
·
Put Hemorrhoids and Constipation Behind You: New Treatment and Technology for 2 of Today's Most Common Yet Least Talked-About Problems by Kenneth Yasny, Kenneth Yasney (1997); ISBN: 1884820220; http://www.amazon.com/exec/obidos/ASIN/1884820220/icongroupin terna
·
The health of women : anaemia, cystitis, backache, constipation, piles, indigestion, nerves, the change, sex in middle age by Wendy Greengross; ISBN: 0900221968; http://www.amazon.com/exec/obidos/ASIN/0900221968/icongroupin terna
·
The Miracle Nutrient: How Dietary Fiber Can Save Your Life by Carl I. Flath (1975); ISBN: 0871311860; http://www.amazon.com/exec/obidos/ASIN/0871311860/icongroupin terna
·
The Natural Laxative Cookbook by Karin Cadwell, et al (1995); ISBN: 0806913444; http://www.amazon.com/exec/obidos/ASIN/0806913444/icongroupin terna
·
The Zen of Bowel Movements by Kathy A. Price; ISBN: 0964290669; http://www.amazon.com/exec/obidos/ASIN/0964290669/icongroupin terna
130 Constipation
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “constipation” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:25 ·
Biofeedback for the treatment of constipation in children. ECRI; Year: 1998; Plymouth Meeting, PA: ECRI, 1998
·
Cause and cure of headaches, backaches and constipation, by William S. Sadler ... and Lena K. Sadler ... Author: Sadler, William Samuel, 1875; Year: 1938; Chicago, American publishers corporation, 1938
·
Childhood encopresis and enuresis: causes and therapy. Author: Charles E. Schaefer; Year: 1979; New York: Van Nostrand Reinhold, c1979; ISBN: 0442245041 http://www.amazon.com/exec/obidos/ASIN/0442245041/icongroupin terna
·
Conquering constipation: the natural guide to intestinal health. Author: by Alan Moyle; Year: 1976; Wellingborough, Eng.: Thorsons, c1976; ISBN: 0722503202 http://www.amazon.com/exec/obidos/ASIN/0722503202/icongroupin terna
·
Constipation: etiology, evaluation, and management. Author: edited by Steven D. Wexner, David C.C. Bartolo; Year: 1995; Oxford; Boston: Butterworth-Heinemann, 1995; ISBN: 0750607769 http://www.amazon.com/exec/obidos/ASIN/0750607769/icongroupin terna
·
Constipation: its causes and cures. Author: Jacques Thiroloix; Year: 1976; New York: St. Martin's Press, c1976
Author:
In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
25
Books 131
·
Constipation and fecal incontinence and motility disturbances of the gut. Author: volume editors, J. Yokoyama, T.A. Angerpointner; Year: 1989; Berlin; New York: Springer-Verlag, c1989; ISBN: 0387508139 (U.S.: alk. paper) http://www.amazon.com/exec/obidos/ASIN/0387508139/icongroupin terna
·
Constipation in childhood. Author: Graham Clayden and Ulfur Agnarsson; Year: 1991; Oxford; New York: Oxford University Press, 1991; ISBN: 0192620444 http://www.amazon.com/exec/obidos/ASIN/0192620444/icongroupin terna
·
Constipation in the elderly: with special reference to the treatment with magnesium hydroxide and a bulk laxative. Author: Osmo Kinnunen; Year: 1990; Oulu: University of Oulu, 1990; ISBN: 9514229681
·
Constipation is a disease = El estreñimiento es una enfermedad. Author: Fernando Padrón, Basilio Anía; Year: 1995; Barcelona: Editorial JIMS, 1995; ISBN: 8460517160
·
Constipation, piles, and other bowel disorders. Author: Richard Heatley; foreword by Denis Burkitt; cartoons by David Nathanson; Year: 1984; Edinburgh; New York: Churchill Livingstone, 1984; ISBN: 0443029156 (pbk.) http://www.amazon.com/exec/obidos/ASIN/0443029156/icongroupin terna
·
Constipation. Author: Ingo Füsgen; Year: 1993; München: MMV Medizin Verlag, c1993; ISBN: 3820812164
·
Constipation. Author: edited by Michael A. Kamm and John E. LennardJones; Year: 1994; Petersfield, UK; Bristol, PA, USA: Wrightson Biomedical Pub., c1994; ISBN: 1871816246 (cloth): http://www.amazon.com/exec/obidos/ASIN/1871816246/icongroupin terna
·
Constipation; its prevention and natural cure. Kenneth; Year: 1949; [Lewes, Sussex, 1949]
·
Crippled colon; causes, consequences, remedies. Author: Kellogg, John Harvey, 1852-1943; Year: 1931; Battle Creek, Mich., Modern Medicine Pub. Co., 1931
·
Diarrhoea and constipation in geriatric practice. Author: edited by Ranjit N. Ratnaike; foreword by Gary R. Andrews; Year: 1999; Cambridge, UK; New York, NY: Cambridge University Press, 1999; ISBN: 0521653886 (pbk.) http://www.amazon.com/exec/obidos/ASIN/0521653886/icongroupin terna
Author: Trueman,
132 Constipation
·
Disorders of the intestines; the causes and cures of constipation and diarrhoea. Author: Vander, Adrián, pseud; Year: 1939; London, Pearson [1939]
·
Effectiveness of laxatives in adults. ; Year: 2001; York [England]: University of York, NHS Centre for Reviews and Dissemination; [London]: Published in association with Royal Society of Medicine Press, c2001
·
Faecal incontinence and related problems in the older adult. Author: J.A. Barrett; Year: 1993; London; Boston: E. Arnold; Boston, MA: Distributed in the Americas by Little, Brown, 1993; ISBN: 0340543612 http://www.amazon.com/exec/obidos/ASIN/0340543612/icongroupin terna
·
Herbal treatment for constipation. Author: Vaidya Bhagwan Dash; Year: 1988; New Delhi: B. Jain Publishers, 1988
·
Herbs for constipation. Author: by William Smith; Year: 1976; Wellingborough, Eng.: Thorsons, 1976; ISBN: 0722503245 http://www.amazon.com/exec/obidos/ASIN/0722503245/icongroupin terna
·
Hindu-Yogi system of practical water cure: as practiced in India and other oriental countries: a condensed system for self treatment. Author: by Yogi Ramacharaka; Year: 1909; Chicago, Ill.: The Yogi Publication Society ..., c1909
·
Homoeopathic treatment of constipation. Author: by H. Bernard; translated and revised from the second Belgian edition, with additions and clinical cases from American sources by T.M. Strong; Year: 1882; New Delhi: B. Jain, 1995; ISBN: 8170216672
·
I know just the thing for that. By J. F. Montague ... Author: Montague, Joseph Franklin, 1893-; Year: 1934; New York, The John Day company [c1934]
·
Inner hygiene: constipation and the pursuit of health in modern society. Author: James C. Whorton; Year: 2000; Oxford; New York: Oxford University Press, 2000; ISBN: 0195135814 (cloth: alk. paper) http://www.amazon.com/exec/obidos/ASIN/0195135814/icongroupin terna
·
Intestinal fitness; a complete revision of James C. Thomson's Constipation and our civilisation (Two health problems). Author: Thomson, C. Leslie (Charles Leslie); Year: 1961; London, Thorson [1961]
·
Laxatives: a practical guide. Author: Francesco Capasso, Timothy S. Gaginella; Year: 1997; Milano; New York: Springer, c1997; ISBN: 3540750371 (soft cover)
Books 133
http://www.amazon.com/exec/obidos/ASIN/3540750371/icongroupin terna ·
New physiologic approach in the treatment of gastrointestinal dysfunction and constipation; a series of pertinent original monographs. Author: Professional Laboratories, inc., New York; Year: 1937; [New York, c1937]
·
Two health problems: constipation and our civilisation. Author: Thomson, James C. (James Charles); Year: 1954; London, Thorsons [1954]
Chapters on Constipation Frequently, constipation will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with constipation, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and constipation using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “constipation” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on constipation: ·
Evidence-Based Therapy of Irritable Bowel Syndrome Source: in Manu, P. Pharmacotherapy of Common Functional Syndromes: Evidence-Based Guidelines for Primary Care Practice. Binghamton, NY: Haworth Medical Press. 2000. p. 175-177. Contact: Available from Haworth Medical Press, an imprint of Haworth Press, Inc. 10 Alice Street, Binghamton, New York 13904-1580. (800) HAWORTH or (800) 429-6784. Outside United States and Canada (607) 722-5857. Fax (800) 895-0582. E-mail:
[email protected]. Website: www.haworthpressinc.com. Price: $69.95 plus shipping and handling. ISBN: 0789005883. Summary: This chapter is from a book that evaluates drug therapies for each of the four major functional disorders: chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome (IBS), and premenstrual syndrome. In this chapter, the final of six short chapters that focus on IBS, the author reviews evidence based therapy for IBS. The author contradicts present thinking that drug therapy for IBS should focus on
134 Constipation
the most disturbing symptoms, using loperamide for diarrhea, fiber for constipation, and anticholinergic agents for pain. The author, instead, contends that research studies do not provide support for the effectiveness of these drug approaches. Because evidence indicates that tricyclic antidepressants are effective for the totality of this illness, the author contends that these drugs should constitute the first line treatment in all cases in which the severity of the syndrome warrants intervention, provided that there are no contraindications to the use of these agents and that the potential for drug interactions has been considered. Monotherapy with amitriptyline or desipramine should be initiated with a starting dose of 10 mg administered once a day in patients with the diarrhea predominant variant of the syndrome. Adjunctive therapy with a bulking agent may lead to a decrease in the overall severity of the syndrome in all patients and ease the bowel habit and stool passage in those with the constipation predominant variant of the syndrome. ·
Gastroesophageal Reflux Disease (GERD) Source: in King, J.E., ed. Mayo Clinic on Digestive Health. Rochester, MN: Mayo Clinic. 2000. p. 61-76. Contact: Available from Mayo Clinic Health Information. 5505 36th Street, SE, Grand Rapids, MI 49512. (800) 291-1128. Website: www.mayoclinic.com. Price: $14.95 plus shipping and handling. ISBN: 1893005046. Summary: This chapter on gastroesophageal reflux disease (GERD) is from a comprehensive guidebook from the Mayo Clinic that focuses on a variety of digestive symptoms, including heartburn, abdominal pain, constipation, and diarrhea, and the common conditions that are often responsible for these symptoms. Written in nontechnical language, the book includes practical information on how the digestive system works, factors that can interfere with its normal functioning, and how to prevent digestive problems. This chapter first reviews the key signs and symptoms of GERD, including heartburn, acid reflux (return of the stomach's acid contents to the esophagus), difficulty swallowing, chest pain, persistent coughing, and hoarseness. The authors describe the anatomy of the stomach and esophagus and the lower esophageal sphincter, which serves as the doorway between them. The authors then note the potential risk factors for getting GERD: being overweight, family history, hiatal hernia, smoking, excessive alcohol, pregnancy, asthma, diabetes, peptic ulcer, delayed stomach emptying, connective tissue disorders, and Zollinger-Ellison syndrome. The chapter also reviews the complications of untreated GERD, which include esophageal narrowing (stricture), ulcer, and Barrett's esophagus (a precancerous condition of the
Books 135
esophagus). One sidebar reviews drugs and supplements that can worsen the symptoms of GERD; a section in the chapter also covers medications that can help, including antacids, acid blockers, proton pump inhibitors (PPIs), and motility (prokinetic) agents. A final section briefly reviews the surgical options for treating GERD. 4 figures. ·
Crohn's Disease and Ulcerative Colitis Source: in King, J.E., ed. Mayo Clinic on Digestive Health. Rochester, MN: Mayo Clinic. 2000. p. 99-114. Contact: Available from Mayo Clinic Health Information. 5505 36th Street, SE, Grand Rapids, MI 49512. (800) 291-1128. Website: www.mayoclinic.com. Price: $14.95 plus shipping and handling. ISBN: 1893005046. Summary: This chapter on Crohn's disease and ulcerative colitis (the two most common inflammatory bowel diseases, IBD) is from a comprehensive guidebook from the Mayo Clinic that focuses on a variety of digestive symptoms, including heartburn, abdominal pain, constipation, and diarrhea, and the common conditions that are often responsible for these symptoms. Written in nontechnical language, the book includes practical information on how the digestive system works, factors that can interfere with its normal functioning, and how to prevent digestive problems. This chapter first reviews the key signs and symptoms of IBD, including diarrhea, abdominal pain and cramping, blood in the stool (feces), fatigue, reduced appetite, weight loss, and fever. The authors note that although these diseases often cannot be cured, they can be treated. There are several therapies that may drastically reduce the patient's symptoms, and possibly even bring about a long term remission. The chapter outlines the differences between the two diseases (Crohn's disease can strike anywhere from the mouth to the anus; ulcerative colitis is typically limited to the colon and rectum), reviews theories about the causes of these problems, and offers classification systems to determine if the disease is mild, moderate or severe. Diagnostic tests used to confirm the presence of IBD include blood tests, X rays, and colonoscopy (which can include biopsy). Medications can effectively reduce symptoms in most people with IBD; drugs used include antiinflammatory drugs (sulfasalazine, mesalazine, olsalazine, corticosteroids), immunosuppressants (such as azathioprine, methotrexate, and cyclosporine), antibiotics (notably metronidazole and ciprofloxacin), nicotine patches, antidiarrheals, laxatives, pain relievers, iron supplements, and vitamin B12 injections. The chapter concludes with suggestions for lifestyle modifications that can help people cope
136 Constipation
with IBD and a section explaining the surgical options that may be used for IBD that is not responsive to other treatments. 1 figure. ·
Celiac Disease Source: in King, J.E., ed. Mayo Clinic on Digestive Health. Rochester, MN: Mayo Clinic. 2000. p. 115-124. Contact: Available from Mayo Clinic Health Information. 5505 36th Street, SE, Grand Rapids, MI 49512. (800) 291-1128. Website: www.mayoclinic.com. Price: $14.95 plus shipping and handling. ISBN: 1893005046. Summary: Celiac disease damages the small intestine and interferes with its ability to absorb certain nutrients from food. People with celiac disease cannot tolerate gluten, a protein found in wheat, barley, rye, and, possibly, oats. This chapter on celiac disease is from a comprehensive guidebook from the Mayo Clinic that focuses on a variety of digestive symptoms, including heartburn, abdominal pain, constipation, and diarrhea, and the common conditions that are often responsible for these symptoms. Written in nontechnical language, the book includes practical information on how the digestive system works, factors that can interfere with its normal functioning, and how to prevent digestive problems. This chapter first reviews the key signs and symptoms of celiac disease, including diarrhea, abdominal gas and bloating, fatigue, weight loss, and stunted growth (in children with celiac disease). The authors review the inheritance of the condition, the various symptoms that may present with celiac disease, and the main treatment, a diet that is completely without gluten (gluten free). The authors encourage readers to learn about food labeling and caution that food processing may need to be considered when determining if a particular food is gluten free. Other sections offer strategies for eating out at restaurants while following a gluten free diet, and for adapting favorite recipes to be gluten free. Sidebars review the differences between celiac disease and similar conditions, the interrelationship between celiac disease and lactose intolerance (difficulty in digesting the sugars present in dairy products), and hidden sources of gluten. 1 figure.
·
Gallstones Source: in King, J.E., ed. Mayo Clinic on Digestive Health. Rochester, MN: Mayo Clinic. 2000. p. 133-142. Contact: Available from Mayo Clinic Health Information. 5505 36th Street, SE, Grand Rapids, MI 49512. (800) 291-1128. Website:
Books 137
www.mayoclinic.com. Price: $14.95 plus shipping and handling. ISBN: 1893005046. Summary: This chapter on gallstones (cholelithiasis) is from a comprehensive guidebook from the Mayo Clinic that focuses on a variety of digestive symptoms, including heartburn, abdominal pain, constipation, and diarrhea, and the common conditions that are often responsible for these symptoms. Written in nontechnical language, the book includes practical information on how the digestive system works, factors that can interfere with its normal functioning, and how to prevent digestive problems. This chapter first reviews the key signs and symptoms of gallstones, including upper abdominal pain; pain in the back, chest, or right shoulder blade; and nausea and vomiting. Gallbladder pain, commonly called a gallbladder attack, occurs when stones in the gallbladder become lodged in the neck of the gallbladder or the cystic duct and obstruct the gallbladder's opening. This leads to a buildup of pressure in the gallbladder as it slowly contracts, causing constant pain and often nausea. The authors review how gallstones form and the three most common types: cholesterol stones, pigment stones, and primary bile duct stones. Risk factors for gallstones include being female, excess weight, diet and dieting (diet high in fat and sugar, fasting, and rapid weight loss diets are particularly risky), age, family history, and ethnic group. Gallstones are diagnosed with the assistance of ultrasound, computed tomography (CT scan), radionuclide scan, blood tests, and endoscopic retrograde cholangiopancreatography (ERCP). Treatment options range from watchful waiting to bile salt tablets, MTBE (methyl tertiary butyl ether) injection, sound wave therapy (extracorporeal shock wave lithotripsy), to surgery, either open or through the use of laparoscopy. One sidebar reviews the home remedies that are purported to prevent gallstones (none are supported), noting that the best preventive steps are to maintain a healthy weight and avoid crash diets. 1 figure. ·
Pancreatitis Source: in King, J.E., ed. Mayo Clinic on Digestive Health. Rochester, MN: Mayo Clinic. 2000. p. 143-150. Contact: Available from Mayo Clinic Health Information. 5505 36th Street, SE, Grand Rapids, MI 49512. (800) 291-1128. Website: www.mayoclinic.com. Price: $14.95 plus shipping and handling. ISBN: 1893005046. Summary: This chapter on pancreatitis (inflammation of the pancreas) is from a comprehensive guidebook from the Mayo Clinic that focuses on a variety of digestive symptoms, including heartburn, abdominal pain,
138 Constipation
constipation, and diarrhea, and the common conditions that are often responsible for these symptoms. Written in nontechnical language, the book includes practical information on how the digestive system works, factors that can interfere with its normal functioning, and how to prevent digestive problems. This chapter first reviews the key signs and symptoms of pancreatitis, which include abdominal pain, nausea and vomiting, fever, bloating and gas, foul-smelling, loose, oily, or bulky stools (feces), and weight loss. The authors describe the physiologic role of the pancreas, then differentiate between acute pancreatitis, which occurs when digestive enzymes produced in the pancreas remain and activate in the pancreas, irritating and inflaming delicate pancreatic tissues, and chronic pancreatitis, which is more difficult to recognize but can result in serious consequences (including diabetes) over time. The two most common known causes for pancreatitis are excessive alcohol use and gallstones. Treatment for acute pancreatitis centers on controlling the pain, allowing the pancreas to rest (intravenous fluids and nutrition), and restoring a normal balance of pancreatic juices (which can include surgery to remove gallstones). Complications of acute pancreatitis include infection, pseudocysts, and abscess. The main goals of treatment for chronic pancreatitis are to control pain and treat malabsorption problems (with enzyme supplementation and treatment for any diabetes). The chapter concludes with strategies for people with chronic pancreatitis to follow: avoid alcohol, eat smaller meals, limit dietary fat, follow a high carbohydrate diet, find safe ways to control pain, and think positively. 1 figure. ·
Everything You Ever Wanted to Ask a Gastroenterologist Source: in Magee, E. Tell Me What to Eat If I Have Irritable Bowel Syndrome. Franklin Lakes, NJ: Career Press, Inc. 2000. p. 12-23. Contact: Available from Career Press, Inc. 3 Tice Road, P.O. Box 687, Franklin Lakes, NJ 07417. (800) 227-3371. Website: www.careerpress.com or www.newpagebooks.com. Price: $10.99 plus shipping and handling. Summary: This chapter is from a book that offers eating and nutrition guidelines for people who have been diagnosed with irritable bowel syndrome (IBS). People with IBS have bowels that tend to overreact in certain situations. Whatever affects the bowels of the population at large, such as diet, hormones, or stress, affects those of people with IBS even more, resulting in the symptoms of the disorder. This introductory chapter answers common questions about IBS ('everything you ever wanted to ask a gastroenterologist'). IBS is described as a common disorder of the intestines that can lead to crampy abdominal pain, gassiness (flatulence), bloating, changes in bowel habits (diarrhea,
Books 139
constipation, or both), a feeling of incomplete emptying of the bowel, and passing mucus with bowel movements. The symptoms range from mildly annoying (for most patients) to disabling (for a few patients), and tend to fluctuate over time. The author explores the hypotheses for the causes of IBS, including a trigger such as flu or food poisoning, the role of hormones (many women have more IBS symptoms during their menstruation), genetics, childhood constipation and colic, and childhood physical or sexual abuse. There is no standard way of treating IBS and there is no drug available to cure the discomfort of an irritable bowel. There are some medications that can help relieve symptoms in some people. Stress may worse IBS symptoms by stimulating colonic spasm is people with IBS. Three types of psychotherapy may be helpful for IBS patients: brief psychodynamic therapy, cognitive behavioral therapy, and hypnosis. The author cautions that some symptoms (gastrointestinal bleeding, fever, weight loss, nocturnal symptoms, fecal incontinence, persistent severe pain) are not part of IBS and may indicate another problem that should be investigated. 2 tables. 1 reference. ·
Main Symptoms of Irritable Bowel Syndrome Source: in Magee, E. Tell Me What to Eat If I Have Irritable Bowel Syndrome. Franklin Lakes, NJ: Career Press, Inc. 2000. p. 24-29. Contact: Available from Career Press, Inc. 3 Tice Road, P.O. Box 687, Franklin Lakes, NJ 07417. (800) 227-3371. Website: www.careerpress.com or www.newpagebooks.com. Price: $10.99 plus shipping and handling. Summary: This chapter is from a book that offers eating and nutrition guidelines for people who have been diagnosed with irritable bowel syndrome (IBS). People with IBS have bowels that tend to overreact in certain situations. Whatever affects the bowels of the population at large, such as diet, hormones, or stress, affects those of people with IBS even more, resulting in the symptoms of the disorder. This chapter describes the main symptoms of IBS, which include abdominal pain, irregular pattern of defecation at least 25 percent of the time, constipation, diarrhea, mucus in the stool, abdominal bloating or swelling, the feeling of incomplete emptying rectum, and gas attacks (flatulence). The author notes that, for many women, IBS symptoms seem to worsen during their periods (menstruation). Therefore, right before and during one's period, it is especially important to avoid trigger foods or stressors that seem to bring on or aggravate bowel symptoms. The chapter concludes with a brief discussion of common IBS symptoms that occur in other parts of the body. These can include heartburn, sleep disturbances, fatigue, bladder or urinary problems, non cardiac chest pain, nausea or bloating, pain in
140 Constipation
the upper abdomen, migraine headaches, painful intercourse, and fibromyalgia. ·
Solving Gastrointestinal Problems Source: in Touchette, N. Diabetes Problem Solver. Alexandria, VA: American Diabetes Association. 1999. p. 249-262. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 442-9742. Website: www.diabetes.org. Price: $19.95 for members; plus shipping and handling. ISBN: 1570400091. Summary: This chapter on solving gastrointestinal (GI) problems is from a patient education handbook on managing diabetes related problems. People with diabetes are more likely to have neuropathy (nerve damage) and experience problems with the GI tract, from the mouth to the rectum. The author discusses gastroparesis (delayed GI motility, particularly stomach emptying), gastroesophageal reflux (stomach acid backing up into the esophagus), diarrhea (and fecal incontinence), constipation, and abdominal pain. For each condition, the author describes the symptoms, provides suggestions for handling the problem, outlines treatment options, and discusses preventive strategies. The diagnostic tests for these conditions are described, including stomach emptying tests, gastroscopy, tests for neuropathy, food diaries, and upper GI x-ray. The chapter is written to help patients understand these GI problems and enable them to incorporate practical preventive strategies into their daily lives.
·
Constipation, Megacolon, and Fecal Impaction Source: in Brandt, L., et al., eds. Clinical Practice of Gastroenterology. Volume One. Philadelphia, PA: Current Medicine. 1999. p. 626-636. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 8746418 or (407) 352-3445. Website: www.wbsaunders.com. Price: $235.00 plus shipping and handling. ISBN: 0443065209 (two volume set); 0443065217 (volume 1); 0443065225 (volume 2). Summary: Constipation is a common symptom and is most common in women and persons with underlying medical conditions, limited diets, immobility, and advanced age. Although constipation is usually mild and is often little more than a nuisance, megacolon (abnormally large or dilated colon) and impaction can become difficult management problems and may lead to life threatening complications such as volvulus (intestinal obstruction caused by twisting of the bowel), stercoral ulcers, perforation, and malnutrition. This chapter on constipation, megacolon,
Books 141
and fecal impaction is from a lengthy textbook that brings practitioners up to date on the complexities of gastroenterology practice, focusing on the essentials of patient care. The authors contend that the major clinical challenge presented by the patient complaining of constipation is differentiating mild, inconsequential symptoms from more severe problems. The authors discuss definitions of constipation, epidemiology, mechanisms of constipation (secondary constipation and megacolon, medications, metabolic disorders, neurologic disorders, connective tissue disorders, paraneoplastic syndromes, acute colonic pseudoobstructions), primary or idiopathic chronic constipation, the diagnostic approach to constipation, and treatment options including retraining and biofeedback, and surgery for chronic constipation. 4 figures. 3 tables. 26 references. ·
Diarrhea and Constipation Source: in Janowitz, H.D. Good Food for Bad Stomachs. New York, NY: Oxford University Press. 1997. p. 110-127. Contact: Available from Oxford University Press. Order Department, 2001 Evans Road, Cary, NC 27513. (800) 451-7556. Fax (919) 677-1303. Price: $12.95 plus shipping and handling. ISBN: 0195126556. Summary: This chapter on diarrhea and constipation is from a book that presents a detailed look at present knowledge about the role of eating habits in preventing, causing, and treating the many disorders that plague the gastrointestinal tract and its associated digestive glands, the liver, the gallbladder, and the pancreas. Diarrhea is defined as bowel movements that occur too often and are too loose, constipation as difficulty in moving one's bowels. To put these definitions into proper perspective, the author notes that the number of bowel movements that normal people in good health can pass varies tremendously, ranging from two to three a day to two to three a week. Therefore, instead of comparing themselves with others, people should look for deviations from their ordinary routines both in number and consistency of the stool. Topics include acute diarrhea, its symptoms, causes, and treatment; what to eat during acute episodes of diarrhea; food poisoning; traveler's diarrhea and how to avoid it; parasites in the stool; secretory diarrhea; food intolerance as a cause of diarrhea; antibiotic associated diarrhea; constipation, its causes and treatments; the role of dietary fiber and treatment with a high fiber diet; the unique role of bran; lubricants; enemas; and fluid intake. 2 tables.
142 Constipation
·
Gastrointestinal Function and Diseases Source: in Byyny, R.L. and Speroff, L. Clinical Guide for the Care of Older Women: Primary and Preventive Care. 2nd ed. Baltimore, MD: Williams and Wilkins. 1996. p. 353-363. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (800) 638-6423 or (410) 528-8555. Fax (800) 4478438. Price: $69.00. ISBN: 0683011510. Summary: This chapter on gastrointestinal function and diseases is from a clinical guidebook for the primary and preventive care of older women. Topics include gastrointestinal changes with aging; esophageal disease, including presbyesophagus, cricopharyngeal achalasia, hiatal hernia and esophageal reflux, achalasia, and esophageal infection; peptic ulcers; nonulcer dyspepsia; diseases of the colon, including diverticular disease, colorectal neoplasms, functional bowel disease, constipation, diarrhea, hemorrhoids and anal fissures; and diseases of the liver, including viral hepatitis, hepatotoxicity from medication, cirrhosis, and cholelithiasis. 33 references.
Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to constipation have been published that consolidate information across various sources. These too might be useful in gaining access to additional guidance on constipation. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:26 ·
Directory of Plain Language Health Information Source: Ottawa, Ontario: Canadian Public Health Association. 1999. 104 p.
Contact: Available from Canadian Public Health Association. 400-1565 Carling Avenue, Ottawa, Ontario, K1Z 8R1. (613) 725-3769. Fax (613) 725You will need to limit your search to “Directories” and constipation using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find directories, use the drop boxes at the bottom of the search page where “You may refine your search by”. For publication date, select “All Years”, select language and the format option “Directory”. By making these selections and typing in “constipation” (or synonyms) into the “For these words:” box, you will only receive results on directories dealing with constipation. You should check back periodically with this database as it is updated every three months. 26
Books 143
9826. E-mail:
[email protected]. PRICE: $19.95 plus shipping and handling. Also available at www.pls.cpha.ca for free. ISBN: 189432403X. Summary: Patient education materials are often written at a level that is higher than the reading level of the people who need the materials. This directory lists 'plain language' patient education materials. An extensive introductory chapter in the directory describes how patient education materials are evaluated and offers specific information about the best strategies to create plain language materials. Each piece of health information in the directory is rated according to its design assessment, in order to help readers make informed decisions about choosing materials. Part I is a list of health subjects presented in alphabetical order, in the style of a typical index. The page number after a listing notes where to find that piece of health information in Part II. Part II is a list of organizations and their contact information. Below the contact information is a list of the plain language health titles produced by the organization. Each title is grouped under a grade level heading, is numbered, and has a design rating. Part III is an alphabetical list of all the organizations in Part II. Materials related to digestive system diseases include allergies, constipation and soiling in children, cholesterol, hepatitis, constipation, diabetes and diet therapy, exercise for weight control, food choices, nutrition, heart health, immunization, low fat cooking, nausea, vomiting, diarrhea, smoking, and weight loss. Appendices to the directory include a guide to the S.M.O.G. readability formula, clear design tips, and plain language tips. The Directory is also available at www.pls.cpha.ca on the Internet.
General Home References In addition to references for constipation, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · The Digestive System (21st Century Health and Wellness) by Regina Avraham; Library Binding (February 2000), Chelsea House Publishing (Library); ISBN: 0791055264; http://www.amazon.com/exec/obidos/ASIN/0791055264/icongroupinterna · American College of Physicians Complete Home Medical Guide (with Interactive Human Anatomy CD-ROM) by David R. Goldmann (Editor), American College of Physicians; Hardcover - 1104 pages, Book & CD-Rom
144 Constipation
edition (1999), DK Publishing; ISBN: 0789444127; http://www.amazon.com/exec/obidos/ASIN/0789444127/icongroupinterna · The American Medical Association Guide to Home Caregiving by the American Medical Association (Editor); Paperback - 256 pages 1 edition (2001), John Wiley & Sons; ISBN: 0471414093; http://www.amazon.com/exec/obidos/ASIN/0471414093/icongroupinterna · Anatomica : The Complete Home Medical Reference by Peter Forrestal (Editor); Hardcover (2000), Book Sales; ISBN: 1740480309; http://www.amazon.com/exec/obidos/ASIN/1740480309/icongroupinterna · The HarperCollins Illustrated Medical Dictionary : The Complete Home Medical Dictionary by Ida G. Dox, et al; Paperback - 656 pages 4th edition (2001), Harper Resource; ISBN: 0062736469; http://www.amazon.com/exec/obidos/ASIN/0062736469/icongroupinterna · Mayo Clinic Guide to Self-Care: Answers for Everyday Health Problems by Philip Hagen, M.D. (Editor), et al; Paperback - 279 pages, 2nd edition (December 15, 1999), Kensington Publishing Corp.; ISBN: 0962786578; http://www.amazon.com/exec/obidos/ASIN/0962786578/icongroupinterna · The Merck Manual of Medical Information : Home Edition (Merck Manual of Medical Information Home Edition (Trade Paper) by Robert Berkow (Editor), Mark H. Beers, M.D. (Editor); Paperback - 1536 pages (2000), Pocket Books; ISBN: 0671027263; http://www.amazon.com/exec/obidos/ASIN/0671027263/icongroupinterna
Vocabulary Builder Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH]
Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Anaemia: A reduction below normal in the number of erythrocytes per cu. mm., in the quantity of haemoglobin, or in the volume of packed red cells per 100 ml. of blood which occurs when the equilibrium between blood loss (through bleeding or destruction) and blood production is disturbed. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the
Books 145
quantity of hemoglobin. [NIH] Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Anticholinergic: An agent that blocks the parasympathetic nerves. Called also parasympatholytic. [EU] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Ascites: Effusion and accumulation of serous fluid in the abdominal cavity; called also abdominal or peritoneal dropsy, hydroperitonia, and hydrops abdominis. [EU] Bezoars: Concretions of swallowed hair, fruit or vegetable fibers, or similar substances found in the alimentary canal. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Cardiac: Pertaining to the heart. [EU] Caustic: An escharotic or corrosive agent. Called also cauterant. [EU] Cholangitis: Inflammation of a bile duct. [EU] Cholecystectomy: Surgical removal of the gallbladder. [NIH] Cholecystitis: Inflammation of the gallbladder. [EU] Cholelithiasis: The presence or formation of gallstones. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Ciprofloxacin: A carboxyfluoroquinoline antimicrobial agent that is effective against a wide range of microorganisms. It has been successfully and safely used in the treatment of resistant respiratory, skin, bone, joint, gastrointestinal, urinary, and genital infections. [NIH] Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Colic: Paroxysms of pain. This condition usually occurs in the abdominal region but may occur in other body regions as well. [NIH] Duodenum: The first or proximal portion of the small intestine, extending from the pylorus to the jejunum; so called because it is about 12 fingerbreadths in length. [EU]
146 Constipation
Dyspepsia: Impairment of the power of function of digestion; usually applied to epigastric discomfort following meals. [EU] Encephalopathy: Any degenerative disease of the brain. [EU] Enuresis: Involuntary discharge of urine after the age at which urinary control should have been achieved; often used alone with specific reference to involuntary discharge of urine occurring during sleep at night (bedwetting, nocturnal enuresis). [EU] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Extracorporeal: Situated or occurring outside the body. [EU] Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU] Gastritis: Inflammation of the stomach. [EU] Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Gastroscopy: Endoscopic examination, therapy or surgery of the interior of the stomach. [NIH] Gluten: The protein of wheat and other grains which gives to the dough its tough elastic character. [EU] Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hepatic: Pertaining to the liver. [EU] Heredity: 1. the genetic transmission of a particular quality or trait from parent to offspring. 2. the genetic constitution of an individual. [EU] Hernia: (he protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [EU] Hiccup: A spasm of the diaphragm that causes a sudden inhalation followed by rapid closure of the glottis which produces a sound. [NIH] Hoarseness: An unnaturally deep or rough quality of voice. [NIH] Homeostasis: A tendency to stability in the normal body states (internal environment) of the organism. It is achieved by a system of control mechanisms activated by negative feedback; e.g. a high level of carbon
Books 147
dioxide in extracellular fluid triggers increased pulmonary ventilation, which in turn causes a decrease in carbon dioxide concentration. [EU] Hyperbilirubinemia: Pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice. [NIH] Ileostomy: Surgical creation of an external opening into the ileum for fecal diversion or drainage. Loop or tube procedures are most often employed. [NIH]
Immunosuppressant: An agent capable of suppressing immune responses. [EU]
Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH] Laparoscopy: Examination, therapy or surgery of the abdomen's interior by means of a laparoscope. [NIH] Lithotripsy: The destruction of a calculus of the kidney, ureter, bladder, or gallbladder by physical forces, including crushing with a lithotriptor through a catheter. Focused percutaneous ultrasound and focused hydraulic shock waves may be used without surgery. Lithotripsy does not include the dissolving of stones by acids or litholysis. Lithotripsy by laser is lithotripsy, laser. [NIH] Menstruation: The cyclic, physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus; it is under hormonal control and normally recurs, usually at approximately four-week intervals, in the absence of pregnancy during the reproductive period (puberty through menopause) of the female of the human and a few species of primates. It is the culmination of the menstrual cycle. [EU] Methotrexate: An antineoplastic antimetabolite with immunosuppressant properties. It is an inhibitor of dihydrofolate reductase and prevents the formation of tetrahydrofolate, necessary for synthesis of thymidylate, an essential component of DNA. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nosocomial: Pertaining to or originating in the hospital, said of an infection not present or incubating prior to admittance to the hospital, but generally occurring 72 hours after admittance; the term is usually used to refer to patient disease, but hospital personnel may also acquire nosocomial infection. [EU] Occult: Obscure; concealed from observation, difficult to understand. [EU]
148 Constipation
Perforation: 1. the act of boring or piercing through a part. 2. a hole made through a part or substance. [EU] Plague: An acute infectious disease caused by yersinia pestis that affects humans, wild rodents, and their ectoparasites. This condition persists due to its firm entrenchment in sylvatic rodent-flea ecosystems throughout the world. Bubonic plague is the most common form. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Remission: A diminution or abatement of the symptoms of a disease; also the period during which such diminution occurs. [EU] Retrograde: 1. moving backward or against the usual direction of flow. 2. degenerating, deteriorating, or catabolic. [EU] Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography. [EU]
Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Urinary: Pertaining to the urine; containing or secreting urine. [EU]
Multimedia 149
CHAPTER 7. MULTIMEDIA ON CONSTIPATION Overview Information on constipation can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on constipation. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.
Video Recordings Most disorders do not have a video dedicated to them. If they do, they are often rather technical in nature. An excellent source of multimedia information on constipation is the Combined Health Information Database. You will need to limit your search to “video recording” and “constipation” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” By making these selections and typing “constipation” (or synonyms) into the “For these words:” box, you will only receive results on video productions. The following is a typical result when searching for video recordings on constipation:
150 Constipation
·
Biopsychosocial Approach to Irritable Bowel Syndrome: Improving the Physician-Patient Relationship Source: Milwaukee, WI: International Foundation on Functional Gastrointestinal Disorders. 1997. (videocassette). Contact: Available from International Foundation for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864, Milwaukee, WI 53217. (888) 964-2001 or (414) 964-1799. Fax (414) 964-7176. E-mail:
[email protected]. Website: www.iffgd.org. Price: $100.00 plus $5.00 shipping. Summary: The irritable bowel syndrome (IBS) is a familiar medical disorder characterized by symptoms of abdominal pain and disturbed defecation (diarrhea or constipation). However, management of patients with IBS has been complicated by a lack of precise definition of the syndrome, incomplete and conflicting views of its pathophysiology, and an absence of specific treatments. This continuing education program helps general or family physicians and gastroenterologists to understand the physiological basis for symptom generation in IBS; to improve diagnostic precision through the use of symptom-based criteria, as well as knowledge of the primary symptom type and the severity of the condition; to understand the illness experience and the patient's clinical outcome; and to plan an approach to treatment that incorporates management of both the biological and psychosocial contributions to this disorder. The videotape program and study guide are divided into two sections. The first section reviews the current pathophysiologic understanding of IBS and presents a biopsychosocial approach to diagnosis and treatment. The second section addresses the process of interaction with the patient, and the development of an effective physician-patient relationship. 103 references. (AA-M).
·
Bottom Line on Hemorrhoids Source: Madison, WI: University of Wisconsin Hospitals and Clinics, Department of Outreach Education. 1996. (videocassette). Contact: Available from University of Wisconsin Hospital and Clinics. Picture of Health, 702 North Blackhawk Avenue, Suite 215, Madison, WI 53705-3357. (800) 757-4354 or (608) 263-6510. Fax (608) 262-7172. Price: $19.95 plus shipping and handling; bulk copies available. Order number 051997A. Summary: Straining when going to the bathroom, constipation, prolonged sitting, and infection can all contribute to hemorrhoids, defined as enlarged veins around the anus. This videotape is one in a series of health promotion programs called 'Picture of Health,' produced
Multimedia 151
by the University of Wisconsin. In this program, moderated by Mary Lee and featuring gastroenterologist John Wyman, the common symptoms, diagnosis, and management of hemorrhoids are covered. Dr. Wyman explains the difference between internal and external hemorrhoids (merely an anatomical distinction), and prolapsed hemorrhoids, which are enlarged internal hemorrhoids that drop (prolapse) outside the anus. Symptoms include pain and bleeding; pain because of blood clots and bleeding due to trauma to the thin walled veins in that area. The causes of hemorrhoids include straining during defecation, pregnancy, prolonged sitting, constipation, childbirth, and obesity. Dr. Wyman recommends that anyone over the age of 40 who experiences rectal bleeding should consult a physician; younger people who experience recurrent bleeding should also see their physician (to rule out inflammatory bowel disease). Treatment options for hemorrhoids include changes in habits, such as not straining, not wiping vigorously, softening the stool with dietary changes (usually the addition of dietary fiber), and not prolonging sitting on the toilet. Surgery is used for external hemorrhoids, to remove the veins and tributaries; for internal hemorrhoids, rubber band ligation is very effective. The program also explores the problem of perianal dermatitis, including its risk factors and treatment options (which focus on keeping the area clean and dry, and not using over the counter creams that are petroleum based). The program reiterates the importance of having any rectal bleeding investigated by one's health care provider. The program concludes by referring viewers to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). ·
What You Really Need to Know About Constipation Source: [Toronto, Ontario, Canada]: Videos for Patients. 1995. (videocassette). Contact: Available from Medical Audio Visual Communications, Inc. Suite 240, 2315 Whirlpool Street, Niagara Falls, NY 14305. Or P.O. Box 84548, 2336 Bloor Street West, Toronto, Ontario M6S 1TO, Canada. (800) 757-4868 or (905) 602-1160. Fax (905) 602-8720. Price: $99.00 (Canadian); contact producer for current price in American dollars. Order Number VFP035. Summary: This patient education videotape provides information about constipation. The videotape begins with a brief sketch featuring comedian John Cleese and narrator Dr. Robert Buckman illustrating the difficulties sometimes experienced by patients during the traditional doctor's explanation. Topics include the anatomy and physiology of the digestive tract and bowels, a definition of constipation and its causes, the
152 Constipation
symptoms and the effects of constipation, how changes in diet and lifestyle can remedy constipation, medications that may be used at the beginning to help constipation, and when to seek medical advice and treatment. Dr. Buckman presents the medical facts, using models, simple diagrams, and graphics to supplement his explanation, and avoiding medical jargon as much as possible. ·
Diverticular Disease and the Older Adult Source: Madison, WI: University of Wisconsin Hospitals and Clinics, Department of Outreach Education. 1995. (videocassette). Contact: Available from University of Wisconsin Hospital and Clinics. Picture of Health, 702 North Blackhawk Avenue, Suite 215, Madison, WI 53705-3357. (800) 757-4354 or (608) 263-6510. Fax (608) 262-7172. Price: $19.95 plus shipping and handling; bulk copies available. Order number 091395B. Summary: Diverticular disease, including diverticulosis and diverticulitis, occurs when pouches (diverticula) form in the intestines. This videotape on coping with diverticular disease is one in a series of health promotion programs called 'Picture of Health,' produced by the University of Wisconsin. In this program, moderated by Mary Lee and featuring gastroenterologist John Wyman, the common etiology (causes), symptoms, diagnosis, and management of diverticular disease are covered. Dr. Wyman focuses on the role of diet as the major culprit in diverticular disease and also reviews why the condition can be difficult to diagnose. Dr. Wyman stresses the preferred term of 'diverticular disease' to connote a degenerative disease process, rather than a finite problem with a simple treatment. Diverticulosis is herniation of the colon lining, resulting in pouch like abnormalities; diverticulitis is what happens when these pouches become inflamed or infected (complications can include hemorrhage and abscess). Although 90 percent of people with diverticular disease have no symptoms, people with symptoms can experience pain (in the left lower abdomen) and chronic inflammation. Dr. Wyman reviews irritable bowel syndrome (IBS) and how it differs from diverticular disease, primarily in the symptoms of diarrhea, constipation, and other disorder bowel habits. A high fiber diet results in bulkier stools, more active and stable colonic bacteria, and an increase in bowel diameter (which reduces overall pressure through the colon). Dr. Wyman reiterates the importance of eating high fiber foods, which are on the bottom of the food pyramid and considers whether diet can actually prevent diverticular disease (probably, but it is not yet proven). The program briefly discusses the diagnostic tests used to confirm complications and treatment of diverticular disease. The program
Multimedia 153
includes simple drawings of the intestines and other pictures used to explain the subject matter under discussion. The program concludes by referring viewers to the National Digestive Diseases Information Clearinghouse (NDDIC). ·
Gastroenterology for the Primary Care Physician Source: Mount Laurel, NJ: CME Conference Video, Inc. 1994. (instructional package). Contact: Available from CME Conference Video, Inc. 2000 Crawford Place, Suite 100, Mount Laurel, NJ 08054. (800) 284-8433. Fax (800) 2845964. Price: $450 plus $12.25 shipping and handling (as of 1995); group practice package available. Program No. 153. Summary: This continuing education course is designed to update internists, family practitioners, and other primary care physicians on new developments in gastroenterology. The format of the course focuses on case presentations emphasizing important and evolving concepts in gastroenterology. The emphasis is on practical diagnostic and therapeutic choices and the development of cost effective management algorithms. Topics include hepatitis C, non-cardiac chest pain, psychopharmacologic approaches to acid reduction, peptic ulcer disease, Helicobacter pylori, risk factors for NSAID injury, Clostridium difficile, travelers' diarrhea, constipation in the elderly, pancreatitis, endoscopic ultrasound, gastroesophageal reflux disease, Barrett's esophagus, liver disease, GI manifestations in AIDS, esophagitis, fecal incontinence, diagnostic testing, irritable bowel syndrome, inflammatory bowel disease, drug therapy, chronic diarrhea, gallstone disease, colon cancer, cirrhosis, and ascites. The program offers 11 hours of AMA-PRA Category 1 credit. (AA-M).
·
Postgraduate Gastroenterology Program Source: Mt. Laurel, NJ: CME Conference Video, Inc. 1992. (videocassettes and syllabus). Contact: Available from P.O. Box 5077, Cherry Hill, NJ 08034-5077. (800) 284-8433. Fax (800) 284-5964. Price: $675. Group practice packages available. Summary: This continuing education video series is designed to enhance understanding of pathophysiology and patient management of gastrointestinal (GI) organ systems and GI disorders and to improve viewers' diagnostic and treatment abilities. Six sections cover gastroduodenal disorders; clinical applications of research; liver diseases; pancreatic and biliary tract diseases; inflammatory bowel syndrome
154 Constipation
(IBS); and esophageal disorders. Specific topics include helicobacter pylori and peptic ulcer disease; gastric emptying; gastroparesis; hormones and neuropeptides; interferon therapy of chronic liver disease; liver transplantation; hepatic encephalopathy; sclerosing cholangitis; chronic pancreatitis; endoscopic retrograde cholangiopancreatography (ECRP); colorectal polyps; surgical therapy for IBS; IBS and constipation; swallowing physiology; and Barrett's esophagus. The video includes interactive sessions between experts in the field of gastroenterology. (AAM).
Bibliography: Multimedia on Constipation The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in constipation (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on constipation. For more information, follow the hyperlink indicated: ·
[motion picture]. Source: produced for the Children's Bureau of the United States Department of Labor by the Worcester Film Corporation; Year: 1926; Format: Posture; United States: The Bureau, c1926
·
Abdomen. Source: written by M.S. Tanner; produced for the Department of Paediatrics; Sheffield University Television; Year: 1993; Format: Videorecording; [Sheffield, Eng.]: University of Sheffield, c1993
·
Cinedefecography in clinical practice : a review of normal and abnormal findings. Source: produced by Ciné-Med; Year: 1991; Format: Videorecording; Woodbury, Conn.: Ciné-Med, c1991
·
Comprehensive care of the elderly. Source: Intercollegiate Center for Nursing Education; Year: 1986; Format: Videorecording; Spokane, Wash.: I.C.N.E., 1986
·
Constipation : a daily problem. Source: [presented by] Marshfield Medical Foundation and Marshfield Clinic; Year: 1981; Format: Videorecording; Marshfield, WI: Marshfield Regional Video Network, 1981
·
Constipation and encopresis. Source: Department of Pediatrics, Emory University, School of Medicine; Year: 1980; Format: Videorecording;
Multimedia 155
Atlanta: Emory Medical Television Network: [for loan or sale by A. W. Calhoun Medical Library], 1980 ·
Diagnosis in clinical disorders of calcium and bone metabolism. Source: a National Medical Audiovisual Center production; [presented by] the U.S. Department of Health, Education, and Welfare, Public Health Service; Year: 1969; Format: Motion picture; United States: The Center, 1969
·
Eating hints for cancer patients. Source: NHV, National Health Video, Inc; Year: 1990; Format: Videorecording; Los Angeles, CA: NHV, c1990
·
Gastro-intestinal tract problems of the aged. Source: Marvin Schuster; produced by Audiovisual Division, R. A. Becker; Year: 1974; Format: Sound recording; [Baltimore: Schuster; New York: for sale by Robert A. Becker Co., Audiovisual Division, 1974]
·
Guide to disabilities. Problems of bladder, bowels, and swallowing in disabled persons. Source: a presentation of Films for the Humanities & Sciences; Year: 2001; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c2001
·
Hirschsprung's disease : constipation and megacolon. Source: presented by the Department of Pediatrics, Emory University, School of Medicine; Year: 1985; Format: Videorecording; Atlanta, Ga.: Emory Medical Television Network, 1985
·
Irritable bowel syndrome : diagnosis and clinical management. Source: with Douglas A. Drossman; Year: 1986; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, 1986
·
Lead poisoning. Source: [Stanley P.] Balcerzak; produced by Ohio State University, Medical Audiovisual and Television Center; Year: 1971; Format: Videorecording; [Columbus, Ohio]: The Center, c1971
·
Limited activity. Source: Concept Media; Year: 1973; Format: Filmstrip; Costa Mesa, Calif.: Concept Media, c1973
·
Nutrition & long term care. Source: NHV, National Health Video Inc; Year: 1997; Format: Videorecording; Los Angeles, CA: NHV, c1997
·
Patient with a herniated intervertebral disk. Source: Trainex Corporation; Year: 1971; Format: Filmstrip; [Garden Grove, Calif.]: Trainex,c1971
·
Personal hygiene for women. Part 1. Source: produced under the supervision of the Bureau of Aeronautics for the Bureau of Medicine and Surgery by Audio Productions, Inc; Year: 1943; Format: Motion picture; United States: Navy Dept., [1943]
·
Physical changes and their implications. Source: Concept Media; Year: 1973; Format: Filmstrip; [Costa Mesa, Calif.]: Concept Media, c1973
156 Constipation
·
Recent advances in managing severe constipation : recorded at DDW 1995 in San Diego. Source: AGA, American Gastroenterological Association; Year: 1995; Format: Sound recording; [Bethesda, Md.]: The Association, [1995?]
·
Special nutrition problems. Source: NHV, National Health Video; Year: 1997; Format: Videorecording; Los Angeles: National Health Video, c1997
·
Special topics. Source: Robin Murphy; Year: 1984; Format: Sound recording; [Santa Fe, N.M.]: R. Murphy, c1984
·
Transabdominal repair of an enterocele. Source: from the Film Library and the Clinical Congress of ACS; produced by Creighton University, Medical Television, Biomedical Communications; Year: 1995; Format: Videorecording; Woodbury, CT: Ciné-Med, [1995]
Vocabulary Builder Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Neuropeptides: Peptides released by neurons as intercellular messengers. Many neuropeptides are also hormones released by non-neuronal cells. [NIH] Petroleum: Naturally occurring complex liquid hydrocarbons which, after distillation, yield combustible fuels, petrochemicals, and lubricants. [NIH]
Periodicals and News 157
CHAPTER 8. PERIODICALS AND NEWS ON CONSTIPATION Overview Keeping up on the news relating to constipation can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on constipation. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover constipation beyond and including those which are published by patient associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.
News Services & Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on constipation is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.
158 Constipation
PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “constipation” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased.
Reuters The Reuters’ Medical News database can be very useful in exploring news archives relating to constipation. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/frame2/arch.html and search by “constipation” (or synonyms). The following was recently listed in this archive for constipation: ·
Constipation may signal Parkinson's risk: study Source: Reuters Health eLine Date: August 13, 2001 http://www.reuters.gov/archive/2001/08/13/eline/links/20010813elin 005.html
·
Constipation linked to increased risk of Parkinson's disease Source: Reuters Medical News Date: August 13, 2001 http://www.reuters.gov/archive/2001/08/13/professional/links/20010 813epid005.html
·
Improvement in constipation with biofeedback linked to gut-specific effects Source: Reuters Medical News Date: July 25, 2001 http://www.reuters.gov/archive/2001/07/25/professional/links/20010 725clin002.html
·
Chronic constipation linked to anxiety, depression Source: Reuters Health eLine Date: July 12, 2001 http://www.reuters.gov/archive/2001/07/12/eline/links/20010712elin 020.html
Periodicals and News 159
·
Tegaserod relieves abdominal pain and constipation in women with IBS Source: Reuters Medical News Date: May 24, 2001 http://www.reuters.gov/archive/2001/05/24/professional/links/20010 524clin003.html
·
Prucalopride accelerates gastrointestinal transit in patients with constipation Source: Reuters Medical News Date: March 06, 2001 http://www.reuters.gov/archive/2001/03/06/professional/links/20010 306clin001.html
·
Constipation is not the root of all evil after all Source: Reuters Health eLine Date: December 27, 2000 http://www.reuters.gov/archive/2000/12/27/eline/links/20001227elin 001.html The NIH
Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within their search engine.
Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name.
Internet Wire Internet Wire is more focused on technology than the other wires. To access this site, go to http://www.internetwire.com and use the “Search Archive” option. Type in “constipation” (or synonyms). As this service is oriented to
160 Constipation
technology, you may wish to search for press releases covering diagnostic procedures or tests that you may have read about.
Search Engines Free-to-view news can also be found in the news section of your favorite search engines (see the health news page at Yahoo: http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “constipation” (or synonyms). If you know the name of a company that is relevant to constipation, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks.
BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “constipation” (or synonyms).
Newsletters on Constipation Given their focus on current and relevant developments, newsletters are often more useful to patients than academic articles. You can find newsletters using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Your investigation must limit the search to “Newsletter” and “constipation.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” By making these selections and typing in “constipation” or synonyms into the “For these words:” box, you will only receive results on newsletters. The following list was generated using the options described above: ·
Evaluation of Severe Constipation Source: Intestinal Fortitude. 4(2): 4-5. Summer 1993. Contact: Available from Intestinal Disease Foundation. 1323 Forbes Avenue, Suite 200, Pittsburgh, PA 15219. (412) 261-5888.
Periodicals and News 161
Summary: This brief article, from a newsletter for people with intestinal diseases, discusses the diagnostic tests used in the evaluation of severe constipation. Topics include the difference between functional constipation and that with an organic cause; the two types of functional constipation, notably motility dysfunctions and outlet obstructions or defecatory disorders; the use of a colonic transit study; anorectal manometry; evacuation proctography; and colon motility. The author emphasizes that patients with severe constipation, and their treating physician, are advised to work with specialists in the field of constipation, in order to take advantage of the available technology and knowledge. ·
Constipation: Causes, Treatment and Prevention Source: Intestinal Fortitude. 4(2): 2-3. Summer 1993. Contact: Available from Intestinal Disease Foundation. 1323 Forbes Avenue, Suite 200, Pittsburgh, PA 15219. (412) 261-5888. Summary: This article, from a newsletter for people with intestinal diseases, reviews the causes, treatment, and prevention of constipation. Topics include the possible causes of constipation, including lifestyle changes, diet, eating habits, bowel habits, medications, laxatives, and exercise; the medical causes of constipation; and psychological disorders. The article concludes with a brief discussion of the role of gastroenterologists who specialize in the evaluation and treatment of intractable constipation.
Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” By making these selections, and typing in “constipation” (or synonyms) into the “For these words:” box, you will only receive results on newsletter articles. You should check back periodically with this database as it is
162 Constipation
updated every 3 months. The following is a typical result when searching for newsletter articles on constipation: ·
Gastrointestinal Motility Disorders of the Colon, Rectum, and Pelvic Floor Source: Participate. 10(1): 3-5. Spring 2001. Contact: Available from International Foundation for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864, Milwaukee, WI 53217. (888) 964-2001 or (414) 964-1799. Fax (414) 964-7176. E-mail:
[email protected]. Website: www.iffgd.org. Summary: Motility is a term used to describe the contraction of the muscles in the gastrointestinal tract. This article, the second in a two part series, reviews gastrointestinal (GI) motility disorders of the colon, rectum, and pelvic flood. The four parts of the GI tract (esophagus, stomach, small intestine and large intestine or colon) are separated from each other by special muscles called sphincters, which normally stay tightly closed and which regulate the movement of food and food residues from one part to another. Each part of the GI tract has a unique function in digestion, and each part has a distinct type of motility and sensation. Motility problems can cause symptoms such as pain, bloating, fullness, and urgency to have a bowel movement. The author describes the normal patterns of large intestine motility and sensation, along with the symptoms that can result from abnormal motility or sensations. Symptoms of motility problems in the large intestine include constipation, diarrhea, fecal incontinence, Hirschsprung's disease, and outlet obstruction type constipation (pelvic floor dyssynergia). For each, the author describes the diagnostic tests that may be used to establish an appropriate diagnosis.
·
Rectocele: Symptoms Include Vaginal Pain or Constipation Source: Participate. 10(3): 5. Fall 2001. Contact: Available from International Foundation for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864, Milwaukee, WI 53217. (888) 964-2001 or (414) 964-1799. Fax (414) 964-7176. E-mail:
[email protected]. Website: www.iffgd.org. Summary: A rectocele is a bulge from the rectum into the vagina and may be present without any other abnormalities. This brief article on rectocele is from a newsletter from the International Foundation for Functional Gastrointestinal Disorders. The author describes the causes of rectocele, the typical symptoms, how rectocele is diagnosed, when treatment for rectocele should be considered, and treatment options. Treatment should
Periodicals and News 163
be considered for rectocele when it causes significant symptoms. Rectoceles that are not causing symptoms do not need to be treated, as advised by the patient's physician. In general, one should avoid constipation by eating a high fiber diet and drinking plenty of fluids. Patients should also avoid prolonged straining at defecation. If symptoms persist with medical therapy, then surgical repair may be indicated. Both colorectal surgeons and gynecologists are trained to deal with these problems. ·
Childhood Defecation Disorders: Constipation and Soiling Source: Participate. 9(3): 4-6. Fall 2000. Contact: Available from International Foundation for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864, Milwaukee, WI 53217. (888) 964-2001 or (414) 964-1799. Fax (414) 964-7176. E-mail:
[email protected]. Website: www.iffgd.org. Summary: This article is the second in a two part series on pediatric functional gastrointestinal (GI) disorders that may prompt parents to bring their child to the doctor for constipation or fecal soiling. In this article, the author focuses on non retentive fecal soiling and functional fecal retention. Functional refers to a disorder where the primary problem is not due to disease or visible tissue damage or inflammation; in this article, the author uses functional to refer to symptoms that occur within the expected range of the body's behavior. Functional fecal retention is defined in children by the passage of large or enormous bowel movements at intervals less than twice per week, and the attempt to avoid having bowel movements on purpose. Accompanying symptoms include soiling of the underclothes, irritability, abdominal cramps, and decreased appetite. Functional fecal retention begins when there is a painful bowel movement and the child learns to fear the urge to have a bowel movement. After diagnosis, treatment goals include family and patient education, medication as necessary to assure painless defecation, and the provision of continued availability and interest in the child's problem. Fecal soiling refers to passage of bowel movements into the underclothing, or other inappropriate places. Fecal soiling commonly accompanies functional fecal retention, or after a chronic problem with diarrhea. Functional non retentive (not associated with fecal retention) fecal soiling is diagnosed in children older than 4, who have bowel movements in places and at times that are inappropriate, at least once a week for 3 months, in the absence of a disease to explain it. Treatment goals are to help the parent to understand that there is no medical disease, and to accept a referral to a mental health professional. Parents
164 Constipation
need guidance to understand that soiling is a symptom of emotional upset, not simply bad behavior. 1 table. ·
Irritable Bowel Syndrome: Clinical Issues Source: Participate. 9(1): 1-4. Spring 2000. Contact: Available from International Foundation for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864, Milwaukee, WI 53217. (888) 964-2001 or (414) 964-1799. Fax (414) 964-7176. E-mail:
[email protected]. Website: www.iffgd.org. Summary: This article discusses irritable bowel syndrome (IBS), a very common condition that is characterized by abdominal pain associated with a change in a bowel pattern (constipation or diarrhea). IBS is considered a condition of the brain-gut connection and triggering factors may variously cause symptoms of diarrhea at one time and constipation at another. There is a wide range of severity of IBS, from mild or infrequent symptoms that the patient manages at home to very severe kinds of symptoms that can cause patients to seek relief with more frequent doctor visits. The article answers common questions about IBS and its treatments. IBS is in the group of conditions that are called functional gastrointestinal disorders, i.e., disorders of dysfunction, rather than pathology such as inflammation or visible tissue damage. Diagnosis include patient history, symptoms according to the Rome Criteria, and diagnostic tests such as colonoscopy or CT scan (computed tomography). Treatments are usually done in response to the specific symptoms. For example, in a patient who usually has constipation, treatment are used that increase the functioning of the bowel, the frequency, and the ease of having a bowel movement. For patients whose symptoms tend more to diarrhea, treatment includes anti diarrheal agents. Pain medications might also be indicated, particularly if the pain is meal related. Reduced dosage prescriptions of antidepressants can be effective to modulate or decrease pain. The author reviews new drugs currently under study, as well as ongoing research into the brain-gut connection. The author also discusses the impact of conceptualizing functional disorders within the traditional disease-based medical framework, which separates the mind from the body. IBS must be recognized as genuine, non trivial, and a disorder that is not fully explained as either psychiatric or organic.
·
Irritable Bowel Syndrome: The Bottom Line Source: Fibromyalgia Frontiers. 7(2): 4-8, 13. March-April 1999.
Periodicals and News 165
Contact: Available from Fibromyalgia Association of Greater Washington, Inc. 13203 Valley Drive, Woodbridge, VA 22191-1531. (703) 790-2324. Fax (703) 494-4103. E-mail:
[email protected]. Summary: This article on irritable bowel syndrome (IBS) is from a newsletter for people with fibromyalgia (a pain disorder). IBS is known as a functional gastrointestinal (GI) disorder because it involves a healthy bowel, without inflammation or disease, that does not perform normally. In IBS, the bowel tends to have an unusual sensitivity to such events as the passage of food particles, fluids, or gas. IBS symptoms, which are usually intermittent rather than constant, are abdominal discomfort, cramping or pain, bloating, abnormal bowel movements (i.e., diarrhea, constipation, or the two alternating), mucus in the stools, and a sensation of incomplete evacuation. IBS is quite common among persons with fibromyalgia; its incidence is estimated at approximately 40 percent among patients with diagnosed fibromyalgia (compared with only 16 percent in normal controls). However, some GI signs are not part of IBS and should be investigated. The author then discusses the pathophysiology of IBS and the treatment options for the syndrome. Although admittedly not high tech, modifying the diet and eating habits and learning to control stress are the most potent weapons available against IBS. Dietary fiber has a central role, and it is important to increase one's intake of fiber slowly to allow the body to adjust and to drink plenty of water as fiber intake increases. The article concludes with the contact information for the International Foundation for Functional Gastrointestinal Disorders and for the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health. 18 references. ·
Irritable Bowel Syndrome: Gaining Control of Your Symptoms Source: Mayo Clinic Health Letter. 17(2): 4-5. February 1999. Contact: Available from Mayo Foundation for Medical Education and Research. 200 First Street, SW, Rochester, MN 55905. Summary: This newsletter article offers strategies to help people with irritable bowel syndrome (IBS) gain control of their symptoms. IBS is a common, chronic gastrointestinal disorder in which the structure of the bowel is normal, but the function is not. The symptoms are produced, in part, by spasms in the walls of the intestines. Some people mainly experience cramping and diarrhea, others alternate between constipation and diarrhea, or have predominantly pain and constipation. Bloating and gas are also common. IBS can be difficult to diagnose because many conditions have similar symptoms. Common treatments include dietary changes, managing stress, the use of medications, antidepressants, and
166 Constipation
alternative therapies, such as peppermint oil. A sidebar addresses the issue of a psychological basis for IBS, concluding that stress no doubt aggravates IBS, but that one doesn't have to be under stress to have the condition. 1 figure. ·
By the Way, Doctor [Severe Constipation] Source: Harvard Health Letter. 24(6): 8. April 1999. Contact: Available from Harvard Medical School Health Publications Group. Harvard Health Letter, P.O. Box 420300, Palm Coast, FL 321420300. (800) 829-9045. E-mail:
[email protected]. Summary: This brief newsletter article is one in a regular column in which readers can pose a question to a medical doctor. In this entry, the question asks, 'I've heard that there is an operation that can cure severe constipation. Are there any drawbacks to it?' The doctor, Stephen Goldfinger, M.D., replies that the operation is serious and involves removing the entire colon and then attaching the small bowel to the rectum. Such surgery is reserved for people with debilitating constipation that defies all conventional treatment methods, which include high fluid and roughage intake, strong laxatives, periodic enemas, and bowel training exercises. When patients are selected properly (including the use of a diagnostic test that checks intestinal motility), almost everyone who has the surgery will be relieved of constipation. However, postoperative problems such as bowel obstruction, persisting abdominal pain, and infections are encountered often enough for the author to be cautious about recommending the operation to any but the most severely affected patients.
·
Dietary Factors in Gastrointestinal Diseases Source: Networking News. 20(4): 1, 5, 10. Summer 1999. Contact: Available from Nutrition Education for the Public. ADA/DPG 52, Bill Evers, 2971 Soldiers Home Road, West Lafayette, IN 47906-1660. Summary: This newsletter article reviews the role of dietary factors in gastrointestinal diseases. Many factors have been implicated to produce worsening of symptoms of functional gastrointestinal disorders (FGID), such as irritable bowel syndrome (IBS), including stress and diet. The author discusses several specific diseases that are associated with adverse reactions to food. The common complaints that are associated with reactions to food are: bloating, heartburn, dyspepsia, excessive gas, diarrhea, and constipation. Some of these diseases (gastroesophageal reflux disease, celiac disease, food allergies, and lactose intolerance) are associated with specific dietary therapies that improve symptoms; each is
Periodicals and News 167
summarized briefly. The author also discusses a rare syndrome, called eosinophilic gastroenteritis, which is treated with prednisone therapy. All of these diseases have characteristics that differentiate them from functional GI disorders (those without a clear underlying pathology). The author notes that a symptoms diary collected over 2 to 3 weeks can help determine the relationship of the symptoms to foods. Many individuals with FGID believe that specific foods are responsible for their symptoms, yet no clear resolution of symptoms occurs when the offending foods are eliminated. An elimination diet should be performed with the help of a health professional, since unmonitored elimination diets can produce malnutrition. 8 references. ·
Diverticular Disease (Diverticulosis and Diverticulitis) Source: Intestinal Fortitude. 9(4): 1-3. 1999. Contact: Available from Intestinal Disease Foundation. 1323 Forbes Avenue, Suite 200, Pittsburgh, PA 15219. (412) 261-5888. Summary: This patient education article reviews diverticular disease (diverticulosis and diverticulitis) and its management. Diverticulosis is a condition in which pouches of intestinal lining balloon out through weak areas of the wall of the large intestine (colon). If the diverticula become infected, the condition is called diverticulitis, which can lead to serious complications. Diverticulosis is very common in North America, where diets tend to be low in fiber. Once formed, diverticula are permanent and cannot be reversed. The goal of management is to keep new diverticula from forming and to prevent complications. Patients with diverticulosis should follow the same advice given to people with constipation: eat regular meals that are high in fiber, drink plenty of fluids, exercise daily, respond right away to the urge to move the bowels, and avoid laxatives. High fiber diets are recommended because they help to create heavier, softer stools which move through the lower part of the gastrointestinal tract more easily than do small, hard stools. The goal is to consume 25 to 40 grams of dietary fiber per day. The article offers suggestions for increasing the amount of dietary fiber, noting that it is a good idea to increase fiber intake slowly (too much fiber too quickly can cause gas and bloating). Symptoms of diverticulitis may include fever and chills, abdominal pain (particularly on the lower left side), disruption of normal bowel activity, and abdominal tenderness. Infection can lead to complications such as rupturing of the diverticula, abscesses, bowel blockage, or leaks through the bowel wall. The article concludes by discussing the treatment options for diverticulitis, including surgical techniques that may be used.
168 Constipation
·
Constipation: How to Find Relief Without Laxatives Source: Environmental Nutrition. 22(9): 2. September 1999. Contact: Available from Environmental Nutrition, Inc. 52 Riverside Drive, New York, NY 10024-6599. (800) 829-5384. Summary: Constipation is defined as infrequent or difficult bowel movements, typically three consecutive days without a movement. This brief article offers strategies for dealing with constipation without resorting to the use of laxatives. The author notes that, most often, constipation is temporary, triggered perhaps by a change in routine (like travel) and requires no real intervention beyond a cup of prune juice or a bowl of bran flakes. The author reviews the causes of constipation, including sedentary habits, diets of processed, low fiber foods, and a tendency to drink too few fluids. Additional contributors to constipation, especially for older people, include muscle weakness, poor dentition (which makes it hard to chew high fiber foods), and certain medications, including antidepressants, antacids, antihistamines, diuretics, opiates, tranquilizers, iron supplements, and calcium supplements. Three sidebars offer practical strategies for coping with constipation, preventing problems, and being cautious with herbal remedies.
·
Dietary Strategies for Coping with the Gastrointestinal Discomforts of Cancer Therapy Source: Intestinal Fortitude. 8(4): 3. 1998. Contact: Available from Intestinal Disease Foundation. 1323 Forbes Avenue, Suite 200, Pittsburgh, PA 15219. (412) 261-5888. Summary: Many patients experience gastrointestinal discomfort as a result of cancer therapy. This brief newsletter article offers strategies for coping with these discomforts. The author recommends tips for six problems: nausea and vomiting, lactose intolerance, heartburn, constipation, diarrhea and cramping, and intestinal gas. In each section, the author provides specific strategies and foods to try. Strategies include eating small amounts of food, increasing fiber and fluid intake, avoiding potentially irritating foods (especially caffeine-containing products and alcohol), and undertaking light exercise. The author encourages readers to try the various suggestions and determine what succeeds in each individual situation.
·
Hemorrhoids: Managing This Harmless but Bothersome Problem Source: Mayo Clinic Health Letter. 14(2): 1-3. February 1996.
Periodicals and News 169
Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 333-9037. Summary: This newsletter article presents information on managing hemorrhoids. Topics include how hemorrhoids develop, constipation as a common cause of hemorrhoids, symptoms of different types of hemorrhoids (internal, prolapsed, external), self-care steps to manage hemorrhoidal flareups, medical treatments (rubber band ligation, infrared coagulation, bipolar electrocoagulation, and laser therapy), surgery, and suggestions to avoid hemorrhoids. 2 figures.
Academic Periodicals covering Constipation Academic periodicals can be a highly technical yet valuable source of information on constipation. We have compiled the following list of periodicals known to publish articles relating to constipation and which are currently indexed within the National Library of Medicine’s PubMed database (follow hyperlinks to view more information, summaries, etc., for each). In addition to these sources, to keep current on articles written on constipation published by any of the periodicals listed below, you can simply follow the hyperlink indicated or go to the following Web site: www.ncbi.nlm.nih.gov/pubmed. Type the periodical’s name into the search box to find the latest studies published. If you want complete details about the historical contents of a periodical, you can also visit http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/ you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.” The following is a sample of periodicals which publish articles on constipation: ·
American Family Physician. (Am Fam Physician) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=A merican+Family+Physician&dispmax=20&dispstart=0
·
Archives of Disease in Childhood. (Arch Dis Child) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ar chives+of+Disease+in+Childhood&dispmax=20&dispstart=0
170 Constipation
·
Bmj (Clinical Research Ed. . (BMJ) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=B mj+(Clinical+Research+Ed.+&dispmax=20&dispstart=0
·
Drugs & Aging. (Drugs Aging) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Dr ugs+&+Aging&dispmax=20&dispstart=0
·
Forschende Komplementarmedizin. (Forsch Komplementarmed) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Fo rschende+Komplementarmedizin&dispmax=20&dispstart=0
·
Postgraduate Medicine. (Postgrad Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Po stgraduate+Medicine&dispmax=20&dispstart=0
·
Zeitschrift Fur Gastroenterologie. (Z Gastroenterol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ze itschrift+Fur+Gastroenterologie&dispmax=20&dispstart=0
Vocabulary Builder Antihistamine: A drug that counteracts the action of histamine. The antihistamines are of two types. The conventional ones, as those used in allergies, block the H1 histamine receptors, whereas the others block the H2 receptors. Called also antihistaminic. [EU] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Dentition: The teeth in the dental arch; ordinarily used to designate the natural teeth in position in their alveoli. [EU] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Filtration: The passage of a liquid through a filter, accomplished by gravity, pressure, or vacuum (suction). [EU]
Periodicals and News 171
Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Myeloma: A tumour composed of cells of the type normally found in the bone marrow. [EU] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Pharmacist: A person trained to prepare and distribute medicines and to give information about them. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH]
Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Sarcoidosis: An idiopathic systemic inflammatory granulomatous disorder comprised of epithelioid and multinucleated giant cells with little necrosis. It usually invades the lungs with fibrosis and may also involve lymph nodes, skin, liver, spleen, eyes, phalangeal bones, and parotid glands. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Transfusion: The introduction of whole blood or blood component directly into the blood stream. [EU] Vaginal: 1. of the nature of a sheath; ensheathing. 2. pertaining to the vagina. 3. pertaining to the tunica vaginalis testis. [EU]
Physician Guidelines and Databases 173
CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.
NIH Guidelines For the more common disorders, the National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
174 Constipation
NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.27 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:28 ·
Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
·
HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
·
NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
·
Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
·
Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
·
Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 28 See http://www.nlm.nih.gov/databases/databases.html. 27
Physician Guidelines and Databases 175
·
Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
·
Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
·
Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
·
Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
·
MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
·
Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
·
Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
While all of the above references may be of interest to physicians who study and treat constipation, the following are particularly noteworthy.
The Combined Health Information Database A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information Package” and constipation using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years,” select your preferred language, and the format option “Fact Sheet.” By making these selections and typing “constipation” (or synonyms) into the “For these words:” box above, you will only receive results on fact sheets dealing with constipation. The following is a sample result:
176 Constipation
·
AIDS : Palliative Care: UNAIDS Technical Update Contact: World Health Organization, Joint United Nations Programme on HIV/AIDS, 20 Avenue Appia, CH-1211 Geneva, http://www.unaids.org. Summary: This report, for health professionals, governmental agencies, and international organizations, discusses palliative care for individuals with the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). Palliative care is a combination of therapies with the aim of achieving the best quality of life for patients (and their families) suffering from life-threatening and ultimately incurable illnesses. This report describes the following symptoms for people with HIV/AIDS: (1) pain; (2) diarrhea and constipation; (3) nausea, vomiting, anorexia, and weight loss; (4) cough and shortness of breath; (5) malaise, weakness, and fatigue; (6) fever, (7) skin problems; and (8) brain impairment. Psychological support through voluntary testing and counseling, spirituality, preparation for death, challenges HIV/AIDS poses to palliative care, and ways to overcome these challenges are discussed. These challenges include perceptions and recognition of palliative care; organizing palliative care training and; providing quality palliative care services. The report discusses current projects initiatives in Zambia, Uganda, the United Kingdom, Cambodia, and India.
·
Good Nutrition Makes A Difference Contact: Children's Medical Center of Dallas, 1935 Motor St, Dallas, TX, 75235, (214) 640-2000. Summary: This manual explains that good nutrition is especially important for people with special needs. It addresses nutrition throughout childhood, focusing on these topics: good nutrition, safe feeding of preschoolers, and the special supplemental food program for women, infants, and children (WIC). After discussing the four major food groups, it suggests nutritious meals for brown bagging to work or school, discusses how to make the food dollar stretch for the most nutritious foods, and explains how to eat defensively to prevent illness. It emphasizes special diets for special situations: nausea and vomiting, constipation and diarrhea, and times when it hurts to eat or food tastes funny. It also provides a section on delicious high-calorie recipes and a basic food groups coloring book.
Physician Guidelines and Databases 177
·
Comprehensive Maternal - Child HIV Management and Research Center Contact: Los Angeles County University of Southern California, Medical Center, Comprehensive Maternal - Child HIV Management and, Research Center, 1640 Marengo St 2nd Fl, Los Angeles, CA, 90089-9260, (323) 226-2200. Summary: This handbook describes the services and schedule of the Maternal and Child HIV Clinic of the Comprehensive Maternal- Child HIV Management & Research Center in Los Angeles, CA. It also provides general information on care of children who are HIV positive. It discusses what HIV is, how children and adolescents may get infected, testing, and prevention. Problems associated with HIV infection in children are listed, including cytomegalovirus, thrush, ear or sinus infections, and hepatitis. Guidelines are presented for immunizations, when to call the doctor, and dental care. A section on medical care for HIV-positive children discusses measles and chicken pox, and specifies treatments for fever, vomiting, diarrhea, and constipation.
·
Revisiting IBS: Perspectives for the New Millennium: Special Report Source: New York, NY: McMahon Publishing Group. 2001. 8 p. Contact: Available from Gastroenterology and Endoscopy News. McMahon Publishing Group, 545 W. 45th St., 8th floor, New York, NY 10036 (800) 526-0828. Website: www.mcmahonmed.com. Price: $5.00 plus shipping and handling. Summary: Recent discoveries in the field of irritable bowel syndrome (IBS) have important implications for gastroenterologists. Research is underway into functional brain imaging techniques to assess activation of brain regions during visceral stimulation, as well as clinical examinations focusing on the relationship between infection and IBS. This report brings gastroenterologists and primary care practitioners up to date on the current approaches in drug therapy for patients with IBS. The authors explain the use of brain imaging techniques to understand how patients with IBS may be more sensitive to gut stimuli, discuss the theory that an acute outbreak of gastroenteritis may lead to long term chronic IBS, and discuss the latest treatment options that can be use for both IBS and the related abdominal pain and discomfort. Treatments for IBS are targeted to symptoms including abdominal pain, diarrhea, constipation, and bloating. The main choices for patients with pain predominant symptoms include antispasmodics, tricyclic antidepressants, and selective serotonic reuptake inhibitors (SSRIs), and 5HT3 antagonists and 5HT4 agonists. Patients with constipation predominant symptoms would be treated with
178 Constipation
fiber, laxatives, or 5HT4 agonists; for patients with diarrhea predominant symptoms, opioid agonists, 5HT3 antagonists, and possibly cholestyramine will be used. Each of these treatments is discussed, with the relevant literature briefly reviewed. A posttest is appended, with which readers can qualify for continuing education credits. References are provided in the text of the report. ·
Sensitive Gut: A Harvard Health Letter Special Report Source: Boston, MA: Harvard Medical School Health Publications Group. 1996. 39 p. Contact: Available from Harvard Medical School Health Publications Group. Department GUT, P.O. Box 380, Boston, MA 02117. (617) 4321485. Fax (617) 432-1506. Price: $16.00 (as of 1996); bulk discounts available. Summary: This report focuses on five functional gastrointestinal (GI) disorders: gastroesophageal reflux disease (GERD), nonulcer dyspepsia, irritable bowel syndrome (IBS), constipation, and excessive gas. The author first introduces the anatomy and physiology of the GI tract, emphasizing the process of digestion. The following five sections present a discussion of the definition, causes, diagnosis, and therapy for each of the disorders. Specific topics include the hiatal hernia connection to GERD, antireflux drug therapy, surgery, Helicobacter pylori infection, psychological factors in dyspepsia, the role of stress in IBS, the types of constipation, belching, and flatulence. The report concludes with an overview of recommended good gut hygiene, an appendix summarizing drugs used to treat functional gastrointestinal disorders, and a glossary of terms. 10 figures. 5 tables.
·
Digestive Diseases in the United States: Epidemiology and Impact Source: Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 1994. 799 p. Contact: Available from National Digestive Diseases Information Clearinghouse. 2 Information Way, Bethesda, MD 20892-3570. (800) 8915389 or (301) 654-3810. E-mail:
[email protected]. Price: $15.00. Summary: This monograph is a compendium of descriptive statistics about the scope and impact of digestive diseases in the United States. Each chapter provides national and population data based on the prevalence, incidence, medical care, disability, mortality, and research needs. Twenty chapters cover the following conditions: infectious diarrheas, viral hepatitis, esophageal cancer, gastric cancer, colorectal cancer, liver cancer, pancreatic cancer, hemorrhoids, esophageal diseases,
Physician Guidelines and Databases 179
peptic ulcer, gastritis and nonulcer dyspepsia, acute appendicitis, abdominal wall hernia, inflammatory bowel diseases, diverticular disease of the colon, constipation, irritable bowel syndrome, chronic liver disease and cirrhosis, gallstones, and pancreatitis. These chapters compare the impact and costs of the disease to other diseases. The book also includes an overview chapter, a chapter about the cost of digestive diseases in the United States, and a listing of all digestive diseases diagnostic codes for the ninth and tenth editions of the International Classification of Diseases. Extensive figures are used throughout the volume. 3 appendices. ·
Screening Older Americans' Nutritional Health: Current Practices and Future Possibilities. Executive Summary Source: Washington, DC, Nutrition Screening Initiative, 24 p., February 1991. Contact: Nutrition Screening Initiative, 2626 Pennsylvania Avenue, NW., Suite 301, Washington, DC 20037. (202) 625-1662. Summary: Screening Older Americans' Nutritional Health: Current Practices and Future Possibilities is an executive summary of a review of existing literature concerning aging and nutrition. The review examines the prevalence of malnutrition among older Americans and the characteristics of aging. It describes the negative impact of malnutrition on ability to function independently and on mental and physical health. Dietary patterns affect the incidence of atherosclerotic disease, hypertension, obesity, some forms of cancer, osteoporosis, diabetes mellitus, hepatobiliary disease, alcoholism and dental caries. Inappropriate dietary intakes may exacerbate existing conditions (e.g., diabetes mellitus, advanced renal insufficiency, hypercholesteremia, certain forms of hypertension, constipation, gastrointestinal problems due to lactose intolerance, and congestive heart failure). The report addresses specific problems and chronic diseases associated with malnutrition or affecting an individual's nutritional status, describes effective nutrition screening techniques and interventions, and outlines recommendations for a more standard approach to nutrition screening. It also highlights gaps in the present knowledge of nutrition and aging that inhibit progress and considers needed improvements in the science base, in medical and health care practices, and in public policy.
·
Screening Older Americans' Nutritional Health: Current Practices and Future Possibilities Source: Washington, DC, Nutrition Screening Initiative, 136 p., February 1991.
180 Constipation
Contact: Nutrition Screening Initiative, 2626 Pennsylvania Avenue, NW., Suite 301, Washington, DC 20037. (202) 625-1662. Summary: Screening Older Americans' Nutritional Health: Current Practices and Future Possibilities reviews existing literature concerning aging and nutrition. The report examines the prevalence of malnutrition among older Americans and the characteristics of aging. It describes the negative impact of malnutrition on the ability to function independently and on mental and physical health. Dietary patterns affect the incidence of atherosclerotic disease, hypertension, obesity, some forms of cancer, osteoporosis, diabetes mellitus, hepatobiliary disease, alcoholism and dental caries. Inappropriate dietary intakes may exacerbate existing conditions (e.g., diabetes mellitus, advanced renal insufficiency, hypercholesteremia, certain forms of hypertension, constipation, gastrointestinal problems due to lactose intolerance, and congestive heart failure). The report addresses specific problems and chronic diseases that are associated with malnutrition or that affect an individual's nutritional status, describes effective nutrition screening techniques and interventions, and outlines recommendations for a more standard approach to nutrition screening. The document highlights gaps in current knowledge of nutrition and aging that inhibit progress and notes needed improvements in the science base, medical and health care practices, and public policy. 7 tables. ·
Increasing Protein and Calories Contact: University of California San Francisco Medical Center, Department of Nutrition and Dietetics, 505 Parnassus Moffitt 294, San Francisco, CA, 94143, (415) 476-1461, http://www.ucsfhealth.org/. Summary: This brochure provides information on the basics of a highprotein and high-calorie diet. The diet is designed to increase the nutritional value of foods and beverages for patients who find it difficult to eat during illness. The brochure contains general diet and nutritional suggestions, followed by specific suggestions for and benefits of increasing the protein and/or calorie content of the diet without increasing the actual amount of food eaten. The brochure also includes suggestions for overcoming specific eating problems, such as feeling too tired to eat, anorexia, feeling of fullness, taste changes, constipation, and diarrhea. Diet modifications for nausea and vomiting as well as suggestions for small meals and nutritious snacks are also provided. The brochure concludes with a short collection of recipes.
·
About Medications Source: Danvers, MA: Scleroderma Foundation. 1998. 12 p.
Physician Guidelines and Databases 181
Contact: Available from Scleroderma Foundation. 12 Kent Way, Suite 101, Byfield, MA 01922. (800) 722-4673 or (978) 463-5843. Fax (978) 4635809. E-mail:
[email protected]. Website: www.scleroderma.org. Price: Single copy $1.00. Summary: This pamphlet for people with scleroderma provides information on medications used to treat some of the more common symptoms of systemic sclerosis. Information on each medication includes the goal of treatment, the basic mechanism of the medication, and the main side effects of the medication. Drugs identified include those for reducing joint and tendon pain, preventing Raynaud's phenomenon, treating diarrhea, relieving constipation, preventing heartburn, improving swallowing difficulty, treating digital ulcers, reducing skin itching, relieving dry mouth and eyes, controlling high blood pressure, relieving pericarditis, and treating reactive depression. In addition, the pamphlet presents some of the drugs under development for treating scleroderma and identifies other potential disease modifying treatments for scleroderma. ·
Managing Your Child's Eating Problems During Cancer Treatment Source: Bethesda, MD: National Cancer Institute (NCI), National Institutes of Health (NIH). March 1994. 33 p. Contact: Available from National Cancer Institute (NCI). Publications Ordering Service, P.O. Box 24128, Baltimore, MD 21227. (800) 422-6237. TTY (800) 332-8615. Fax (301) 330-7968. Website: rex.nci.nih.gov. Price: Single copy free. NIH Publication Number 94-2038. Summary: This booklet contains a variety of ideas that have helped parents cope with their children's eating problems related to cancer treatment. The author describes the nutrition problems that may be associated with different cancer treatments and lists simple steps for the home care management of these problems. The booklet offers strategies for coping with the side effects of cancer therapy, including loss of appetite, sore mouth or throat, changed sense of taste, dry mouth, nausea, vomiting, diarrhea, constipation, weight gain, tooth decay, and lactose intolerance. A final section offers suggestions for increasing the child's intake of protein and calories. The booklet concludes with a glossary of terms and definitions related to diet, nutrition, and cancer treatment. The booklet also provides a brief description of the Cancer Information Service (800-4-CANCER) and the American Cancer Society (800-227-2345). 4 tables.
182 Constipation
·
Fiber Facts Source: Fort Worth, TX: Konsyl Pharmaceuticals, Inc. 1999. [2 p.]. Contact: Available from Konsyl Pharmaceuticals, Inc. 4200 South Hulen Street, Suite 513, Fort Worth, TX 76109-4912. (800) 356-6795 or (817) 7638011. Fax (817) 731-9389. Website: www.konsyl.com. Price: Single copy free. Summary: This brochure provides basic information about dietary fiber, defined as the part of the plant that cannot be digested by humans. Fiber is found in grains, cereals, fruits, vegetables, nuts, seeds, and legumes (dried beans, peas, and lentils). There are two kinds of fiber and most sources of fiber contain a mixture of both types. Soluble fiber absorbs water and promotes good intestinal health by increasing bowel motility which enhances transit through the intestinal tract. Insoluble fiber absorbs little water but is still important because it improves the transit time necessary to move fecal material through the colon. The National Cancer Institute has recommended eating 25 to 35 grams of fiber a day as a step toward preventing colon cancer. Most Americans consume only 10 to 15 grams of fiber per day. The brochure reviews strategies that readers can implement to increase their fiber intake, but notes that it is important to increase the level slowly. A chart is provided for readers to determine their present level of dietary fiber intake. The author discusses the use of fiber supplements, such as Konsyl (the manufacturer of which is the producer of this brochure). The brochure summarizes how increased fiber will benefit each of six disease areas: constipation, hemorrhoids, diverticular disease, irritable bowel syndrome (IBS), colon cancer, and cardiovascular disease. The brochure is illustrated with full color drawings and photographs. 1 table. 4 figures.
·
Taking Care of Your Colon Source: Santa Cruz, CA: ETR Associates. 1999. 6 p. Contact: Available from ETR Associates. P.O. Box 1830, Santa Cruz, CA 95061-1830. (800) 321-4407. Fax (800) 435-8433. Website: www.etr.org. Price: $16.00 for 50 copies plus shipping and handling, bulk copies available. Order number R362. Summary: This educational brochure offers information about the role of the colon (large intestine) and strategies for maintaining colon health. The colon reabsorbs most of the water from undigested food, then moves solid waste out of the body. Most colon problems have clear symptoms, such as cramps, constipation, or diarrhea. The brochure briefly defines some common problems, including diverticulosis (colon pockets), irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), colon
Physician Guidelines and Databases 183
polyps, and infections of the colon. The brochure then focuses on prevention of problems, with an emphasis on including enough dietary fiber and fluids in one's daily intake. Fiber in the diet promotes regular bowel movements, makes constipation and cramping less likely, reduces the time that waste remains in the colon, eases diverticulosis and IBS, may reduce the risk of colon cancer and some other cancers, and lowers levels of low density cholesterol (LDL). The brochure recommends that readers avoid laxatives, high fat foods, colonics or enemas, and too much caffeine or alcohol. The brochure offers suggestions for treating minor problems with diarrhea and constipation, then concludes with a discussion of colon cancer and the screening tests used to diagnose colon cancer (including a digital rectal exam, a stool blood test, a flexible sigmoidoscopy, and colonoscopy). 1 figure. 1 table. ·
Colorectal Health: The Wellness Way. [Salud Colorrectal: Conservacion de la Salud] Source: San Bruno, CA: StayWell Company. 1999. [2 p.]. Contact: Available from StayWell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 2444512. E-mail:
[email protected]. Website: www.staywell.com. Price: $20.00 for pack of 50; plus shipping and handling. Summary: There are three basic ingredients in promoting colorectal health: eating right, exercising regularly, and getting regular screening exams. This patient education brochure describes these strategies. Written in nontechnical language, the brochure first illustrates the colorectal anatomy and defines common problems, including polyps, colitis, cancer, and hemorrhoids. The brochure then focuses on colorectal cancer, including risk factors (age and family history) and symptoms, such as blood in the stool, constipation or diarrhea, increase in intestinal gas, and pain in the abdomen. The brochure stresses that early colorectal cancer is often without symptoms, which is why annual screenings are so important. The brochure then describes two rectal examinations that help doctors diagnose colorectal cancers: the digital rectal examination and the proctosigmoidoscopy (the procto). Each examination is described and illustrated (with a male figure in the illustrations). The brochure also includes a colorectal checklist for readers to see whether they are following recommendations to prevent colorectal cancer and detect problems early. A brief list of health resources, including the toll free telephone number for a cancer information line (1-800-4CANCER) is provided. The brochure is illustrated with full color line drawings and is available in English or Spanish. 12 figures.
184 Constipation
·
Diverticulosis and Diverticulitis: Understanding and Managing Two Common Colon Problems. [Diverticulosis y Diverticulitis: Como Entender y Controlar Problemas Comunes del Colon] Source: San Bruno, CA: StayWell Company. 1999. 7 p. Contact: Available from Staywell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 2444512. Price: $1.25 per copy; plus shipping and handling. Summary: This patient education brochure describes two common colon problems: diverticulosis and diverticulitis. Written in nontechnical language, the brochure defines diverticulosis as small pouches in the colon wall; diverticulitis is a more serious problem that occurs when these pouches become infected or inflamed. Although aging may contribute to colon problems, food choices are the primary concern for the health of one's colon. A low fiber, high fat diet can lead to an unhealthy colon. The brochure describes how pressure can cause pouches in the colon and then the conditions that can lead to diverticulitis. Symptoms often include pain, fever, chills, cramping, bloating, constipation, or diarrhea. Diet changes or medications may be enough to bring relief; in severe cases, surgery may be needed. The diagnosis will include the patient's history, a medical exam, and diagnostic tests, including barium enema, sigmoidoscopy, and colonoscopy. The two keys to controlling diverticulosis are dietary fiber (roughage) and liquid. Fiber absorbs water as it travels through the colon, helping the stool stay soft and move smoothly with less pressure. Eating more high fiber foods and drinking more liquids can often keep diverticulosis in check. If diverticulitis symptoms are mild, the treatment may begin with a temporary liquid diet and oral antibiotics. If the diverticulitis is severe, the patient may need bed rest, hospitalization, and intravenous (IV) antibiotics and nutrients. Surgery may be indicated in some cases and the brochure outlines the typical colon surgery resection that is used. The brochure concludes by reminding readers of the importance of dietary fiber and lists common foods that are high in fiber. The brochure is illustrated with full color line drawings and is available in English or Spanish. 19 figures.
·
What Can Digestion Tell You About Your Health? Source: Asheville, NC: Great Smokies Diagnostic Laboratory. 1998. [2 p.]. Contact: Available from Great Smokies Diagnostic Laboratory. 63 Zillicoa Street, Asheville, NC 28801-1074. (800) 522-4762 or (704) 253-0621. Fax (704) 252-9303. E-mail:
[email protected]. Website: www.greatsmokieslab.com. Price: Single copy free.
Physician Guidelines and Databases 185
Summary: This brochure describes the Comprehensive Digestive Stool Analysis (CDSA), a group of 25 tests performed on a stool sample, which can reveal information about a patient's gastrointestinal health. The CDSA evaluates the digestion of food molecules and absorption of nutrients, the presence of hidden yeast or bacterial infections, intestinal flora balance, intestinal immune function, and dietary fiber intake. The brochure emphasizes that poor digestion or imbalances in the intestinal flora can result in many illnesses, from annoying complaints such as chronic constipation and abdominal pain, to more serious illnesses that may appear unrelated to digestion, such as asthma or migraines. The brochure reviews the role of some of the components of a healthy gastrointestinal tract, including stomach acid and other digestive enzymes, the bacteria in the digestive tract, and the immune system. For proper gastrointestinal health, the body must carefully coordinate the breakdown, absorption, and elimination of food. Bacteria must be in proper balance, and immune function must be adequate. The brochure includes a checklist readers can use to assess their own need for a CDSA. 1 figure. ·
Help for Common Digestive Problems Source: Zetland, New South Wales, Australia: Multicultural Health Communication Service. 1998. (web brochure). Contact: Available from Multicultural Health Communication Service. Royal South Sydney Community Health Complex, Joynton Avenue, Zetland, New South Wales, Australia 2107. (02) 9382 8111. E-mail:
[email protected]. Website: mhcs.health.nsw.gov.au/. Item is available only through the website and can be found under Diseases and Conditions. Summary: This brochure, available online through the Multicultural Health Communication Service, is one of a series of health information publications available in languages other than English. The Service facilitates the communication of quality information about health issues and services to people of non-English-speaking backgrounds. This brochure offers suggestions for handling common digestive problems, including heartburn, peptic ulcer, irritable bowel syndrome (IBS), and constipation. A burning pain (heartburn) just behind the breastbone is usually a symptom of acid reflux, a condition where gastric acid backs up into the esophagus. The brochure describes the differences in the sensations caused by heartburn and the symptoms of a heart attack. Acid reflux can be caused by some foods and drinks or by a stomach ulcer. The brochure discusses the role of Helicobacter pylori in stomach ulcers. The brochure then briefly describes IBS, including the symptoms and risk
186 Constipation
factors, and encourages readers to contact their health care providers when certain symptoms (blood in the bowel movements, weight loss, or family history of bowel cancer) are present . The section on constipation warns readers not to rely on laxatives, but instead to increase their consumption of dietary fiber and fluids and to exercise regularly. The brochure concludes by reminding readers of the importance of following a balanced diet that includes plenty of cereals and grains, and of the positive impact on the digestive system of ceasing to smoke. The brochure is not illustrated and is written in straightforward, nontechnical language. ·
Food for Life: A Care Giver's Guide to Gastrostomy Tube Feedings of Adults Source: Atlanta, GA: Pritchett and Hull Associates, Inc. 1996. 24 p. Contact: Available from Pritchett and Hull Associates, Inc. 3440 Oakcliff Road NE, Suite 110, Atlanta, GA 30340-3079. (800) 241-4925. World Wide Web: http://www.p-h.com/. Price: $5.25 plus shipping (retail); $3.95 plus shipping (wholesale to health professionals). Summary: This booklet provides care givers with a practical overview of gastrostomy tube feeding for adults. The author focuses on teaching home care givers the confidence needed to feed their loved ones with gastrostomy (G) tubes. Topics include bolus versus continuous feedings; what to if a tube comes out; 1, 2, and 3-port tubes; tube and skin care; safety checks; residual checks and tube flushing; the types of food used for G tubes; giving medicine through a G tube; and common side effects, including sore mouth, gas or upset stomach, diarrhea, and constipation; and how to handle each side effect. The booklet concludes with a brief section discussing the importance of the care giver getting support for her or himself. The booklet is written at a low reading level in large, clear type. Colorful illustrations depict many of the concepts and techniques discussed.
·
Managing Bladder and Bowel Problems: Practical Ways of Helping You Better Care for a Person with Memory Loss and Confusion Source: Santa Cruz, CA: Journeyworks Publishing. 1996. 2 p. Contact: Available from Journeyworks Publishing. P.O. Box 8466, Santa Cruz, CA 95061. (800) 775-1998 or (408) 423-1400. Fax (408) 423-8102. Price: Single copy free; bulk copies available. ISBN: 1568850085. Summary: This brochure presents practical suggestions for caregivers who are managing bladder and bowel problems in people with memory loss and confusion. Ten strategies are presented and discussed. They
Physician Guidelines and Databases 187
include: have the person use the toilet regularly, watch for signals, use simple clothing, try protective garments, give clear instructions, make using the bathroom easy and comfortable, use fluids and foods to prevent problems, plan for accidents, talk with a doctor, and help the person relax. Each strategy is illustrated with a line drawing and includes a bulleted list of ideas to try. The diet therapy section reminds readers that plenty of liquids, fruits, vegetables, and grains can help prevent constipation. In addition, the use of a food diary can identify foods that cause loose bowels (diarrhea). ·
Renal Nutrition: The Basics Source: Alexandria, LA: Elaine Preston Rowzee. 1997. 34 p. Contact: Available from Elaine Preston Rowzee. Perdue Kidney Center, Box 30116, 405 Third Street, Alexandria, LA 71301. (318) 487-1063. Price: $7.00. Summary: This booklet provides patients or new dietitians with basic information on the renal diet. The author offers tips and suggestions for making the renal diet a little easier to understand and live with. Eleven chapters cover kidney physiology and function; blood urea nitrogen (BUN) levels and what they mean; potassium and its impact on cardiovascular health; sodium and fluid levels; phosphorus, calcium, and the bones; constipation; iron supplementation; the role of erythropoietin (EPO) in fighting anemia; determining the need for nutritional supplements; the indications for intradialytic parenteral nutrition (IDPN) used with patients on hemodialysis, or intraperitoneal nutrition used with patients on peritoneal dialysis; and determining dialysis adequacy. A separate chapter addresses ways to ease the monotonous lifestyle that can be common for a patient on dialysis; suggestions include the use of stickers, contests, bulletin boards, and cookbooks. The final chapter provides answers to commonly asked questions on topics that include managing elevated magnesium levels, cramping in patients on IDPN, the lack of potassium and phosphorus information on standard food labels, managing thirst, and managing serum aluminum levels. Simple line drawings and charts supplement the text. 17 references.
·
Eating for good health: A nutrition handbook for caretakers of the handicapped child Source: Baltimore, MD: John F. Kennedy Institute for Handicapped Children, The Nutrition Division. n.d. 18 pp. Contact: Available from Jackie Krick, John F. Kennedy Institute for Handicapped Children, Nutrition Division, 707 North Broadway, Room
188 Constipation
20, Baltimore, MD 21205. Telephone: (410) 522-5441. 1-9 copies: $5.50 each ($4.00 + $1.50 handling); 10 or more: $3.00 includes shipping and handling. Summary: This packet provides information that ties together the relationship of nutrition factors and clinical strategies to disabilities. Topics are covered by both a scientific based description for professionals and a nutrition education fact sheet for families and parents, and include: feeding, dental health, fluids, diet and underweight, diet and weight control, dietary fiber and constipation, lead poisoning, megavitamin therapy, nutritional effects of drug therapy, and hyperactivity.
The NLM Gateway29 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for many of NLM’s information resources or databases.30 One target audience for the Gateway is the Internet user who is new to NLM’s online resources and does not know what information is available or how best to search for it. This audience may include physicians and other healthcare providers, researchers, librarians, students, and, increasingly, patients, their families, and the public.31 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “constipation” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category.
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 31 Other users may find the Gateway useful for an overall search of NLM’s information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 29 30
Physician Guidelines and Databases 189
Results Summary Category Items Found Journal Articles 343118 Books / Periodicals / Audio Visual 2561 Consumer Health 292 Meeting Abstracts 3093 Other Collections 100 Total 349164
HSTAT32 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.33 HSTAT’s audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.34 Simply search by “constipation” (or synonyms) at the following Web site: http://text.nlm.nih.gov. Coffee Break: Tutorials for Biologists35 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. To this end, we Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. The HSTAT URL is http://hstat.nlm.nih.gov/. 34 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force’s Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 35 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 32 33
190 Constipation
recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.36 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.37 This site has new articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access the Coffee Break Web site at http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
·
Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center’s MARS electronic medical record system; see the following Web site: http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.
·
Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
·
MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical literature, and to explore relevant Web sites; see http://www.med.virginia.edu/~wmd4n/medweaver.html.
·
Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language generally used by caregivers into terms from formal, controlled vocabularies; see http://www.lexical.com/Metaphrase.html.
The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 37 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 36
Physician Guidelines and Databases 191
The Genome Project and Constipation With all the discussion in the press about the Human Genome Project, it is only natural that physicians, researchers, and patients want to know about how human genes relate to constipation. In the following section, we will discuss databases and references used by physicians and scientists who work in this area.
Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).38 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. Go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html to search the database. Type “constipation” (or synonyms) in the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. By following these links, especially the link titled “Database Links,” you will be exposed to numerous specialized databases that are largely used by the scientific community. These databases are overly technical and seldom used by the general public, but offer an abundance of information. The following is an example of the results you can obtain from the OMIM for constipation: ·
Adrenomyodystrophy Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?300270
·
Alpha-thalassemia/mental Retardation Syndrome, X-linked Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?301040
Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.
38
192 Constipation
·
Anal Sphincter Dysplasia Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?105563
·
Anal Sphincter Myopathy, Internal Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?105565
·
Autonomic Control, Congenital Failure of Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?209880
·
Collagen, Type Iii, Alpha-1 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?120180
·
Coproporphyria Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?121300
·
Currarino Syndrome Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?176450
·
Diabetes Insipidus, Nephrogenic, X-linked Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?304800
·
Disorganization, Mouse, Homolog of Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?223200
Genes and Disease (NCBI - Map) The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by the system of the body associated with it. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to re-visit it from time to time. The following systems and associated disorders are addressed: ·
Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn’s disease, DiGeorge syndrome, familial Mediterranean fever,
Physician Guidelines and Databases 193
immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html ·
Metabolism: Food and energy. Examples: Adreno-leukodystrophy, Atherosclerosis, Best disease, Gaucher disease, Glucose galactose malabsorption, Gyrate atrophy, Juvenile onset diabetes, Obesity, Paroxysmal nocturnal hemoglobinuria, Phenylketonuria, Refsum disease, Tangier disease, Tay-Sachs disease. Web site: http://www.ncbi.nlm.nih.gov/disease/Metabolism.html
·
Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html
·
Signals: Cellular messages. Examples: Ataxia telangiectasia, Baldness, Cockayne syndrome, Glaucoma, SRY: sex determination, Tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html
·
Transporters: Pumps and channels. Examples: Cystic Fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html Entrez
Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·
PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
·
Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide
·
Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein
·
Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure
194 Constipation
·
Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome
·
PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset
·
OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM
·
Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy
·
Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books
·
ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/
To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” In the box next to “for,” enter “constipation” (or synonyms) and click “Go.”
Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database39 This online resource can be quite useful. It has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html you can also search across syndromes using an alphabetical index. You can also search at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html.
39
Physician Guidelines and Databases 195
The Genome Database40 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “constipation” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms). This database is extremely technical as it was created for specialists. The articles are the results which are the most accessible to non-professionals and often listed under the heading “Citations.” The contact names are also accessible to non-professionals.
Specialized References The following books are specialized references written for professionals interested in constipation (sorted alphabetically by title, hyperlinks provide rankings, information, and reviews at Amazon.com): · Blackwell’s Primary Care Essentials: Gastointestinal Disease by David W. Hay; Paperback, 1st edition (December 15, 2001), Blackwell Science Inc; ISBN: 0632045035; http://www.amazon.com/exec/obidos/ASIN/0632045035/icongroupinterna · Gastrointestinal Problems by Martin S. Lipsky, M.D. (Editor), Richard Sadovsky, M.D. (Editor); Paperback - 194 pages, 1st edition (August 15, Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html#mission.
40
196 Constipation
2000), Lippincott, Williams & Wilkins Publishers; ISBN: 0781720540; http://www.amazon.com/exec/obidos/ASIN/0781720540/icongroupinterna · Rome II: The Functional Gastrointestinal Disorders by Douglas A. Drossman (Editor); Paperback - 800 pages, 2nd edition (March 1, 2000), Degnon Associates Inc.; ISBN: 0965683729; http://www.amazon.com/exec/obidos/ASIN/0965683729/icongroupinterna
Vocabulary Builder Cardiovascular: Pertaining to the heart and blood vessels. [EU] Collagen: The protein substance of the white fibres (collagenous fibres) of skin, tendon, bone, cartilage, and all other connective tissue; composed of molecules of tropocollagen (q.v.), it is converted into gelatin by boiling. collagenous pertaining to collagen; forming or producing collagen. [EU] Confusion: Disturbed orientation in regard to time, place, or person, sometimes accompanied by disordered consciousness. [EU] Cytomegalovirus: A genus of the family herpesviridae, subfamily betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Dietetics: The study and regulation of the diet. [NIH] Erythropoietin: Glycoprotein hormone, secreted chiefly by the kidney in the adult and the liver in the fetus, that acts on erythroid stem cells of the bone marrow to stimulate proliferation and differentiation. [NIH] Flushing: A transient reddening of the face that may be due to fever, certain drugs, exertion, stress, or a disease process. [NIH] Myopathy: Any disease of a muscle. [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Thalassemia: A group of hereditary hemolytic anemias in which there is decreased synthesis of one or more hemoglobin polypeptide chains. There are several genetic types with clinical pictures ranging from barely detectable hematologic abnormality to severe and fatal anemia. [NIH]
Dissertations 197
CHAPTER 10. DISSERTATIONS ON CONSTIPATION Overview University researchers are active in studying almost all known disorders and conditions. The result of research is often published in the form of Doctoral or Master’s dissertations. You should understand, therefore, that applied diagnostic procedures and/or therapies can take many years to develop after the thesis that proposed the new technique or approach was written. In this chapter, we will give you a bibliography on recent dissertations relating to constipation. You can read about these in more detail using the Internet or your local medical library. We will also provide you with information on how to use the Internet to stay current on dissertations.
Dissertations on Constipation ProQuest Digital Dissertations is the largest archive of academic dissertations available. From this archive, we have compiled the following list covering dissertations devoted to constipation. You will see that the information provided includes the dissertation’s title, its author, and the author’s institution. To read more about the following, simply use the Internet address indicated. The following covers recent dissertations dealing with constipation: ·
Anorexia Nervosa: a Psychological Birth Anomaly (separation Individuation, Psychoanalytical, Developmental Psychology, Borderline Personality Disorder, Object Relations) by Brainard,
198 Constipation
Marythelma Bryant, Phd from The University of New Mexico, 1984, 516 pages http://wwwlib.umi.com/dissertations/fullcit/8425910 ·
Assessment of the Effectiveness of Paediatric Psychoeducational Programs on Family Functioning by Roblin, Nancy Elizabeth; Edd from University of Toronto (canada), 1999, 159 pages http://wwwlib.umi.com/dissertations/fullcit/NQ41077
·
'die Sprache Aus Dem Bett Reissen': Feminist Satire in the Works of Elfriede Jelinek and Isolde Schaad (switzerland, Austria) by Scheffer, Julia Ann; Phd from University of Washington, 2001, 241 pages http://wwwlib.umi.com/dissertations/fullcit/3014112
·
Eating Bodies Eating Texts: Metaphors of Incorporation and Consumption in Walter Benjamin, Dada, and Futurism by Novero, Cecilia; Phd from The University of Chicago, 2000, 493 pages http://wwwlib.umi.com/dissertations/fullcit/9965129
·
Irritable Bowel Syndrome: Pathophysiological and Clinical Aspects by Simren, Magnus; Meddr from Goteborgs Universitet (sweden), 2001, 96 pages http://wwwlib.umi.com/dissertations/fullcit/f443793
Keeping Current As previously mentioned, an effective way to stay current on dissertations dedicated to constipation is to use the database called ProQuest Digital Dissertations via the Internet, located at the following Web address: http://wwwlib.umi.com/dissertations. The site allows you to freely access the last two years of citations and abstracts. Ask your medical librarian if the library has full and unlimited access to this database. From the library, you should be able to do more complete searches than with the limited 2-year access available to the general public.
199
PART III. APPENDICES
ABOUT PART III Part III is a collection of appendices on general medical topics which may be of interest to patients with constipation and related conditions.
Researching Your Medications 201
APPENDIX A. RESEARCHING YOUR MEDICATIONS Overview There are a number of sources available on new or existing medications which could be prescribed to patients with constipation. While a number of hard copy or CD-Rom resources are available to patients and physicians for research purposes, a more flexible method is to use Internet-based databases. In this chapter, we will begin with a general overview of medications. We will then proceed to outline official recommendations on how you should view your medications. You may also want to research medications that you are currently taking for other conditions as they may interact with medications for constipation. Research can give you information on the side effects, interactions, and limitations of prescription drugs used in the treatment of constipation. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
202 Constipation
Your Medications: The Basics41 The Agency for Health Care Research and Quality has published extremely useful guidelines on how you can best participate in the medication aspects of constipation. Taking medicines is not always as simple as swallowing a pill. It can involve many steps and decisions each day. The AHCRQ recommends that patients with constipation take part in treatment decisions. Do not be afraid to ask questions and talk about your concerns. By taking a moment to ask questions early, you may avoid problems later. Here are some points to cover each time a new medicine is prescribed: ·
Ask about all parts of your treatment, including diet changes, exercise, and medicines.
·
Ask about the risks and benefits of each medicine or other treatment you might receive.
·
Ask how often you or your doctor will check for side effects from a given medication.
Do not hesitate to ask what is important to you about your medicines. You may want a medicine with the fewest side effects, or the fewest doses to take each day. You may care most about cost, or how the medicine might affect how you live or work. Or, you may want the medicine your doctor believes will work the best. Telling your doctor will help him or her select the best treatment for you. Do not be afraid to “bother” your doctor with your concerns and questions about medications for constipation. You can also talk to a nurse or a pharmacist. They can help you better understand your treatment plan. Feel free to bring a friend or family member with you when you visit your doctor. Talking over your options with someone you trust can help you make better choices, especially if you are not feeling well. Specifically, ask your doctor the following: ·
The name of the medicine and what it is supposed to do.
·
How and when to take the medicine, how much to take, and for how long.
·
What food, drinks, other medicines, or activities you should avoid while taking the medicine.
·
What side effects the medicine may have, and what to do if they occur.
·
If you can get a refill, and how often.
41
This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.
Researching Your Medications 203
·
About any terms or directions you do not understand.
·
What to do if you miss a dose.
·
If there is written information you can take home (most pharmacies have information sheets on your prescription medicines; some even offer large-print or Spanish versions).
Do not forget to tell your doctor about all the medicines you are currently taking (not just those for constipation). This includes prescription medicines and the medicines that you buy over the counter. Then your doctor can avoid giving you a new medicine that may not work well with the medications you take now. When talking to your doctor, you may wish to prepare a list of medicines you currently take, the reason you take them, and how you take them. Be sure to include the following information for each: ·
Name of medicine
·
Reason taken
·
Dosage
·
Time(s) of day
Also include any over-the-counter medicines, such as: ·
Laxatives
·
Diet pills
·
Vitamins
·
Cold medicine
·
Aspirin or other pain, headache, or fever medicine
·
Cough medicine
·
Allergy relief medicine
·
Antacids
·
Sleeping pills
·
Others (include names)
Learning More about Your Medications Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications your doctor has recommended for constipation. One such
204 Constipation
source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the “U.S. Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at www.usp.org. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database.42 While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopoeia. It is important to read the disclaimer by the United States Pharmacopoeia (http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using the information provided. Of course, we as editors cannot be certain as to what medications you are taking. Therefore, we have compiled a list of medications associated with the treatment of constipation. Once again, due to space limitations, we only list a sample of medications and provide hyperlinks to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to constipation: Alosetron ·
Systemic - U.S. Brands: Lotronex http://www.nlm.nih.gov/medlineplus/druginfo/alosetronsystem ic500107.html
Though cumbersome, the FDA database can be freely browsed at the following site: www.fda.gov/cder/da/da.htm.
42
Researching Your Medications 205
Glycerin ·
Systemic - U.S. Brands: Glyrol; Osmoglyn http://www.nlm.nih.gov/medlineplus/druginfo/glycerinsystemi c202263.html
Laxatives ·
Oral - U.S. Brands: Afko-Lube; Afko-Lube Lax 40; Agoral Marshmallow; Agoral Raspberry; Alaxin; Alophen; Alphamul; Alramucil Orange; Alramucil Regular; Bilagog; Bilax; Bisac-Evac; Black-Draught; Black-Draught Lax-Senna; Carter's Little Pills; Cholac; Chronulac; Cillium; Cit http://www.nlm.nih.gov/medlineplus/druginfo/laxativesoral202 319.html
·
Rectal - U.S. Brands: Bisco-Lax; Ceo-Two; Dacodyl; Deficol; Dulcolax; Fleet Babylax; Fleet Bisacodyl; Fleet Enema; Fleet Enema for Children; Fleet Enema Mineral Oil; Fleet Glycerin Laxative; Fleet Laxative; Sani-Supp; Senokot; Theralax; Therevac Plus; Therevac-SB http://www.nlm.nih.gov/medlineplus/druginfo/laxativesrectal2 02320.html
Thiamine (Vitamin B 1 ) ·
Systemic - U.S. Brands: Biamine http://www.nlm.nih.gov/medlineplus/druginfo/thiaminevitami nb1systemic202560.html
Vincristine ·
Systemic - U.S. Brands: Oncovin; Vincrex http://www.nlm.nih.gov/medlineplus/druginfo/vincristinesyste mic202594.html
Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. You may be able to access these sources from your local medical library or your doctor’s office.
206 Constipation
Reuters Health Drug Database The Reuters Health Drug Database can be searched by keyword at the hyperlink: http://www.reutershealth.com/frame2/drug.html. The following medications are listed in the Reuters’ database as associated with constipation (including those with contraindications):43 ·
Alendronate Sodium http://www.reutershealth.com/atoz/html/Alendronate_Sodium.htm
·
Alprazolam http://www.reutershealth.com/atoz/html/Alprazolam.htm
·
Amantadine HCl http://www.reutershealth.com/atoz/html/Amantadine_HCl.htm
·
Amiloride HCl http://www.reutershealth.com/atoz/html/Amiloride_HCl.htm
·
Amiodarone http://www.reutershealth.com/atoz/html/Amiodarone.htm
·
Amitriptyline HCl http://www.reutershealth.com/atoz/html/Amitriptyline_HCl.htm
·
Amobarbital Secobarbital http://www.reutershealth.com/atoz/html/Amobarbital_Secobarbital.htm
·
Amobarbital Sodium http://www.reutershealth.com/atoz/html/Amobarbital_Sodium.htm
·
Amoxapine http://www.reutershealth.com/atoz/html/Amoxapine.htm
·
Amphetamine http://www.reutershealth.com/atoz/html/Amphetamine.htm
·
Amphetamine (Racemic Amphetamine Sulfate) http://www.reutershealth.com/atoz/html/Amphetamine_(Racemic_A mphetamine_Sulfate).htm
·
Atorvastatin Calcium http://www.reutershealth.com/atoz/html/Atorvastatin_Calcium.htm
·
Atovaquone http://www.reutershealth.com/atoz/html/Atovaquone.htm
43
Adapted from A to Z Drug Facts by Facts and Comparisons.
Researching Your Medications 207
·
Atropine Sulfate Scopolamine Hydrobromide Hyoscyamine Sulfate Phenobarbital http://www.reutershealth.com/atoz/html/Atropine_Sulfate_Scopolami ne_Hydrobromide_Hyoscyamine_Sulfate_Phenobarbital.htm
·
Bupropion HCl http://www.reutershealth.com/atoz/html/Bupropion_HCl.htm
·
Butalbital Acetaminophen Caffeine Codeine Phosphate http://www.reutershealth.com/atoz/html/Butalbital_Acetaminophen_ Caffeine_Codeine_Phosphate.htm
·
Butalbital Aspirin Caffeine http://www.reutershealth.com/atoz/html/Butalbital_Aspirin_Caffeine. htm
·
Butalbital Aspirin Caffeine Codeine Phosphate http://www.reutershealth.com/atoz/html/Butalbital_Aspirin_Caffeine _Codeine_Phosphate.htm
·
Butorphanol Tartrate http://www.reutershealth.com/atoz/html/Butorphanol_Tartrate.htm
·
Captopril http://www.reutershealth.com/atoz/html/Captopril.htm
·
Carbamazepine http://www.reutershealth.com/atoz/html/Carbamazepine.htm
·
Carteolol HCl http://www.reutershealth.com/atoz/html/Carteolol_HCl.htm
·
Cetirizine http://www.reutershealth.com/atoz/html/Cetirizine.htm
·
Charcoal activated http://www.reutershealth.com/atoz/html/Charcoal_activated.htm
·
Chlordiazepoxide Amitriptyline http://www.reutershealth.com/atoz/html/Chlordiazepoxide_Amitript yline.htm
·
Chlorpheniramine Maleate http://www.reutershealth.com/atoz/html/Chlorpheniramine_Maleate. htm
·
Cidofovir http://www.reutershealth.com/atoz/html/Cidofovir.htm
·
Clemastine Fumarate http://www.reutershealth.com/atoz/html/Clemastine_Fumarate.htm
208 Constipation
·
Clomipramine HCl http://www.reutershealth.com/atoz/html/Clomipramine_HCl.htm
·
Clonazepam http://www.reutershealth.com/atoz/html/Clonazepam.htm
·
Clonidine HCl http://www.reutershealth.com/atoz/html/Clonidine_HCl.htm
·
Clorazepate Dipotassium http://www.reutershealth.com/atoz/html/Clorazepate_Dipotassium.htm
·
Clozapine http://www.reutershealth.com/atoz/html/Clozapine.htm
·
Codeine http://www.reutershealth.com/atoz/html/Codeine.htm
·
Colesevelam http://www.reutershealth.com/atoz/html/Colesevelam.htm
·
Colestipol Hydrochloride http://www.reutershealth.com/atoz/html/Colestipol_Hydrochloride.htm
·
Cyclobenzaprine HCl http://www.reutershealth.com/atoz/html/Cyclobenzaprine_HCl.htm
·
Cyproheptadine HCl http://www.reutershealth.com/atoz/html/Cyproheptadine_HCl.htm
·
Dantrolene Sodium http://www.reutershealth.com/atoz/html/Dantrolene_Sodium.htm
·
Delavirdine Mesylate http://www.reutershealth.com/atoz/html/Delavirdine_Mesylate.htm
·
Desipramine HCl http://www.reutershealth.com/atoz/html/Desipramine_HCl.htm
·
Dextroamphetamine Sulfate http://www.reutershealth.com/atoz/html/Dextroamphetamine_Sulfate .htm
·
Diazepam http://www.reutershealth.com/atoz/html/Diazepam.htm
·
Dicyclomine HCl http://www.reutershealth.com/atoz/html/Dicyclomine_HCl.htm
·
Diethylpropion HCI http://www.reutershealth.com/atoz/html/Diethylpropion_HCI.htm
Researching Your Medications 209
·
Doxepin HCl http://www.reutershealth.com/atoz/html/Doxepin_HCl.htm
·
Enalapril Maleate Hydrochlorothiazide http://www.reutershealth.com/atoz/html/Enalapril_Maleate_Hydroch lorothiazide.htm
·
Entacapone http://www.reutershealth.com/atoz/html/Entacapone.htm
·
Epoprostenol Sodium http://www.reutershealth.com/atoz/html/Epoprostenol_Sodium.htm
·
Esomeprazole Magnesium http://www.reutershealth.com/atoz/html/Esomeprazole_Magnesium. htm
·
Etidronate Disodium http://www.reutershealth.com/atoz/html/Etidronate_Disodium.htm
·
Etodolac http://www.reutershealth.com/atoz/html/Etodolac.htm
·
Famotidine http://www.reutershealth.com/atoz/html/Famotidine.htm
·
Felbamate http://www.reutershealth.com/atoz/html/Felbamate.htm
·
Felodipine http://www.reutershealth.com/atoz/html/Felodipine.htm
·
Fenofibrate http://www.reutershealth.com/atoz/html/Fenofibrate.htm
·
Fenoprofen Calcium http://www.reutershealth.com/atoz/html/Fenoprofen_Calcium.htm
·
Fentanyl http://www.reutershealth.com/atoz/html/Fentanyl.htm
·
Fentanyl Transdermal System http://www.reutershealth.com/atoz/html/Fentanyl_Transdermal_Syst em.htm
·
Ferrous Salts http://www.reutershealth.com/atoz/html/Ferrous_Salts.htm
·
Flecainide Acetate http://www.reutershealth.com/atoz/html/Flecainide_Acetate.htm
210 Constipation
·
Fluoxetine HCl http://www.reutershealth.com/atoz/html/Fluoxetine_HCl.htm
·
Fluphenazine http://www.reutershealth.com/atoz/html/Fluphenazine.htm
·
Flurazepam HCl http://www.reutershealth.com/atoz/html/Flurazepam_HCl.htm
·
Flurbiprofen http://www.reutershealth.com/atoz/html/Flurbiprofen.htm
·
Fluvastatin http://www.reutershealth.com/atoz/html/Fluvastatin.htm
·
Fluvoxamine Maleate http://www.reutershealth.com/atoz/html/Fluvoxamine_Maleate.htm
·
Foscarnet Sodium http://www.reutershealth.com/atoz/html/Foscarnet_Sodium.htm
·
Foscarnet Sodium (Phosphonoformic Acid) http://www.reutershealth.com/atoz/html/Foscarnet_Sodium_(Phosph onoformic_Acid).htm
·
Fosphenytoin http://www.reutershealth.com/atoz/html/Fosphenytoin.htm
·
Furosemide http://www.reutershealth.com/atoz/html/Furosemide.htm
·
Gabapentin http://www.reutershealth.com/atoz/html/Gabapentin.htm
·
Galantamine Hydrobromide http://www.reutershealth.com/atoz/html/Galantamine_Hydrobromid e.htm
·
Gallium Nitrate http://www.reutershealth.com/atoz/html/Gallium_Nitrate.htm
·
Gatifloxacin http://www.reutershealth.com/atoz/html/Gatifloxacin.htm
·
Gemfibrozil http://www.reutershealth.com/atoz/html/Gemfibrozil.htm
·
Glycerin http://www.reutershealth.com/atoz/html/Glycerin.htm
·
Glycerin (Glycerol) http://www.reutershealth.com/atoz/html/Glycerin_(Glycerol).htm
Researching Your Medications 211
·
Glycopyrrolate http://www.reutershealth.com/atoz/html/Glycopyrrolate.htm
·
Goserelin Acetate http://www.reutershealth.com/atoz/html/Goserelin_Acetate.htm
·
Guanabenz Acetate http://www.reutershealth.com/atoz/html/Guanabenz_Acetate.htm
·
Guanadrel http://www.reutershealth.com/atoz/html/Guanadrel.htm
·
Guanfacine HCl http://www.reutershealth.com/atoz/html/Guanfacine_HCl.htm
·
Haloperidol http://www.reutershealth.com/atoz/html/Haloperidol.htm
·
Hydralazine HCI http://www.reutershealth.com/atoz/html/Hydralazine_HCI.htm
·
Hydrochlorothiazide Triamterene(HCTZ Triamterene) http://www.reutershealth.com/atoz/html/Hydrochlorothiazide_Triamt erene(HCTZ_Triamterene).htm
·
Hydrochlorothiazide(HCTZ) http://www.reutershealth.com/atoz/html/Hydrochlorothiazide(HCTZ) .htm
·
Hydrocodone Bitartrate Acetaminophen http://www.reutershealth.com/atoz/html/Hydrocodone_Bitartrate_Ac etaminophen.htm
·
Hydromorphone HCl http://www.reutershealth.com/atoz/html/Hydromorphone_HCl.htm
·
Hydroxyurea http://www.reutershealth.com/atoz/html/Hydroxyurea.htm
·
Ibuprofen http://www.reutershealth.com/atoz/html/Ibuprofen.htm
·
Imipramine HCl http://www.reutershealth.com/atoz/html/Imipramine_HCl.htm
·
Indapamide http://www.reutershealth.com/atoz/html/Indapamide.htm
·
Interferon Alfacon-I http://www.reutershealth.com/atoz/html/Interferon_Alfacon-I.htm
212 Constipation
·
Interferon Beta-1b (rIFN-B) http://www.reutershealth.com/atoz/html/Interferon_Beta-1b_(rIFNB).htm
·
Interferon Beta-1b(rIFN-B) http://www.reutershealth.com/atoz/html/Interferon_Beta-1b(rIFNB).htm
·
Ipratropium Bromide http://www.reutershealth.com/atoz/html/Ipratropium_Bromide.htm
·
Ipratropium Bromide Albuterol Sulfate http://www.reutershealth.com/atoz/html/Ipratropium_Bromide_Albu terol_Sulfate.htm
·
Iron Dextran http://www.reutershealth.com/atoz/html/Iron_Dextran.htm
·
Isradipine http://www.reutershealth.com/atoz/html/Isradipine.htm
·
Itraconazole http://www.reutershealth.com/atoz/html/Itraconazole.htm
·
Kaolin Pectin http://www.reutershealth.com/atoz/html/Kaolin_Pectin.htm
·
Ketoprofen http://www.reutershealth.com/atoz/html/Ketoprofen.htm
·
Lactulose http://www.reutershealth.com/atoz/html/Lactulose.htm
·
Lamotrigine http://www.reutershealth.com/atoz/html/Lamotrigine.htm
·
Lansoprazole http://www.reutershealth.com/atoz/html/Lansoprazole.htm
·
Leuprolide Acetate http://www.reutershealth.com/atoz/html/Leuprolide_Acetate.htm
·
Lopinavir Ritonavir http://www.reutershealth.com/atoz/html/Lopinavir_Ritonavir.htm
·
Lovastatin http://www.reutershealth.com/atoz/html/Lovastatin.htm
·
Morphine Sulfate http://www.reutershealth.com/atoz/html/Morphine_Sulfate.htm
Researching Your Medications 213
·
Mycophenolate Mofetil http://www.reutershealth.com/atoz/html/Mycophenolate_Mofetil.htm
·
Nabumetone http://www.reutershealth.com/atoz/html/Nabumetone.htm
·
Nalbuphine HCl http://www.reutershealth.com/atoz/html/Nalbuphine_HCl.htm
·
Naproxen http://www.reutershealth.com/atoz/html/Naproxen.htm
·
Naratriptan http://www.reutershealth.com/atoz/html/Naratriptan.htm
·
Nefazodone Hydrochloride http://www.reutershealth.com/atoz/html/Nefazodone_Hydrochloride. htm
·
Nicardipine HCL http://www.reutershealth.com/atoz/html/Nicardipine_HCL.htm
·
Nicotine http://www.reutershealth.com/atoz/html/Nicotine.htm
·
Nifedipine http://www.reutershealth.com/atoz/html/Nifedipine.htm
·
Nizatidine http://www.reutershealth.com/atoz/html/Nizatidine.htm
·
Nortriptyline HCl http://www.reutershealth.com/atoz/html/Nortriptyline_HCl.htm
·
Octreotide Acetate http://www.reutershealth.com/atoz/html/Octreotide_Acetate.htm
·
Olanzapine http://www.reutershealth.com/atoz/html/Olanzapine.htm
·
Omeprazole http://www.reutershealth.com/atoz/html/Omeprazole.htm
·
Ondansetron HCl http://www.reutershealth.com/atoz/html/Ondansetron_HCl.htm
·
Orphenadrine Citrate http://www.reutershealth.com/atoz/html/Orphenadrine_Citrate.htm
·
Oxaprozin http://www.reutershealth.com/atoz/html/Oxaprozin.htm
214 Constipation
·
Oxazepam http://www.reutershealth.com/atoz/html/Oxazepam.htm
·
Oxybutynin Chloride http://www.reutershealth.com/atoz/html/Oxybutynin_Chloride.htm
·
Oxycodone Acetaminophen http://www.reutershealth.com/atoz/html/Oxycodone_Acetaminophen .htm
·
Oxycodone HCl http://www.reutershealth.com/atoz/html/Oxycodone_HCl.htm
·
Pamidronate Disodium http://www.reutershealth.com/atoz/html/Pamidronate_Disodium.htm
·
Pantoprazole http://www.reutershealth.com/atoz/html/Pantoprazole.htm
·
Pantoprazole Sodium http://www.reutershealth.com/atoz/html/Pantoprazole_Sodium.htm
·
Papaverine HCl http://www.reutershealth.com/atoz/html/Papaverine_HCl.htm
·
Paroxetine HCl http://www.reutershealth.com/atoz/html/Paroxetine_HCl.htm
·
Pentazocine http://www.reutershealth.com/atoz/html/Pentazocine.htm
·
Pentobarbital Sodium http://www.reutershealth.com/atoz/html/Pentobarbital_Sodium.htm
·
Pergolide Mesylate http://www.reutershealth.com/atoz/html/Pergolide_Mesylate.htm
·
Perphenazine http://www.reutershealth.com/atoz/html/Perphenazine.htm
·
Perphenazine Amitriptyline http://www.reutershealth.com/atoz/html/Perphenazine_Amitriptyline .htm
·
Phenelzine Sulfate http://www.reutershealth.com/atoz/html/Phenelzine_Sulfate.htm
·
Phenobarbital http://www.reutershealth.com/atoz/html/Phenobarbital.htm
·
Phenytoin http://www.reutershealth.com/atoz/html/Phenytoin.htm
Researching Your Medications 215
·
Piroxicam http://www.reutershealth.com/atoz/html/Piroxicam.htm
·
Pramipexole Dihydrochloride http://www.reutershealth.com/atoz/html/Pramipexole_Dihydrochlori de.htm
·
Pravastatin Sodium http://www.reutershealth.com/atoz/html/Pravastatin_Sodium.htm
·
Prazosin http://www.reutershealth.com/atoz/html/Prazosin.htm
·
Prochlorperazine http://www.reutershealth.com/atoz/html/Prochlorperazine.htm
·
Procyclidine http://www.reutershealth.com/atoz/html/Procyclidine.htm
·
Promethazine HCl http://www.reutershealth.com/atoz/html/Promethazine_HCl.htm
·
Propafenone http://www.reutershealth.com/atoz/html/Propafenone.htm
·
Propantheline Bromide http://www.reutershealth.com/atoz/html/Propantheline_Bromide.htm
·
Propoxyphene http://www.reutershealth.com/atoz/html/Propoxyphene.htm
·
Propoxyphene Acetaminophen http://www.reutershealth.com/atoz/html/Propoxyphene_Acetaminop hen.htm
·
Propoxyphene HCl Acetaminophen http://www.reutershealth.com/atoz/html/Propoxyphene_HCl_Acetam inophen.htm
·
Protriptyline HCl http://www.reutershealth.com/atoz/html/Protriptyline_HCl.htm
·
Quazepam http://www.reutershealth.com/atoz/html/Quazepam.htm
·
Quetiapine Fumarate http://www.reutershealth.com/atoz/html/Quetiapine_Fumarate.htm
·
Ranitidine http://www.reutershealth.com/atoz/html/Ranitidine.htm
216 Constipation
·
Ranitidine Bismuth Citrate http://www.reutershealth.com/atoz/html/Ranitidine_Bismuth_Citrate. htm
·
Repaglinide http://www.reutershealth.com/atoz/html/Repaglinide.htm
·
Risperidone http://www.reutershealth.com/atoz/html/Risperidone.htm
·
Ritodrine HCl http://www.reutershealth.com/atoz/html/Ritodrine_HCl.htm
·
Ritonavir http://www.reutershealth.com/atoz/html/Ritonavir.htm
·
Rivastigmine Tartrate http://www.reutershealth.com/atoz/html/Rivastigmine_Tartrate.htm
·
Rizatriptan http://www.reutershealth.com/atoz/html/Rizatriptan.htm
·
Rofecoxib http://www.reutershealth.com/atoz/html/Rofecoxib.htm
·
Ropinirole Hydrochloride http://www.reutershealth.com/atoz/html/Ropinirole_Hydrochloride.h tm
·
Saquinavir Mesylate http://www.reutershealth.com/atoz/html/Saquinavir_Mesylate.htm
·
Secobarbital Sodium http://www.reutershealth.com/atoz/html/Secobarbital_Sodium.htm
·
Senna http://www.reutershealth.com/atoz/html/Senna.htm
·
Sertraline HCl http://www.reutershealth.com/atoz/html/Sertraline_HCl.htm
·
Sibutramine Hydrochloride http://www.reutershealth.com/atoz/html/Sibutramine_Hydrochloride. htm
·
Simvastatin http://www.reutershealth.com/atoz/html/Simvastatin.htm
·
Sirolimus http://www.reutershealth.com/atoz/html/Sirolimus.htm
Researching Your Medications 217
·
Sodium Polystyrene Sulfonate http://www.reutershealth.com/atoz/html/Sodium_Polystyrene_Sulfon ate.htm
·
Sotalol HCl http://www.reutershealth.com/atoz/html/Sotalol_HCl.htm
·
Sucralfate http://www.reutershealth.com/atoz/html/Sucralfate.htm
·
Sufentanil Citrate http://www.reutershealth.com/atoz/html/Sufentanil_Citrate.htm
·
Thalidomide http://www.reutershealth.com/atoz/html/Thalidomide.htm
·
Thioridazine HCl http://www.reutershealth.com/atoz/html/Thioridazine_HCl.htm
·
Thiothixene http://www.reutershealth.com/atoz/html/Thiothixene.htm
·
Tiludronate Disodium http://www.reutershealth.com/atoz/html/Tiludronate_Disodium.htm
·
Tinzaparin Sodium http://www.reutershealth.com/atoz/html/Tinzaparin_Sodium.htm
·
Tolcapone http://www.reutershealth.com/atoz/html/Tolcapone.htm
·
Tolmetin Sodium http://www.reutershealth.com/atoz/html/Tolmetin_Sodium.htm
·
Tolterodine Tartrate http://www.reutershealth.com/atoz/html/Tolterodine_Tartrate.htm
·
Topiramate http://www.reutershealth.com/atoz/html/Topiramate.htm
·
Torsemide http://www.reutershealth.com/atoz/html/Torsemide.htm
·
Tramadol Hydrochloride http://www.reutershealth.com/atoz/html/Tramadol_Hydrochloride.htm
·
Tranylcypromine Sulfate http://www.reutershealth.com/atoz/html/Tranylcypromine_Sulfate.htm
·
Trazodone HCl http://www.reutershealth.com/atoz/html/Trazodone_HCl.htm
218 Constipation
·
Triazolam http://www.reutershealth.com/atoz/html/Triazolam.htm
·
Trifluoperazine HCl http://www.reutershealth.com/atoz/html/Trifluoperazine_HCl.htm
·
Trihexyphenidyl HCl http://www.reutershealth.com/atoz/html/Trihexyphenidyl_HCl.htm
·
Triprolidine HCl http://www.reutershealth.com/atoz/html/Triprolidine_HCl.htm
·
Valacyclovir Hydrochloride http://www.reutershealth.com/atoz/html/Valacyclovir_Hydrochloride .htm
·
Valproic Acid and Derivatives http://www.reutershealth.com/atoz/html/Valproic_Acid_and_Derivati ves.htm
·
Venlafaxine http://www.reutershealth.com/atoz/html/Venlafaxine.htm
Mosby’s GenRx Mosby’s GenRx database (also available on CD-Rom and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Information in Mosby’s GenRx database can be obtained at the following hyperlink: http://www.genrx.com/Mosby/PhyGenRx/group.html.
Physicians Desk Reference The Physicians Desk Reference database (also available in CD-Rom and book format) is a full-text drug database. The database is searchable by brand name, generic name or by indication. It features multiple drug interactions reports. Information can be obtained at the following hyperlink: http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm.
Other Web Sites A number of additional Web sites discuss drug information. As an example, you may like to look at www.drugs.com which reproduces the information
Researching Your Medications 219
in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. which allows users to download articles on various drugs and therapeutics for a nominal fee: http://www.medletter.com/.
Contraindications and Interactions (Hidden Dangers) Some of the medications mentioned in the previous discussions can be problematic for patients with constipation--not because they are used in the treatment process, but because of contraindications, or side effects. Medications with contraindications are those that could react with drugs used to treat constipation or potentially create deleterious side effects in patients with constipation. You should ask your physician about any contraindications, especially as these might apply to other medications that you may be taking for common ailments. Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect. Drug interactions may make your medications less effective, cause unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you. Be sure to read the label every time you use a nonprescription or prescription drug, and take the time to learn about drug interactions. These precautions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense. Drug labels contain important information about ingredients, uses, warnings, and directions which you should take the time to read and understand. Labels also include warnings about possible drug interactions. Further, drug labels may change as new information becomes available. This is why it’s especially important to read the label every time you use a medication. When your doctor prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins, botanicals, minerals and herbals you take as well as the foods you eat. Ask your pharmacist for the package insert for each prescription drug you take. The package insert provides more information about potential drug interactions.
220 Constipation
A Final Warning At some point, you may hear of alternative medications from friends, relatives, or in the news media. Advertisements may suggest that certain alternative drugs can produce positive results for patients with constipation. Exercise caution--some of these drugs may have fraudulent claims, and others may actually hurt you. The Food and Drug Administration (FDA) is the official U.S. agency charged with discovering which medications are likely to improve the health of patients with constipation. The FDA warns patients to watch out for44: ·
Secret formulas (real scientists share what they know)
·
Amazing breakthroughs or miracle cures (real breakthroughs don’t happen very often; when they do, real scientists do not call them amazing or miracles)
·
Quick, painless, or guaranteed cures
·
If it sounds too good to be true, it probably isn’t true.
If you have any questions about any kind of medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.
General References In addition to the resources provided earlier in this chapter, the following general references describe medications (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): · Drug Development: Molecular Targets for Gi Diseases by Timothy S. Gaginella (Editor), Antonio Guglietta (Editor); Hardcover - 288 pages (December 1999), Humana Press; ISBN: 0896035891; http://www.amazon.com/exec/obidos/ASIN/0896035891/icongroupinterna · Drug Therapy for Gastrointestinal and Liver Diseases by Michael J.G. Farthing, M.D. (Editor), Anne B. Ballinger (Editor); Hardcover - 346 pages, 1st edition (August 15, 2001), Martin Dunitz Ltd.; ISBN: 1853177334; http://www.amazon.com/exec/obidos/ASIN/1853177334/icongroupinterna This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.
44
Researching Your Medications 221
· Immunopharmacology of the Gastrointestinal System (Handbook of Immunopharmacology) by John L. Wallace (Editor); Hardcover (October 1997), Academic Press; ISBN: 0127328602; http://www.amazon.com/exec/obidos/ASIN/0127328602/icongroupinterna · A Pharmacologic Approach to Gastrointestinal Disorders by James H. Lewis, M.D. (Editor); Hardcover – (February 1994), Lippincott, Williams & Wilkins; ISBN: 0683049704; http://www.amazon.com/exec/obidos/ASIN/0683049704/icongroupinterna
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak anti-inflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Albuterol: A racemic mixture with a 1:1 ratio of the r-isomer, levalbuterol, and s-albuterol. It is a short-acting beta2-adrenergic agonist with its main clinical use in asthma. [NIH] Amiodarone: An antianginal and antiarrhythmic drug. It increases the duration of ventricular and atrial muscle action by inhibiting Na,K-activated myocardial adenosine triphosphatase. There is a resulting decrease in heart rate and in vascular resistance. [NIH] Amoxapine: The N-demethylated derivative of the antipsychotic agent loxapine that works by blocking the reuptake of norepinephrine, serotonin, or both. It also blocks dopamine receptors. [NIH] Amphetamine: A powerful central nervous system stimulant and sympathomimetic. Amphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulation of release of monamines, and inhibiting monoamine oxidase. Amphetamine is also a drug of abuse and a psychotomimetic. The l- and the d,l-forms are included here. The l-form has less central nervous system activity but stronger cardiovascular effects. The d-form is dextroamphetamine. [NIH] Bismuth: A metallic element that has the atomic symbol Bi, atomic number 83 and atomic weight 208.98. [NIH] Captopril: A potent and specific inhibitor of peptidyl-dipeptidase A. It blocks the conversion of angiotensin I to angiotensin II, a vasoconstrictor and important regulator of arterial blood pressure. Captopril acts to suppress the renin-angiotensin system and inhibits pressure responses to exogenous
222 Constipation
angiotensin. [NIH] Carbamazepine: An anticonvulsant used to control grand mal and psychomotor or focal seizures. Its mode of action is not fully understood, but some of its actions resemble those of phenytoin; although there is little chemical resemblance between the two compounds, their three-dimensional structure is similar. [NIH] Cetirizine: A potent second-generation histamine H1 antagonist that is effective in the treatment of allergic rhinitis, chronic urticaria, and polleninduced asthma. Unlike many traditional antihistamines, it does not cause drowsiness or anticholinergic side effects. [NIH] Clonazepam: An anticonvulsant used for several types of seizures, including myotonic or atonic seizures, photosensitive epilepsy, and absence seizures, although tolerance may develop. It is seldom effective in generalized tonic-clonic or partial seizures. The mechanism of action appears to involve the enhancement of gaba receptor responses. [NIH] Clorazepate Dipotassium: A water-soluble benzodiazepine derivative effective in the treatment of anxiety. It has also muscle relaxant and anticonvulsant actions. [NIH] Clozapine: A tricylic dibenzodiazepine, classified as an atypical antipsychotic agent. It binds several types of central nervous system receptors, and displays a unique pharmacological profile. Clozapine is a serotonin antagonist, with strong binding to 5-HT 2A/2C receptor subtype. It also displays strong affinity to several dopaminergic receptors, but shows only weak antagonism at the dopamine D2 receptor, a receptor commonly thought to modulate neuroleptic activity. Agranulocytosis is a major adverse effect associated with administration of this agent. [NIH] Codeine: An opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough. [NIH] Etodolac: A nonsteroidal anti-inflammatory agent with potent analgesic and antiarthritic properties. It has been shown to be effective in the treatment of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and in the alleviation of postoperative pain. [NIH] Famotidine: A competitive histamine H2-receptor antagonist. Its main pharmacodynamic effect is the inhibition of gastric secretion. [NIH] Felodipine: A dihydropyridine calcium antagonist with positive inotropic effects. It lowers blood pressure by reducing peripheral vascular resistance through a highly selective action on smooth muscle in arteriolar resistance vessels. [NIH] Fluphenazine:
A phenothiazine used in the treatment of psychoses. Its
Researching Your Medications 223
properties and uses are generally similar to those of chlorpromazine. [NIH] Flurbiprofen: An anti-inflammatory analgesic and antipyretic of the phenylalkynoic acid series. It has been shown to reduce bone resorption in periodontal disease by inhibiting carbonic anhydrase. [NIH] Furosemide: A sulfamyl saluretic and diuretic. It has a fast onset and short duration of action and is used in edema and chronic renal insufficiency. [NIH] Gemfibrozil: A lipid-regulating agent that lowers elevated serum lipids primarily by decreasing serum triglycerides with a variable reduction in total cholesterol. These decreases occur primarily in the VLDL fraction and less frequently in the LDL fraction. Gemfibrozil increases HDL subfractions HDL2 and HDL3 as well as apolipoproteins A-I and A-II. Its mechanism of action has not been definitely established. [NIH] Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH] Glycopyrrolate: A muscarinic antagonist used as an antispasmodic, in some disorders of the gastrointestinal tract, and to reduce salivation with some anesthetics. [NIH] Hydroxyurea: An antineoplastic agent that inhibits DNA synthesis through the inhibition of ribonucleoside diphosphate reductase. [NIH] Ibuprofen: A nonsteroidal anti-inflammatory agent with analgesic properties used in the therapy of rheumatism and arthritis. [NIH] Indapamide: A sulfamyl diuretic with about 16x the effect of furosemide. It has also been shown to be an effective antihypertensive agent in the clinic. [NIH]
Itraconazole: An antifungal agent that has been used in the treatment of histoplasmosis, blastomycosis, cryptococcal meningitis, and aspergillosis. [NIH]
Ketoprofen: An ibuprofen-type anti-inflammatory analgesic and antipyretic. It is used in the treatment of rheumatoid arthritis and osteoarthritis. [NIH] Naproxen: An anti-inflammatory agent with analgesic and antipyretic properties. Both the acid and its sodium salt are used in the treatment of rheumatoid arthritis and other rheumatic or musculoskeletal disorders, dysmenorrhea, and acute gout. [NIH] Nifedipine: A potent vasodilator agent with calcium antagonistic action. It is a useful anti-anginal agent that also lowers blood pressure. The use of nifedipine as a tocolytic is being investigated. [NIH] Nizatidine: A histamine H2 receptor antagonist with low toxicity that inhibits gastric acid secretion. The drug is used for the treatment of duodenal
224 Constipation
ulcers. [NIH] Oxazepam: A benzodiazepine used in the treatment of anxiety, alcohol withdrawal, and insomnia. [NIH] Perphenazine: An antipsychotic phenothiazine derivative with actions and uses similar to those of chlorpromazine. [NIH] Piroxicam: 4-Hydroxy-2-methyl-N-2-pyridyl-2H-1,2-benzothiazine-3carboxamide 1,1-dioxide. A non-steroidal anti-inflammatory agent that is well established in the treatment of rheumatoid arthritis and osteoarthritis. Its usefulness has also been demonstrated in the treatment of musculoskeletal disorders, dysmenorrhea, and postoperative pain. Its long half-life enables it to be administered once daily. The drug has also been shown to be effective if administered rectally. Gastrointestinal complaints are the most frequently reported side effects. [NIH] Prazosin: A selective adrenergic alpha-1 antagonist used in the treatment of heart failure, hypertension, pheochromocytoma, Raynaud's syndrome, prostatic hypertrophy, and urinary retention. [NIH] Procyclidine: A muscarinic antagonist that crosses the blood-brain barrier and is used in the treatment of drug-induced extrapyramidal disorders and in parkinsonism. [NIH] Propafenone: An antiarrhythmia agent that is particularly effective in ventricular arrhythmias. It also has weak beta-blocking activity. The drug is generally well tolerated. [NIH] Propoxyphene: A narcotic analgesic structurally related to methadone. Only the dextro-isomer has an analgesic effect; the levo-isomer appears to exert an antitussive effect. [NIH] Risperidone: A selective blocker of dopamine D2 and serotonin-5-HT-2 receptors that acts as an atypical antipsychotic agent. It has been shown to improve both positive and negative symptoms in the treatment of schizophrenia. [NIH] Scopolamine: An alkaloid from Solanaceae, especially Datura metel L. and Scopola carniolica. Scopolamine and its quaternary derivatives act as antimuscarinics like atropine, but may have more central nervous system effects. Among the many uses are as an anesthetic premedication, in urinary incontinence, in motion sickness, as an antispasmodic, and as a mydriatic and cycloplegic. [NIH] Sirolimus: A macrolide compound obtained from Streptomyces hygroscopicus that acts by selectively blocking the transcriptional activation of cytokines thereby inhibiting cytokine production. It is bioactive only when bound to immunophilins. Sirolimus is a potent immunosuppressant and possesses both antifungal and antineoplastic properties. [NIH]
Researching Your Medications 225
Sucralfate: A basic aluminum complex of sulfated sucrose. It is advocated in the therapy of peptic, duodenal, and prepyloric ulcers, gastritis, reflux esophagitis, and other gastrointestinal irritations. It acts primarily at the ulcer site, where it has cytoprotective, pepsinostatic, antacid, and bile acidbinding properties. The drug is only slightly absorbed by the digestive mucosa, which explains the absence of systemic effects and toxicity. [NIH] Thalidomide: A pharmaceutical agent originally introduced as a nonbarbiturate hypnotic, but withdrawn from the market because of its known tetratogenic effects. It has been reintroduced and used for a number of immunological and inflammatory disorders. Thalidomide displays immunosuppresive and anti-angiogenic activity. It inhibits release of tumor necrosis factor alpha from monocytes, and modulates other cytokine action. [NIH]
Thiothixene: A thioxanthine used as an antipsychotic agent. Its effects are similar to the phenothiazine antipsychotics. [NIH] Triamterene: A pteridine that is used as a mild diuretic. [NIH] Triazolam: A short-acting benzodiazepine used in the treatment of insomnia. Some countries temporarily withdrew triazolam from the market because of concerns about adverse reactions, mostly psychological, associated with higher dose ranges. Its use at lower doses with appropriate care and labeling has been reaffirmed by the FDA and most other countries. [NIH]
Researching Alternative Medicine 227
APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your friends or doctor have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to constipation. Finally, at the conclusion of this chapter, we will provide a list of readings on constipation from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine’s (NCCAM) overview of complementary and alternative medicine.
What Is CAM?45 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and 45
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.
228 Constipation
treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.
What Are the Domains of Alternative Medicine?46 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are
46
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.
Researching Alternative Medicine 229
practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India’s traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body’s defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.
230 Constipation
Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind’s capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.
Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine’s use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.
Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body’s systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues.
Researching Alternative Medicine 231
Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient’s recovery and that healing is promoted when the body’s energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.
Can Alternatives Affect My Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your medical treatment. It becomes all the more important to speak with your doctor who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for patients of both genders and all ages.47
47
Adapted from http://www.4woman.gov/faq/alternative.htm.
232 Constipation
Is It Okay to Want Both Traditional and Alternative Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.
Finding CAM References on Constipation Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for constipation. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required. The Combined Health Information Database For a targeted search, The Combined Health Information Database is a bibliographic database produced by health-related agencies of the Federal Government (mostly from the National Institutes of Health). This database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “constipation” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: ·
Biofeedback Avoids Surgery in Patients With Slow-Transit Constipation: Report of Four Cases Source: Diseases of the Colon and Rectum. 44(5): 737-740. May 2001.
Researching Alternative Medicine 233
Summary: This journal article describes the use of biofeedback as a treatment for patients with slow transit constipation. Biofeedback is an established treatment for intractable constipation in patients with an element of pelvic floor dysfunction. In those with intractable slow transit constipation and normal pelvic floor function, colectomy is usually recommended. This article reports four patients with isolated slow transit constipation who benefitted from biofeedback and avoided surgery. All four patients underwent extensive testing for pelvic floor dysfunction before completing a standard biofeedback course of four outpatient sessions. All improved in terms of bowel frequency, laxative use, bloating, straining, and lifestyle. Improvement was maintained over a median followup of 9 months without the need for further treatment. The authors conclude that biofeedback appears to be a safe and inexpensive treatment for patients with isolated slow transit constipation, and it may obviate the need for surgery in a significant proportion. The article has 1 table and 9 references. (AA-M). ·
Identification of Patients Likely To Benefit from Biofeedback for Outlet Obstruction Constipation (letter to the editor) Source: British Journal of Surgery. 86: 1484. 1999. Summary: This letter to the editor discusses the characteristics of patients most likely to benefit from biofeedback for outlet obstruction constipation. Early studies of biofeedback for constipation reported success rates ranging from 87-100 percent. However, most of these studies involved patients whose only diagnosis was paradoxical puborectalis contraction. In more recent years the indications have broadened, and success rates have decreased to 29-63 percent. In the author's recent study of 194 patients, 63 percent of those who completed the treatment protocol experienced complete success compared with only 25 percent of those who dropped out. The author suggests that patients who are well motivated and have no evidence of severe pelvic floor damage are most likely to benefit from biofeedback for outlet obstruction constipation. The letter has 14 references.
·
Herbs To Improve Digestion: Herbal Remedies for Stomach Pain, Constipation, Ulcers, Colitis and Other Gastrointestinal Problems Source: New Canaan, CT: Keats Publishing, Inc. 1996. 90 p. Contact: Available from Keats Publishing, Inc., division of NTC/Contemporary. 203 Kitchawan Road, South Salem, NY 10590. 914533-1175, FAX: 914-533-0035. Price: $4.95. ISBN: 087983742X.
234 Constipation
Summary: This book describes the use of herbs to improve digestion, including herbal remedies for stomach pain, constipation, ulcers, colitis, and other gastrointestinal problems. It provides an overview of the digestive system, including the digestive process and the role of bacteria. It discusses juicing, food sensitivities, digestive enzymes, and the role of exercise in improving digestion. It contains descriptions of frequently occurring digestive disorders such as colic, constipation, Crohn's disease, diarrhea, diverticulitis, flatulence, gastritis, heartburn, hemorrhoids, indigestion, irritable bowel syndrome, and ulcers. It provides suggestions on using herbs to treat these problems, and describes 12 steps to better digestion. This book contains a resource list and an index. ·
Acupuncture Treatment of Constipation Due to Diabetes Mellitus: An Observation of 21 Cases Source: International Journal of Clinical Acupuncture. 6(1): 19-21. 1995. Summary: This journal article describes the outcomes of acupuncture treatment in 21 patients with constipation due to diabetes mellitus. The patients were 8 males and 13 females, aged 43 to 72 years, who were treated in the Endocrinology Department of the Hubei Medical College, China. The duration of diabetes ranged from 3 to 30 years, and the duration of constipation ranged from 1 to 23 years. The regimen for treating diabetes was continued, and acupuncture was applied only for the secondary constipation. Needling was performed bilaterally at the Ciliao (BL 32), Zhigou (SJ 6), and Zusanli (ST 36) points. Acupuncture was administered once daily, with five treatments constituting a therapeutic course. Outcomes were rated as cured, effective, or failed according to predefined criteria. Of the 21 cases, 18 (85.7 percent) were cured and 3 (14.3 percent) were effective after 1 course of treatment. Among 15 cases followed for 6 months, 4 had a recurrence of constipation 3 to 5 months after treatment. The recurrence was less severe than the initial constipation, and was cured with another needling. The authors conclude that acupuncture may be useful for other complications of diabetes in addition to constipation.
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine’s databases to allow patients to search for articles that specifically relate to constipation and complementary medicine. To search the database, go to the following Web
Researching Alternative Medicine 235
site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “constipation” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine (CAM) that are related to constipation: ·
A comparison of Agiolax and lactulose in elderly patients with chronic constipation. Author(s): Passmore AP, Davies KW, Flanagan PG, Stoker C, Scott MG. Source: Pharmacology. 1993 October; 47 Suppl 1: 249-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8234437&dopt=Abstract
·
A double-blind trial of a celandin, aloevera and psyllium laxative preparation in adult patients with constipation. Author(s): Odes HS, Madar Z. Source: Digestion. 1991; 49(2): 65-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1800188&dopt=Abstract
·
A multi-centre, general practice comparison of ispaghula husk with lactulose and other laxatives in the treatment of simple constipation. Author(s): Dettmar PW, Sykes J. Source: Current Medical Research and Opinion. 1998; 14(4): 227-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9891195&dopt=Abstract
·
Abdominal massage therapy for chronic constipation: A systematic review of controlled clinical trials. Author(s): Ernst E. Source: Forschende Komplementarmedizin. 1999 June; 6(3): 149-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10460984&dopt=Abstract
·
Abdominal wall massage: effect on colonic function in healthy volunteers and in patients with chronic constipation. Author(s): Klauser AG, Flaschentrager J, Gehrke A, Muller-Lissner SA. Source: Zeitschrift Fur Gastroenterologie. 1992 April; 30(4): 247-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1534955&dopt=Abstract
236 Constipation
·
Advances in the management of pediatric constipation. Author(s): Nurko S. Source: Current Gastroenterology Reports. 2000 June; 2(3): 234-40. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10957935&dopt=Abstract
·
Amitriptyline-induced constipation in cynomolgus monkeys is beneficial for the evaluation of laxative efficacy. Author(s): Tsusumi K, Kishimoto S, Koshitani O, Kohri H. Source: Biol Pharm Bull. 2000 May; 23(5): 657-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10823684&dopt=Abstract
·
An alternative biofeedback-based behavior modification treatment for a case of chronic constipation. Author(s): Singles JM, Mikulka PJ, Cox DJ, Mittal RK. Source: Journal of Behavior Therapy and Experimental Psychiatry. 1992 September; 23(3): 231-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1487540&dopt=Abstract
·
An open, randomised, parallel group study of lactulose versus ispaghula in the treatment of chronic constipation in adults. Author(s): Rouse M, Chapman N, Mahapatra M, Grillage M, Atkinson SN, Prescott P. Source: Br J Clin Pract. 1991 Spring; 45(1): 28-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1931536&dopt=Abstract
·
Anal sphincter biofeedback relaxation treatment for women with intractable constipation symptoms. Author(s): Turnbull GK, Ritvo PG. Source: Diseases of the Colon and Rectum. 1992 June; 35(6): 530-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1587169&dopt=Abstract
·
Anismus: the cause of constipation? Results of investigation and treatment. Author(s): Duthie GS, Bartolo DC.
Researching Alternative Medicine 237
Source: World Journal of Surgery. 1992 September-October; 16(5): 831-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1462616&dopt=Abstract ·
Anorectal and pelvic floor function. Relevance of continence, incontinence, and constipation. Author(s): Sagar PM, Pemberton JH. Source: Gastroenterology Clinics of North America. 1996 March; 25(1): 163-82. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8682571&dopt=Abstract
·
Application of the colorectal laboratory in diagnosis and treatment of functional constipation. Author(s): Kuijpers HC. Source: Diseases of the Colon and Rectum. 1990 January; 33(1): 35-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2295275&dopt=Abstract
·
Aromatherapy massage for joint pain and constipation in a patient with Guillian Barre. Author(s): Shirreffs CM. Source: Complementary Therapies in Nursing & Midwifery. 2001 May; 7(2): 78-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11855776&dopt=Abstract
·
Behavioral medicine treatment in chronic constipation with paradoxical anal sphincter contraction. Author(s): Dahl J, Lindquist BL, Tysk C, Leissner P, Philipson L, Jarnerot G. Source: Diseases of the Colon and Rectum. 1991 September; 34(9): 769-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1914742&dopt=Abstract
·
Behavioural treatment (biofeedback) for constipation following hysterectomy. Author(s): Roy AJ, Emmanuel AV, Storrie JB, Bowers J, Kamm MA.
238 Constipation
Source: The British Journal of Surgery. 2000 January; 87(1): 100-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10606919&dopt=Abstract ·
Biofeedback avoids surgery in patients with slow-transit constipation: report of four cases. Author(s): Brown SR, Donati D, Seow-Choen F, Ho YH. Source: Diseases of the Colon and Rectum. 2001 May; 44(5): 737-9; Discussion 739-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11357038&dopt=Abstract
·
Biofeedback for constipation? Author(s): Wexner SD. Source: Diseases of the Colon and Rectum. 1998 May; 41(5): 670-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9593258&dopt=Abstract
·
Biofeedback is effective therapy for fecal incontinence and constipation. Author(s): Ko CY, Tong J, Lehman RE, Shelton AA, Schrock TR, Welton ML. Source: Archives of Surgery (Chicago, Ill. : 1960). 1997 August; 132(8): 829-33; Discussion 833-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9267265&dopt=Abstract
·
Biofeedback provides long-term benefit for patients with intractable, slow and normal transit constipation. Author(s): Chiotakakou-Faliakou E, Kamm MA, Roy AJ, Storrie JB, Turner IC. Source: Gut. 1998 April; 42(4): 517-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9616314&dopt=Abstract
·
Biofeedback retraining in patients with functional constipation and paradoxical puborectalis contraction: comparison of anal manometry and sphincter electromyography for feedback. Author(s): Glia A, Gylin M, Gullberg K, Lindberg G.
Researching Alternative Medicine 239
Source: Diseases of the Colon and Rectum. 1997 August; 40(8): 889-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9269803&dopt=Abstract ·
Biofeedback training for constipation in adults and children. Author(s): Weber J, Ducrotte P, Touchais JY, Roussignol C, Denis P. Source: Diseases of the Colon and Rectum. 1987 November; 30(11): 844-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3677958&dopt=Abstract
·
Biofeedback training in children with functional constipation. A critical review. Author(s): Loening-Baucke V. Source: Digestive Diseases and Sciences. 1996 January; 41(1): 65-71. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8565768&dopt=Abstract
·
Biofeedback training in chronic constipation. Author(s): Benninga MA, Buller HA, Taminiau JA. Source: Archives of Disease in Childhood. 1993 January; 68(1): 126-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8434996&dopt=Abstract
·
Biofeedback training in treatment of childhood constipation: a randomised controlled study. Author(s): van der Plas RN, Benninga MA, Buller HA, Bossuyt PM, Akkermans LM, Redekop WK, Taminiau JA. Source: Lancet. 1996 September 21; 348(9030): 776-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8813983&dopt=Abstract
·
Biofeedback training is useful in fecal incontinence but disappointing in constipation. Author(s): Keck JO, Staniunas RJ, Coller JA, Barrett RC, Oster ME, Schoetz DJ Jr, Roberts PL, Murray JJ, Veidenheimer MC. Source: Diseases of the Colon and Rectum. 1994 December; 37(12): 1271-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7995157&dopt=Abstract
240 Constipation
·
Biofeedback treatment for chronic constipation and encopresis in childhood: long-term outcome. Author(s): Loening-Baucke V. Source: Pediatrics. 1995 July; 96(1 Pt 1): 105-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7596696&dopt=Abstract
·
Biofeedback treatment of constipation: a comparison of two methods. Author(s): Bleijenberg G, Kuijpers HC. Source: The American Journal of Gastroenterology. 1994 July; 89(7): 10216. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8017359&dopt=Abstract
·
Biofeedback: a first-line treatment for idiopathic constipation. Author(s): Storrie JB. Source: British Journal of Nursing (Mark Allen Publishing). 1997 February 13-26; 6(3): 152-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9104120&dopt=Abstract
·
Body acupuncture: effect on colonic function in chronic constipation. Author(s): Klauser AG, Rubach A, Bertsche O, Muller-Lissner SA. Source: Zeitschrift Fur Gastroenterologie. 1993 October; 31(10): 605-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8256475&dopt=Abstract
·
Botulinum toxin in the treatment of outlet obstruction constipation caused by puborectalis syndrome. Author(s): Maria G, Brisinda G, Bentivoglio AR, Cassetta E, Albanese A. Source: Diseases of the Colon and Rectum. 2000 March; 43(3): 376-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10733120&dopt=Abstract
·
Can I safely use powdered fiber drinks such as Metamucil to relieve constipation without my body becoming reliant on them? Author(s): Feinberg AW. Source: Health News. 2000 January; 6(1): 10. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11019667&dopt=Abstract
Researching Alternative Medicine 241
·
Chronic constipation--is the work-up worth the cost? Author(s): Rantis PC Jr, Vernava AM 3rd, Daniel GL, Longo WE. Source: Diseases of the Colon and Rectum. 1997 March; 40(3): 280-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9118741&dopt=Abstract
·
Chronic idiopathic constipation: a psychological enquiry. Author(s): Dykes S, Smilgin-Humphreys S, Bass C. Source: European Journal of Gastroenterology & Hepatology. 2001 January; 13(1): 39-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11204807&dopt=Abstract
·
Chronic idiopathic constipation: pathophysiology and treatment. Author(s): Velio P, Bassotti G. Source: Journal of Clinical Gastroenterology. 1996 April; 22(3): 190-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8724256&dopt=Abstract
·
Clinical and experimental studies on the treatment of senile constipation with shenshen wan. Author(s): Zhang S, Chang Y, Wang N, Xu D, Liu Z. Source: J Tradit Chin Med. 1996 September; 16(3): 182-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9389115&dopt=Abstract
·
Clinical and physiologic effects of biofeedback in outlet obstruction constipation. Author(s): Ho YH, Tan M, Goh HS. Source: Diseases of the Colon and Rectum. 1996 May; 39(5): 520-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8620801&dopt=Abstract
·
Clinical management of constipation. Author(s): Lennard-Jones JE. Source: Pharmacology. 1993 October; 47 Suppl 1: 216-23. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8234432&dopt=Abstract
·
Clinical management of intractable constipation. Author(s): Camilleri M, Thompson WG, Fleshman JW, Pemberton JH.
242 Constipation
Source: Annals of Internal Medicine. 1994 October 1; 121(7): 520-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8067650&dopt=Abstract ·
Constipation and biofeedback in children. Author(s): Wald A. Source: Digestive Diseases and Sciences. 1996 August; 41(8): 1653-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8769296&dopt=Abstract
·
Constipation and dietary fiber intake in children. Author(s): McClung HJ, Boyne L, Heitlinger L. Source: Pediatrics. 1995 November; 96(5 Pt 2): 999-1000. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7494681&dopt=Abstract
·
Constipation and fecal incontinence in the elderly. Author(s): Wald A. Source: Gastroenterology Clinics of North America. 1990 June; 19(2): 40518. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2194952&dopt=Abstract
·
Constipation and fecal incontinence in the elderly. Author(s): Wald A. Source: Semin Gastrointest Dis. 1994 October; 5(4): 179-88. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7834251&dopt=Abstract
·
Constipation in children. Author(s): Leung AK, Chan PY, Cho HY. Source: American Family Physician. 1996 August; 54(2): 611-8, 627. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8701840&dopt=Abstract
·
Constipation in infants and children. Author(s): Loening-Baucke V.
Researching Alternative Medicine 243
Source: Iowa Med. 1991 February; 81(2): 59-62. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2007540&dopt=Abstract ·
Constipation in Parkinson's disease: objective assessment and response to psyllium. Author(s): Ashraf W, Pfeiffer RF, Park F, Lof J, Quigley EM. Source: Movement Disorders : Official Journal of the Movement Disorder Society. 1997 November; 12(6): 946-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9399219&dopt=Abstract
·
Constipation in the elderly. Author(s): Schaefer DC, Cheskin LJ. Source: American Family Physician. 1998 September 15; 58(4): 907-14. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9767726&dopt=Abstract
·
Constipation. Pathogenesis and management. Author(s): Shafik A. Source: Drugs. 1993 April; 45(4): 528-40. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7684673&dopt=Abstract
·
Constipation: a physiological approach. Author(s): Thompson WG. Source: Canadian Journal of Gastroenterology = Journal Canadien De Gastroenterologie. 2000 November; 14 Suppl D: 155D-162D. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11110630&dopt=Abstract
·
Constipation: an approach to diagnosis, treatment, referral. Author(s): Soffer EE. Source: Cleve Clin J Med. 1999 January; 66(1): 41-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9926630&dopt=Abstract
244 Constipation
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
·
AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
·
Chinese Medicine: http://www.newcenturynutrition.com/
·
drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html
·
Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
·
Google: http://directory.google.com/Top/Health/Alternative/
·
Healthnotes: http://www.thedacare.org/healthnotes/
·
Open Directory Project: http://dmoz.org/Health/Alternative/
·
TPN.com: http://www.tnp.com/
·
Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
·
WebMDÒHealth: http://my.webmd.com/drugs_and_herbs
·
WellNet: http://www.wellnet.ca/herbsa-c.htm
·
WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to constipation; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
General Overview Constipation Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Constipation.htm Constipation Source: Integrative Medicine Communications; www.onemedicine.com
Researching Alternative Medicine 245
Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsLookups/Uses/co nstipation.html Constipation Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Consti pationcc.html Constipation Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000284.html ·
Alternative Therapy Acupuncture Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Therapy/Acupuncture.htm Acupuncture Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Acupu ncturecm.html Ayurveda Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,672, 00.html Colon Therapy Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Therapy/Colon_Therapy.htm Colon therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,682, 00.html
246 Constipation
Ehretism Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/e.html Homeopathy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,703, 00.html Hydrotherapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,705, 00.html Medical graphology Alternative names: grapho-diagnostics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/m.html Osteopathy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,724, 00.html Shiatsu Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,733, 00.html Traditional Chinese medicine Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 85,00.html Yoga Source: Integrative Medicine Communications; www.onemedicine.com
Researching Alternative Medicine 247
Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Yogac m.html ·
Chinese Medicine Badou Alternative names: Croton Fruit; Fructus Crotonis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Badoushuang Alternative names: Defatted Croton Seed Powder; Semen Crotonis Pulveratum Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Baiziren Alternative names: Chinese Arborvitae Kernel; Semen Platycladi Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Baochi San Alternative names: Baochi Powder Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Baochi%20San&mh =10&sb=---&view_records=View+Records Bimazi Alternative names: Castor Seed; Semen Ricini Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Binglang Sixiao Wan Alternative names: Binglang Sixiao Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Binglang%20Sixiao %20Wan&mh=10&sb=---&view_records=View+Records
248 Constipation
Dahuang Alternative names: Rhubarb; Radix et Rhizoma Rhei Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Daii Alternative names: Japanese Thistle Herb; Herba Cirsii Japonici Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Danggui Alternative names: Chinese Angelica; Radix Angelicae Sinensis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Danggui Longhui Wan Alternative names: Danggui Longhui Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Danggui%20Longh ui%20Wan&mh=10&sb=---&view_records=View+Records Daochi Wan Alternative names: Daochi Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Daochi%20Wan&m h=10&sb=---&view_records=View+Records Fangfeng Tongsheng Wan Alternative names: Fangfeng Tongsheng Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Fangfeng%20Tongs heng%20Wan&mh=10&sb=---&view_records=View+Records Fengmi Alternative names: Honey; Mel Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/
Researching Alternative Medicine 249
Fuzi Alternative names: Beivedere Fruit; Difuzi; Fructus Kochiae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Gansui Alternative names: Gansui Root; Radix Kansui Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Gualou Alternative names: Snakegourd Fruit; Fructus Trichosanthis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Gualouzi Alternative names: Snakegourd Seed; Semen Trichosanthis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Heizhima Alternative names: Black Sesame; Semen Sesami Nigrum Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Heshouwu Alternative names: Fleeceflower Root; Radix Polygoni Multiflori Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Hongdaii Alternative names: Knoxia Root; Radix Knoxiae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Houpo Alternative names: Officinal Magnolia Bark; Cortex Officinalis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Huomaren Alternative names: Hemp Seed; Semen Cannabis
Magnoliae
250 Constipation
Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Jingdaii Alternative names: Peking Euphorbia Root; Radix Euphorbiae Pekinensis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Juemingzi Alternative names: Cassia Seed; Semen Cassiae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Kuxingren Alternative names: Bitter Apricot Seed; Semen Armeniacae Amarum Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Laifuzi Alternative names: Radish Seed; Semen Raphani Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Liuhuang Alternative names: Sulfur; Sulfur Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Liuwei Anxiao San Alternative names: Liuwei Anxiao Powder Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Liuwei%20Anxiao %20San&mh=10&sb=---&view_records=View+Records Luhui Alternative names: Aloes; Luhui (Lu Hui); Aloe Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Luohanguo Alternative names: Grosvenor Momordica Fruit; Fructus Momordicae
Researching Alternative Medicine 251
Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Maidong Alternative names: Liriope Root Tuber; Shanmaidong; Radix Liriopes Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Mangxiao Alternative names: Sodium Sulfate; Natrii Sulfas1 Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Maren Runchang Wan Alternative names: Maren Runchang Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Maren%20Runchan g%20Wan&mh=10&sb=---&view_records=View+Records Mengshi Guntan Wan Alternative names: Mengshi Guntan Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Mengshi%20Gunta n%20Wan&mh=10&sb=---&view_records=View+Records Muxiang Binglang Wang Alternative names: Muxiang Binglang PillsMuxiang Binglang Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Muxiang%20Bingla ng%20Wang&mh=10&sb=---&view_records=View+Records Pangdahai Alternative names: Boat-fruited Sterculia Seed; Semen Sterculiae Lychnophorae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/
252 Constipation
Qianjinzi Alternative names: Caper Euphorbia Seed; Semen Euphorbiae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Qianniuzi Alternative names: Pharbitis Seed; Semen Pharbitidis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Qingfei Yihuo Wan Alternative names: Qingfei Yihuo Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Qingfei%20Yihuo% 20Wan&mh=10&sb=---&view_records=View+Records Qingfen Alternative names: Calomel; Calomelas Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Qingning Wan Alternative names: Qingning Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Qingning%20Wan &mh=10&sb=---&view_records=View+Records Reyanning Keli Alternative names: Reyanning Granules; Reyanning Keli
(Rey Yan Ning Ke Li) Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Reyanning%20Keli &mh=10&sb=---&view_records=View+Records Sangshen Alternative names: Mulberry Fruit; Fructus Mori Source: Chinese Materia Medica
Researching Alternative Medicine 253
Hyperlink: http://www.newcenturynutrition.com/ Shanglu Alternative names: Pokeberry Root; Radix Phytolaccae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Shanmaidong Alternative names: Liriope Root Tuber; Radix Liriopes Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Shanzha Huazhi Wan Alternative names: Shanzha Huazhi Pills; Shanzha Huazhi Wan (Shan Zha Hua Zhi Wan) Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Shanzha%20Huazh i%20Wan&mh=10&sb=---&view_records=View+Records Taoren Alternative names: English Walnut Seed; Hetaoren; Semen Juglandis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Tiandong Alternative names: Cochinchinese Asparagus Root; Radix Asparagi Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Tianwang Buxin Wan Alternative names: Tianwang Buxin Pills; Tianwang Buxin Wan
(Ti An Wang Bu Xin Wan) Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Tianwang%20Buxi n%20Wan&mh=10&sb=---&view_records=View+Records Xuanmingfen Alternative names: Exsiccated Sodium Sulfate; Natrii Sulfas Exsiccatus Source: Chinese Materia Medica
254 Constipation
Hyperlink: http://www.newcenturynutrition.com/ Xuanshen Alternative names: Figwort Root; Radix Scrophulariae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Yamazi Alternative names: Linseed; Semen Lini Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Yuliren Alternative names: Chinese Dwarf Cherry Seed; Semen Pruni Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Zhimu Alternative names: Common Anemarrhena Rhizome; Anemarrhenae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/
Rhizoma
Zhishi Alternative names: Immature Orange Fruit; Fructus Aurantii Immaturus Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Zhuyazao Alternative names: Chinese Honeylocust Abnormal Fruit; Fructus Gleditsiae Abnormalis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Zisuzi Alternative names: Perilia Fruit; Fructus Perillae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ ·
Homeopathy Bryonia Source: Healthnotes, Inc.; www.healthnotes.com
Researching Alternative Medicine 255
Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Bryonia.htm Calcarea carbonica Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Calcarea_ca rbonica.htm Causticum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Causticum. htm Graphites Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Graphites.htm Lycopodium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Lycopodiu m.htm Nux vomica Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Nux_vomic a.htm Sepia Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Sepia.htm Silicea (Silica) Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Silicea.htm
256 Constipation
Sulphur Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Sulphur.htm ·
Herbs and Supplements Acidophilus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Acidophilus Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Irritabl eBowelSyndromecc.html Acidophilus Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Acidophilus Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Proctiti scc.html Acidophilus and Other Probiotics Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000089.html Activated charcoal Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Activated charcoal Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com
Researching Alternative Medicine 257
Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,832, 00.html Agrimony Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,833, 00.html Aloe Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Constipation.htm Aloe Alternative names: Aloe vera, Aloe barbadensis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Aloe.htm Aloe vera Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 01,00.html Alpha-Lipoic Acid Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Angelica sinensis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/DongQuaic h.html Anise Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Irritabl eBowelSyndromecc.html
258 Constipation
Antacids Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastro esophagealRefluxDiseasecc.html Antibiotics Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diverti cularDiseasecc.html Antibiotics Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Proctiti scc.html Antibiotics Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Aortic Glycosaminoglycans Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000292.html Atropine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Atropine.htm Barberry Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000284.html Barberry Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsa-c.htm
Researching Alternative Medicine 259
B-carotene Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Beta Carotenecs.html B-carotene Alternative names: Beta-Carotene Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/Inter actions/BetaCarotenecs.html Beta-Carotene Alternative names: b-carotene, Trans-beta Carotene; Provitamin A, Betacarotenum Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Beta Carotenecs.html Beta-Carotene Alternative names: b-carotene Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/Inter actions/BetaCarotenecs.html Betacarotenum Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Beta Carotenecs.html Betacarotenum Alternative names: b-carotene Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/Inter actions/BetaCarotenecs.html Bisacodyl Source: Healthnotes, Inc.; www.healthnotes.com
260 Constipation
Hyperlink: http://www.thedacare.org/healthnotes/Drug/Bisacodyl.htm Bismuth Subsalicylate Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Bismuth_Subsalicylate.h tm Blackberry Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Bladderwrack Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Blessed Thistle Alternative names: Cnicus benedictus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Blessed_Thistle.htm Blue Flag Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsa-c.htm Blueberry Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Boswellia Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Proctiti scc.html Bovine Colostrum Source: Healthnotes, Inc.; www.healthnotes.com
Researching Alternative Medicine 261
Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Brewer's Yeast Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Butcher's broom Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 10,00.html Caffeine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Proctiti scc.html Caffeine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hemor rhoidscc.html Caffeine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diverti cularDiseasecc.html Caffeine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Consti pationcc.html Caffeine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastro esophagealRefluxDiseasecc.html
262 Constipation
Caraway Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Irritable_Bowel.htm Cardiac Glycosides Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Cardio vascularMedicationsCardiacGlycosidescl.html Carob Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Cascara Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Constipation.htm Cascara Alternative names: Cascara sagrada, Rhamnus purshiani cortex Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Cascara.htm Cascara Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Consti pationcc.html Cascara Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000284.html Cascara Sagrada Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Consti pationcc.html
Researching Alternative Medicine 263
Cascara Sagrada Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000284.html Cascara Sagrada Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsa-c.htm Cascara sagrada Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 13,00.html Chamomile Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Irritable_Bowel.htm Chamomile Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Chamomile Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Chemotherapy Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Chinese Angelica Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/DongQuaic h.html
264 Constipation
Chlorophyll Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Constipation.htm Chlorophyll Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Chlorophyll.htm Chymotrypsin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Cimetidine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Ciprofloxacin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Cisapride Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Irritable_Bowel.htm Collinsonia Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000292.html Colostrum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Comfrey Source: Integrative Medicine Communications; www.onemedicine.com
Researching Alternative Medicine 265
Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hemor rhoidscc.html Cranesbill Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Culver's Root Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsa-c.htm Dandelion Alternative names: Taraxacum officinale Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Dandelion.htm Dandelion Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Consti pationcc.html Dandelion Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000284.html Dandelion Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000143.html Dandelion Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 21,00.html
266 Constipation
Danggui Alternative names: Angelica sinensis, Chinese Angelica, Dang Gui, Danngui, Dong Qua, Tang Kuei, Tan Kue Bai zhi(Note: Dong quai should not be confused with Angelica root or Angelica seed.) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/DongQuaic h.html Digestive Enzymes Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Consti pationcc.html Docusate Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Docusate.htm Docusate Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Consti pationcc.html Dong Quai Alternative names: Angelica sinensis, Chinese Angelica, Dang Gui, Danngui, Dong Qua, Tang Kuei, Tan Kue Bai zhi(Note: Dong quai should not be confused with Angelica root or Angelica seed.) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/DongQuaic h.html Doxycycline Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Electrolytes Source: Integrative Medicine Communications; www.onemedicine.com
Researching Alternative Medicine 267
Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Evening Primrose Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Irritable_Bowel.htm Fennel Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Consti pationcc.html Fennel Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Irritabl eBowelSyndromecc.html Fenugreek Alternative names: Trigonella foenum-graecum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Fenugreek.htm Fenugreek Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000156.html Fiber Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Irritable_Bowel.htm Fiber Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diverticular_Disease. htm
268 Constipation
Fiber Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Fiber Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Constipation.htm Fiber Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Fiber.htm Fiber Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hemorrhoids.htm Fiber Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diverti cularDiseasecc.html Fiber Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hemor rhoidscc.html Fiber Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Irritabl eBowelSyndromecc.html Fiber Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Fiber cs.html
Researching Alternative Medicine 269
Fiber Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000298.html Fiber Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000284.html Flavonoids Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hemorrhoids.htm Flavonoids Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000292.html Flaxseed Alternative names: Linum usitatissimum, Linseed Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Flaxseedch. html Flaxseed Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000284.html FOS Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 26,00.html Fo-Ti Alternative names: Polygonum multiflorum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Fo-ti.htm Ginger Source: Integrative Medicine Communications; www.onemedicine.com
270 Constipation
Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Irritabl eBowelSyndromecc.html Ginseng Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Glucomannan Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diverticular_Disease. htm Glucomannan Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Glucomannan.htm Glucomannan Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Constipation.htm Glutamine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diverti cularDiseasecc.html Glutamine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Proctiti scc.html Glycyrrhiza glabra Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Licoricech.h tml
Researching Alternative Medicine 271
Glycyrrhiza1 Alternative names: Licorice; Glycyrrhiza glabra L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Goldenseal Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Grapefruit Seed Extract Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Irritable_Bowel.htm Grapefruit Seed Extract Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Grapefruit_Seed_Extract .htm Green Tea Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hemor rhoidscc.html Gymnema Alternative names: Gymnema sylvestre Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Gymnema.htm Gymnema sylvestre Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 34,00.html He Shou Wu Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000160.html
272 Constipation
Herbal Medicine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Irritable_Bowel.htm Herbal Medicine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Herbal Medicine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastro esophagealRefluxDiseasecc.html Horse Chestnut Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hemorrhoids.htm Horse Chestnut Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hemor rhoidscc.html Hydantoin Derivatives Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Antico nvulsantMedicationsHydantoinDerivativescl.html Hydrocortisone Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Proctiti scc.html Hypericum perforatum Source: Integrative Medicine Communications; www.onemedicine.com
Researching Alternative Medicine 273
Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/StJohnsWor tch.html Insoluble fiber Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Constipation.htm Ipecac Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Ispaghula Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Irritable_Bowel.htm Ispaghula Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Psyll iumcs.html Klamathweed Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/StJohnsWor tch.html Lactase Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Irritable_Bowel.htm Lactase Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm
274 Constipation
Lactobacillus Acidophilus Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Proctiti scc.html Lactulose Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diverticular_Disease. htm Lactulose Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Constipation.htm Lactulose Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Lactulose.htm Lecithin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm Licorice Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastro esophagealRefluxDiseasecc.html Licorice Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Consti pationcc.html Licorice Alternative names: Glycyrrhiza glabra, Spanish Licorice Source: Integrative Medicine Communications; www.onemedicine.com
Researching Alternative Medicine 275
Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Licoricech.h tml Linseed Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Flaxseedch. html Linum usitatissimum Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Flaxseedch. html Lipoic Acid Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000093.html Loop Diuretics Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Diureti csLoopDiureticscl.html Marshmallow Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Marshmallow Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 42,00.html Meadowsweet Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Irritabl eBowelSyndromecc.html
276 Constipation
Mesoglycan Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000292.html Methylcellulose Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Methylcellulose.htm Milk Thistle Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Irritabl eBowelSyndromecc.html Milk Thistle Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Milk Thistle Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000209.html Oak Alternative names: Quercus spp. Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Oak.htm Oak Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Ocimum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Constipation.htm Oral Contraceptives Source: Healthnotes, Inc.; www.healthnotes.com
Researching Alternative Medicine 277
Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm Organ Mountain Crape Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsm-o.htm Passionflower Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Irritabl eBowelSyndromecc.html Peppermint Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm Peppermint Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Irritable_Bowel.htm Peppermint Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Irritabl eBowelSyndromecc.html Peppermint Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000298.html Peppermint Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,812, 00.html Picrorhiza Alternative names: Picrorhiza kurroa Source: Healthnotes, Inc.; www.healthnotes.com
278 Constipation
Hyperlink: http://www.thedacare.org/healthnotes/Herb/Picrorhiza.htm Plantago Isphagula Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Psyll iumcs.html Plantago psyllium Alternative names: Psyllium, Ispaghula; Plantago psyllium/ovata Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Probiotics Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Probiotics Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Proctiti scc.html Psyllium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Psyllium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Irritable_Bowel.htm Psyllium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hemorrhoids.htm Psyllium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Psyllium.htm
Researching Alternative Medicine 279
Psyllium Alternative names: Plantago ovata, Plantago ispaghula Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Psyllium.htm Psyllium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Constipation.htm Psyllium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hemor rhoidscc.html Psyllium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diverti cularDiseasecc.html Psyllium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Irritabl eBowelSyndromecc.html Psyllium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Consti pationcc.html Psyllium Alternative names: Ispaghula,Plantago isphagula Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Psyll iumcs.html Psyllium Source: Prima Communications, Inc.
280 Constipation
Hyperlink: http://www.personalhealthzone.com/pg000284.html Psyllium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,814, 00.html Raspberry Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm SAMe (S-adenosylmethionine) Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,818, 00.html Senna Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Constipation.htm Senna Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Senna.htm Senna Alternative names: Cassia senna, Cassia angustifolia Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Senna.htm Slippery Elm Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Irritabl eBowelSyndromecc.html Slippery elm Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com
Researching Alternative Medicine 281
Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 56,00.html Spanish Licorice Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Licoricech.h tml St. John's Wort Alternative names: Hypericum perforatum, Klamathweed Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/StJohnsWor tch.html St. John's wort Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,824, 00.html Stimulant Laxatives Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Constipation.htm Tang Kuei Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/DongQuaic h.html Tea Tree Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Thyme Source: Integrative Medicine Communications; www.onemedicine.com
282 Constipation
Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Trans-Beta-Carotene Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Beta Carotenecs.html Trans-Beta-Carotene Alternative names: Beta-Carotene Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/Inter actions/BetaCarotenecs.html Trypsin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Turmeric Alternative names: Curcuma longa Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Turmeric.htm Valerian Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Irritabl eBowelSyndromecc.html Verapamil Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Verapamil.htm Wormwood Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Irritable_Bowel.htm
Researching Alternative Medicine 283
Yellow Dock Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Consti pationcc.html Yellow Dock Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsw-z.htm ·
Related Conditions Alcoholism Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Alcoho lismcc.html Allergies and Sensitivities Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Allergies.htm Anemia Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Anemi acc.html Anxiety Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Anxiet ycc.html Ascariasis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Round wormscc.html
284 Constipation
Benign Prostatic Hyperplasia Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Benign ProstaticHyperplasiacc.html Blood Pressure, High Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html BPH Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Benign ProstaticHyperplasiacc.html Bulimia Nervosa Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Bulimi aNervosacc.html Cancer, Colorectal Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Cancer Colorectalcc.html Cholesterol, High Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hyperc holesterolemiacc.html Chronic Candidiasis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Chronic_Candidiasis. htm
Researching Alternative Medicine 285
Colorectal Cancer Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Cancer Colorectalcc.html Depression Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Depres sioncc.html Diarrhea Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Diverticular Disease Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diverticular_Disease. htm Diverticular Disease Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diverti cularDiseasecc.html Dysmenorrhea Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Dysmenorrhea.htm Dysmenorrhea Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Dysme norrheacc.html Eating Disorders, Bulimia Source: Integrative Medicine Communications; www.onemedicine.com
286 Constipation
Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Bulimi aNervosacc.html Epilepsy Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Seizure Disorderscc.html Food Poisoning Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Gallstones Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm Gastroesophageal Reflux Disease Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastro esophagealRefluxDiseasecc.html Guinea Worm Disease Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Round wormscc.html Heartburn Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastro esophagealRefluxDiseasecc.html Hemorrhoids Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hemorrhoids.htm
Researching Alternative Medicine 287
Hemorrhoids Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hemor rhoidscc.html Hemorrhoids Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000292.html High Blood Pressure Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html High Cholesterol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hyperc holesterolemiacc.html Hookworm Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Round wormscc.html Hypercholesterolemia Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hyperc holesterolemiacc.html Hyperparathyroidism Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hyper parathyroidismPrimarycc.html Hypertension Source: Integrative Medicine Communications; www.onemedicine.com
288 Constipation
Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Hypochondriasis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypoc hondriasiscc.html Hypothyroidism Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypothyroidism.htm Hypothyroidism Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypot hyroidismcc.html Incontinence, Urinary Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Urinar yIncontinencecc.html Iron-Deficiency Anemia Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Iron_Deficiency.htm Irritable Bowel Syndrome Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Irritable_Bowel.htm Irritable Bowel Syndrome Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Irritabl eBowelSyndromecc.html
Researching Alternative Medicine 289
Irritable Bowel Syndrome Alternative names: Spastic Colon Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000298.html Loiasis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Round wormscc.html Lupus Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/System icLupusErythematosuscc.html Lymphatic Filariasis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Round wormscc.html Menstrual Pain Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Dysme norrheacc.html Multiple Sclerosis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Multip leSclerosiscc.html Parasites Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Parasites.htm Parasitic Infection, Roundworms Source: Integrative Medicine Communications; www.onemedicine.com
290 Constipation
Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Round wormscc.html Parathyroid, Overactive Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hyper parathyroidismPrimarycc.html Parkinson's Disease Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Parkinsons_Disease.h tm Parkinson's Disease Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Parkin sonsDiseasecc.html Pinworm Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Round wormscc.html PMS Alternative names: Premenstrual Stress Syndrome Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000289.html Proctitis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Proctiti scc.html Prostate Enlargement Source: Integrative Medicine Communications; www.onemedicine.com
Researching Alternative Medicine 291
Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Benign ProstaticHyperplasiacc.html Rectal Inflammation Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Proctiti scc.html River Blindness Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Round wormscc.html Roundworms Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Round wormscc.html Rubella Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Rubell acc.html Seizure Disorders Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Seizure Disorderscc.html Spastic Colon Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Irritabl eBowelSyndromecc.html Systemic Lupus Erythematosus Source: Integrative Medicine Communications; www.onemedicine.com
292 Constipation
Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/System icLupusErythematosuscc.html Threadworm Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Round wormscc.html Thyroid, Underactive Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypot hyroidismcc.html Trichinosis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Round wormscc.html Urinary Incontinence Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Urinar yIncontinencecc.html Visceral Larva Migrans Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Round wormscc.html Vitamin B12 Deficiency Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Vitamin_B12_Deficie ncy.htm Whipworm Source: Integrative Medicine Communications; www.onemedicine.com
Researching Alternative Medicine 293
Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Round wormscc.html
General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Gastrointestinal Disorders and Nutrition by Tonia Reinhard; Paperback 192 pages (January 24, 2002), McGraw-Hill Professional Publishing; ISBN: 0737303611; http://www.amazon.com/exec/obidos/ASIN/0737303611/icongroupinterna · Healthy Digestion the Natural Way: Preventing and Healing Heartburn, Constipation, Gas, Diarrhea, Inflammatory Bowel and Gallbladder Diseases, Ulcers, Irritable Bowel Syndrome, and More by D. Lindsey Berkson, et al; Paperback - 256 pages, 1st edition (February 2000), John Wiley & Sons; ISBN: 0471349623; http://www.amazon.com/exec/obidos/ASIN/0471349623/icongroupinterna · No More Heartburn: Stop the Pain in 30 Days--Naturally!: The Safe, Effective Way to Prevent and Heal Chronic Gastrointestinal Disorders by Sherry A. Rogers, M.D.; Paperback - 320 pages (February 2000), Kensington Publishing Corp.; ISBN: 1575665107; http://www.amazon.com/exec/obidos/ASIN/1575665107/icongroupinterna For additional information on complementary and alternative medicine, ask your doctor or write to: National Institutes of Health National Center for Complementary and Alternative Medicine Clearinghouse P. O. Box 8218 Silver Spring, MD 20907-8218
Researching Nutrition 295
APPENDIX C. RESEARCHING NUTRITION Overview Since the time of Hippocrates, doctors have understood the importance of diet and nutrition to patients’ health and well-being. Since then, they have accumulated an impressive archive of studies and knowledge dedicated to this subject. Based on their experience, doctors and healthcare providers may recommend particular dietary supplements to patients with constipation. Any dietary recommendation is based on a patient’s age, body mass, gender, lifestyle, eating habits, food preferences, and health condition. It is therefore likely that different patients with constipation may be given different recommendations. Some recommendations may be directly related to constipation, while others may be more related to the patient’s general health. These recommendations, themselves, may differ from what official sources recommend for the average person. In this chapter we will begin by briefly reviewing the essentials of diet and nutrition that will broadly frame more detailed discussions of constipation. We will then show you how to find studies dedicated specifically to nutrition and constipation.
296 Constipation
Food and Nutrition: General Principles What Are Essential Foods? Food is generally viewed by official sources as consisting of six basic elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and (6) minerals. Consuming a combination of these elements is considered to be a healthy diet: ·
Fluids are essential to human life as 80-percent of the body is composed of water. Water is lost via urination, sweating, diarrhea, vomiting, diuretics (drugs that increase urination), caffeine, and physical exertion.
·
Carbohydrates are the main source for human energy (thermoregulation) and the bulk of typical diets. They are mostly classified as being either simple or complex. Simple carbohydrates include sugars which are often consumed in the form of cookies, candies, or cakes. Complex carbohydrates consist of starches and dietary fibers. Starches are consumed in the form of pastas, breads, potatoes, rice, and other foods. Soluble fibers can be eaten in the form of certain vegetables, fruits, oats, and legumes. Insoluble fibers include brown rice, whole grains, certain fruits, wheat bran and legumes.
·
Proteins are eaten to build and repair human tissues. Some foods that are high in protein are also high in fat and calories. Food sources for protein include nuts, meat, fish, cheese, and other dairy products.
·
Fats are consumed for both energy and the absorption of certain vitamins. There are many types of fats, with many general publications recommending the intake of unsaturated fats or those low in cholesterol.
Vitamins and minerals are fundamental to human health, growth, and, in some cases, disease prevention. Most are consumed in your diet (exceptions being vitamins K and D which are produced by intestinal bacteria and sunlight on the skin, respectively). Each vitamin and mineral plays a different role in health. The following outlines essential vitamins: ·
Vitamin A is important to the health of your eyes, hair, bones, and skin; sources of vitamin A include foods such as eggs, carrots, and cantaloupe.
·
Vitamin B1, also known as thiamine, is important for your nervous system and energy production; food sources for thiamine include meat, peas, fortified cereals, bread, and whole grains.
·
Vitamin B2, also known as riboflavin, is important for your nervous system and muscles, but is also involved in the release of proteins from
Researching Nutrition 297
nutrients; food sources for riboflavin include dairy products, leafy vegetables, meat, and eggs. ·
Vitamin B3, also known as niacin, is important for healthy skin and helps the body use energy; food sources for niacin include peas, peanuts, fish, and whole grains
·
Vitamin B6, also known as pyridoxine, is important for the regulation of cells in the nervous system and is vital for blood formation; food sources for pyridoxine include bananas, whole grains, meat, and fish.
·
Vitamin B12 is vital for a healthy nervous system and for the growth of red blood cells in bone marrow; food sources for vitamin B12 include yeast, milk, fish, eggs, and meat.
·
Vitamin C allows the body’s immune system to fight various diseases, strengthens body tissue, and improves the body’s use of iron; food sources for vitamin C include a wide variety of fruits and vegetables.
·
Vitamin D helps the body absorb calcium which strengthens bones and teeth; food sources for vitamin D include oily fish and dairy products.
·
Vitamin E can help protect certain organs and tissues from various degenerative diseases; food sources for vitamin E include margarine, vegetables, eggs, and fish.
·
Vitamin K is essential for bone formation and blood clotting; common food sources for vitamin K include leafy green vegetables.
·
Folic Acid maintains healthy cells and blood and, when taken by a pregnant woman, can prevent her fetus from developing neural tube defects; food sources for folic acid include nuts, fortified breads, leafy green vegetables, and whole grains.
It should be noted that one can overdose on certain vitamins which become toxic if consumed in excess (e.g. vitamin A, D, E and K). Like vitamins, minerals are chemicals that are required by the body to remain in good health. Because the human body does not manufacture these chemicals internally, we obtain them from food and other dietary sources. The more important minerals include: ·
Calcium is needed for healthy bones, teeth, and muscles, but also helps the nervous system function; food sources for calcium include dry beans, peas, eggs, and dairy products.
·
Chromium is helpful in regulating sugar levels in blood; food sources for chromium include egg yolks, raw sugar, cheese, nuts, beets, whole grains, and meat.
298 Constipation
·
Fluoride is used by the body to help prevent tooth decay and to reinforce bone strength; sources of fluoride include drinking water and certain brands of toothpaste.
·
Iodine helps regulate the body’s use of energy by synthesizing into the hormone thyroxine; food sources include leafy green vegetables, nuts, egg yolks, and red meat.
·
Iron helps maintain muscles and the formation of red blood cells and certain proteins; food sources for iron include meat, dairy products, eggs, and leafy green vegetables.
·
Magnesium is important for the production of DNA, as well as for healthy teeth, bones, muscles, and nerves; food sources for magnesium include dried fruit, dark green vegetables, nuts, and seafood.
·
Phosphorous is used by the body to work with calcium to form bones and teeth; food sources for phosphorous include eggs, meat, cereals, and dairy products.
·
Selenium primarily helps maintain normal heart and liver functions; food sources for selenium include wholegrain cereals, fish, meat, and dairy products.
·
Zinc helps wounds heal, the formation of sperm, and encourage rapid growth and energy; food sources include dried beans, shellfish, eggs, and nuts.
The United States government periodically publishes recommended diets and consumption levels of the various elements of food. Again, your doctor may encourage deviations from the average official recommendation based on your specific condition. To learn more about basic dietary guidelines, visit the Web site: http://www.health.gov/dietaryguidelines/. Based on these guidelines, many foods are required to list the nutrition levels on the food’s packaging. Labeling Requirements are listed at the following site maintained by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government recommends that consumers become familiar with the following abbreviations before reading FDA literature:48 ·
DVs (Daily Values): A new dietary reference term that will appear on the food label. It is made up of two sets of references, DRVs and RDIs.
·
DRVs (Daily Reference Values): A set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium.
48
Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.
Researching Nutrition 299
·
RDIs (Reference Daily Intakes): A set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. The name “RDI” replaces the term “U.S. RDA.”
·
RDAs (Recommended Dietary Allowances): A set of estimated nutrient allowances established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge. What Are Dietary Supplements?49
Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail. Dietary supplements are provided in many forms including tablets, capsules, powders, gel-tabs, extracts, and liquids. Historically in the United States, the most prevalent type of dietary supplement was a multivitamin/mineral tablet or capsule that was available in pharmacies, either by prescription or “over the counter.” Supplements containing strictly herbal preparations were less widely available. Currently in the United States, a wide array of supplement products are available, including vitamin, mineral, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin. The Office of Dietary Supplements (ODS) of the National Institutes of Health is the official agency of the United States which has the expressed goal of acquiring “new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.”50 According to the ODS, dietary supplements can have an important impact on the prevention and management of disease and on the maintenance of health.51 The ODS notes that considerable research on the effects of dietary supplements has been conducted in Asia and Europe where This discussion has been adapted from the NIH: http://ods.od.nih.gov/whatare/whatare.html. 50 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920, Fax: (301) 480-1845, E-mail:
[email protected]. 51 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health and Education Act defines dietary supplements as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” 49
300 Constipation
the use of plant products, in particular, has a long tradition. However, the overwhelming majority of supplements have not been studied scientifically. To explore the role of dietary supplements in the improvement of health care, the ODS plans, organizes, and supports conferences, workshops, and symposia on scientific topics related to dietary supplements. The ODS often works in conjunction with other NIH Institutes and Centers, other government agencies, professional organizations, and public advocacy groups. To learn more about official information on dietary supplements, visit the ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact: The Office of Dietary Supplements National Institutes of Health Building 31, Room 1B29 31 Center Drive, MSC 2086 Bethesda, Maryland 20892-2086 Tel: (301) 435-2920 Fax: (301) 480-1845 E-mail:
[email protected] Finding Studies on Constipation The NIH maintains an office dedicated to patient nutrition and diet. The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.52 IBIDS is available to the public free of charge through the ODS Internet page: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We recommend that you start with the Consumer Database. While you may not find references for the topics that are of most interest to you, check back Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
52
Researching Nutrition 301
periodically as this database is frequently updated. More studies can be found by searching the Full IBIDS Database. Healthcare professionals and researchers generally use the third option, which lists peer-reviewed citations. In all cases, we suggest that you take advantage of the “Advanced Search” option that allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “constipation” (or synonyms) into the search box. To narrow the search, you can also select the “Title” field. The following is a typical result when searching for recently indexed consumer information on constipation: ·
Constipation, fibre intake and the menstrual cycle. Source: Davies, J. Nutr-food-sci. Bradford, West Yorkshire, England : MCB University Press. 1998. (4/5) page 272-274. 0034-6659
·
Constipation. 1. The hard facts. Source: Harv-Health-Lett. Boston, Mass. : Harvard Medical School Health Publications Group. February 1991. volume 16 (4) page 1-4. ill. 1052-1577
·
Obesity, weight-reducing programmes and constipation. Source: Anderson, E. Davies, J. Nutr-food-sci. Bradford, West Yorkshire, England : MCB University Press. Nov/December 1999. (6) page 303-306. 0034-6659
The following information is typical of that found when using the “Full IBIDS Database” when searching using “constipation” (or a synonym): ·
A six-year old suffering from constipation. Source: Brown, S Kerrigan, P Waterston, T Practitioner. 2000 February; 244(1607): 63-8 0032-6518
·
Advances in the management of pediatric constipation. Author(s): Combined Program in Pediatric Gastroenterology and Nutrition, Children's Hospital, Boston, MA 02115, USA.
[email protected] Source: Nurko, S Curr-Gastroenterol-Repage 2000 June; 2(3): 234-40 15228037
·
Amitriptyline-induced constipation in cynomolgus monkeys is beneficial for the evaluation of laxative efficacy. Author(s): Research and Development, Otsuka Pharmaceutical Factory, Inc., Naruto, Tokushima, Japan.
[email protected] Source: Tsusumi, K Kishimoto, S Koshitani, O Kohri, H Biol-Pharm-Bull. 2000 May; 23(5): 657-9 0918-6158
·
Can I safely use powdered fiber drinks such as Metamucil to relieve constipation without my body becoming reliant on them? Source: Feinberg, A W Health-News. 2000 January; 6(1): 10 1081-5880
302 Constipation
·
Chronic constipation in adults. How far should evaluation and treatment go? Author(s): Gastroenterology Division, University of Missouri, Columbia School of Medicine. Source: Marshall, J B Postgrad-Med. 1990 September 1; 88(3): 49-51, 54, 57-9, 63 0032-5481
·
Chronic constipation management for institutionalized older adults. Author(s): Department of Community and Preventive Medicine, Cancer Center, University of Rochester School of Medicine, USA. Source: Howard, L V West, D Ossip Klein, D J Geriatr-Nurs. 2000 MarApril; 21(2): 78-82; quiz 82-3 0197-4572
·
Clinical subgroups of chronic constipation: exploring the potential of polyethylene glycol. Author(s): Mayo Clinic, Rochester, MN, USA.
[email protected] Source: Camilleri, M Ital-J-Gastroenterol-Hepatol. 1999 November; 31 Suppl 3S253-4 1125-8055
·
Clostridial constipation's broad pathology. Source: Johnson, S Med-Hypotheses. 2001 April; 56(4): 532-6 0306-9877
·
Constipation and fecal impaction in the long-term care patient. Author(s): Department of Medicine, University of Chicago Medical Center, Illinois. Source: Alessi, C A Henderson, C T Clin-Geriatr-Med. 1988 August; 4(3): 571-88 0749-0690
·
Constipation and the use of laxatives: a comparison between transdermal fentanyl and oral morphine. Author(s): Department of Anaesthesiology, University of Cologne, Germany.
[email protected] Source: Radbruch, L Sabatowski, R Loick, G Kulbe, C Kasper, M Grond, S Lehmann, K A Palliat-Med. 2000 March; 14(2): 111-9 0269-2163
·
Constipation in elderly long-stay patients: its treatment by magnesium hydroxide and bulk-laxative. Author(s): Department of Medicine, Health Centre Hospital of Oulu, Finland. Source: Kinnunen, O Salokannel, J Ann-Clin-Res. 1987; 19(5): 321-3 00034762
·
Constipation in elderly patients attending a polyclinic. Author(s): Department of Biostatistics, University of the Orange Free State, Bloemfontein. Source: Meiring, P J Joubert, G S-Afr-Med-J. 1998 July; 88(7): 888-90 00382469
Researching Nutrition 303
·
Constipation in infants and children. Source: Dilliway, G Practitioner. 2001 September; 245(1626): 761-3 00326518
·
Constipation in the cancer patient: causes and management. Source: Portenoy, R K Med-Clin-North-Am. 1987 March; 71(2): 303-11 0025-7125
·
Constipation related to narcotic therapy. A protocol for nurses and patients. Author(s): Rhode Island Hospital, Providence 02903. Source: Cameron, J C Cancer-Nurs. 1992 October; 15(5): 372-7 0162-220X
·
Constipation, diarrhea, and irritable bowel syndrome. Author(s): Attending Colon and Rectal Surgeon, Department of Surgery, Wilford Hall Medical Center, San Antonio, Texas, USA. Source: Browning, S M Prim-Care. 1999 March; 26(1): 113-39 0095-4543
·
Constipation, fibre intake and the menstrual cycle. Source: Davies, J. Nutr-food-sci. Bradford, West Yorkshire, England : MCB University Press. 1998. (4/5) page 272-274. 0034-6659
·
Constipation, laxative use, and colon cancer among middle-aged adults. Author(s): Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, WA 98104 USA. Source: Jacobs, E J White, E Epidemiology. 1998 July; 9(4): 385-91 10443983
·
Constipation. 1. The hard facts. Source: Harv-Health-Lett. Boston, Mass. : Harvard Medical School Health Publications Group. February 1991. volume 16 (4) page 1-4. ill. 1052-1577
·
Constipation-2. Treatment. Author(s): Continence Care, West Cumbria Health Care NHS Trust. Source: Colley, W Nurs-Times. 1999 May 26-June 1; 95(21): suppl 1-2 0954-7762
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
304 Constipation
·
The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
·
The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
·
The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
·
The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
·
Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
·
Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
·
Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
·
Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
·
Google: http://directory.google.com/Top/Health/Nutrition/
·
Healthnotes: http://www.thedacare.org/healthnotes/
·
Open Directory Project: http://dmoz.org/Health/Nutrition/
·
Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
·
WebMDÒHealth: http://my.webmd.com/nutrition
·
WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to constipation; please note that any particular subject below may indicate either a therapeutic use, or a
Researching Nutrition 305
contraindication (potential danger), and does not reflect an official recommendation: ·
Vitamins Ascorbic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Ascorbic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm Provitamin A Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Beta Carotenecs.html Provitamin A Alternative names: Beta-Carotene Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/Inter actions/BetaCarotenecs.html Vitamin C Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,904, 00.html Vitamin D Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,905, 00.html
306 Constipation
·
Minerals Calcium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Calcium.htm Calcium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Calcium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Calcium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Calci umcs.html Calcium Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000113.html Calcium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,884, 00.html Chondroitin Alternative names: chondroitin sulfate, sodium chondroitin sulfate Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Chon droitincs.html Folate Source: Healthnotes, Inc.; www.healthnotes.com
Researching Nutrition 307
Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Iron Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Iron.htm Magnesium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Magnesium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Proctiti scc.html Magnesium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Magnesium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,890, 00.html Magnesium Hydroxide Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Magnesium_Hydroxide. htm Potassium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Potassium Source: Integrative Medicine Communications; www.onemedicine.com
308 Constipation
Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Quercetin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hemor rhoidscc.html ·
Food and Diet Apple juice Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Consti pationcc.html Apple juice Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Apple juice Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hemor rhoidscc.html Apple juice Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Irritabl eBowelSyndromecc.html Apples Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Applesauce Source: Healthnotes, Inc.; www.healthnotes.com
Researching Nutrition 309
Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Artichoke Alternative names: Cynara scolymus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Artichoke.htm Artificial Sweeteners Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Proctiti scc.html Bananas Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Bananas Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Irritabl eBowelSyndromecc.html Barley Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Beans Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Irritabl eBowelSyndromecc.html Beef Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diverti cularDiseasecc.html
310 Constipation
Beef Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Berries Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Berries Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hemor rhoidscc.html Beverages Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm Blackberries Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,142,00.ht ml Bread Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diverti cularDiseasecc.html Broccoli Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Brown rice Source: Healthnotes, Inc.; www.healthnotes.com
Researching Nutrition 311
Hyperlink: http://www.thedacare.org/healthnotes/Concern/Constipation.htm Brown rice Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Irritable_Bowel.htm Cereals Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Constipation.htm Chocolate Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastro esophagealRefluxDiseasecc.html Cinnamon Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Clams Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Coffee Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Coffee Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm Coffee Source: Integrative Medicine Communications; www.onemedicine.com
312 Constipation
Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastro esophagealRefluxDiseasecc.html Complex carbohydrates Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,993, 00.html Corn Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Corn Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Irritabl eBowelSyndromecc.html Cream Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Cream Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Proctiti scc.html Cream Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000292.html Dairy Foods Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Proctiti scc.html
Researching Nutrition 313
Eggs Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm Eggs Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Eggs Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Irritabl eBowelSyndromecc.html Fats Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm Fats Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Consti pationcc.html Fats Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hemor rhoidscc.html Fats Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastro esophagealRefluxDiseasecc.html Fish Source: Integrative Medicine Communications; www.onemedicine.com
314 Constipation
Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diverti cularDiseasecc.html Fish Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Consti pationcc.html Fish Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Fish Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Proctiti scc.html Fish Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Irritabl eBowelSyndromecc.html Fish Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hemor rhoidscc.html Flaxseeds Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Flaxseeds.htm Fruit Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm
Researching Nutrition 315
Fruit Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Grains Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Grains Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hemor rhoidscc.html Grains Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Consti pationcc.html Grapefruit Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Irritable_Bowel.htm Ham Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html High Cholesterol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm High-Fiber Diet Source: Healthnotes, Inc.; www.healthnotes.com
316 Constipation
Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diverticular_Disease. htm High-Fiber Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/High_Fiber_Diet.htm High-Fiber Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hemorrhoids.htm High-Fiber Diet Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diverti cularDiseasecc.html High-Fiber Diet Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000292.html Honey Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Ice cream Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Lamb Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diverti cularDiseasecc.html Lettuce Source: Integrative Medicine Communications; www.onemedicine.com
Researching Nutrition 317
Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diverti cularDiseasecc.html Magnesium Sulfate Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Proctiti scc.html Mayonnaise Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Meat Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm Meat Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diverti cularDiseasecc.html Meat Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Milk Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Constipation.htm Milk Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm
318 Constipation
Milk Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Milk Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Irritable_Bowel.htm Milk Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Irritabl eBowelSyndromecc.html Milk Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Milk Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diverti cularDiseasecc.html Mushrooms Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Mussels Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Nuts Source: Integrative Medicine Communications; www.onemedicine.com
Researching Nutrition 319
Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Irritabl eBowelSyndromecc.html Nuts Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hemor rhoidscc.html Nuts Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Consti pationcc.html Obesity Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm Omega-3 Fatty Acids Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diverti cularDiseasecc.html Omega-6 Fatty Acids Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diverti cularDiseasecc.html Oysters Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Papaya Source: Integrative Medicine Communications; www.onemedicine.com
320 Constipation
Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastro esophagealRefluxDiseasecc.html Peanuts Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Irritabl eBowelSyndromecc.html Polyunsaturated Fats Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Polyunsaturated_ Fats.htm Poultry Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Prunes Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Consti pationcc.html Prunes Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hemor rhoidscc.html Rhubarb Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Constipation.htm Rhubarb Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000284.html
Researching Nutrition 321
Rhubarb Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsp-r.htm Rice Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Rice Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Irritable_Bowel.htm Rice Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Constipation.htm Rice Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Saturated Fats Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Consti pationcc.html Saturated Fats Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hemor rhoidscc.html Seeds Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Constipation.htm
322 Constipation
Seeds Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hemorrhoids.htm Seeds Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Irritable_Bowel.htm Seeds Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diverti cularDiseasecc.html Seeds Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000284.html Shrimp Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Soup Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Soy Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Soy.htm Spinach Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diverti cularDiseasecc.html Spinach Source: Integrative Medicine Communications; www.onemedicine.com
Researching Nutrition 323
Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Sucralfate Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Proctiti scc.html Sugar Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Irritable_Bowel.htm Sweeteners Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Proctiti scc.html Syrup Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Tea Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Irritable_Bowel.htm Tea Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Tea Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Tea.htm
324 Constipation
Tea Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Consti pationcc.html Tea Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Tea Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastro esophagealRefluxDiseasecc.html Tea Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Irritabl eBowelSyndromecc.html Tea Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hemor rhoidscc.html Tomatoes Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Irritabl eBowelSyndromecc.html Turkey Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000284.html Vegetables Source: Integrative Medicine Communications; www.onemedicine.com
Researching Nutrition 325
Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Consti pationcc.html Vegetables Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Vegetables Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hemor rhoidscc.html Vegetables Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Irritabl eBowelSyndromecc.html Vegetarian Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm Water Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Water.htm Water Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Constipation.htm Water Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Irritable_Bowel.htm
326 Constipation
Water Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Water Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hemorrhoids.htm Water Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/FoodP oisoningcc.html Water Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Consti pationcc.html Water Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hemor rhoidscc.html Water Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Irritabl eBowelSyndromecc.html Water Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diverti cularDiseasecc.html Water Source: Integrative Medicine Communications; www.onemedicine.com
Researching Nutrition 327
Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Gastro esophagealRefluxDiseasecc.html Water Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000284.html Weight Loss Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diverticular_Disease. htm Weight Loss Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm Wheat Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Irritable_Bowel.htm Wheat Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Wheat Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Gallstones.htm Wheat Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Constipation.htm Wheat Source: Integrative Medicine Communications; www.onemedicine.com
328 Constipation
Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Irritabl eBowelSyndromecc.html Yogurt Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm
Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Polyethylene: A vinyl polymer made from ethylene. It can be branched or linear. Branched or low-density polyethylene is tough and pliable but not to the same degree as linear polyethylene. Linear or high-density polyethylene has a greater hardness and tensile strength. Polyethylene is used in a variety of products, including implants and prostheses. [NIH] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH]
Researching Nutrition 329
Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH]
Finding Medical Libraries 331
APPENDIX D. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM’s interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.53
53
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
332 Constipation
Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):54 ·
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
·
Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM
·
Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
·
California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html
·
California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html
·
California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
·
California: Gateway Health Library (Sutter Gould Medical Foundation)
·
California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/
54
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries 333
·
California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
·
California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
·
California: San José PlaneTree Health Library, http://planetreesanjose.org/
·
California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html
·
California: University of California, Davis. Health Sciences Libraries
·
California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html
·
California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/
·
Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm
·
Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
·
Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
·
Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml
·
Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm
·
Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html
·
Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
·
Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp
·
Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/
334 Constipation
·
Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm
·
Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html
·
Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/
·
Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm
·
Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/
·
Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/
·
Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/
·
Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm
·
Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html
·
Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm
·
Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/
·
Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library
·
Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10
·
Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html
·
Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
·
Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml
Finding Medical Libraries 335
·
Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
·
Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
·
Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html
·
Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
·
Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp
·
Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital), http://www.southcoast.org/library/
·
Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
·
Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/
·
Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
·
Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
·
Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
·
Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm
·
Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html
·
Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41
336 Constipation
·
National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
·
National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
·
National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
·
Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm
·
New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
·
New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm
·
New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm
·
New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/
·
New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
·
New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/
·
New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html
·
New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
·
Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
·
Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp
Finding Medical Libraries 337
·
Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/
·
Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/
·
Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml
·
Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html
·
Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html
·
Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
·
Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp
·
Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm
·
Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/
·
South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm
·
Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
·
Texas: Matustik Family Resource Center (Cook Children’s Health Care System), http://www.cookchildrens.com/Matustik_Library.html
·
Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
·
Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/
Constipation in Children 339
APPENDIX E. CONSTIPATION IN CHILDREN Overview55 Constipation means that bowel movements are hard and dry, difficult or painful to pass, and less frequent than usual. It is a common problem for children, but it is usually temporary and no cause for parents to be concerned. When a child does not eat enough fiber, drink enough liquids, or get enough exercise, constipation is more likely to occur. It also happens when children ignore the urge to have a bowel movement, which they often do out of either embarrassment to use a public bathroom, fear or lack of confidence in the absence of a parent, or unwillingness to take a break from play. Sometimes constipation is caused by medicines or a disease. Symptoms of constipation include ·
No bowel movement for several days or daily bowel movements that are hard and dry
·
Cramping abdominal pain
·
Nausea
·
Vomiting
·
Weight loss
·
Liquid or solid, clay-like stool in the child’s underwear--a sign that stool is backed up in the rectum
Adapted from The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): http://www.niddk.nih.gov/health/digest/summary/conchild/index.htm.
55
340 Constipation
Constipation can make a bowel movement painful, so the child may try to prevent having one. Clenching buttocks, rocking up and down on toes, and turning red in the face are signs of trying to hold in a bowel movement. Treatment depends on the child’s age and the severity of the problem. Often eating more fiber (fruits, vegetables, whole-grain cereal), drinking more liquids, and getting more exercise will solve the problem. Sometimes a child may need an enema to remove the stool or a laxative to soften it or prevent a future episode. However, laxatives can be dangerous to children and should be given only with a doctor’s approval. Although constipation is usually harmless, it can be a sign or cause of a more serious problem. A child should see a doctor if ·
Episodes of constipation last longer than 3 weeks.
·
Child is unable to participate in normal activities.
·
Small, painful tears appear in the skin around the anus.
·
A small amount of the intestinal lining is pushed out of the anus (hemorrhoids).
·
Normal pushing is not enough to expel stool.
·
Liquid or soft stool leaks out of the anus.
For More Information For more information, contact: American Academy of Pediatrics National Headquarters 141 Northwest Point Boulevard Elk Grove Village, IL 60007-1098 Phone: (847) 434-4000 Fax: (847) 434-8000 Internet: www.aap.org International Foundation for Functional Gastrointestinal Disorders (IFFGD) P.O. Box 17864 Milwaukee, WI 53217 Phone: 1-888-964-2001 or (414) 964-1799 Fax: (414) 964-7176
Constipation in Children 341
Email:
[email protected] Internet: www.iffgd.org
Additional Information on Constipation in Children The National Digestive Diseases Information Clearinghouse collects resource information on digestive diseases for the Combined Health Information Database (CHID). CHID is a database produced by health-related agencies of the Federal Government. This database provides titles, abstracts, and availability information for health information and health education resources. To provide you with the most up-to-date resources, information specialists at the clearinghouse created an automatic search of CHID. To obtain this information you may view the results of the automatic search on Constipation in Children. Or, if you wish to perform your own search of the database, you may access the CHID Online web site and search CHID yourself.
Online Glossaries 343
ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
·
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
·
Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
·
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
·
On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/
·
Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
·
Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html
Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia Web site address is http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a) and drkoop.com (http://www.drkoop.com/). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to constipation and keep them on file. The NIH, in particular, suggests that patients with constipation visit the following Web sites in the ADAM Medical Encyclopedia:
344 Constipation
·
Basic Guidelines for Constipation Constipation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003125.htm
·
Signs & Symptoms for Constipation Abdominal cramps Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003120.htm Abdominal pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003120.htm Bloating Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003123.htm Blood in the stool Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003130.htm Depression Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003213.htm Malaise Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003089.htm Tenesmus Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003131.htm Unexplained weight loss Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003107.htm
·
Diagnostics and Tests for Constipation
Online Glossaries 345
ANA Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003535.htm Barium enema Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003817.htm CBC Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003642.htm Colonoscopy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003886.htm Proctosigmoidoscopy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003885.htm PT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003652.htm PTT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003653.htm Upper GI series Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003816.htm X-rays of the abdomen Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003815.htm ·
Nutrition for Constipation Bulk Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002470.htm
346 Constipation
Coffee Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002445.htm Fiber Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002470.htm ·
Background Topics for Constipation Bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm Bowel retraining Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003971.htm Endocrine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002351.htm Exercise Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001941.htm Meconium Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002262.htm Physical activity Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001941.htm Physical examination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002274.htm
Online Glossaries 347
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
·
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
·
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
·
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
Glossary 349
CONSTIPATION GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Pertaining to the abdomen. [EU] Abscess: A localized collection of pus caused by suppuration buried in tissues, organs, or confined spaces. [EU] Absenteeism: Chronic absence from work or other duty. [NIH] Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak anti-inflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Acetylcholinesterase: An enzyme that catalyzes the hydrolysis of acetylcholine to choline and acetate. In the CNS, this enzyme plays a role in the function of peripheral neuromuscular junctions. EC 3.1.1.7. [NIH] Adhesions: Pathological processes consisting of the union of the opposing surfaces of a wound. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH]
Albuterol: A racemic mixture with a 1:1 ratio of the r-isomer, levalbuterol, and s-albuterol. It is a short-acting beta2-adrenergic agonist with its main clinical use in ASTHMA. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaloid: One of a large group of nitrogenous basis substances found in plants. They are usually very bitter and many are pharmacologically active. Examples are atropine, caffeine, coniine, morphine, nicotine, quinine, strychnine. The term is also applied to synthetic substances (artificial a's) which have structures similar to plant alkaloids, such as procaine. [EU]
350 Constipation
Aluminum: A metallic element that has the atomic number 13, atomic symbol Al, and atomic weight 26.98. [NIH] Amiodarone: An antianginal and antiarrhythmic drug. It increases the duration of ventricular and atrial muscle action by inhibiting Na,K-activated myocardial adenosine triphosphatase. There is a resulting decrease in heart rate and in vascular resistance. [NIH] Amoxapine: The N-demethylated derivative of the antipsychotic agent loxapine that works by blocking the reuptake of norepinephrine, serotonin, or both. It also blocks dopamine receptors. [NIH] Amphetamine: A powerful central nervous system stimulant and sympathomimetic. Amphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulation of release of monamines, and inhibiting monoamine oxidase. Amphetamine is also a drug of abuse and a psychotomimetic. The l- and the d,l-forms are included here. The l-form has less central nervous system activity but stronger cardiovascular effects. The d-form is dextroamphetamine. [NIH] Anaemia: A reduction below normal in the number of erythrocytes per cu. mm., in the quantity of haemoglobin, or in the volume of packed red cells per 100 ml. of blood which occurs when the equilibrium between blood loss (through bleeding or destruction) and blood production is disturbed. [EU] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH]
Anorectal: Pertaining to the anus and rectum or to the junction region between the two. [EU] Anorexia: Lack or loss of the appetite for food. [EU] Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Anticholinergic: An agent that blocks the parasympathetic nerves. Called also parasympatholytic. [EU] Anticonvulsant: An agent that prevents or relieves convulsions. [EU]
Glossary 351
Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Antihistamine: A drug that counteracts the action of histamine. The antihistamines are of two types. The conventional ones, as those used in allergies, block the H1 histamine receptors, whereas the others block the H2 receptors. Called also antihistaminic. [EU] Antihypertensive: An agent that reduces high blood pressure. [EU] Antispasmodic: An agent that relieves spasm. [EU] Anus: The distal or terminal orifice of the alimentary canal. [EU] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Aromatic: Having a spicy odour. [EU] Ascariasis: Infection by nematodes of the genus ascaris. Ingestion of infective eggs causes diarrhea and pneumonitis. Its distribution is more prevalent in areas of poor sanitation and where human feces are used for fertilizer. [NIH] Ascites: Effusion and accumulation of serous fluid in the abdominal cavity; called also abdominal or peritoneal dropsy, hydroperitonia, and hydrops abdominis. [EU] Atrophy: A wasting away; a diminution in the size of a cell, tissue, organ, or part. [EU] Autonomic: Self-controlling; functionally independent. [EU] Bacillus: A genus of bacteria of the family Bacillaceae, including large aerobic or facultatively anaerobic, spore-forming, rod-shaped cells, the great majority of which are gram-positive and motile. The genus is separated into 48 species, of which three are pathogenic, or potentially pathogenic, and the remainder are saprophytic soil forms. Many organisms historically called Bacillus are now classified in other genera. [EU] Barium: An element of the alkaline earth group of metals. It has an atomic symbol Ba, atomic number 56, and atomic weight 138. All of its acid-soluble salts are poisonous. [NIH] Baths: The immersion or washing of the body or any of its parts in water or other medium for cleansing or medical treatment. It includes bathing for personal hygiene as well as for medical purposes with the addition of
352 Constipation
therapeutic agents, such as alkalines, antiseptics, oil, etc. [NIH] Beauty: Characteristics or attributes of persons or things which elicit pleasurable feelings. [NIH] Benign: Not malignant; not recurrent; favourable for recovery. [EU] Bezoars: Concretions of swallowed hair, fruit or vegetable fibers, or similar substances found in the alimentary canal. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Biliary: Pertaining to the bile, to the bile ducts, or to the gallbladder. [EU] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Bismuth: A metallic element that has the atomic symbol Bi, atomic number 83 and atomic weight 208.98. [NIH] Campylobacter: A genus of bacteria found in the reproductive organs, intestinal tract, and oral cavity of animals and man. Some species are pathogenic. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Captopril: A potent and specific inhibitor of peptidyl-dipeptidase A. It blocks the conversion of angiotensin I to angiotensin II, a vasoconstrictor and important regulator of arterial blood pressure. Captopril acts to suppress the renin-angiotensin system and inhibits pressure responses to exogenous angiotensin. [NIH] Carbamazepine: An anticonvulsant used to control grand mal and psychomotor or focal seizures. Its mode of action is not fully understood, but some of its actions resemble those of phenytoin; although there is little chemical resemblance between the two compounds, their three-dimensional structure is similar. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Carcinoma: A malignant new growth made up of epithelial cells tending to infiltrate the surrounding tissues and give rise to metastases. [EU]
Glossary 353
Cardiovascular: Pertaining to the heart and blood vessels. [EU] Catheter: A tubular, flexible, surgical instrument for withdrawing fluids from (or introducing fluids into) a cavity of the body, especially one for introduction into the bladder through the urethra for the withdraw of urine. [EU]
Caustic: An escharotic or corrosive agent. Called also cauterant. [EU] Cetirizine: A potent second-generation histamine H1 antagonist that is effective in the treatment of allergic rhinitis, chronic urticaria, and polleninduced asthma. Unlike many traditional antihistamines, it does not cause drowsiness or anticholinergic side effects. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Cholangitis: Inflammation of a bile duct. [EU] Cholecystectomy: Surgical removal of the gallbladder. [NIH] Cholecystitis: Inflammation of the gallbladder. [EU] Cholelithiasis: The presence or formation of gallstones. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chronic: Persisting over a long period of time. [EU] Ciprofloxacin: A carboxyfluoroquinoline antimicrobial agent that is effective against a wide range of microorganisms. It has been successfully and safely used in the treatment of resistant respiratory, skin, bone, joint, gastrointestinal, urinary, and genital infections. [NIH] Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Clonazepam: An anticonvulsant used for several types of seizures, including myotonic or atonic seizures, photosensitive epilepsy, and absence seizures, although tolerance may develop. It is seldom effective in generalized tonic-clonic or partial seizures. The mechanism of action appears to involve the enhancement of GABA receptor responses. [NIH] Clorazepate Dipotassium: A water-soluble benzodiazepine derivative effective in the treatment of anxiety. It has also muscle relaxant and anticonvulsant actions. [NIH]
354 Constipation
Clostridium: A genus of motile or nonmotile gram-positive bacteria of the family bacillaceae. Many species have been identified with some being pathogenic. They occur in water, soil, and in the intestinal tract of humans and lower animals. [NIH] Clozapine: A tricylic dibenzodiazepine, classified as an atypical antipsychotic agent. It binds several types of central nervous system receptors, and displays a unique pharmacological profile. Clozapine is a serotonin antagonist, with strong binding to 5-HT 2A/2C receptor subtype. It also displays strong affinity to several dopaminergic receptors, but shows only weak antagonism at the dopamine D2 receptor, a receptor commonly thought to modulate neuroleptic activity. Agranulocytosis is a major adverse effect associated with administration of this agent. [NIH] Coagulation: 1. the process of clot formation. 2. in colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. in surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Codeine: An opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough. [NIH] Colic: Paroxysms of pain. This condition usually occurs in the abdominal region but may occur in other body regions as well. [NIH] Colitis: Inflammation of the colon. [EU] Collagen: The protein substance of the white fibres (collagenous fibres) of skin, tendon, bone, cartilage, and all other connective tissue; composed of molecules of tropocollagen (q.v.), it is converted into gelatin by boiling. collagenous pertaining to collagen; forming or producing collagen. [EU] Colonoscopy: Endoscopic examination, therapy or surgery of the luminal surface of the colon. [NIH] Colorectal: Pertaining to or affecting the colon and rectum. [EU] Confusion: Disturbed orientation in regard to time, place, or person, sometimes accompanied by disordered consciousness. [EU] Constipation: Infrequent or difficult evacuation of the faeces. [EU] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Contractility: stimulus. [EU]
Capacity for becoming short in response to a suitable
Cryosurgery: The use of freezing as a special surgical technique to destroy
Glossary 355
or excise tissue. [NIH] Cyclospora: A genus of coccidian parasites in the family eimeriidae. Cyclospora cayetanensis is pathogenic in humans, probably transmitted via the fecal-oral route, and causes nausea and diarrhea. [NIH] Cytomegalovirus: A genus of the family herpesviridae, subfamily betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Cytotoxic: Pertaining to or exhibiting cytotoxicity. [EU] Defecation: The normal process of elimination of fecal material from the rectum. [NIH] Defecography: Radiographic examination of the process of defecation after the instillation of a contrast media into the rectum. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water. Called also anhydration, deaquation and hypohydration. [EU] Dentition: The teeth in the dental arch; ordinarily used to designate the natural teeth in position in their alveoli. [EU] Dentures: An appliance used as an artificial or prosthetic replacement for missing teeth and adjacent tissues. It does not include crowns, dental abutments, nor tooth, artificial. [NIH] Dermatitis: Inflammation of the skin. [EU] Desensitization: The prevention or reduction of immediate hypersensitivity reactions by administration of graded doses of allergen; called also hyposensitization and immunotherapy. [EU] Desipramine: A tricyclic dibenzazepine compound that potentiates neurotransmission. Desipramine selectively blocks reuptake of norepinephrine from the neural synapse, and also appears to impair serotonin transport. This compound also possesses minor anticholingeric activity, through its affinity to muscarinic receptors. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Dietetics: The study and regulation of the diet. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Diverticulitis: Inflammation of a diverticulum, especially inflammation related to colonic diverticula, which may undergo perforation with abscess
356 Constipation
formation. Sometimes called left-sided or L-sides appendicitis. [EU] Diverticulum: A pathological condition manifested as a pouch or sac opening from a tubular or sacular organ. [NIH] Duodenum: The first or proximal portion of the small intestine, extending from the pylorus to the jejunum; so called because it is about 12 fingerbreadths in length. [EU] Dyspepsia: Impairment of the power of function of digestion; usually applied to epigastric discomfort following meals. [EU] Dysphagia: Difficulty in swallowing. [EU] Dysplasia: Abnormality of development; in pathology, alteration in size, shape, and organization of adult cells. [EU] Dystonia: Disordered tonicity of muscle. [EU] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electromyography: Recording of the changes in electric potential of muscle by means of surface or needle electrodes. [NIH] Encephalopathy: Any degenerative disease of the brain. [EU] Encopresis: Incontinence of feces not due to organic defect or illness. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endoscopy: Visual inspection of any cavity of the body by means of an endoscope. [EU] Enema: A clyster or injection; a liquid injected or to be injected into the rectum. [EU] Entamoeba: A genus of ameboid protozoa characterized by the presence of beaded chromatin on the inner surface of the nuclear membrane. Its organisms are parasitic in invertebrates and vertebrates, including humans. [NIH]
Enteritis: Inflammation of the intestine, applied chiefly to inflammation of the small intestine; see also enterocolitis. [EU] Enterocolitis: Inflammation involving both the small intestine and the colon; see also enteritis. [EU] Enuresis: Involuntary discharge of urine after the age at which urinary control should have been achieved; often used alone with specific reference to involuntary discharge of urine occurring during sleep at night (bedwetting, nocturnal enuresis). [EU]
Glossary 357
Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Epigastric: Pertaining to the epigastrium. [EU] Eructation: The act of belching, or of casting up wind from the stomach through the mouth. [EU] Erythropoietin: Glycoprotein hormone, secreted chiefly by the kidney in the adult and the liver in the fetus, that acts on erythroid stem cells of the bone marrow to stimulate proliferation and differentiation. [NIH] Escherichia: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms occur in the lower part of the intestine of warmblooded animals. The species are either nonpathogenic or opportunistic pathogens. [NIH] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Ethnopharmacology: The study of the actions and properties of drugs, usually derived from medicinal plants, indigenous to a population or ethnic group. [NIH] Etodolac: A nonsteroidal anti-inflammatory agent with potent analgesic and antiarthritic properties. It has been shown to be effective in the treatment of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and in the alleviation of postoperative pain. [NIH] Evacuation: An emptying, as of the bowels. [EU] Extracorporeal: Situated or occurring outside the body. [EU] Faecal: Pertaining to or of the nature of feces. [EU] Famotidine: A competitive histamine H2-receptor antagonist. Its main pharmacodynamic effect is the inhibition of gastric secretion. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Fats: One of the three main classes of foods and a source of energy in the body. Fats help the body use some vitamins and keep the skin healthy. They also serve as energy stores for the body. In food, there are two types of fats: saturated and unsaturated. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria,
358 Constipation
cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Felodipine: A dihydropyridine calcium antagonist with positive inotropic effects. It lowers blood pressure by reducing peripheral vascular resistance through a highly selective action on smooth muscle in arteriolar resistance vessels. [NIH] Fermentation: An enzyme-induced chemical change in organic compounds that takes place in the absence of oxygen. The change usually results in the production of ethanol or lactic acid, and the production of energy. [NIH] Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU] Filtration: The passage of a liquid through a filter, accomplished by gravity, pressure, or vacuum (suction). [EU] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Flatulence: The presence of excessive amounts of air or gases in the stomach or intestine, leading to distention of the organs. [EU] Fluphenazine: A phenothiazine used in the treatment of psychoses. Its properties and uses are generally similar to those of chlorpromazine. [NIH] Flurbiprofen: An anti-inflammatory analgesic and antipyretic of the phenylalkynoic acid series. It has been shown to reduce bone resorption in periodontal disease by inhibiting carbonic anhydrase. [NIH] Flushing: A transient reddening of the face that may be due to fever, certain drugs, exertion, stress, or a disease process. [NIH] Furosemide: A sulfamyl saluretic and diuretic. It has a fast onset and short duration of action and is used in edema and chronic renal insufficiency. [NIH] Gastritis: Inflammation of the stomach. [EU] Gastroduodenal: Pertaining to or communicating with the stomach and duodenum, as a gastroduodenal fistula. [EU] Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Gastroscopy: Endoscopic examination, therapy or surgery of the interior of the stomach. [NIH]
Glossary 359
Gastrostomy: Creation of an artificial external opening into the stomach for nutritional support or gastrointestinal compression. [NIH] Gemfibrozil: A lipid-regulating agent that lowers elevated serum lipids primarily by decreasing serum triglycerides with a variable reduction in total cholesterol. These decreases occur primarily in the VLDL fraction and less frequently in the LDL fraction. Gemfibrozil increases HDL subfractions HDL2 and HDL3 as well as apolipoproteins A-I and A-II. Its mechanism of action has not been definitely established. [NIH] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Gluten: The protein of wheat and other grains which gives to the dough its tough elastic character. [EU] Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH] Glycopyrrolate: A muscarinic antagonist used as an antispasmodic, in some disorders of the gastrointestinal tract, and to reduce salivation with some anesthetics. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Hematemesis: Vomiting of blood. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [NIH] Hepatic: Pertaining to the liver. [EU] Hepatitis: Inflammation of the liver. [EU]
360 Constipation
Hepatobiliary: Pertaining to the liver and the bile or the biliary ducts. [EU] Heredity: 1. the genetic transmission of a particular quality or trait from parent to offspring. 2. the genetic constitution of an individual. [EU] Hernia: (he protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [EU] Hiccup: A spasm of the diaphragm that causes a sudden inhalation followed by rapid closure of the glottis which produces a sound. [NIH] Hoarseness: An unnaturally deep or rough quality of voice. [NIH] Homeostasis: A tendency to stability in the normal body states (internal environment) of the organism. It is achieved by a system of control mechanisms activated by negative feedback; e.g. a high level of carbon dioxide in extracellular fluid triggers increased pulmonary ventilation, which in turn causes a decrease in carbon dioxide concentration. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hydrogen: Hydrogen. The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydroxyurea: An antineoplastic agent that inhibits DNA synthesis through the inhibition of ribonucleoside diphosphate reductase. [NIH] Hyperbilirubinemia: Pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice. [NIH] Hypercalcemia: Abnormally high level of calcium in the blood. [NIH] Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU] Hypersensitivity: A state of altered reactivity in which the body reacts with an exaggerated immune response to a foreign substance. Hypersensitivity reactions are classified as immediate or delayed, types I and IV, respectively, in the Gell and Coombs classification (q.v.) of immune responses. [EU] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90
Glossary 361
mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Hyperthyroidism: 1. excessive functional activity of the thyroid gland. 2. the abnormal condition resulting from hyperthyroidism marked by increased metabolic rate, enlargement of the thyroid gland, rapid heart rate, high blood pressure, and various secondary symptoms. [EU] Hysterectomy: The operation of excising the uterus, performed either through the abdominal wall (abdominal h.) or through the vagina (vaginal h.) [EU] Ibuprofen: A nonsteroidal anti-inflammatory agent with analgesic properties used in the therapy of rheumatism and arthritis. [NIH] Idiopathic: Of the nature of an idiopathy; self-originated; of unknown causation. [EU] Ileostomy: Surgical creation of an external opening into the ileum for fecal diversion or drainage. Loop or tube procedures are most often employed. [NIH]
Ileus: Obstruction of the intestines. [EU] Immunosuppressant: An agent capable of suppressing immune responses. [EU]
Incontinence: Inability to control excretory functions, as defecation (faecal i.) or urination (urinary i.). [EU] Indapamide: A sulfamyl diuretic with about 16x the effect of furosemide. It has also been shown to be an effective antihypertensive agent in the clinic. [NIH]
Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Individuation: A process of differentiation having for its goal the development of the individual personality. [NIH] Inertia: Inactivity, inability to move spontaneously. [EU] Infarction: 1. the formation of an infarct. 2. an infarct. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]
Insomnia: Inability to sleep; abnormal wakefulness. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally
362 Constipation
promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Intervertebral: Situated between two contiguous vertebrae. [EU] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Itraconazole: An antifungal agent that has been used in the treatment of histoplasmosis, blastomycosis, cryptococcal meningitis, and aspergillosis. [NIH]
Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH] Jejunostomy: Surgical formation of an opening through the abdominal wall into the jejunum, usually for enteral hyperalimentation. [NIH] Ketoprofen: An ibuprofen-type anti-inflammatory analgesic and antipyretic. It is used in the treatment of rheumatoid arthritis and osteoarthritis. [NIH] Laparoscopy: Examination, therapy or surgery of the abdomen's interior by means of a laparoscope. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Lithotripsy: The destruction of a calculus of the kidney, ureter, bladder, or
Glossary 363
gallbladder by physical forces, including crushing with a lithotriptor through a catheter. Focused percutaneous ultrasound and focused hydraulic shock waves may be used without surgery. Lithotripsy does not include the dissolving of stones by acids or litholysis. Lithotripsy by laser is lithotripsy, laser. [NIH] Lumen: The cavity or channel within a tube or tubular organ. [EU] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH]
Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malaise: A vague feeling of bodily discomfort. [EU] Malignant: Tending to become progressively worse and to result in death. Having the properties of anaplasia, invasion, and metastasis; said of tumours. [EU] Mammary: Pertaining to the mamma, or breast. [EU] Meconium: The thick green-to-black mucilaginous material found in the intestines of a full-term fetus. It consists of secretions of the intestinal glands, bile pigments, fatty acids, amniotic fluid, and intrauterine debris. It constitutes the first stools passed by a newborn. [NIH] Megacolon: An abnormally large or dilated colon; the condition may be congenital or acquired, acute or chronic. [EU] Melena: 1. the passage of dark, pitchy, and grumous stools stained with blood pigments or with altered blood. 2. black vomit. [EU] Menstruation: The cyclic, physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus; it is under hormonal control and normally recurs, usually at approximately four-week intervals, in the absence of pregnancy during the reproductive period (puberty through menopause) of the female of the human and a few species of primates. It is the culmination of the menstrual cycle. [EU] Methotrexate: An antineoplastic antimetabolite with immunosuppressant properties. It is an inhibitor of dihydrofolate reductase and prevents the formation of tetrahydrofolate, necessary for synthesis of thymidylate, an essential component of DNA. [NIH] Micturition: The passage of urine; urination. [EU] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Monotherapy: A therapy which uses only one drug. [EU] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central
364 Constipation
nervous system and on smooth muscle. [NIH] Motility: The ability to move spontaneously. [EU] Mucus: The free slime of the mucous membranes, composed of secretion of the glands, along with various inorganic salts, desquamated cells, and leucocytes. [EU] Myeloma: A tumour composed of cells of the type normally found in the bone marrow. [EU] Myopathy: Any disease of a muscle. [EU] Naproxen: An anti-inflammatory agent with analgesic and antipyretic properties. Both the acid and its sodium salt are used in the treatment of rheumatoid arthritis and other rheumatic or musculoskeletal disorders, dysmenorrhea, and acute gout. [NIH] Narcotic: 1. pertaining to or producing narcosis. 2. an agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Neostigmine: A cholinesterase inhibitor used in the treatment of myasthenia gravis and to reverse the effects of muscle relaxants such as gallamine and tubocurarine. Neostigmine, unlike physostigmine, does not cross the blood-brain barrier. [NIH] Nephritis: Inflammation of the kidney; a focal or diffuse proliferative or destructive process which may involve the glomerulus, tubule, or interstitial renal tissue. [EU] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH]
Glossary 365
Neuropathy: A general term denoting functional disturbances and/or pathological changes in the peripheral nervous system. The etiology may be known e.g. arsenical n., diabetic n., ischemic n., traumatic n.) or unknown. Encephalopathy and myelopathy are corresponding terms relating to involvement of the brain and spinal cord, respectively. The term is also used to designate noninflammatory lesions in the peripheral nervous system, in contrast to inflammatory lesions (neuritis). [EU] Neuropeptides: Peptides released by neurons as intercellular messengers. Many neuropeptides are also hormones released by non-neuronal cells. [NIH] Neurosurgery: A surgical specialty concerned with the treatment of diseases and disorders of the brain, spinal cord, and peripheral and sympathetic nervous system. [NIH] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nifedipine: A potent vasodilator agent with calcium antagonistic action. It is a useful anti-anginal agent that also lowers blood pressure. The use of nifedipine as a tocolytic is being investigated. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nizatidine: A histamine H2 receptor antagonist with low toxicity that inhibits gastric acid secretion. The drug is used for the treatment of duodenal ulcers. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Nosocomial: Pertaining to or originating in the hospital, said of an infection not present or incubating prior to admittance to the hospital, but generally occurring 72 hours after admittance; the term is usually used to refer to patient disease, but hospital personnel may also acquire nosocomial infection. [EU]
366 Constipation
Occult: Obscure; concealed from observation, difficult to understand. [EU] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Oral: Pertaining to the mouth, taken through or applied in the mouth, as an oral medication or an oral thermometer. [EU] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Outpatients: Persons who receive ambulatory care at an outpatient department or clinic without room and board being provided. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Oxazepam: A benzodiazepine used in the treatment of anxiety, alcohol withdrawal, and insomnia. [NIH] Pacemaker: An object or substance that influences the rate at which a certain phenomenon occurs; often used alone to indicate the natural cardiac pacemaker or an artificial cardiac pacemaker. In biochemistry, a substance whose rate of reaction sets the pace for a series of interrelated reactions. [EU] Paediatric: Of or relating to the care and medical treatment of children; belonging to or concerned with paediatrics. [EU] Palliative: 1. affording relief, but not cure. 2. an alleviating medicine. [EU] Pancreas: An organ behind the lower part of the stomach that is about the size of a hand. It makes insulin so that the body can use glucose (sugar) for energy. It also makes enzymes that help the body digest food. Spread all over the pancreas are areas called the islets of Langerhans. The cells in these areas each have a special purpose. The alpha cells make glucagon, which raises the level of glucose in the blood; the beta cells make insulin; the delta cells make somatostatin. There are also the PP cells and the D1 cells, about which little is known. [NIH] Pancreatitis: Inflammation (pain, tenderness) of the pancreas; it can make the pancreas stop working. It is caused by drinking too much alcohol, by disease in the gallbladder, or by a virus. [NIH] Paradoxical: Occurring at variance with the normal rule. [EU] Parasitic: Pertaining to, of the nature of, or caused by a parasite. [EU] Parathyroid: 1. situated beside the thyroid gland. 2. one of the parathyroid glands. 3. a sterile preparation of the water-soluble principle(s) of the parathyroid glands, ad-ministered parenterally as an antihypocalcaemic,
Glossary 367
especially in the treatment of acute hypoparathyroidism with tetany. [EU] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Particle: A tiny mass of material. [EU] Pathologic: 1. indicative of or caused by a morbid condition. 2. pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Pelvic: Pertaining to the pelvis. [EU] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Perforation: 1. the act of boring or piercing through a part. 2. a hole made through a part or substance. [EU] Perianal: Located around the anus. [EU] Pericarditis: Inflammation of the pericardium. [EU] Peristalsis: The wormlike movement by which the alimentary canal or other tubular organs provided with both longitudinal and circular muscle fibres propel their contents. It consists of a wave of contraction passing along the tube for variable distances. [EU] Perphenazine: An antipsychotic phenothiazine derivative with actions and uses similar to those of chlorpromazine. [NIH] Petroleum: Naturally occurring complex liquid hydrocarbons which, after distillation, yield combustible fuels, petrochemicals, and lubricants. [NIH] Pharmacist: A person trained to prepare and distribute medicines and to give information about them. [NIH] Pharmacokinetics: The action of drugs in the body over a period of time, including the processes of absorption, distribution, localization in tissues, biotransformation, and excretion. [EU] Phenolphthalein: An acid-base indicator which is colorless in acid solution, but turns pink to red as the solution becomes alkaline. It is used medicinally as a cathartic. [NIH] Piroxicam: 4-Hydroxy-2-methyl-N-2-pyridyl-2H-1,2-benzothiazine-3carboxamide 1,1-dioxide. A non-steroidal anti-inflammatory agent that is well established in the treatment of rheumatoid arthritis and osteoarthritis. Its usefulness has also been demonstrated in the treatment of musculoskeletal disorders, dysmenorrhea, and postoperative pain. Its long
368 Constipation
half-life enables it to be administered once daily. The drug has also been shown to be effective if administered rectally. Gastrointestinal complaints are the most frequently reported side effects. [NIH] Plague: An acute infectious disease caused by yersinia pestis that affects humans, wild rodents, and their ectoparasites. This condition persists due to its firm entrenchment in sylvatic rodent-flea ecosystems throughout the world. Bubonic plague is the most common form. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polyethylene: A vinyl polymer made from ethylene. It can be branched or linear. Branched or low-density polyethylene is tough and pliable but not to the same degree as linear polyethylene. Linear or high-density polyethylene has a greater hardness and tensile strength. Polyethylene is used in a variety of products, including implants and prostheses. [NIH] Porphyria: A pathological state in man and some lower animals that is often due to genetic factors, is characterized by abnormalities of porphyrin metabolism, and results in the excretion of large quantities of porphyrins in the urine and in extreme sensitivity to light. [EU] Postoperative: Occurring after a surgical operation. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Povidone: A polyvinyl polymer of variable molecular weight; used as suspending and dispersing agent and vehicle for pharmaceuticals; also used as blood volume expander. [NIH] Prazosin: A selective adrenergic alpha-1 antagonist used in the treatment of heart failure, hypertension, pheochromocytoma, Raynaud's syndrome, prostatic hypertrophy, and urinary retention. [NIH] Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH]
Premenstrual: Occurring before menstruation. [EU] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Prevalence: The number of people in a given group or population who are reported to have a disease. [NIH] Proctitis: Inflammation of the rectum. [EU] Procyclidine: A muscarinic antagonist that crosses the blood-brain barrier
Glossary 369
and is used in the treatment of drug-induced extrapyramidal disorders and in parkinsonism. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prolapse: 1. the falling down, or sinking, of a part or viscus; procidentia. 2. to undergo such displacement. [EU] Propafenone: An antiarrhythmia agent that is particularly effective in ventricular arrhythmias. It also has weak beta-blocking activity. The drug is generally well tolerated. [NIH] Propoxyphene: A narcotic analgesic structurally related to methadone. Only the dextro-isomer has an analgesic effect; the levo-isomer appears to exert an antitussive effect. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Proxy: A person authorized to decide or act for another person, for example, a person having durable power of attorney. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]
Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH] Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Reflex: 1; reflected. 2. a reflected action or movement; the sum total of any
370 Constipation
particular involuntary activity. [EU] Reflux: A backward or return flow. [EU] Relaxant: 1. lessening or reducing tension. 2. an agent that lessens tension. [EU]
Remission: A diminution or abatement of the symptoms of a disease; also the period during which such diminution occurs. [EU] Resection: Excision of a portion or all of an organ or other structure. [EU] Retrograde: 1. moving backward or against the usual direction of flow. 2. degenerating, deteriorating, or catabolic. [EU] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Risperidone: A selective blocker of dopamine D2 and serotonin-5-HT-2 receptors that acts as an atypical antipsychotic agent. It has been shown to improve both positive and negative symptoms in the treatment of schizophrenia. [NIH] Saline: Salty; of the nature of a salt; containing a salt or salts. [EU] Salmonella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that utilizes citrate as a sole carbon source. It is pathogenic for humans, causing enteric fevers, gastroenteritis, and bacteremia. Food poisoning is the most common clinical manifestation. Organisms within this genus are separated on the basis of antigenic characteristics, sugar fermentation patterns, and bacteriophage susceptibility. [NIH] Sarcoidosis: An idiopathic systemic inflammatory granulomatous disorder comprised of epithelioid and multinucleated giant cells with little necrosis. It usually invades the lungs with fibrosis and may also involve lymph nodes, skin, liver, spleen, eyes, phalangeal bones, and parotid glands. [NIH] Sclerosis: A induration, or hardening; especially hardening of a part from inflammation and in diseases of the interstitial substance. The term is used chiefly for such a hardening of the nervous system due to hyperplasia of the connective tissue or to designate hardening of the blood vessels. [EU] Scopolamine: An alkaloid from Solanaceae, especially Datura metel L. and Scopola carniolica. Scopolamine and its quaternary derivatives act as antimuscarinics like atropine, but may have more central nervous system effects. Among the many uses are as an anesthetic premedication, in urinary incontinence, in motion sickness, as an antispasmodic, and as a mydriatic and cycloplegic. [NIH] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific
Glossary 371
substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Sedentary: 1. sitting habitually; of inactive habits. 2. pertaining to a sitting posture. [EU] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Senna: Preparations of Cassia senna L. and C. angustifolia of the Leguminosae. They contain sennosides, which are anthraquinone type cathartics and are used in many different preparations as laxatives. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Sigmoid: 1. shaped like the letter S or the letter C. 2. the sigmoid colon. [EU] Sigmoidoscopy: Endoscopic examination, therapy or surgery of the sigmoid flexure. [NIH] Silicon: Silicon. A trace element that constitutes about 27.6% of the earth's crust in the form of silicon dioxide. It does not occur free in nature. Silicon has the atomic symbol Si, atomic number 14, and atomic weight 28.09. [NIH] Sirolimus: A macrolide compound obtained from Streptomyces hygroscopicus that acts by selectively blocking the transcriptional activation of cytokines thereby inhibiting cytokine production. It is bioactive only when bound to immunophilins. Sirolimus is a potent immunosuppressant and possesses both antifungal and antineoplastic properties. [NIH] Somatic: 1. pertaining to or characteristic of the soma or body. 2. pertaining to the body wall in contrast to the viscera. [EU] Spastic: 1. of the nature of or characterized by spasms. 2. hypertonic, so that the muscles are stiff and the movements awkward. 3. a person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU] Spasticity: A state of hypertonicity, or increase over the normal tone of a muscle, with heightened deep tendon reflexes. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sphincter: A ringlike band of muscle fibres that constricts a passage or
372 Constipation
closes a natural orifice; called also musculus sphincter. [EU] Stenosis: Narrowing or stricture of a duct or canal. [EU] Stimulant: 1. producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. an agent or remedy that produces stimulation. [EU] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Sucralfate: A basic aluminum complex of sulfated sucrose. It is advocated in the therapy of peptic, duodenal, and prepyloric ulcers, gastritis, reflux esophagitis, and other gastrointestinal irritations. It acts primarily at the ulcer site, where it has cytoprotective, pepsinostatic, antacid, and bile acidbinding properties. The drug is only slightly absorbed by the digestive mucosa, which explains the absence of systemic effects and toxicity. [NIH] Surgical: Of, pertaining to, or correctable by surgery. [EU] Sympathetic: 1. pertaining to, caused by, or exhibiting sympathy. 2. a sympathetic nerve or the sympathetic nervous system. [EU] Symptomatic: 1. pertaining to or of the nature of a symptom. 2. indicative (of a particular disease or disorder). 3. exhibiting the symptoms of a particular disease but having a different cause. 4. directed at the allying of symptoms, as symptomatic treatment. [EU] Symptomatology: 1. that branch of medicine with treats of symptoms; the systematic discussion of symptoms. 2. the combined symptoms of a disease. [EU]
Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synergistic: Acting together; enhancing the effect of another force or agent. [EU]
Systemic: Pertaining to or affecting the body as a whole. [EU] Tears: The fluid secreted by the lacrimal glands. This fluid moistens the conjunctiva and cornea. [NIH] Tenesmus: Straining, especially ineffectual and painful straining at stool or in urination. [EU] Thalassemia: A group of hereditary hemolytic anemias in which there is decreased synthesis of one or more hemoglobin polypeptide chains. There are several genetic types with clinical pictures ranging from barely detectable hematologic abnormality to severe and fatal anemia. [NIH]
Glossary 373
Thalidomide: A pharmaceutical agent originally introduced as a nonbarbiturate hypnotic, but withdrawn from the market because of its known tetratogenic effects. It has been reintroduced and used for a number of immunological and inflammatory disorders. Thalidomide displays immunosuppresive and anti-angiogenic activity. It inhibits release of tumor necrosis factor alpha from monocytes, and modulates other cytokine action. [NIH]
Thermoregulation: Heat regulation. [EU] Thiothixene: A thioxanthine used as an antipsychotic agent. Its effects are similar to the phenothiazine antipsychotics. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography. [EU]
Tone: 1. the normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. a particular quality of sound or of voice. 3. to make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Toothache: Pain in the adjacent areas of the teeth. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Transaminase: Aminotransferase (= a subclass of enzymes of the transferase class that catalyse the transfer of an amino group from a donor (generally an amino acid) to an acceptor (generally 2-keto acid). Most of these enzymes are pyridoxal-phosphate-proteins. [EU] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Transfusion: The introduction of whole blood or blood component directly into the blood stream. [EU] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU]
374 Constipation
Triamterene: A pteridine that is used as a mild diuretic. [NIH] Triazolam: A short-acting benzodiazepine used in the treatment of insomnia. Some countries temporarily withdrew triazolam from the market because of concerns about adverse reactions, mostly psychological, associated with higher dose ranges. Its use at lower doses with appropriate care and labeling has been reaffirmed by the FDA and most other countries. [NIH]
Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Trimebutine: Proposed spasmolytic with possible local anesthetic action used in gastrointestinal disorders. [NIH] Ulcer: A break in the skin; a deep sore. People with diabetes may get ulcers from minor scrapes on the feet or legs, from cuts that heal slowly, or from the rubbing of shoes that do not fit well. Ulcers can become infected. [NIH] Ulceration: 1. the formation or development of an ulcer. 2. an ulcer. [EU] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Urinary: Pertaining to the urine; containing or secreting urine. [EU] Urodynamics: The mechanical laws of fluid dynamics as they apply to urine transport. [NIH] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Uterus: The hollow muscular organ in female mammals in which the fertilized ovum normally becomes embedded and in which the developing embryo and fetus is nourished. In the nongravid human, it is a pear-shaped structure; about 3 inches in length, consisting of a body, fundus, isthmus, and cervix. Its cavity opens into the vagina below, and into the uterine tube on either side at the cornu. It is supported by direct attachment to the vagina and by indirect attachment to various other nearby pelvic structures. Called also metra. [EU] Vaginal: 1. of the nature of a sheath; ensheathing. 2. pertaining to the vagina. 3. pertaining to the tunica vaginalis testis. [EU] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Veins: The vessels carrying blood toward the heart. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU]
Glossary 375
Warts: Benign epidermal proliferations or tumors; some are viral in origin. [NIH]
Withdrawal: 1. a pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) a substancespecific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Yersinia: A genus of gram-negative, facultatively anaerobic rod- to coccobacillus-shaped bacteria that occurs in a broad spectrum of habitats. [NIH]
General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna
·
Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg, M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna
·
A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinterna
·
Dorland’s Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna
·
Dorland’s Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna
·
Dorland’s Pocket Medical Dictionary (Dorland’s Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B
376 Constipation
Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna /103-4193558-7304618 ·
Melloni’s Illustrated Medical Dictionary (Melloni’s Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna
·
Stedman’s Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna
·
Stedman’s Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN: 068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupinterna
·
Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co, ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna
Index 377
INDEX A Abdomen .......42, 44, 140, 147, 152, 183, 345, 349, 362, 364, 372 Abscess ...................40, 47, 138, 152, 355 Absenteeism..........................................75 Acetylcholinesterase..............................84 Adhesions..............................................16 Adolescence ..........42, 120, 144, 349, 367 Adverse ....76, 82, 91, 166, 222, 225, 354, 374 Albuterol ......................................221, 349 Algorithms............................122, 123, 153 Alimentary.......39, 42, 118, 145, 351, 352, 362, 367 Alkaline ....................39, 43, 114, 351, 367 Alkaloid ..61, 106, 147, 224, 363, 365, 370 Aluminum.................14, 74, 187, 225, 372 Anaemia ..............................................129 Anal ......16, 17, 19, 21, 28, 30, 47, 79, 89, 100, 115, 120, 123, 142, 237, 238 Analgesic ......82, 107, 221, 222, 223, 224, 349, 354, 357, 358, 361, 362, 363, 364, 369 Anatomical...........................................151 Anemia ................120, 187, 193, 196, 372 Anomalies ..............................74, 121, 124 Anorectal ....16, 19, 21, 32, 47, 48, 77, 78, 89, 94, 96, 122, 161 Anorexia ..........79, 90, 146, 176, 180, 358 Antibiotic ................................43, 141, 371 Anticholinergic .....................134, 222, 353 Anticonvulsant .....................222, 352, 353 Antidepressant.................................61, 87 Antihypertensive ..................114, 223, 361 Antispasmodic .............223, 224, 359, 370 Anus .....15, 16, 17, 18, 19, 21, 39, 47, 72, 79, 112, 135, 150, 340, 350, 367 Anxiety.................158, 222, 224, 353, 366 Aromatic ................................................90 Ascariasis ..............................................73 Ascites .................................121, 122, 153 Aspiration...............................................27 Atopic...................................................114 Atrophy ..........................................84, 193 Autonomic..........34, 84, 92, 107, 112, 365 B Bacillus ................................................114 Barium ...............................17, 18, 32, 184 Baths ...............................................21, 28 Beauty .................................................114 Benign .............................56, 79, 122, 364
Bezoars............................................... 121 Bile ..... 105, 137, 145, 147, 225, 352, 353, 360, 362, 372 Biliary ..... 32, 48, 73, 105, 120, 122, 153, 360 Bioavailability ........................................ 84 Biopsy ............................... 18, 72, 78, 135 C Capsules ....................................... 18, 299 Carbohydrate 41, 124, 138, 223, 298, 359 Carcinoma............................................. 47 Cardiac........................ 107, 139, 153, 366 Cardiovascular ............ 182, 187, 221, 350 Catheter ................................ 19, 147, 363 Caustic ........................................ 121, 122 Cerebral .................. 41, 43, 114, 358, 371 Character .................... 146, 156, 355, 359 Chemotherapy ................................ 73, 90 Cholangitis .................................. 122, 154 Cholecystectomy ................................ 122 Cholecystitis........................................ 122 Cholesterol ....... 137, 143, 183, 223, 296, 298, 359 Ciprofloxacin ....................................... 135 Cirrhosis...................... 124, 142, 153, 179 Coagulation................................... 30, 169 Colic .................................... 124, 139, 234 Colitis ...... 47, 49, 79, 121, 122, 123, 135, 183, 234 Collagen...................................... 196, 354 Colonoscopy ...... 17, 18, 47, 73, 135, 164, 183, 184 Colorectal... 16, 17, 30, 47, 120, 142, 154, 163, 178, 183, 237 Confusion............................................ 186 Contamination....................................... 87 Contractility ........................................... 84 Cryosurgery .......................................... 30 Cytomegalovirus ................................. 177 Cytotoxic ............................................... 90 D Defecation...... 29, 40, 42, 75, 80, 89, 115, 125, 139, 150, 151, 163, 355, 361 Degenerative .............. 146, 152, 297, 356 Dehydration..................................... 20, 74 Dentition.............................................. 168 Dentures ............................................... 74 Dermatitis.................................... 114, 151 Desensitization ................................... 116 Desipramine............................ 61, 87, 134
378 Constipation
Digestion.....27, 29, 32, 44, 103, 108, 115, 146, 162, 178, 185, 234, 349, 356, 367, 372 Diverticulum.............................40, 79, 355 Duodenum .....41, 121, 124, 145, 352, 358 Dyspepsia...120, 121, 123, 142, 166, 178, 179 Dysphagia..............................72, 120, 123 Dysplasia .................................92, 97, 193 Dystonia...............................................100 E Edema .........................................223, 358 Electrolyte....................................171, 368 Electromyography..........................78, 238 Encephalopathy...........................122, 154 Encopresis .......86, 95, 98, 102, 120, 130, 154, 240 Endoscopy.....................................73, 122 Enema .........17, 18, 21, 32, 184, 340, 345 Enteritis..................................75, 105, 356 Enterocolitis ...........................79, 105, 356 Enuresis...............................130, 146, 356 Enzyme .......92, 103, 105, 117, 138, 349, 357, 358 Epigastric ...............................72, 146, 356 Eructation ..............................................90 Erythropoietin ......................................187 Esophagitis ..................121, 153, 225, 372 Evacuation..31, 40, 75, 85, 101, 115, 116, 161, 165, 354 Extracorporeal .....................................137 F Faecal ................................42, 96, 98, 361 Fatigue......28, 48, 90, 133, 135, 136, 139, 170, 176, 351 Fats .......13, 41, 106, 145, 296, 352, 353, 357, 362 Feces ....40, 104, 105, 115, 135, 138, 351, 356, 357 Fermentation .......................109, 114, 370 Fissure.......................................21, 47, 79 Flatulence ...115, 120, 122, 123, 138, 139, 178, 234 Flushing ...............................................186 Furosemide..................................223, 361 G Gastritis ...............122, 179, 225, 234, 372 Gastroduodenal ...... 32, 41, 48, 121, 153, 358 Gastroenteritis ....109, 122, 124, 167, 177, 370 Gastroscopy ........................................140 Gastrostomy ..................................34, 186 Glucose ......35, 41, 42, 92, 107, 359, 361, 366 Gluten ..................................................136
Granule ................................................. 20 H Heartburn . 27, 34, 92, 120, 121, 123, 134, 135, 136, 137, 139, 166, 168, 181, 185, 234 Helicobacter ........................................ 154 Hematemesis ........................................ 72 Hematology..................................... 10, 91 Heme .................................................... 28 Hemorrhage ........ 108, 120, 122, 152, 369 Hemorrhoids ...... 21, 28, 29, 47, 79, 142, 150, 169, 178, 182, 183, 234, 340 Hepatic........................ 120, 122, 124, 154 Hepatitis ..... 114, 120, 121, 122, 124, 142, 143, 153, 177, 178 Hepatobiliary ............................... 179, 180 Heredity............................................... 124 Hernia ................. 121, 134, 142, 178, 179 Hoarseness......................................... 134 Homeostasis ....................................... 124 Hormonal ........................ 14, 16, 147, 363 Hydrogen ................ 39, 82, 105, 352, 360 Hyperbilirubinemia ...................... 147, 362 Hypercalcemia ...................................... 48 Hyperplasia ............................. 43, 79, 370 Hypersensitivity..................... 74, 117, 355 Hypertension...... 114, 122, 124, 179, 180, 224, 368 Hyperthyroidism ...................... 31, 41, 361 Hysterectomy...................................... 237 I Idiopathic ....... 13, 15, 16, 80, 92, 94, 102, 117, 141, 171, 240, 241, 361, 370 Ileostomy............................................. 125 Ileus ...................................................... 73 Immunization ...................... 109, 143, 371 Immunosuppressant ... 147, 224, 363, 371 Incontinence .... 32, 47, 48, 78, 92, 95, 96, 98, 122, 123, 124, 131, 132, 139, 140, 153, 162, 224, 237, 238, 239, 242, 370 Indicative...... 92, 108, 109, 110, 367, 372, 374 Inertia .................................. 16, 21, 77, 78 Infarction ............................................. 114 Inflammation .... 40, 43, 75, 105, 123, 137, 145, 146, 152, 163, 164, 165, 351, 353, 355, 356, 358, 370 Ingestion ............. 121, 122, 148, 299, 368 Insomnia ............... 28, 224, 225, 366, 374 Insulin........ 35, 41, 42, 107, 359, 362, 366 Intermittent .................................... 27, 165 Intervertebral....................................... 155 Intestines.. 13, 20, 27, 106, 117, 132, 138, 146, 152, 165, 357, 358, 361, 363 J Jaundice.............................. 120, 122, 124
Index 379
Jejunostomy ..........................................34 L Laparoscopy ........................................137 Ligation ........................................151, 169 Lipid .........................42, 91, 223, 359, 362 Lithotripsy ............................................137 Lumen....................................................80 Lupus .....................................................13 M Malabsorption .......27, 72, 121, 122, 124, 138, 193 Malaise ..........................................77, 176 Malignant .................56, 82, 104, 122, 352 Mammary...............................................90 Megacolon .........................4, 77, 140, 155 Melena ...................................................72 Menstruation................................139, 368 Methotrexate........................................135 Micturition ..............................................77 Molecular .......10, 47, 108, 110, 113, 118, 148, 174, 190, 191, 368, 369, 373, 374 Morphine ......42, 67, 90, 93, 98, 302, 349, 364 Motility ..29, 33, 34, 46, 73, 75, 80, 82, 84, 88, 92, 97, 102, 121, 122, 131, 135, 140, 161, 162, 166, 182 Mucus ..............................21, 75, 139, 165 N Narcotic .........61, 107, 224, 303, 363, 369 Nausea .......27, 31, 34, 73, 77, 87, 90, 92, 104, 120, 121, 123, 137, 138, 139, 143, 146, 168, 176, 180, 181, 355, 358 Neonatal ..............................................124 Neoplasms...............47, 56, 121, 142, 364 Neostigmine...........................................84 Nephritis ..............................................114 Neural ....................................67, 297, 355 Neuromuscular ................35, 89, 103, 349 Neuronal ..........................92, 97, 156, 365 Neurons .......92, 107, 109, 147, 156, 364, 365, 372 Neuropeptides .....................154, 156, 365 Niacin...................................................297 Nicotine..........................67, 123, 135, 349 Nifedipine.....................................223, 365 Nitrogen ...............................................187 Norepinephrine ........67, 92, 221, 350, 355 Nosocomial..........................123, 147, 365 O Occult ..................................................120 Opiate ..........................................106, 363 Oral .....35, 39, 42, 82, 83, 90, 91, 93, 104, 184, 302, 352, 355, 366 Osmotic .................................................80 Osteoporosis ...............................179, 180 Outpatients ............................................61
Overdose ............................................ 297 P Pacemaker.................................. 107, 366 Palliative........................................ 81, 176 Pancreas ....... 42, 72, 108, 121, 122, 124, 137, 141, 361, 366 Pancreatitis .. 73, 121, 122, 124, 137, 153, 154, 179 Paradoxical ......................... 233, 237, 238 Parasitic .............. 105, 121, 122, 124, 356 Parathyroid.............................. 48, 56, 366 Parenteral ............. 34, 121, 123, 124, 187 Pathologic ............................................. 72 Pelvic ...... 32, 44, 48, 78, 95, 97, 99, 125, 162, 233, 237, 374 Peptic ..... 72, 73, 122, 134, 142, 153, 154, 179, 185, 225, 372 Perforation ............................ 40, 140, 355 Perianal............................................... 151 Pericarditis .......................................... 181 Peristalsis............................................ 112 Petroleum............................................ 151 Pharmacist .................................. 202, 219 Pharmacokinetics ........................... 84, 91 Phenolphthalein .................................... 20 Plague................................. 141, 148, 368 Poisoning ... 109, 124, 139, 141, 146, 155, 188, 358, 370 Polyethylene ....................... 302, 328, 368 Porphyria............................................... 27 Postoperative ..... 73, 166, 222, 224, 357, 367 Potassium ................................... 187, 298 Povidone ............................................. 113 Prednisone.......................................... 167 Premenstrual ...................................... 133 Presynaptic ........................................... 92 Prevalence .................... 75, 178, 179, 180 Prolapse............................ 21, 47, 77, 151 Proximal ........ 85, 108, 112, 145, 356, 368 Proxy..................................................... 79 Psychiatric........................................... 164 Psychiatry ........................................... 369 Psychology.................................... 95, 123 Psychotherapy ........................ 76, 89, 139 Pulse ..................................................... 28 Purpura ................................................. 79 R Receptor ...... 82, 91, 222, 223, 353, 354, 357, 365 Recurrence ................................... 22, 234 Reflex.................................................. 115 Relaxant...................................... 222, 353 Remission ............................. 43, 135, 369 Resection ............................................ 184 Retrograde .......................... 122, 137, 154
380 Constipation
Riboflavin.............................................296 S Saline.....................................................77 Sclerosis ....................13, 15, 96, 181, 193 Secretion ......21, 42, 43, 73, 80, 222, 223, 357, 364, 365, 371 Sedentary ......................................30, 168 Selenium..............................................298 Senna ..............97, 98, 102, 109, 116, 371 Serum ............91, 109, 187, 223, 359, 371 Sigmoid........................16, 18, 29, 43, 371 Sigmoidoscopy ....18, 28, 32, 37, 183, 184 Silicon ....................................................89 Somatic..................................77, 144, 349 Spastic .....................................14, 43, 371 Spasticity ...............................43, 116, 371 Spectrum .........................10, 78, 110, 375 Sphincter ......17, 19, 21, 43, 79, 100, 134, 236, 237, 238, 372 Stenosis .................................................92 Stimulant................................20, 221, 350 Stomach ...27, 29, 41, 105, 107, 115, 117, 121, 124, 134, 140, 146, 162, 185, 186, 234, 357, 358, 359, 366 Surgical.....21, 30, 40, 44, 77, 78, 99, 107, 121, 125, 135, 136, 154, 163, 167, 353, 354, 365, 368, 374 Sympathetic...................92, 107, 365, 372 Symptomatic..........................87, 109, 372 Symptomatology....................................89 Synaptic .......................................147, 365 Synergistic ...........................................116 T Tears .............................................21, 340
Thalassemia........................................ 191 Thermoregulation................................ 296 Thyroxine ............................................ 298 Tomography................................ 137, 164 Tone.................... 14, 17, 19, 84, 118, 371 Toothache ............................................. 72 Toxicity.................. 90, 223, 225, 365, 372 Toxicology..................................... 10, 175 Toxin ................................................... 240 Transdermal.................................. 93, 302 Transplantation ..... 73, 121, 122, 124, 154 Triazolam .................................... 225, 374 Tricyclic ........... 39, 67, 134, 177, 351, 355 Trimebutine ........................................... 76 U Ulcer....... 34, 73, 121, 122, 134, 153, 154, 179, 185, 225, 372, 374 Ulceration.............................................. 72 Ultrasonography ................................... 79 Urinary ... 42, 44, 139, 145, 146, 224, 353, 356, 361, 368, 370, 374 Urodynamics ......................................... 97 Urology.................................................. 10 Uterus ................... 14, 106, 147, 361, 363 V Vaginal ........................................ 106, 361 Vascular ................ 72, 221, 222, 350, 358 Veins ............................................. 28, 150 Viral. 56, 74, 120, 122, 124, 142, 178, 375 Visceral ................................... 34, 74, 177 W Warts..................................................... 47 Withdrawal ............................ 91, 224, 366
Index 381
382 Constipation
Index 383
384 Constipation
