Idiopathic constipation: A challenging but manageable problem
| Autor: | Belinda H. Dickie, Giulia Brisighelli, Alberto Peña, Marc A. Levitt, Jason S. Frischer, Andrea Bischoff |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Constipation Adolescent Senna medicine.medical_treatment Laxative Bowel management Drug Administration Schedule Young Adult 03 medical and health sciences 0302 clinical medicine Clinical Protocols 030225 pediatrics medicine Humans Child Retrospective Studies biology Encopresis business.industry Senna Extract Infant Retrospective cohort study General Medicine biology.organism_classification Surgery Radiography Treatment Outcome Laxatives Child Preschool Pediatrics Perinatology and Child Health Vomiting Defecation Female 030211 gastroenterology & hepatology medicine.symptom business Follow-Up Studies |
| Zdroj: | Journal of Pediatric Surgery. 53:1742-1747 |
| ISSN: | 0022-3468 |
| Popis: | Purpose A protocol to treat idiopathic constipation is presented. Methods A contrast enema is performed in every patient and, when indicated, patients are initially submitted to a "clean out" protocol. All patients are started on a Senna-based laxative. The initial dosage is empirically determined and adjusted daily, during a one week period, based on history and abdominal radiographs, until the amount of Senna that empties the colon is reached. The management is considered successful when patients empty their colon daily and stop soiling. If the laxatives dose provokes abdominal cramping, distension, and vomiting, without producing bowel movements, patients are considered nonmanageable. Results From 2005 to 2012, 215 patients were treated. 121 (56%) were males. The average age was 8.2years (range: 1–20). 160 patients (74%) presented encopresis. 67 patients (32%) needed a clean out. After one week, 181 patients (84%) achieved successful management, with an average Senna dose of 67mg (range: 5–175mg). In 34 patients (16%) the treatment was unsuccessful: 19 were nonmanageable, 3 noncompliant, and 12 continued soiling. At a later follow-up (median: 329days) the success rate for 174 patients was 81%. Conclusion We designed a successful protocol to manage idiopathic constipation. The key points are clean out before starting laxatives, individual adjustments of laxative, and radiological monitoring of colonic emptying. Treatment study Level IV. |
| Databáze: | OpenAIRE |
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