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

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Laxatives Oral Stimulants

If difficulty in expelling stool is the cause of constipation, it may be corrected with laxatives, also referred to as oral stimulants. Laxatives provide a chemical irritant to the bowel. Although a number of over-the-counter laxatives are available, care should be taken to avoid the use of harsh laxatives, which may be highly habit-forming. The same results may be obtained by using the fol- lowing milder laxatives, which are less harmful to the bowel and induce bowel movements gently, usually overnight or within 8 to 12 hours

Stool Softeners

If the cause of constipation is hard stool, stool softeners are used to draw increased amounts of water from body tissues into the bowel, thereby decreasing hardness and facilitating elimination. Consistent use is recommended to obtain maximal benefit as with bulk formers, stool softeners are not habit-forming. They include Colace (also known as DSS) take one pill every morning and evening

Nonprescription Drugs

Nonprescription drugs are drugs that are designated by the FDA to be safe (if taken as directed) and obtained without a prescription. These drugs are also referred to as over-the-counter (OTC) drugs and may be purchased in a variety of settings, such as a pharmacy, drugstore, or in the local supermarket. OTC drugs include those given for symptoms of the common cold, headaches, constipation, diarrhea, and upset stomach.

Adverse Reactions

Drowsiness is the most common reaction seen with the use of skeletal muscle relaxants. Additional adverse reactions are given in the Summary Drug Table Drugs Used to Treat Musculoskeletal Disorders. Some of the adverse reactions that may be seen with the administration of diazepam include drowsiness, sedation, sleepiness, lethargy, constipation or diarrhea, bradycardia or tachycardia, and rash.

Monitoring and Managing Common Adverse Reactions

Some patients may experience one or more adverse drug reactions during treatment with adrenergic blocking drugs. As with any drug, the nurse must report adverse reactions to the primary care provider and record the reactions on the patient's chart. Nursing judgment in this matter is necessary because some adverse reactions are serious or potentially serious in nature. In these cases, the nurse should withhold the next dose of the drug and contact the primary care provider immediately. The nurse also reports to the primary care provider any adverse reactions that pose no serious threat. Adverse reactions that pose no serious threat to the patient's well-being, such as dry mouth or mild constipation, may have to be tolerated by the patient. It is important to assure the patient that, in some instances, these less serious reactions disappear or lessen in intensity after a time. However, even minor adverse drug reactions can be distressing to the patient, especially when they persist for...

Establishing a Bowel Program

Because decreased sensation in the rectal area in MS may decrease perception of the need to have a bowel movement, stool may remain in the rectum and become hard and constipating. Although this and other factors may lead to constipation becoming a significant problem, it is manageable with a commitment to following an established elimination schedule, timing of meals, fluid intake, and the use of medications if necessary. The first step in establishing a bowel program is to select the time that is most convenient to have a bowel movement. Although this may vary depending on your job commitments, family routines, and other daily activities, the most effective time to have a bowel movement is shortly after a meal because there normally is a greater movement of contents through the bowel at that time. With this in mind, 15 to 30 minutes of uninterrupted time in which to have a bowel movement should be scheduled.

Summary Drug Table Antianxiety Drugs

Transient mild drowsiness, sedation, nausea, depression, lethargy, apathy, confusion, constipation, diarrhea, dry mouth, incontinence, visual disturbances Transient mild drowsiness, sedation, nausea, depression, lethargy, apathy, confusion, constipation, diarrhea, dry mouth, incontinence, visual disturbances Transient mild drowsiness, sedation, nausea, depression, lethargy, apathy, confusion, constipation, diarrhea, dry mouth, incontinence, visual disturbances Transient mild drowsiness, sedation, nausea, depression, lethargy, apathy, confusion, constipation, diarrhea, dry mouth, incontinence, visual disturbances Transient mild drowsiness, sedation, nausea, depression, lethargy, apathy, confusion, constipation, diarrhea, dry mouth, incontinence, visual disturbances

Summary Drug Table Antidepressants

Effects (dry mouth, dry eyes, urinary retention), nausea, nasal congestion, blurred vision, orthostatic hypotension, lethargy, confusion, constipation, diarrhea effects (dry mouth, dry eyes, urinary retention), nausea, nasal congestion, blurred vision, orthostatic hypotension, lethargy, confusion, constipation, diarrhea urinary retention), nausea, nasal congestion, blurred vision, orthostatic hypotension, lethargy, confusion, constipation, diarrhea (dry mouth, dry eyes, urinary retention), nausea, nasal congestion, blurred vision, orthostatic hypotension, lethargy, confusion, constipation, diarrhea effects (dry mouth, dry eyes, urinary retention), nausea, nasal congestion, blurred vision, orthostatic hypotension, lethargy, confusion, constipation, diarrhea effects (dry mouth, dry eyes, urinary retention), nausea, nasal congestion, blurred vision, orthostatic hypotension, lethargy, confusion, constipation, diarrhea urinary retention), nausea, nasal congestion, blurred vision,...

Diarrhea and Incontinence

Diarrhea is much less common than constipation in people with MS. However, it may be a significant problem because there may not be adequate warning of an impending attack and incontinence may therefore occur. The probable cause of such diarrhea is a reflex-like activity that results from the short-circuiting in MS, causing frequent emptying even though the bowel is not full. The key to controlling diarrhea is to make the stool bulkier without producing constipation. Bulk formers such as Metamucil or Perdiem Plus may be helpful because they absorb water and therefore make the stool firmer. When it is used to treat diarrhea, a bulk former should be taken no more than once a day, and it should not be followed by the recommended extra fluid that is needed when a bulk former is used to treat constipation. In extreme cases, medications that slow the movement of the bowel muscles may be needed to control diarrhea, such as Kaopectate , Imodium , or Lomotil .

Summary Drug Table Antipsychotic Drugs Continued

Dyskinesia, dry eyes, blurred vision, constipation, dry mouth, photosensitivity dizziness, vertigo, nausea, constipation, dry mouth, diarrhea, headache, restlessness, blurred vision nervousness, akathisia, constipation, fever, weight gain sedation, headache, arrhythmias, dyspepsia, fever, constipation, extrapyramidal effects

Abnormal findings

In severe constipation, faeces can be palpable in any part of the colon. Indentation of a lump by finger pressure is evidence that it is faecal. Sometimes, however, a hard, craggy lump of faeces can only be distinguished from malignancy by re-examination following defecation. Enlargement of the bladder, ovary or uterus, suspected from inspection, may be confirmed as a dome-shaped swelling rising from the pubis. An upper abdominal mass which does not move on respiration is either a fixed retroperitoneal structure (e.g. aorta or pancreas) or is attached to the abdominal wall. Masses which arc situated within the abdominal wall continue to be palpable when the muscles are contracted, for example by raising the head off the pillow. Tightening the abdominal muscles in this way identifies the intersections of the recti abdominis (Fig. 5.9). An intersection may mislead (lie beginner into believing that a tumour or the liver edge has been felt. Masses situated more deeply within the abdominal...

Critical Thinking Exercises

A patient in the medical clinic is taking cholestyramine (Questran) for hyperlipidemia. The primary health care provider has prescribed TLC for the patient. The patient is on a low-fat diet and walks daily for exercise. His major complaint at this visit is constipation, which is very bothersome to him. Discuss how you would approach this situation with the patient. What information would you give the patient concerning his constipation

Contraindications Precautions And Interactions

Laxatives are contraindicated in patients with known hypersensitivity and those with persistent abdominal pain, nausea, or vomiting of unknown cause or signs of acute appendicitis, fecal impaction, intestinal obstruction, or acute hepatitis. These drugs are used only as directed because excessive or prolonged use may cause dependence. Magnesium hydroxide is used cautiously in patients with any degree of renal impairment. Laxatives

Ongoing Assessment

The nurse assesses the patient receiving one of these drugs for relief of symptoms (such as diarrhea, pain, or constipation). The primary health care provider is notified if the drug fails to relieve symptoms. The nurse monitors vital signs daily or more frequently if the patient has a bleeding peptic ulcer, severe diarrhea, or other condition that may warrant more frequent

Is Lazer Treatment For Crps Type 1 Dangerous

Bier Block Technique

The use of opioids in the treatment of neuropathic pain, and specifically in CRPS, has not been studied. Opioids are useful in nociceptive pain, and their effect is related to interaction at the level of the spinal cord with the opioid receptors. Although their use may be considered controversial in chronic, nonmalignant pain, a patient with unremitting pain should be tried on opioid therapy. This should occur early on in the treatment. It is important to control the patient's pain utilizing all available means so that active physical therapy can be pursued and disuse atrophy avoided. As is true whenever using opioids, constipation should be expected and treated prophylactically.

Susan E Frates MS RD and Heidi Schauster MS RD

Eating disorders are characterized by a disturbed relationship between nutritional intake and body image, often leading to subsequent medical problems. While eating disorders are found predominantly in the adolescent and young adult populations, they are increasingly being recognized in children and preadolescents. Eating disorders are the third most common chronic illness in adolescents following obesity and asthma.1 Anorexia nervosa is estimated to occur in < 3 of adolescent women and bulimia nervosa in 1 to 49r.- Undiagnosed disordered eating appears to afflict many school-aged Americans. In 1995. over one-third of Boston high school students reported that they were trying to lose weight. Six to seven percent of these students reported having vomited or taken laxatives in the last 30 days to avoid absorbing calories.-1 Males are also currently emerging as a population at risk for disordered eating. The age of onset of eating disorders appears to be decreasing. behavior...

Cerebral Palsy And Developmental Disabilities

Down syndromes) Failure to thrive (Rett syndrome, cerebral palsy CP ) Short stature (Down, Hurler's, Russell-Silver, and Cornelia de Lange's syndromes) Gastrointestinal symptoms Diarrhea Constipation Altered nutrient needs nutrient deficiencies Drug-nutrient interactions (anticonvulsants, diuretics, laxatives, tranquilizers) Fluid. Fluid requirements may be higher in some children with DD due to constipation, increased fluid losses (drooling, excessive sweating), and or increased requirements. Standard guidelines for fluid based on body weight should be followed, with adjustment for special considerations as noted above (see Table 17-3, Fluid Requirements). Some children with DD are on multiple medications, which can interfere with nutrient absorption, appetite, elimination patterns, and level of alertness for feeding. For example, children with seizures who are on multiple anticonvulsant medications should be monitored for adequate vitamin D and folic acid intake as requirements for...

Bowel Obstruction In The Elderly

Sigmoid volvulus is 20 times more likely in the patient age 60 yr and greater (19). This age association may be due to acquired redundancy of the sigmoid colon. High-residue diets are believed to be the causative factor in developing a redundant sigmoid (20). Other factors associated with volvulus are Parkinson's disease, dementia including Alzheimer's disease, bedridden state, and prior abdominal operations, all of which increase in frequency in the elderly patient. Sigmoid volvulus usually presents as acute onset of colicky abdominal pain, distention, and obstipation. When strangulation has Pain out of proportion to the physical examination is one of the hallmarks of acute mesenteric ischemia. This pain is severe, poorly localized, and can be associated with nausea, vomiting, diarrhea, and or constipation. When late in the presentation or when perforation occurs the patient may develop abdominal distention, tenderness to palpation, hypotension, and or generalized peritonitis....

Protocol For Treatment And Followup

New hormone deficiency or deficiencies are identified by obtaining a thorough clinical history and physical examination and measurement of appropriate hormone concentrations. Fatigue, weight gain, decreased mental alertness, and constipation suggest hypothyroidism. Fatigue, orthostatic symptoms, diminished appetite, and weight loss suggest adrenal insufficiency. A decrease in libido or erectile dysfunction suggests hypogonadism in men and a change in menses (irregular menses, amenorrhea), diminished libido, or hot flashes suggest gonadal failure in women. The symptoms of GH deficiency overlap with other hormone deficiencies and include fatigue, decreased exercise tolerance, increase in abdominal adiposity, and diminished sense of well-being. Appropriate hormone studies include measurement of serum thyroxine (or free thyrox-ine, free T4), early morning cortisol, testosterone (men), and estradiol (women). Measurement of serum thyroid-stimulating hormone (TSH) is not helpful and may be...

Abdominal distension bloating

Subacute obstruction, constipation taking drugs with anticholinergic effects, such as tricyclic antidepressants. Painless abdominal distension and constipation from early childhood in the absence of faecal soiling suggests the possibility of Hirschsprung's disease. Fluctuating abdominal swelling which develops during the day hut resolves overnight is particularly common in women and is rarely if ever due to organic disease. It usually occurs with other symptoms of the irritable bowel syndrome, namely abdominal pain relieved by defecation and altered bowel habit. Painful abdominal distension suggests intestinal obstruction associated with intestinal colic. Chronic simple constipation rarely produces painful distension unless associated with the irritable bowel syndrome.

Special Considerations

A specific complication in patients that have had only a suture rectopexy is the angulation of the redundant sigmoid colon after placement of the sutures. This problem should be detected and avoided by intraoperative inspection of the lumen with a rigid proctoscope before evacuating pneumoperitoneum. If this condition is not noted intra-operatively, the patient will present with difficulty evacuating and worsening constipation in the months after surgery. This is indeed a difficult problem to manage at that point and will require takedown of the previous rectopexy and possibly a sigmoid resection. Usually, these are patients with redundant sigmoid colon at the time of the initial rectopexy. Return of bowel function can also be delayed especially in patients with a history of chronic constipation. Our practice is to allow the patient to have a clear liquid diet the day immediately after surgery. We watch for progression of recovery of intestinal function. When passage of gas has been...

Roberfroid M 1983 A Review Comparing

H., Non-starch polysaccharides (dietary fibre) including bulk laxatives in constipation, in Constipation, Kamm, M. A., Lennard-Jones, J. E., Eds., Wrightson Biomedical, Petersfield, U.K., pp. 307-314, 1994. 137. Den Hond, E., Geypens, B., Ghoos, Y., Effect of high performance chicory inulin on constipation, Nutr. Res., 20, 731-736, 2000.

Gastric and Esophageal Fistula

Left Thoracotomy Fundoplication Picture

Herniation of the wrap into the chest Sudden increase in intraabdominal pressure (tumultuous recovery from anesthesia, prostatism, constipation, straining under heavy loads) Inappropriate approximation of the crura Large hiatal hernia Short esophagus Postoperative gastric distension

Surgical Complications

The possibility of epidural and intrathecal hemorrhage is frequently mentioned, with the obvious risk of neurological injury. This complication, unfortunately, tends to occur at the time of catheter implant. Pre-operatively, care should be taken to discontinue nonsteroidal anti-inflammatory drugs and reverse any anticoagulation. Signs of a developing hematoma are usually a sudden increase in focal back pain associated with tenderness, progressing numbness and or weakness in the lower extremities, and loss of bowel or bladder control (in the form of retention constipation or incontinence). This clinical presentation warrants immediate imaging with MRI or CT myelogram and emergent neurosurgical intervention if there is neurological deterioration.

Crohn S Disease Indication To Total Abdominal Colectomy

Except for cancer, the indications for laparoscopic total abdominal colectomy are basically the same as in open surgery. For less experienced laparoscopic surgeons, however, further restrictions may apply such as previous operations with formation of intraabdominal adhesions, obesity, or fistula formation, because these conditions may make laparoscopic orientation and accessibility difficult.1,2 This is especially true for the anatomic regions of the omentum, transverse colon, and meso-colon including its vessels. If the laparoscopic approach proves to be difficult, early conversion is recommended. In Crohn's disease, extensive colonic involvement or pancolitis with rectal sparing is an indication for total abdominal colectomy.3-5 It may also be indicated in rare cases of ulcerative colitis with minimal rectal involvement but still carries the risk of leaving behind the principally diseased rectum with all its consequences.6-10 In familial adenomatous polyposis, the situation is...

Lambert Eaton Myasthenic Syndrome Clinical features

Active Zone Freeze Fracture Endplate

Lambert-Eaton myasthenic syndrome (LEMS) is a presynaptic disorder of neuromuscular transmission which is caused by the production of antibodies to voltage-gated Ca2+ channels at the motor nerve terminals. This results in a marked reduction in acetylcholine release, the failure of neuromuscular transmission and muscle weakness. Muscle weakness is most common in the limbs, so that patients complain that their legs feel stiff or weak and they find difficulty in walking indeed, in some individuals the symptoms of the disease may be sufficiently severe to render them bedbound. Tendon reflexes are also weak or absent. Unlike myasthenia gravis, in LEMS muscle weakness does not increase with exercise in fact, muscle strength and tendon reflexes are briefly enhanced during the first few seconds of maximal effort. LEMS is also associated with symptoms indicative of disturbance of the autonomic nervous system, including decreased salivation and sweating, constipation and impotence. In most, but...

Long Term Complications

Bleeding requiring return to the hospital occurs in 1.4 of patients (21). This can usually be avoided by controlling the initial bleeding during hospitalization as described above and discharging the patient only when the urine is essentially clear. Patients are counseled to restrict heavy lifting for 4-6 wk and to avoid constipation by maintaining adequate fluid intake and taking stool softeners. However, the inherent increase in activity with departure from the hospital inevitably puts patients at risk for recurrent hematuria. When hematuria does recur, it generally can be managed conservatively by restricting activity and increasing fluid intake. If hematuria is more significant, clot formation can occur, with a strong potential for obstruction and urinary retention. In this situation, all clots should be removed with a large irrigating catheter, after which continued bleeding can be managed with continuous bladder irrigation and catheter traction. Continued bleeding usually...

Alteration in Cellular Environment

Drug that acts by altering the cellular environment by lubrication is sunscreen. An example of a drug that acts by altering absorption is activated charcoal, which is administered orally to absorb a toxic chemical ingested into the gastrointestinal tract. The stool softener docusate is an example of a drug that acts by altering the surface of the cellular membrane. Docusate has emulsifying and lubricating activity that causes a lowering of the surface tension in the cells of the bowel, permitting water and fats to enter the stool. This softens the fecal mass, allowing easier passage of the stool.

Water and ions are absorbed in the large intestine

The colon absorbs water and ions, producing semisolid feces from the slurry of indigestible materials it receives from the small intestine. Absorption of too much water in the colon can cause constipation. The opposite condition, diarrhea, results if too little water is absorbed, or if water is secreted into the colon. (Both constipation and diarrhea can be induced by toxins from certain microorganisms.) Feces are stored in the last segment of the colon until they are excreted.

Systemic Sclerosis and Related Syndromes

Cine-esophagography or manometric evaluations can help distinguish the pattern of esophageal involvement. Stomach involvement is less commonly symptomatic, but gastroparesis can contribute to dyspepsia and a sense of bloating. Gastric telangiectases occur but are uncommonly a cause of bleeding. Intestinal hypermotility can lead to bloating and cramps in addition to bacterial overgrowth, malabsorption, and diarrhea. Colonic manifestations often include constipation or pseudo-obstruction. Wide-mouthed colonic diverticula are common but are often not of clinical significance.

Flatulence Diarrhea and Irritable Bowel Syndrome

Anti Reflux Surgery

Problems related to flatulence, diarrhea, and irritable bowel syndrome (IBS) are very common among adult patients with or without GERD.38 It is therefore to be expected that many patients will have these symptoms both before and after anti-reflux surgery. In a study from our institution, diarrhea was present in 14 of patients before surgery and 29 after. Other symptoms included bloating (3 preoperative, 19 postoperative), constipation (15 and 18 , respectively), and abdominal pain (2 and 8 , respectively) (Figure 9.1).39 Flatulence has been reported in 12-88 of patients after anti-reflux surgery.40,41 It has been suggested that this flatulence is attributable to the patient's inability to belch and subsequent passage of more gas into and then through the gastrointestinal tract.42 Most of these studies are retrospective and at risk for recall bias, because many only surveyed patients after surgery and asked them to recall how they were before the surgery. In general, the suggested...

Clostridium botulinum Botulism

Within a matter of hours or days paralysis symptoms occur, especially in the nerves of the head. Frequent symptoms include seeing double, difficulty swallowing and speaking, constipation, and dry mucosa. Lethality rates range from 25-70 , depending on the amount of toxin ingested. Death usually results from respiratory paralysis. Wound botulism results from wound infection by C. botulinum and is very rare. Infant botulism, first described in 1976, results from ingestion of spores with food (e.g., honey). Probably due to the conditions prevailing in the intestines of infants up to the age of six months, the spores are able to proliferate there and produce the toxin. The lethality of infant botulism is low (< 1 ).

Fighting Asthma Gastrointestinal Disorders Parasites

The major anti-asthma drugs come from ephed-rine, extracted from the ma huang plant (Ephedra sinaica), and its structural derivatives. Plant-derived drugs that affect the gastrointestinal tract include castor oil, senna, and aloes as laxatives, opiate alkaloids as antidiarrheals, and ipecac from Cephaelis acuminata as an emetic. The most useful

Patterns of presentation

A sudden onset of severe abdominal pain which progresses rapidly, becomes generalised in site and constant in nature, in a' previously asymptomatic patient, suggests either perforation of a hollow viscus, a ruptured aortic aneurysm or a mesenteric arterial occlusion. Prior symptoms may help the differential diagnosis preceding constipation suggests colonic carcinoma or diverticular disease as the catisc of the perforation, and preceding dyspepsia suggests a perforated peptic ulcer. Coexisting peripheral vascular disease, hypertension, cardiac failure or atrial fibrillation suggest a vascular disorder, e.g. aortic aneurysm, mesenteric ischaemia. The development of peripheral circulatory failure (shock) following the onset of the pain, strongly suggests intra-abdominal bleeding, e.g. ruptured aortic aneurysm or ectopic pregnancy. The rapid onset of abdominal pain may also occur if an organ twists - An 06-year-old man presented with central abdominal pain of 12 hours'...

Capsule Endoscopy in Crohns Disease

Others recommend more complex preparation with various combinations of laxatives sennoside, polyethylene glycol (PEG) solution . After swallowing the capsule endoscope with 100-200 ml of water containing 100 mg of simethicone, the patient could drink 2 h later and eat 4 h later. In patients who have undergone gastric surgery or those with gastropare-sis, the video capsule could be inserted endoscopical-ly in the small intestine. Stomach passage takes an average of 34 min, and passes through the small intestine in about 4 h. Complete visualisation of the small bowel up to the caecum is achieved in 80 of patients. Most operators recommend a plain abdominal X-ray be performed 7-14 days after the examination if the capsule examination does not show images of the colon and the patient does not see the capsule passage in the stool. The capsule is designed to be used once, and after it is passed with the stool, it is not reusable 64 . On completion of the examination, the recorded images are...

The Development of Good Bowel Habits Dietary Management

Good eating habits are important to achieving good bowel control. It is important to have a routine and to eat balanced meals at regular times and in a relaxed atmosphere. The intake of adequate amounts of liquid (8 to 12 cups daily) and the addition of fiber to the diet generally alleviates constipation. Dietary fiber is that portion of plant materials that is resistant to digestion its addition to the diet aids in the formation of softer stool and decreases the amount of time required for stool to pass through the intestinal tract.

Management Outcome and Complications

What is more difficult, is the management of a reservoir ileostomy in the early and late post-operative periods however, the selected patients are usually very strongly motivated to actively cope with the new condition. At the end of the operation, and as long as the ileus has completely resolved, a permanent catheter is placed in the reservoir in order to drain the pouch and avoid disruption, leakage and nipple valve desusception. Subsequently, the catheter is periodically occluded and the time of drainage is progressively reduced. Some irrigation may be necessary to avoid faeces and food particles obstructing the catheter both in the early post-operative period, when the patient starts eating, and then at the time when the pouch is functioning. After a few weeks, the patient becomes aware of the necessity of emptying the reservoir and, usually, this manoeuvre is easily accomplished three or four times a day. Besides the complications already mentioned as being associated with any...

Exercise Can Modify the Rate of Gastric Emptying and Intestinal Absorption

Although exercise is often recommended as treatment for postsurgical ileus, uncomplicated constipation, or irritable bowel syndrome, little is known in these areas. However, chronic dynamic exercise does substantially decrease the risk for colon cancer, possibly via increases in food and fiber intake, with consequent acceleration of colonic transit.

Isolation And Identification A Botulinum Neurotoxin Detection

The confirmation of the clinical diagnosis of botulism is most effectively achieved by detection of the botulinum toxin in the clinical specimens from patients (61). Blood serum collected from patients before administration of the therapeutic polyvalent antiserum, and feces are routinely tested for botulinum toxin. Constipation from botulism can be an impediment to diagnosis an enema of sterile water may be required to obtain an adequate fecal sample. Other clinical samples that can be analyzed for botulinum neurotoxins are vomitus, gastric contents, or autopsy specimens submitted from fatal cases.

The Gastrointestinal Tract and Its Control

The rectum usually remains empty until just before and during defecation, when stool enters it either as a result of a mass propulsive movement or by voluntary contraction of the abdominal muscles. In a manner similar to what happens when the bladder initiates urination, filling of the rectum with stool causes nerve endings in the rectal wall to transmit a message of fullness to an area of the spinal cord that is involved in bowel function. As stool leaves the rectum, it passes through the anal canal, which contains the internal and external sphincter muscles. The sphincters, ring-shaped muscles that control the opening and closing of the passageway from the rectum, normally are contracted to prevent leakage. The internal sphincter is under the control of the spinal cord its relaxation is what is termed an involuntary reflex because it is not under conscious control, and its relaxation depends only on stretching of the rectal wall by stool. In contrast, the external sphincter is under...

Gerontologic Alert

Older adults are particularly prone to constipation when tak- Iing the bile acid sequestrants. The nurse should monitor older adults closely for hard dry stools, difficulty passing stools, and any complaints of constipation. An accurate record of bowel movements must be kept.

Drug history DH

It is important to obtain full details of the prescribed drugs and any olher medications the patient may be taking. These include over-the-counter remedies and alternative medicine treatments, particularly herbal remedies, laxatives, analgesics and vitamin mineral supplements. The name of each drug, the dose, dosage regime and duration of treatment should be noted, along with significant side-effects. In hospital, not uncommonly, the patient may not know the name of a drug and may have omitted lo bring the medication. In such circumstances the patient's general practice should be contacted to obtain the details. This is also advisable when douht arises about the accuracy of the information - for instance when the account seems unlikely or potentially hazardous. A drug addict may be intentionally misleading the doctor ahout his or her regular supply.

Laboratory studies

Calcium channel blockers are the best-studied agents and the usual first choice. Some calcium channel blockers, in addition to causing vasodilation, may inhibit in vivo platelet activation and enhance the thrombolytic activity of blood. However, they can aggravate esophageal reflux or constipation. They should be avoided during pregnancy.

Foodborne Botulism

Over half of foodborne botulism patients suffer from prodromal nausea or vomiting (54), which do not occur in infant or wound botulism. This gastrointestinal distress may be due to metabolites from C. botulinum or co-contaminants in the tainted food. Progressive cranial nerve palsies, a sine qua non of botulism, are among the first symptoms and signs to appear and the last to recede. These include double vision, drooping eyelids, slurred and muted speech, an inability to swallow food and saliva, gaze paralysis, and dilated pupils (mydriasis). Weakness soon becomes apparent below the neck, as the limbs become progressively paretic and hypotonic. Respiratory distress results from upper airway obstruction, aspiration, or respiratory paralysis. Mydriasis and diminished deep tendon reflexes may lag behind other findings. Constipation, urinary retention, and hypotension occur in more severe cases. At any stage of illness, the patient becomes easily fatigued. Recovery proceeds over weeks to...

Infant Botulism

When attempting to link an item from the baby's diet with the subsequent diagnosis of infant botulism, one must carefully compare the timing of feedings with the onset of symptoms. For instance, both corn syrup and honey have been given to treat constipation caused by infant botulism. Herbal teas have been given to infants believed to have colic, who instead were distraught from hunger caused by the feeding paralysis of early infant botulism.

Barbiturates

The most common adverse reaction associated with phenobarbital is sedation, which can range from mild sleepiness or drowsiness to somnolence. These drugs may also cause nausea, vomiting, constipation, brady-cardia, hypoventilation, skin rash, headache, fever, and diarrhea. Agitation, rather than sedation, may occur in some patients. Some of these adverse effects may be reduced or eliminated as therapy continues. Occasionally, a slight dosage reduction, without reducing the ability of the drug to control the seizures, will reduce or eliminate some of these adverse reactions.

Opioids

Unfortunately, the oral dose of opioid required to achieve a therapeutic concentration at the spinal cord level and thus provide adequate pain relief must be relatively large, which can result in concomitant adverse effects such as constipation, sedation, and respiratory depression. Thus, the potential goal of the intrathecal or epidural administration of opioids is to provide local, targeted, effective analgesia with lower doses and avoid the potential systemic side effects resulting from the indirect route of administration of high-dose opioids.

Medications

Medications may be needed if constipation cannot be corrected by changing the diet, increasing fluid intake, and or establishing a routine. To determine the most appropriate medication, the reason for the constipation must be determined, because it may be caused by lack of bulk, hard stools, or difficulty in expelling stool. Bulkformers may be prescribed if the cause of constipation is inadequate bulk in the diet and stool. These agents add substance to the stool by increasing its bulk and water content. In order to be effective, bulk formers should be taken with one or two glasses of liquid this combination distends the GI tract, which in turn increases the passage of stool through it. Defecation usually occurs within 12 to 24 hours, although in some cases it may be delayed for up to three days. The daily use of bulk formers is necessary for maximal Medications for the Management of Constipation Stool softeners Hard stool causes constipation

Cerebral Palsy

Cerebral palsy (CP) comprises a group of chronic, nonprogressive disorders of the nervous system that produce abnormalities of posture, muscle tone, and motor coordination. It is classified according to the specific abnormality in muscle tone (hypertonia, hypotonia) and extrapyramidal signs (choreoathetosis. ataxia, and dystonia). There is an estimated incidence of 2 cases per 1000 live births.1 Due to their motor involvement, children with CP may have many of the feeding problems listed in Table 22-1. including poor growth and oral-motor feeding difficulties due to poor oralmotor control. In addition, medications commonly used to help treat spasticity, seizures, constipation, and or gastroesophageal reflux can impact nutrient intake and feeding skills as well as behavioral state (lethargy, distraction, drowsiness) at mealtime. Regular monitoring of growth, diet intake, and oral-motor feeding skills by a multidisci-plinary team is essential to maximize growth, intake, oralmotor...

Editors Comments

Indications We would consider sigmoid resection in most young and healthy patients even if not symptomatically constipated because constipation tends to worsen after simple rectopexy. Patient positioning We place the monitors near the knees of the patient. Electrosurgical devices are placed lateral to the patient, and the suction device is placed near the head of the patient in our setup. Instrumentation We use similar instruments. Cannula positioning Our positioning is similar.

Oxybutynin

Oxybutynin (Ditropan) acts by relaxing the bladder muscle and reducing spasm. Oxybutynin is used to treat bladder instability (ie, urgency, frequency, leakage, incontinence, and painful or difficult urination) caused by a neurogenic bladder (altered bladder function caused by a nervous system abnormality). Adverse reactions observed in patients taking oxybutynin include dry mouth, constipation or diarrhea, decreased production of tears, decreased sweating, gastrointestinal disturbances, dim vision, and urinary hesistancy.

Altered bowel habit

The normal bowel habit varies between several evacuations per day to one every 3 days or so. Changes in bowel habit may be the first symptom of serious underlying disease. Constipation may be used by the patient to describe hard pellety stools, infrequent defecation or excessive straining at stool with difficulty in evacuation (dyschezia). Similarly, diarrhoea may be used to describe frequent defecation, loose or fluid stools, urgency of defecation, Ihe persistent desire to defecate or faecal incontinence. Tenesmus, the feeling of incomplete rectal evacuation with a persistent desire to defecate, is common in infective colitis, rectal carcinoma, rectal prolapse and the irritable bowel syndrome. The irritable bowel syndrome is a common cause of altered bowel function in patients under the age of 50 years. The principal symptoms include episodic constipation and diarrhoea associated with abdominal distension, intermittent abdominal pain relieved by defecation and often accompanied by...

Balloon Dilatation

The stenosis of the small intestine is one of the typical symptoms of CD. The standard treatment should be strictureplasty or resection of the affected part 34 . The less common clinical manifestation is large-intestine stricture, which is diagnosed when a colonoscope of a standard diameter (13-13.6 mm) cannot be inserted through the affected part of the intestine. The clinical manifestations of the stricture include flatulence, tenesmus (when the stricture is localised near the rectum), constipation, abdominal pain, ileus or subileus 34 . The exacerbation and severity of symptoms depend on the diameter of the narrowing. An intestinal diameter greater than 13 mm usually suffices for correct passage. When the diameter of the stricture falls below 9 mm, it leads to increased symptoms of obstruction 35 . This type of changes is observed usually in neoplastic tumours of the large intestine. When neoplastic etiology is excluded, the most frequent causes are the healing complications of the...

Cascara

Agent is produced by the action of intestinal flora, and the cascarosides are transformed into aloe-emodin anthrone (Figure 3.33). Cascara has a similar pharmacological action to senna, i.e. it stimulates peristalsis of the large intestine, and has found major use in the correction of habitual constipation. It has a stronger effect than senna, however, and its routine usage is not now recommended.

Allied Drugs

Dantron (danthron 1,8-dihydroxyanthraquinone) (Figure 3.34) is known as a natural product, but for drug use is produced synthetically. It is prescribed to relieve constipation in geriatric and terminally ill patients. Dithranol (1,8-dihydroxyanthrone) is used as topical agent to treat troublesome cases of psoriasis. Diacetylrhein is marketed in some countries for the treatment of osteoarthritis.

Hman In Vb Studies

Ancies reflect differences of study design, pressure sensors and patients selection 5 . Diarrhea may partly be explained by changes in mucosal secretory and absorptive functions, but some authors also suggest that alterations in colonic motility may also contribute to increased urgency and frequency of defecation in patients with ulcerative colitis. The cause of diarrhea could be identified in an excessive propulsive activity 6, 7 , or in rectosigmoid inflammation rather than by rapid transit 8 . The disease is often associated with right-sided constipation and left-sided diarrhea 9 , reflecting proximal colonic stasis with rapid transit through the rectosigmoid region 8 . The paradoxical slowing of transit in the small intestine and proximal colon seem to be consequential to an increased sensitivity to normal colonic contents which delays transit 10 . Clinical studies suggest that active inflammation is accompanied by a reduction in contractile activity in the diseased area and it...

Cellulitiserysipelas

Perianal cellulitis is a superficial, painful eruption caused by Group A streptococci. This infection is often accompanied by itching or painful defecation (14). This disorder is found almost exclusively in children. If the disorder becomes chronic, fissures, discharge, and rectal bleeding may occur.

Gastrointestinal

A common side effect of narcotic and opiod analgesics is constipation and decreased bowel function. Assessment of bowel function is imperative in the postoperative management of these patients. The nursing staff needs to auscultate bowel sounds every shift. It is important to avoid constipation. The patient routinely receives stool softeners unless contraindicated. The diet is progressed from clear liquid diet the first postoperative night to a regular diet, as tolerated.

Constipation Prescription

Constipation Prescription

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

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