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Idiopathic Constipation and Other Motility Disorders

  • Alberto Peña
  • Andrea Bischoff
Chapter
  • 1.7k Downloads

Abstract

The methods of evaluation of patients with severe constipation including nuclear transit studies, sitz markers, ultrasound, and rectal manometry are critically discussed. The authors offer their original way to evaluate the magnitude of the constipation problem, based on the amount of senna laxative, necessary to empty the colon completely, as radiologically demonstrated.

The literature is abundant in different methods to deal with this problem, including psychotherapy, physiotherapy, biofeedback, dietetic measures, electrical simulation, and Botox injections. All these alternatives are critically discussed. The authors present their concepts related with the management of constipation. These concepts are based on the fact that this condition is incurable but manageable and that it is represented by a spectrum in terms of severity. In other words, constipation may be minimal and easy to manage or may appear with different degrees of severity to the point to overlap with the problem known as “intestinal pseudo-obstruction,” and therefore each patient will need a different type of treatment. The principles of the author’s management are also based on the fact that the best way to monitor the amount of stool in the colon as a response to the different treatments is by taking abdominal x-ray films.

A protocol of management of idiopathic constipation is presented in this chapter. The protocol is based on the fact that every patient is different and needs a different amount of laxatives that can only be determined by trial and error. In the authors’ experience, 15 % of patients do not respond to this medical management and require an operation. A critical discussion is presented by the different surgical procedures and methods used by different authors including myectomy, Malone procedure, and colonic resections.

Keywords

Botulinum Toxin Anal Canal Bowel Movement Internal Sphincter Contrast Enema 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Animation 25.1

Animation showing the disimpaction process (WMV 37952 kb)

References

  1. 1.
    Bartlett J (ed) (1919) Familiar quotations, 10th edn. Little, Brown, Boston, p 627Google Scholar
  2. 2.
    Bellman M (1966) Studies on encopresis. Acta Paediatr Scand 170(Suppl):1–15Google Scholar
  3. 3.
    Levine MD (1975) Children with encopresis: a descriptive analysis. Pediatrics 56:412–416PubMedGoogle Scholar
  4. 4.
    Taitz LS, Water JKH, Urwin OM, Molnar D (1986) Factors associated with outcome in management of defecation disorders. Arch Dis Child 61:472–477PubMedCentralPubMedGoogle Scholar
  5. 5.
    Sandler RS, Jordan MC, Shelton BJV (1990) Demographic and dietary determinants of constipation in the US population. Am J Public Health 80:185–189PubMedCentralPubMedGoogle Scholar
  6. 6.
    Taylor R (1990) Management of constipation. Br Med J 300:1063–1064Google Scholar
  7. 7.
    Pinkerton P (1957) Pathogenic megacolon in children: the implications of bowel negativism. Arch Dis Child 33:371–380Google Scholar
  8. 8.
    Berg I, Jones KV (1964) Functional fecal incontinence in children. Arch Dis Child 39:465–472PubMedCentralPubMedGoogle Scholar
  9. 9.
    Gabel S, Hegedus AM, Wald A, Chandra R, Chiponis D (1986) Prevalence of behavior problems and mental health utilization among encopretic children: implications for behavioral pediatrics. J Dev Behav Pediatr 7:293–297PubMedGoogle Scholar
  10. 10.
    MacNamara M (1965) Notes on a case of lifelong encopresis. Br J Med Psychol 38:333–338PubMedGoogle Scholar
  11. 11.
    Shane M (1967) Encopresis in a latency boy: an arrest along a developmental line. Psychoanal Study Child 22:296–314PubMedGoogle Scholar
  12. 12.
    Silber S (1968) Encopresis: rectal rebellion and anal anarchy. J Am Soc Psychosom Dent Med 15:97–106PubMedGoogle Scholar
  13. 13.
    Holschneider AM, Puri P (2000) Anal sphincter achalasia and ultrashort Hirschsprung’s disease. In: Holschneider AM, Puri P (eds) Hirschsprung’s disease and allied disorders, 2nd edn. Harwood Academic Publishers, The Netherlands, pp 399–424Google Scholar
  14. 14.
    Fadda B, Welskop J, Muntefering H, Meier-Ruge W, Engert J (1987) Achalasia of the anal sphincter. Pediatr Surg Int 2:81–85Google Scholar
  15. 15.
    Hecker WC, Holschneider A, Fendel H, Schauer A, Meister P, Beige H (1973) Die chronische obstipation beim kind durch anal sphincterachalasie. Dtsh Med Wochenschr 98:2334–2340Google Scholar
  16. 16.
    Oue T, Puri P (1999) Altered intramuscular innervation and synapse formation in internal sphincter achalasia. Pediatr Surg Int 15(3–4):192–194PubMedGoogle Scholar
  17. 17.
    Holschneider AM, Puri P (2000) Diagnosis of Hirschsprung’s disease and allied disorders. In: Holschneider AM, Puri P (eds) Hirschsprung’s disease and allied disorders, 2nd edn. Harwood Academic Publishers, The Netherlands, pp 230–245Google Scholar
  18. 18.
    Meunier P, Marechal JM, DeBeaujeu MJ (1979) Rectoanal pressures and rectal sensitivity studies in chronic childhood constipation. Gastroenterology 77:330–336PubMedGoogle Scholar
  19. 19.
    Loening-Baucke VA (1984) Abnormal anorectal function in children recovered from chronic constipation and encopresis. Gastroenterology 87:1299–1304PubMedGoogle Scholar
  20. 20.
    Keren S, Wagner Y, Heldenberg D, Golan M (1988) Studies of manometric abnormalities of the rectoanal region during defecation in constipated and soiling children: modification through biofeedback therapy. Am J Gastroenterol 83:827–831PubMedGoogle Scholar
  21. 21.
    Corazziari E, Cucchiara S, Staiano A et al (1985) Gastrointestinal transit time, frequency of defecation, and anorectal manometry in healthy and constipated children. J Pediatr 106:379–382PubMedGoogle Scholar
  22. 22.
    Lynn HB, van Heerden JA (1975) Rectal myectomy in Hirschsprung’s disease: a decade of experience. Arch Surg 110:991–994PubMedGoogle Scholar
  23. 23.
    Bourdelat D, Barbet JP, Gross PH (1994–1995) Constipation of the child: usefulness of anorectal sphincterectomyectomy. Chirurgie (memoires de l’Academie) 120:48–52Google Scholar
  24. 24.
    Ecaluwe D, Yoneda A, Akl U, Puri P (2001) Internal anal sphincter achalasia: outcome after internal sphincter myectomy. J Pediatr Surg 36:736–738Google Scholar
  25. 25.
    Pinho M, Yoshioka K, Keighley MRB (1989) Long term results of anorectal myectomy for chronic constipation. Br J Surg 7:1163–1164Google Scholar
  26. 26.
    Ure BM, Holschneider AM, Schulten D, Meier-Ruge W (1999) Intestinal transit time in children with intestinal neuronal malformations mimicking Hirschsprung’s disease. Eur J Pediatr Surg 9:91–95PubMedGoogle Scholar
  27. 27.
    Stoss F (1990) Neuronal dysplasia: considerations for the pathogenesis and treatment of primary chronic constipation in adults. Int J Colorectal Dis 5:106–112PubMedGoogle Scholar
  28. 28.
    Fadda B, Maier W, Meier-Ruge W, Scharli A, Daum R (1983) Neuronale Intestinale Displasie: eine kritische 10 Jahres analyse klinischer und bioptischer Diagnostik. Z Kinderchir 38:305–311PubMedGoogle Scholar
  29. 29.
    Dickson JAS, Variend S (1983) Colonic neuronal dysplasia. Acta Paediatr Scand 72:635–637PubMedGoogle Scholar
  30. 30.
    Scharli AF, Meier-Ruge W (1981) Localized and disseminated forms of neuronal intestinal dysplasia mimicking Hirschsprung’s disease. J Pediatr Surg 16:164–170PubMedGoogle Scholar
  31. 31.
    Pistor G, vonKap-Herr SH, Grussner R, Munakata H, Munterfertigo H (1987) Neuronal intestinal dysplasia: modern diagnosis and therapy: report of 23 patients. Pediatr Surg Int 87:352–358Google Scholar
  32. 32.
    Csury L, Peña A (1995) Intestinal neuronal dysplasia: myth or reality? Pediatr Surg Int 10:441–446Google Scholar
  33. 33.
    Schofield DE, Yunis EJ (1991) Intestinal neuronal dysplasia. J Pediatr Gastroenterol Nutr 12(2):182–189PubMedGoogle Scholar
  34. 34.
    Kubota A, Yamauchi K, Yonekura T, Kosumi T, Oyanagi H, Mushiake S, Nakayama M, Imura K, Okada A (2001) Clinicopathologic relationship of hypoganglionosis. J Pediatr Surg 36(6):898–900PubMedGoogle Scholar
  35. 35.
    Schärli AF, Sossai R (1998) Hypoganglionosis. Semin Pediatr Surg 7(3):187–191PubMedGoogle Scholar
  36. 36.
    Munakata K, Okabe I, Morita K (1992) Hypoganglionosis. Pediatr Surg Int 7:8–11Google Scholar
  37. 37.
    Meier-Ruge WA, Brunner LA (2001) Morphometric assessment of Hirschsprung’s disease: associated hypoganglionosis of the colonic myenteric plexus. Pediatr Dev Pathol 4(1):53–61PubMedGoogle Scholar
  38. 38.
    Rolle U, Yoneda A, Solari V, Nemeth L, Puri P (2002) Abnormalities of C-Kit-positive cellular network in isolated hypoganglionosis. J Pediatr Surg 37(5):709–714PubMedGoogle Scholar
  39. 39.
    Nissan S, Bar-Maor JA (1971) Further experience in the diagnosis and surgical treatment of short-segment Hirschsprung’s disease and idiopathic megacolon. J Pediatr Surg 6(6):738–741PubMedGoogle Scholar
  40. 40.
    Scobie WG, Mackinlay GA (1977) Anorectal myectomy in treatment of ultra short segment Hirschsprung’s disease: report of 26 cases. Arch Dis Child 52:713–715PubMedCentralPubMedGoogle Scholar
  41. 41.
    Meier-Ruge W, Schärli AF (1986) The epidemiology and enzyme histotopochemical characterization of ultrashort-segment Hirschsprung’s disease. Pediatr Surg Int 1(1):37–42Google Scholar
  42. 42.
    Neilson IR, Yazbeck S (1990) Ultrashort Hirschsprung’s disease: myth or reality. J Pediatr Surg 25(11):1135–1138PubMedGoogle Scholar
  43. 43.
    Smith B (1968) Pre and postnatal development of the ganglion cells of the rectum and its surgical implications. J Pediatr Surg 3:386–391PubMedGoogle Scholar
  44. 44.
    Aldridge RT, Campbell PE (1968) Ganglion cell distribution in the normal rectum and anal canal: a basis for the diagnosis of Hirschsprung’s disease by anorectal biopsy. J Pediatr Surg 3:475–490PubMedGoogle Scholar
  45. 45.
    Ricciardi R, Counihan TC, Banner BF, Sweeney WB (1998) What is the normal aganglionic segment of anorectum in adults? Dis Colon Rectum 42(3):380–382Google Scholar
  46. 46.
    Wheatley JM, Hutson JM, Chow CW, Oliver M, Hurley MR (1999) Slow-transit constipation in childhood. J Pediatr Surg 34(5):829–832PubMedGoogle Scholar
  47. 47.
    Kluck P, Tibboel D, Leendertse-Verloop K, van der Kamp AWM, ten Kate FJW, Molenaar JC (1986) Diagnosis of congenital neurogenic abnormalities of the bowel with monoclonal antineurofilament antibodies. J Pediatr Surg 21:132–135PubMedGoogle Scholar
  48. 48.
    Rolle U, Piaseczna-Piotrowska A, Puri P (2007) Interstitial cells of Cajal in the normal gut and in intestinal motility disorders of childhood. Pediatr Surg Int 23(12):1139–1152PubMedGoogle Scholar
  49. 49.
    Stern HP, Stroh SE, Fiedorek SC et al (1995) Increased plasma levels of pancreatic polypeptide and decreased plasma levels of motilin in encopretic children. Pediatrics 96:111–116PubMedGoogle Scholar
  50. 50.
    Davidson M, Kugler MM, Bauer CH (1963) Diagnosis and management in children with severe and protracted constipation and obstipation. J Pediatr 62:261–275PubMedGoogle Scholar
  51. 51.
    Levine MD, Bakow H (1976) Children with encopresis: a study of treatment outcome. Pediatrics 58:845–852PubMedGoogle Scholar
  52. 52.
    Katz C, Drongowski RA, Coran AG (1987) Long-term management of chronic constipation in children. J Pediatr Surg 22:976–978PubMedGoogle Scholar
  53. 53.
    Clayden GS (1992) Management of chronic constipation. Arch Dis Child 67:340–344PubMedCentralPubMedGoogle Scholar
  54. 54.
    Loening-Baucke V (1994) Management of chronic constipation in infants and toddlers. Am Fam Physician 49:397–406PubMedGoogle Scholar
  55. 55.
    Poenaru D, Roblin N, Bird M et al (1997) The pediatric bowel management clinic: initial results of a multidisciplinary approach to functional constipation in children. J Pediatr Surg 32:843–848PubMedGoogle Scholar
  56. 56.
    Loening-Baucke V (1995) Functional constipation. Semin Pediatr Surg 4:26–34PubMedGoogle Scholar
  57. 57.
    Loening-Baucke V (1993) Chronic constipation in children. Gastroenterology 105:1557–1564PubMedGoogle Scholar
  58. 58.
    Lewis AV, Hillemeier AC (1989) Pediatric constipation: diagnosis and treatment. Pract Gastroenterol 13:31–39Google Scholar
  59. 59.
    Olness K, McParland FA, Piper J (1978) Biofeedback: a new modality in the management of children with fecal soiling. J Pediatr 96:623–626Google Scholar
  60. 60.
    Fishman LN, Jacobowitz Israel E (1994) An approach to the child with constipation. Sem Colon Rectal Surg 5:116–123Google Scholar
  61. 61.
    Sutphen JL, Borowitz SM, Hutchinson RL (1995) Long-term follow up of medically treated childhood constipation. Clin Pediatr (Phila) 34:576–580Google Scholar
  62. 62.
    Loening-Baucke V (1989) Factors determining outcome in children with chronic constipation and fecal soiling. Gut 30:999–1006PubMedCentralPubMedGoogle Scholar
  63. 63.
    Frost G, Ellett M, Winchester M (1994) Outpatient quality assurance monitor: constipation. Gastroenterol Nurs 17:57–60PubMedGoogle Scholar
  64. 64.
    Abrahamian P, Lloyd-Still JD (1984) Chronic constipation in childhood: a longitudinal study of 186 patients. J Pediatr Gastroenterol Nutr 3:460–467PubMedGoogle Scholar
  65. 65.
    Sims CG, Remler H, Cox DJ (1987) Biofeedback and behavioral treatment of elimination disorders. Clin Biofeedback Health 10:115–122Google Scholar
  66. 66.
    Karlbom U, Hallden M, Eeg-Olofsson KE, Pahlman L, Graf W (1997) Results of biofeedback in constipated patients. Dis Colon Rectum 40:1149–1155PubMedGoogle Scholar
  67. 67.
    Wald A, Chandra R, Gabel S, Chiponis D (1987) Evaluation of biofeedback in childhood encopresis. J Pediatr Gastroenterol Nutr 6:554–558PubMedGoogle Scholar
  68. 68.
    Lowery SP, Srour JW, Whitehead WE, Schuster MM (1985) Habit training as treatment of encopresis secondary to chronic constipation. J Pediatr Gastroenterol Nutr 4:397–401PubMedGoogle Scholar
  69. 69.
    Davis HM, Mitchell WS, Marks FM (1977) A pilot study of encopretic children treated by behavior modification. Practitioner 219:228–230PubMedGoogle Scholar
  70. 70.
    Ashkenazi Z (1975) The treatment of encopresis using a discriminative stimulus and positive reinforcement. J Behav Ther Exp Psychiatry 6:155–157Google Scholar
  71. 71.
    Feldman PC, Villanueva S, Lanne V, Devroede G (1993) Use of play with clay to treat children with intractable encopresis. J Pediatr 122:483–488PubMedGoogle Scholar
  72. 72.
    Stark LJ, Owens SJ, Spirito A, Lewis A, Guevremont D (1990) Group behavioral treatment of retentive encopresis. J Pediatr Psychol 15:659–671PubMedGoogle Scholar
  73. 73.
    Rappaport L, Landman G, Fenton T, Levine MD (1986) Locus of control as predictor of compliance and outcome in treatment of encopresis. J Pediatr 109:1061–1064PubMedGoogle Scholar
  74. 74.
    Young GC (1973) The treatment of childhood encopresis by conditioned gastro-ileal reflex training. Behav Res Ther 11:499–503PubMedGoogle Scholar
  75. 75.
    Hendren WH (1978) Constipation caused by anterior location of the anus and its surgical correction. J Pediatr Surg 13:505–512PubMedGoogle Scholar
  76. 76.
    Leape LL, Ramenofsky ML (1978) Anterior ectopic anus: a common cause of constipation in children. J Pediatr Surg 13:627–630PubMedGoogle Scholar
  77. 77.
    Reisner SH, Sivan Y, Nitzan M, Merlob P (1984) Determination of anterior misplacement of the anus in newborn infants and children. Pediatrics 73:216–217PubMedGoogle Scholar
  78. 78.
    Ishitani MB, Rodgers BM (1991) Anteriorly displaced anus: an under-recognized cause of chronic constipation. Pediatr Surg Int 6:217–220Google Scholar
  79. 79.
    DeLorenzo C, Flores AF, Reddy SN, Hyman PE (1992) Use of colonic manometry to differentiate causes of intractable constipation in children. J Pediatr 120:690–695Google Scholar
  80. 80.
    Reynolds JC, Ouyang A, Lee CA, Baker L, Sunshine A, Cohen S (1987) Chronic severe constipation: prospective motility studies in 25 consecutive patients. Gastroenterology 92:414–420PubMedGoogle Scholar
  81. 81.
    Martin MJ, Steele SR, Mullenix PS, Noel JM, Weichmann D, Azarow KS (2004) A pilot study using total colonic manometry in the surgical evaluation of pediatric functional colonic obstruction. J Pediatr Surg 39(3):352–359; discussion 352–359PubMedGoogle Scholar
  82. 82.
    Martin MJ, Steele SR, Noel JM, Weichmann D, Azarow KS (2001) Total colonic manometry as a guide for surgical management of functional colonic obstruction: preliminary results. J Pediatr Surg 36(12):1757–1763PubMedGoogle Scholar
  83. 83.
    Bruhin-Feichter S, Meier-Ruge W, Martucciello G, Bruder E (2012) Connective tissue in gut development: a key player in motility and in intestinal desmosis. Eur J Pediatr Surg 22(6):445–459. doi: 10.1055/s-0032-1322544 PubMedGoogle Scholar
  84. 84.
    Bautista Casasnovas A, Varela Cives R, Villanueva Jeremias A, Castro Gago M, Cadranel S, Tojo Sierra R (1991) Measurement of colonic transit time in children. J Pediatr Gastroenterol Nutr 13:42–45PubMedGoogle Scholar
  85. 85.
    Metcalf AM, Phillips SF, Zinsmeister AR, MacCarty RL, Beart RW, Wolff BG (1987) Simplified assessment of segmental colonic transit. Gastroenterology 92:40–47PubMedGoogle Scholar
  86. 86.
    Papadopoulou A, Clayden GS, Booth IW (1994) The clinical value of solid marker transit studies in childhood constipation and soiling. Eur J Pediatr 153:560–564PubMedGoogle Scholar
  87. 87.
    Benninga MA, Buller HA, Tytgat GNJ, Akkermans LMA, Bossuyt PM, Taminiau JAJM (1996) Colonic transit time in constipated children: does pediatric slow-transit constipation exist? J Pediatr Gastroenterol Nutr 23:241–251PubMedGoogle Scholar
  88. 88.
    Vattimo A, Burroni L, Bertelli P, Messina M, Meucci D, Tota G (1994) Total and segmental colon transit time in constipated children assessed by scintigraphy with 111In-DTPA given orally. J Nucl Biol Med 37(4):218–222Google Scholar
  89. 89.
    Marshall J, Hutson JM, Anticich N, Stanton MP (2001) Antegrade continence enemas in the treatment of slow-transit constipation. J Pediatr Surg 36(8):1227–1230PubMedGoogle Scholar
  90. 90.
    Shin YM, Southwell BR, Stanton MP, Hutson JM (2002) Signs and symptoms of slow-transit constipation versus functional retention. J Pediatr Surg 37(12):1762–1765PubMedGoogle Scholar
  91. 91.
    Sutcliffe JR, King SK, Hutson JM, Cook DJ, Southwell BR (2009) Gastrointestinal transit in children with chronic idiopathic constipation. Pediatr Surg Int 25(6):465–472. doi: 10.1007/s00383-009-2374-2 PubMedGoogle Scholar
  92. 92.
    Wagener S, Shankar KR, Turnock RR, Lamont GL, Baillie CT (2004) Colonic transit time–what is normal? J Pediatr Surg 39(2):166–169; discussion 166–169PubMedGoogle Scholar
  93. 93.
    Clarke MC, Chase JW, Gibb S, Catto-Smith AG, Hutson JM, Southwell BR (2009) Standard medical therapies do not alter colonic transit time in children with treatment-resistant slow-transit constipation. Pediatr Surg Int 25(6):473–478. doi: 10.1007/s00383-009-2372-4 PubMedGoogle Scholar
  94. 94.
    Hutson JM, Chase JW, Clarke MC, King SK, Sutcliffe J, Gibb S, Catto-Smith AG, Robertson VJ, Southwell BR (2009) Slow-transit constipation in children: our experience. Pediatr Surg Int 25(5):403–406. doi: 10.1007/s00383-009-2363-5 PubMedGoogle Scholar
  95. 95.
    Taminiau J, Benninga M (2005) Pediatric clinical research will benefit from Rome III. J Pediatr Gastroenterol Nutr 41(Suppl 1):S30–S31PubMedGoogle Scholar
  96. 96.
    Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, Walker LS (2006) Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology 130(5):1527–1537PubMedGoogle Scholar
  97. 97.
    Talley NJ (2007) Functional gastrointestinal disorders in 2007 and Rome III: something new, something borrowed, something objective. Rev Gastroenterol Disord 7(2):97–105PubMedGoogle Scholar
  98. 98.
    Varma MG, Wang JY, Berian JR, Patterson TR, McCrea GL, Hart SL (2008) The constipation severity instrument: a validated measure. Dis Colon Rectum 51(2):162–172. doi: 10.1007/s10350-007-9140-0 PubMedGoogle Scholar
  99. 99.
    Staiano A, Cucchiara S, Andreotti MR, Minella R, Manzi G (1991) Effect of cisapride on chronic idiopathic constipation in children. Dig Dis Sci 36:733–736PubMedGoogle Scholar
  100. 100.
    Nurko S, Garcia-Aranda JA, Guerrero VY, Worona LB (1996) Treatment of intractable constipation in children: experience with cisapride. J Pediatr Gastroenterol Nutr 22:38–44PubMedGoogle Scholar
  101. 101.
    Murray RD, Ulysses B, Li K, McClung HJ, Heitlinger L, Rehm D (1990) Cisapride for intractable constipation in children: observations from an open trial. J Pediatr Gastroenterol Nutr 11:503–508PubMedGoogle Scholar
  102. 102.
    Messineo A, Codrich D, Monai M, Martellossi S, Ventura A (2001) The treatment of internal anal sphincter achalasia with botulinum toxin. Pediatr Surg Int 17:521–523PubMedGoogle Scholar
  103. 103.
    Pasticha PJ, Ravich WJ, Hendrix TR et al (1995) Intrasphincteric botulinum toxin for the treatment of achalasia. N Engl J Med 322:774–778Google Scholar
  104. 104.
    Jankovic J, Brin MF (1991) Therapeutic uses of botulinum toxin. N Engl J Med 324:1186–1194PubMedGoogle Scholar
  105. 105.
    Keshtgar AS, Ward HC, Clayden GS (2013) Pathophysiology of chronic childhood constipation: functional and morphological evaluation by anorectal manometry and endosonography and colonic transit study. J Pediatr Surg 48(4):806–812. doi: 10.1016/j.jpedsurg.2012.08.037 PubMedGoogle Scholar
  106. 106.
    Morales MA, Hernández D, Bustamante S, Bachiller I, Rojas A (2009) Is senna laxative use associated to cathartic colon, genotoxicity, or carcinogenicity? J Toxicol 2009:287247. doi: 10.1155/2009/287247 PubMedCentralPubMedGoogle Scholar
  107. 107.
    Surh I, Brix A, French JE, Collins BJ, Sanders JM, Vallant M, Dunnick JK (2013) Toxicology and carcinogenesis study of senna in C3B6.129F1-Trp53 tm1Brd N12 haploinsufficient mice. Toxicol Pathol 41(5):770–778. doi: 10.1177/0192623312464304 PubMedGoogle Scholar
  108. 108.
    Heidemann A, Miltenburger HG, Mengs U (1993) The genotoxicity status of senna. Pharmacology 47(Suppl 1):178–186PubMedGoogle Scholar
  109. 109.
    Lydén-Sokolowski A, Nilsson A, Sjöberg P (1993) Two-year carcinogenicity study with sennosides in the rat: emphasis on gastro-intestinal alterations. Pharmacology 47(Suppl 1):209–215PubMedGoogle Scholar
  110. 110.
    Siegers CP (1992) Anthranoid laxatives and colorectal cancer. Trends Pharmacol Sci 13(6):229–231PubMedGoogle Scholar
  111. 111.
    Hirabayashi T, Matsufuji H, Yokoyama J, Hagane K, Hoshino K, Morikawa Y, Kitajima M (2003) Colorectal motility induction by sacral nerve electrostimulation in a canine model: implications for colonic pacing. Dis Colon Rectum 46(6):809–817PubMedGoogle Scholar
  112. 112.
    Har AF, Rescorla FJ, Croffie JM (2013) Quality of life in pediatric patients with unremitting constipation pre and post Malone Antegrade Continence Enema (MACE) procedure. J Pediatr Surg 48(8):1733–1737. doi: 10.1016/j.jpedsurg.2013.01.045 PubMedGoogle Scholar
  113. 113.
    Christison-Lagay ER, Rodriguez L, Kurtz M, St Pierre K, Doody DP, Goldstein AM (2010) Antegrade colonic enemas and intestinal diversion are highly effective in the management of children with intractable constipation. J Pediatr Surg 45(1):213–219. doi: 10.1016/j.jpedsurg.2009.10.034; discussion 219PubMedGoogle Scholar
  114. 114.
    Rongen MJGM, Gerritsen van der Hoop A, Baeten CGMI (2001) Cecal access for antegrade colon enemas in medically refractory slow-transit constipation. Dis Colon Rectum 44:1644–1648PubMedGoogle Scholar
  115. 115.
    Kuijpers HC (1990) Application of the colorectal laboratory in diagnosis and treatment of functional constipation. Dis Colon Rectum 33:35–39PubMedGoogle Scholar
  116. 116.
    Devroede G (1992) Constipation: a sign of a disease to be treated surgically, or a symptom to be deciphered as nonverbal communication? J Clin Gastroenterol 15:189–191PubMedGoogle Scholar
  117. 117.
    Yoshioka K, Keighley MRB (1989) Clinical results of colectomy for severe constipation. Br J Surg 76:600–604PubMedGoogle Scholar
  118. 118.
    Peña A, El-Behery M (1993) Megasigmoid: a source of pseudo-incontinence in children with repaired anorectal malformations. J Pediatr Surg 28:1–5Google Scholar
  119. 119.
    Asipu D, Jaffray B (2010) Treatment of severe childhood constipation with restorative proctocolectomy. Arch Dis Child 95(11):867–870. doi: 10.1136/adc.2009.172973 PubMedGoogle Scholar
  120. 120.
    Clayden GS, Adeyinka T, Kufeji D, Keshtgar AS (2010) Surgical management of severe chronic constipation. Arch Dis Child 95(11):859–860. doi: 10.1136/adc.2009.180802 PubMedGoogle Scholar
  121. 121.
    Sugarman I (2010) Treatment of severe childhood constipation with restorative proctocolectomy: the surgeon’s view. Arch Dis Child 95(11):861–862. doi: 10.1136/adc.2009.180810 PubMedGoogle Scholar
  122. 122.
    Lee SL, DuBois JJ, Montes-Garces RG, Inglis K, Biediger W (2002) Surgical management of chronic unremitting constipation and fecal incontinence associated with megarectum: a preliminary report. J Pediatr Surg 37(1):76–79PubMedGoogle Scholar
  123. 123.
    Jaffray B (2009) What happens to children with idiopathic constipation who receive an antegrade continent enema? An actuarial analysis of 80 consecutive cases. J Pediatr Surg 44(2):404–407. doi: 10.1016/j.jpedsurg.2008.10.097 PubMedGoogle Scholar
  124. 124.
    Bonilla SF, Flores A, Jackson CC, Chwals WJ, Orkin BA (2013) Management of pediatric patients with refractory constipation who fail cecostomy. J Pediatr Surg 48(9):1931–1935. doi: 10.1016/j.jpedsurg.2012.12.034  10.1016/j.jpedsurg.2012.12.034 PubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Alberto Peña
    • 1
  • Andrea Bischoff
    • 1
  1. 1.Pediatric SurgeryColorectal Center for Children Cincinnati Children’s HospitalCincinnatiUSA

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