Help For Irritable Bowel Syndrome (IBS) - Education, Support, & Self Help for Irritable Bowel Syndrome   
Heather & Company View Cart  
Shop for IBSIBS Message BoardsIBS News & ReviewsStore Finder  
Home
IBS Diet & Recipes
IBS Books
IBS Supplements
Yoga for IBS
Hypnosis for IBS
Tummy Teas

All Boards >> Irritable Bowel Syndrome Research Library

HeatherAdministrator

Reged: 12/09/02
Posts: 7374
Loc: Seattle, WA
Constipation and its management
      09/16/03 03:41 PM

Constipation and its management

BMJ 2003;327:459-460 (30 August)

Options go beyond laxatives and include behavioural treatment as well as new drugs

Although slow to emerge, major advances have occurred in understanding the causes and management of constipation. It now receives the attention deserved of a symptom that affects a quarter of the population at some time. Most important is the recognition that different pathophysiological processes can result in the final common symptoms of decreased bowel frequency or impaired rectal evacuation. Different clinical syndromes require different therapeutic approaches.

Bowel frequency is influenced by several factors including intake of dietary fibre, emotional make up, and psychological morbidity. Introspective individuals have a lower bowel frequency and produce less stool than extroverts. Infrequent bowel actions in the absence of symptoms can be regarded as part of the normal spectrum of bowel frequency. Low bowel frequency is more common in women.

Controlled cross sectional studies have shown that psychological morbidity is commonly associated with severe constipation.1 In some patients it is the key causative factor. Other factors include childhood problems such as sexual or physical abuse, loss of a parent through death or separation, or disturbed toileting behaviour. Underlying depression is another cause. For some the gut is their "outlet valve" for the normal stresses of living. The pathways between brain and gut that link emotions to bowel function have been largely characterised and shown to involve cerebral corticotrophin releasing factor and efferent autonomic pathways. Although psychological factors should be sought at initial assessment, in some patients they are less important. Not all patients have a psychological "skeleton."

The distinction as to whether a patient has a normal diameter or dilated large bowel is of practical importance. Severe intractable constipation with resistance to laxatives in the presence of an apparently normal (non-dilated) colon is seen most commonly in women of reproductive age. When transit is slow the key physiological abnormality is diminished colonic propulsive activity. There are associated changes in upper gut transit and sensory function. Although neural abnormalities can be shown in the colon, such as changes in the pacemaker cells of Cajal, these may be secondary to chronic ingestion of laxatives. The reversibility of impaired function by behavioural treatment2 implies that neural changes are often secondary.

Constipation is now recognised as an important symptom in a range of patients' groups with other primary pathology. Almost all patients with spinal injury experience constipation; lack of bowel control is one of their most distressing symptoms.3 It is also common in patients with multiple sclerosis. Patients with mild disease can be helped by behavioural treatment, which shows that in patients with neurological disease bowel dysfunction often has a reversible component.

Patients with a dilated bowel constitute a different clinical problem. Those with a dilated rectum and faecal impaction—so called idiopathic megarectum—are usually teenagers or young adults of either sex.4 They have often soiled since childhood. In some the problem has a behavioural basis, whereas in others there may be subtle neuromuscular abnormalities of the gut. Constipation with faecal impaction is also seen in elderly patients, especially those in care. Poor general health, impaired mobility, inadequate toilet facilities, and drugs may all contribute. Patients with dilation throughout the gut are rare and they usually have a discrete abnormality of enteric nerves or muscle, leading to impaired propulsion. In such patients with chronic intestinal pseudo-obstruction, constipation is only part of a complex mix of symptoms including pain, vomiting, and nutritional impairment.

For people with mild longstanding constipation investigations are not required, and dietary management is usually sufficient to relieve symptoms. When chronic constipation is more severe, detailed consideration of likely causes and other treatments is warranted.

Many patients with mild constipation can be managed with simple bulking agents or laxatives. After thousands of years of empirical use of such agents, prescribing can now be based on evidence from controlled trials. In elderly patients with resistant constipation, a stimulant such as senna, possibly combined with a bulking agent, is more effective and cheaper than lactulose.5 Polyethylene glycol based laxatives have recently been shown to provide long term benefit in patients with idiopathic constipation and faecal impaction.

For many patients, however, laxatives do not provide sustained relief of symptoms. In addition increasing dietary fibre has been shown to worsen symptoms in many patients by causing increased bloating without an improvement in bowel function.6

Behaviour therapy, including biofeedback (teaching the patient to normalise pelvic floor function while watching real time feedback about sphincter function) and habit training, has become established as the most effective form of treatment for patients with either slow transit or impaired evacuation, when traditional treatments have failed.2 Behavioural treatments comprise a "package" of care, including exercises focused on the gut, help in coming off laxatives, and psychological support. Such treatment has been shown to improve symptoms, transit time through the gut, psychological wellbeing, and quality of life, as well as leading to reduced use of laxatives.2 7 8 It has been shown to be effective in patients with slow gut transit, impaired rectal emptying, constipation after childbirth or pelvic surgery such as hysterectomy, solitary rectal ulcer from the trauma of straining, rectocele (anterior rectal wall bulge from repeated straining), and in patients with mild degrees of neurological disease such as multiple sclerosis. Long term follow up of cohorts of patients has shown that for most of these conditions about two thirds of patients are helped.7

For those who do not benefit from simple bulking agents, laxatives, or behavioural treatments, new pharmacological approaches may offer help. The neurochemical basis for peristalsis is now better appreciated and known to involve 5-hydroxytryptamine4 (serotonin type 4) receptors.9 In contrast to laxatives, which work via a luminal mechanism, the newly developed 5-hydroxytryptamine4 agonists are absorbed in the small intestine and induce peristalsis through a systemic mechanism. Tegaserod and prucalopride are two such drugs; the former is licensed in the United States but not in the United Kingdom or most of Europe. The latter is still under development.

Patients with idiopathic megarectum should have their bowel emptied completely before titrating an osmotic laxative.4 Such a laxative may be required in the long term, although behavioural treatment seems also to help some of these patients.

Surgery was commonly used in the past to treat patients with intractable constipation, such as young women with severe idiopathic constipation. The variable and unpredictable results of colectomy,10 together with the success of conservative treatments, has made this necessary only rarely. When surgery is being considered, new techniques, such as sacral nerve stimulation, may modify bowel neuromuscular control while avoiding irreversible bowel resection.11 This treatment involves chronic neural stimulation via percutaneously placed fine sacral electrodes.

The paradigm of a drug or operation for every condition needs broadening when treating constipation. When simple treatments have failed and specialist treatment is sought, broadly based multidisciplinary teams need to be able to offer more than laxatives and surgery. It might be argued that such a trivial symptom is not deserving of such use of resources. However, patients with functional gut symptoms have impaired quality of life and consume a large amount of healthcare resources. While relieving symptoms, effective treatments are also likely to be cost effective.

Michael A Kamm, professor of gastroenterology

St Mark's Hospital, Harrow HA1 3UJ (kamm@imperial.ac.uk)




--------------------------------------------------------------------------------
Competing interests: MK has been an adviser to Abbott, Johnson and Johnson, Medtronic, and Novartis.
References


Mason HJ, Serrano-Ikkos E, Kamm MA. Psychological morbidity in women with idiopathic constipation. Am J Gastroenterol 2000;95: 2852-7.[CrossRef][ISI][Medline]
Chiotakakou-Faliakou E, Kamm MA, Roy AJ, Storrie JB, Turner IC. Biofeedback provides long term benefit for patients with intractable, slow and normal transit constipation. Gut 1998;42: 517-21.[Abstract/Free Full Text]
Glickman S, Kamm MA. Bowel dysfunction in spinal cord injury patients. Lancet 1996;347: 1651-3.[ISI][Medline]
Gattuso JM, Kamm MA. Clinical features of idiopathic megarectum and idiopathic megacolon. Gut 1997;41: 93-9.[Abstract/Free Full Text]
Passmore AP, Wilson-Davies K, Stoker C, Scott ME. Chronic constipation in long stay elderly patients: a comparison of lactulose and a senna-fibre combination. BMJ 1993;307: 769-71.[ISI][Medline]
Francis CY, Whorwell PJ. Bran and irritable bowel syndrome: time for reappraisal. Lancet 1994;344: 39-40.[ISI][Medline]
Emmanuel AV, Kamm MA. Response to a behavioural treatment, biofeedback, in constipated patients is associated with improved gut transit and autonomic innervation. Gut 2001;49: 214-9.[Abstract/Free Full Text]
Mason HJ, Serrano-Ikkos E, Kamm MA. Psychological state and quality of life in patients treated by behavioral treatment (biofeedback) for intractable constipation. Am J Gastroenterol 2002;97: 3154-9.[CrossRef][ISI][Medline]
Grider JR, Foxx-Orenstein AE, Jin JG. 5-Hydroxytryptamine4 receptor agonists initiate the peristaltic reflex in human, rat, and guinea pig intestine. Gastroenterology 1998;115: 370-80.[ISI][Medline]
Kamm MA, Hawley PR, Lennard-Jones JE. Outcome of colectomy for severe idiopathic constipation. Gut 1988;29: 969-73.[Abstract]
Kenefick NJ, Nicholls RJ, Cohen RG, Kamm MA. Permanent sacral nerve stimulation for treatment of idiopathic constipation. Br J Surg 2002;89: 882-8.[CrossRef][ISI][Medline]

web page

--------------------
Heather is the Administrator of the IBS Message Boards. She’s the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!

Post Extras Print Post   Remind Me!     Notify Moderator

Entire thread
Subject Posted by Posted on
* General IBS / Bowel Dysfunction HeatherAdministrator 07/14/03 01:56 PM
. * Gut microbiome can diagnose colorectal cancer? HeatherAdministrator   08/12/14 11:21 AM
. * Sacral nerve stimulation does not help IBS HeatherAdministrator   07/15/14 02:57 PM
. * Small Study of IBS Patients Suggests Symptom Improvement with Fecal Microbiota Transplant HeatherAdministrator   06/27/14 04:15 PM
. * Vitamin D Role in Fecal Incontinence? HeatherAdministrator   05/22/14 05:03 PM
. * Colonic bile acid exposure influenced IBS symptoms HeatherAdministrator   05/22/14 04:50 PM
. * Good Vibration(s) for Constipation? HeatherAdministrator   05/12/14 03:55 PM
. * Can you give your spouse IBS? HeatherAdministrator   04/22/14 02:12 PM
. * Factors linked to chronic constipation HeatherAdministrator   04/07/14 02:06 PM
. * IBS patients' health perceptions focus on non-GI issues HeatherAdministrator   04/07/14 01:35 PM
. * Is IBS Funding a Joke? HeatherAdministrator   01/17/14 11:53 AM
. * Blood Test for IBS? HeatherAdministrator   10/16/13 01:30 PM
. * Gut microbes closely linked to proper immune function HeatherAdministrator   09/17/13 02:09 PM
. * More bugs in your gut = better health, lower body weight. HeatherAdministrator   08/30/13 11:32 AM
. * Top 10 Questions to Ask Your Doc about IBS HeatherAdministrator   08/16/13 01:01 PM
. * Had your gallbladder out? You may not have IBS. HeatherAdministrator   08/16/13 01:01 PM
. * IBS Quick Tip - Bloating Relief HeatherAdministrator   08/16/13 01:00 PM
. * Hot Summer Weather Affects IBS HeatherAdministrator   08/16/13 12:58 PM
. * Chronic Heartburn May Raise Odds for Throat Cancer HeatherAdministrator   05/29/13 09:57 AM
. * Support the Functional Gastrointestinal and Motility Disorders Research Enhancement Act HeatherAdministrator   04/22/13 01:52 PM
. * IBS increased risk for osteoporosis, related fractures HeatherAdministrator   03/18/13 01:23 PM
. * Weight Loss Better Than Drugs for Heartburn HeatherAdministrator   02/13/13 10:42 AM
. * Greater antibiotic use raises incidence of C. diff infections HeatherAdministrator   10/31/12 11:35 AM
. * No evidence supports colonic irrigation for IBS HeatherAdministrator   06/15/12 03:11 PM
. * Two Questions For Your Doctor Before A Colonoscopy HeatherAdministrator   06/15/12 03:06 PM
. * Dietary cleanses risky HeatherAdministrator   06/15/12 01:22 PM
. * Army of gut microbes keep us fit and healthy HeatherAdministrator   06/15/12 01:19 PM
. * Irritable Bowel Syndrome (IBS) and Bacteria in Gut HeatherAdministrator   05/30/12 11:59 AM
. * Can a Gut Check Boost Sleep, Sex and Brain Power? HeatherAdministrator   05/02/12 10:27 AM
. * April is IBS Awareness Month HeatherAdministrator   04/23/12 01:47 PM
. * Fecal matter, delivered by enema, helps heal in nine out of 10 cases HeatherAdministrator   04/23/12 01:34 PM
. * Too Many Americans Skipping Colon Cancer Screening HeatherAdministrator   03/13/12 05:02 PM
. * Chronic Heartburn a Growing Problem in U.S. HeatherAdministrator   01/05/12 01:46 PM
. * Fecal Transplants Show Promise for Gastrointestinal Ills HeatherAdministrator   11/23/11 02:37 PM
. * Stomach bug giardia linked to IBS and chronic fatigue syndrome HeatherAdministrator   10/06/11 07:02 PM
. * Gut analysis with smart pill could be new key to IBS treatment HeatherAdministrator   10/06/11 06:58 PM
. * Colon Cleansing Not Backed by Science and Can Be Dangerous HeatherAdministrator   08/03/11 03:45 PM
. * Gut Bacteria Falls Into Three Major Types HeatherAdministrator   05/05/11 11:13 AM
. * Stress May Alter Gut Bacteria and Hurt Immune System HeatherAdministrator   04/06/11 04:31 PM
. * Factors associated with co-morbid irritable bowel syndrome and chronic fatigue HeatherAdministrator   02/10/11 10:21 AM
. * Subtypes of Irritable Bowel Syndrome Based on Abdominal Pain/Discomfort Severity and Bowel Pattern HeatherAdministrator   02/10/11 10:14 AM
. * Irritable Bowel Syndrome Is Not In Your Head HeatherAdministrator   09/24/10 02:42 PM
. * Pain perception during colonoscopy higher in IBS patients than in non-IBS patients HeatherAdministrator   07/21/10 03:52 PM
. * Can Choir Singing Improve Irritable Bowel Syndrome? HeatherAdministrator   06/24/10 01:48 PM
. * Patients with IBS are NOT more likely to develop polyps, colon cancer HeatherAdministrator   05/12/10 01:18 PM
. * Rome Foundation Introduces Clinical Tool For Diagnosis Of Functional Gastrointestinal Disorders HeatherAdministrator   04/12/10 11:40 AM
. * Rotating Shift Workers At More Risk For Irritable Bowel Syndrome HeatherAdministrator   04/12/10 11:39 AM
. * Irritable bowel syndrome (IBS) does seem to run in families HeatherAdministrator   04/02/10 11:14 AM
. * IBS Does Not Increase Risk of Colon Cancer or IBD HeatherAdministrator   03/12/10 11:30 AM
. * Validation of Symptom-Based Diagnostic Criteria for Irritable Bowel Syndrome HeatherAdministrator   03/11/10 01:53 PM
. * Importance of early diagnosis in patients with irritable bowel syndrome HeatherAdministrator   03/11/10 01:44 PM
. * Altered profiles of intestinal microbiota and organic acids may be the origin of symptoms in irritable bowel syndrome HeatherAdministrator   03/11/10 01:12 PM
. * Constipation: a potential cause of pelvic floor damage? HeatherAdministrator   09/29/09 12:10 PM
. * Patients say they would give up 25% of their remaining life to be rid of IBS HeatherAdministrator   08/28/09 01:21 PM
. * IBS - it's the pain and the stigma HeatherAdministrator   08/28/09 01:16 PM
. * Wasington state retailers required to make bathrooms available to people with IBS and IBD HeatherAdministrator   05/13/09 01:06 PM
. * Development of an educational intervention for patients with Irritable Bowel Syndrome HeatherAdministrator   02/06/09 12:20 PM
. * Prevalence of Functional Gastrointestinal Disorders in Patients With Fibromyalgia and the Role of Psychologic Distress HeatherAdministrator   01/22/09 04:47 PM
. * Highlights of ACG's New Recommendations on IBS Therapies HeatherAdministrator   01/09/09 11:10 AM
. * Irritable Bowel Syndrome Can Have Genetic Causes HeatherAdministrator   12/16/08 11:42 AM
. * Is IBS part of a cascade of events? HeatherAdministrator   10/27/08 10:56 AM
. * Contributions of Pain Sensitivity and Colonic Motility to IBS Symptom Severity HeatherAdministrator   10/21/08 02:38 PM
. * Subgroup classification in irritable bowel syndrome patients over time HeatherAdministrator   10/09/08 01:56 PM
. * Genetic factors may play a role in IBS HeatherAdministrator   09/26/08 02:52 PM
. * Genetics of Irritable Bowel Syndrome HeatherAdministrator   08/27/08 12:43 PM
. * Irritable bowel syndrome: an international study of symptoms in eight countries HeatherAdministrator   08/07/08 12:42 PM
. * Gallstones, cholecystectomy and irritable bowel syndrome HeatherAdministrator   04/22/08 04:01 PM
. * Abdominal Bloating in Employed Adults: Prevalence, Risk Factors, and Association With Other Bowel Disorders HeatherAdministrator   04/22/08 02:07 PM
. * IBS is keeping me hostage! HeatherAdministrator   03/14/08 11:12 AM
. * Abdominal Bloating and Distension in Functional Gastrointestinal Disorders HeatherAdministrator   02/28/08 03:16 PM
. * Psychological distress and GI symptoms are related to severity of bloating HeatherAdministrator   02/28/08 02:40 PM
. * Irritable Bowel Syndrome's Possible Genetic Link HeatherAdministrator   02/04/08 10:43 AM
. * Patients with allergies appear to have a higher incidence of irritable bowel syndrome (IBS) HeatherAdministrator   02/04/08 10:19 AM
. * Train operator suffering from irritable bowel syndrome sues for lost wages HeatherAdministrator   12/06/07 02:45 PM
. * IBS may not affect small bowel transit time, but age does HeatherAdministrator   10/24/07 01:56 PM
. * Diagnostic work-up of IBS HeatherAdministrator   10/24/07 12:15 PM
. * Neural mechanisms of pelvic organ cross-sensitization. HeatherAdministrator   10/10/07 11:41 AM
. * Incidence and Prognosis of Post-Infectious Irritable Bowel Syndrome HeatherAdministrator   09/13/07 11:21 AM
. * Irritable bowel syndrome and the Rome III criteria: for better or for worse? HeatherAdministrator   08/28/07 04:15 PM
. * Quality of Life in Patients With IBD and IBS Differs Between Subjects Recruited from Clinic or the Internet HeatherAdministrator   08/09/07 11:31 AM
. * Fecal microbiota of irritable bowel syndrome patients differs significantly from that of healthy subjects HeatherAdministrator   08/02/07 03:08 PM
. * Irritable bowel syndrome and bloating HeatherAdministrator   08/02/07 03:02 PM
. * IBS And Restless Legs Syndrome Linked HeatherAdministrator   08/02/07 02:50 PM
. * Overlapping upper and lower gastrointestinal symptoms in irritable bowel syndrome patients HeatherAdministrator   06/20/07 01:49 PM
. * Bacterial Overgrowth Apparently NOT Important in IBS HeatherAdministrator   06/06/07 10:51 AM
. * Irritable bowel syndrome: patients' attitudes, concerns and level of knowledge HeatherAdministrator   05/23/07 02:32 PM
. * Influence of genetics on irritable bowel syndrome HeatherAdministrator   05/23/07 02:25 PM
. * Diarrhea-predominant irritable bowel syndrome and possible microscopic colitis HeatherAdministrator   05/11/07 03:37 PM
. * Breath Methane Levels Correlate With Constipation in IBS HeatherAdministrator   04/28/07 10:13 AM
. * 7 common myths – and facts – about IBS HeatherAdministrator   04/11/07 04:17 PM
. * Symptomatic overlap between irritable bowel syndrome and microscopic colitis HeatherAdministrator   03/18/07 04:48 PM
. * Reactions to a guided self-management intervention in a randomised controlled trial for IBS HeatherAdministrator   03/18/07 04:39 PM
. * Audit of Subtypes of Functional Constipation in a Gastroenterology Referral Center HeatherAdministrator   03/18/07 04:26 PM
. * New insights into the pathogenesis and pathophysiology of irritable bowel syndrome HeatherAdministrator   03/01/07 01:17 PM
. * Overly Anxious and Driven People Prone to Irritable Bowel Syndrome HeatherAdministrator   03/01/07 12:37 PM
. * Paid Participants Sought for Online IBS University Research Study HeatherAdministrator   02/26/07 11:43 AM
. * Physical activity and intestinal gas clearance in patients with bloating. HeatherAdministrator   02/04/07 04:11 PM
. * Familial Aggregation in Constipated Subjects HeatherAdministrator   01/21/07 04:12 PM
. * Participate in a research study looking at attitudes and opinions about people who have IBS HeatherAdministrator   12/29/06 04:15 PM
. * Most important barriers to the optimal management of patients with IBS-C and chronic constipation HeatherAdministrator   12/01/06 01:23 PM
. * Traveler's Diarrhea May Boost Risk of Irritable Bowel Syndrome HeatherAdministrator   10/14/06 02:28 PM
. * Irritable Bowel Syndrome Linked to Migraine, Fibromyalgia, and Depression HeatherAdministrator   10/14/06 02:24 PM
. * Restricted Fetal Growth Linked to Irritable Bowel Syndrome HeatherAdministrator   10/14/06 02:21 PM
. * The Science of IBS - Postinfectious IBS and Small Intestinal Bacterial Overgrowth HeatherAdministrator   09/30/06 03:23 PM
. * The Science of IBS - Environment and Genetics HeatherAdministrator   09/17/06 02:36 PM
. * Making a Positive Diagnosis of IBS HeatherAdministrator   08/19/06 11:56 AM
. * IBS -- Review and What's New - Abstract and Introduction HeatherAdministrator   08/05/06 03:58 PM
. * Treatment of Functional Diarrhea HeatherAdministrator   07/17/06 01:54 PM
. * Prevalence and Incidence of Chronic Constipation HeatherAdministrator   07/05/06 05:35 PM
. * Rome III Diagnostic Criteria HeatherAdministrator   06/12/06 04:16 PM
. * Determinants of Healthcare-Seeking Behaviour in IBS HeatherAdministrator   06/04/06 11:48 AM
. * Genetic cause for irritable bowel syndrome HeatherAdministrator   05/29/06 01:48 PM
. * Cytokines May Provide Marker for Irritable Bowel Syndrome HeatherAdministrator   05/14/06 05:04 PM
. * Introduction to IBS Constipation - the Problem HeatherAdministrator   05/14/06 04:57 PM
. * Gender, Age, Society, Culture, and the Patient's Perspective in IBS HeatherAdministrator   05/13/06 03:16 PM
. * What IBS Patients Need - But Don't Get - From Their Physicians HeatherAdministrator   05/08/06 04:37 PM
. * Antibiotic use and irritable bowel syndrome (IBS). HeatherAdministrator   04/15/06 04:02 PM
. * Older Versus Younger Patients with Irritable Bowel Syndrome HeatherAdministrator   04/15/06 03:11 PM
. * Prevalence of irritable bowel syndrome and depression in fibromyalgia HeatherAdministrator   04/15/06 03:04 PM
. * Intestinal serotonin signalling in irritable bowel syndrome HeatherAdministrator   04/15/06 02:59 PM
. * Gender-related differences in visceral perception in health and irritable bowel syndrome HeatherAdministrator   04/15/06 02:47 PM
. * Role of Stress, Infection, Inflammation in IBS HeatherAdministrator   03/16/06 12:22 PM
. * Pathophysiologic Mechanisms of IBS HeatherAdministrator   03/16/06 12:16 PM
. * Gum Chewing Stimulates Bowel Activity and Reduces Surgical Recovery Time HeatherAdministrator   03/04/06 01:04 PM
. * A bulging midriff roughly doubles women's chances of gallstone surgery HeatherAdministrator   03/04/06 12:56 PM
. * Lifestyle Factors and Symptoms of Gastro-oesophageal Reflux HeatherAdministrator   02/18/06 01:42 PM
. * IBS Patients Show Greater Brain Response to Subliminal Gut Stimuli HeatherAdministrator   02/18/06 01:32 PM
. * Discrepancies between Patient-Reported Outcomes and Clinician-Reported Outcomes in IBS HeatherAdministrator   02/01/06 12:15 PM
. * Distension technique influences the relationship between colonic and rectal hypersensitivity in IBS HeatherAdministrator   02/01/06 12:04 PM
. * Stability of Irritable Bowel Syndrome Using a Rome II-Based Classification HeatherAdministrator   01/18/06 04:27 PM
. * Digestive Woes May Keep the Overweight From Exercising HeatherAdministrator   01/18/06 04:00 PM
. * Possible role of nitric oxide in visceral hypersensitivity in patients with irritable bowel syndrome HeatherAdministrator   01/08/06 05:03 PM
. * A Survey on Patient Educational Needs in Irritable Bowel Syndrome HeatherAdministrator   01/08/06 04:53 PM
. * Gut motor function: immunological control in enteric infection and inflammation HeatherAdministrator   12/21/05 12:41 PM
. * Post-infectious Irritable Bowel Syndrome HeatherAdministrator   12/19/05 04:55 PM
. * Clinical Insights in IBS-C and Chronic Constipation HeatherAdministrator   12/08/05 12:37 PM
. * New Studies Gauge Knowledge, Attitudes and Preferences of Patients with Irritable Bowel Syndrome HeatherAdministrator   11/12/05 01:30 PM
. * The Genetics of Irritable Bowel Syndrome HeatherAdministrator   11/12/05 01:10 PM
. * Irritable Bowel Syndrome Study Shows That Targeted Antibiotics Lead To Long-lasting Improvement HeatherAdministrator   11/12/05 01:00 PM
. * Colonic Immune Activity and Blood T Lymphocytes in Patients With Irritable Bowel Syndrome HeatherAdministrator   10/28/05 11:48 AM
. * Brain activation responses to auditory stimuli in IBS HeatherAdministrator   10/28/05 11:42 AM
. * Functional Constipation Linked to Obesity in Children HeatherAdministrator   10/11/05 01:43 PM
. * Childhood Abdominal Pain May Progress to Adult Irritable Bowel Syndrome HeatherAdministrator   10/11/05 01:36 PM
. * Bronchial Hyperresponsiveness in Irritable Bowel Syndrome HeatherAdministrator   10/11/05 01:16 PM
. * The Impact of Somatization on the Use of Gastrointestinal Health-Care Resources in Patients with IBS HeatherAdministrator   09/22/05 04:51 PM
. * Abdominal Bloating - Four Factors HeatherAdministrator   09/22/05 04:47 PM
. * Abdominal Bloating HeatherAdministrator   09/22/05 04:46 PM
. * Guidelines for the Management of Dyspepsia HeatherAdministrator   09/22/05 04:35 PM
. * IBS and Functional Dyspepsia: Different Diseases or a Single Disorder With Different Manifestations? HeatherAdministrator   09/13/05 01:03 PM
. * Increased Prevalence of Obesity in Children With Functional Constipation HeatherAdministrator   09/13/05 12:45 PM
. * Irritable Bowel Syndrome: Toward an Understanding of Severity HeatherAdministrator   09/01/05 11:19 AM
. * How Do Symptoms in Chronic Constipation and IBS With Constipation Differ? HeatherAdministrator   08/22/05 04:51 PM
. * Role of Carbon Dioxide-Releasing Suppositories in the Treatment of Chronic Functional Constipation HeatherAdministrator   08/22/05 04:32 PM
. * Physiological Mechanisms Underlying Perceptions of Nausea and Stomach Fullness HeatherAdministrator   08/07/05 04:33 PM
. * Gastrointestinal infections can have lasting consequences as IBS HeatherAdministrator   08/07/05 04:08 PM
. * Dyspepsia and Irritable Bowel Syndrome After a Salmonella Gastroenteritis Outbreak HeatherAdministrator   07/24/05 02:48 PM
. * Abdominal Radiography Not Useful in Constipated Children HeatherAdministrator   07/24/05 02:30 PM
. * IBS—The Irritation of Inflammation HeatherAdministrator   07/24/05 02:16 PM
. * Irritable Bowel Syndrome in the United States: Prevalence, Symptom Patterns and Impact HeatherAdministrator   07/05/05 03:40 PM
. * IBS: Improving Diagnosis, Serotonin Signaling, and Implications for Treatment HeatherAdministrator   07/05/05 03:30 PM
. * Neural Cross-Talk May Explain Overlap of Irritable Bowel, Interstitial Cystitis HeatherAdministrator   07/05/05 03:11 PM
. * Health Economics of IBS HeatherAdministrator   07/05/05 03:01 PM
. * Overlapping Upper and Lower Gastrointestinal Symptoms in Irritable Bowel Syndrome HeatherAdministrator   06/20/05 03:52 PM
. * Diagnostic Yield of Alarm Features in Irritable Bowel Syndrome HeatherAdministrator   06/20/05 03:44 PM
. * Colon Cancer Test Misses Growths in Women HeatherAdministrator   06/05/05 05:56 PM
. * Nongastrointestinal symptoms of irritable bowel syndrome HeatherAdministrator   05/22/05 07:14 PM
. * Partnering With Gastroenterologists to Evaluate Patients With Chronic Constipation HeatherAdministrator   05/08/05 06:16 PM
. * Impairment in Work Productivity and Health-related Quality of Life in Patients With IBS HeatherAdministrator   05/08/05 06:11 PM
. * Nerves, Reflexes, and the Enteric Nervous System: Pathogenesis of the Irritable Bowel Syndrome HeatherAdministrator   05/08/05 06:06 PM
. * What Does the Future Hold for Irritable Bowel Syndrome HeatherAdministrator   05/08/05 06:02 PM
. * Towards a better understanding of abdominal bloating and distension in functional GI disorders HeatherAdministrator   04/24/05 03:40 PM
. * IBS is a risk factor for GERD HeatherAdministrator   04/10/05 06:25 PM
. * New Recommendations for Treating Children With Chronic Abdominal Pain HeatherAdministrator   03/28/05 01:59 PM
. * Irritable bowel syndrome in developing countries HeatherAdministrator   03/28/05 01:29 PM
. * Stress and the gastrointestinal tract HeatherAdministrator   03/28/05 01:27 PM
. * Alternating Bowel Habit Subtype in Patients with Irritable Bowel Syndrome HeatherAdministrator   03/28/05 12:28 PM
. * Fecal Microbiota of Irritable Bowel Syndrome Patients HeatherAdministrator   03/04/05 12:11 PM
. * Post-infectious IBS in patients with Shigella infection HeatherAdministrator   03/04/05 12:03 PM
. * Surgical Treatment of Chronic Functional Constipation? HeatherAdministrator   03/04/05 11:24 AM
. * Chronic constipation in children HeatherAdministrator   02/19/05 05:53 PM
. * Intestinal infection and irritable bowel syndrome. HeatherAdministrator   02/19/05 05:36 PM
. * Overlap of GI symptom complexes in a US community HeatherAdministrator   02/06/05 02:35 PM
. * Magnetic pill tracking: a novel non-invasive tool for investigation of human digestive motility HeatherAdministrator   02/06/05 02:27 PM
. * The value of a general therapeutic approach in subjects with irritable bowel syndrome HeatherAdministrator   02/06/05 02:22 PM
. * Is Constipation Associated with Decreased Physical Activity in Normally Active Subjects? HeatherAdministrator   02/06/05 02:18 PM
. * High interdigestive and postprandial motilin levels in patients with the irritable bowel syndrome HeatherAdministrator   02/06/05 02:12 PM
. * 10% to 20% of older adults have IBS HeatherAdministrator   01/23/05 05:05 PM
. * Diagnostic Criteria for Irritable Bowel Syndrome - Family Practice Doctors Unaware of Guidelines HeatherAdministrator   01/07/05 06:20 PM
. * Stress Increases Visceral Sensitivity in IBS Patients HeatherAdministrator   01/07/05 06:13 PM
. * Treatment of irritable bowel syndrome with colonic pacing HeatherAdministrator   01/07/05 05:53 PM
. * Irritable bowel syndrome: colonoscopy painful and difficult? HeatherAdministrator   01/07/05 05:50 PM
. * Suicide in IBS patients emphasizes need for improvements in treatment HeatherAdministrator   01/07/05 05:47 PM
. * New Risk for Asthma, Allergy Found in the Gut HeatherAdministrator   01/07/05 04:53 PM
. * Salt intake and smoking play major roles in GERD HeatherAdministrator   12/20/04 02:11 PM
. * Constipation and Laxative Use Found to Increase Colon Cancer Risk HeatherAdministrator   12/20/04 01:30 PM
. * Link Between Irritable Bowel Syndrome (IBS), Alcoholism and Mental Illness HeatherAdministrator   12/20/04 01:24 PM
. * Complementary and alternative medicine in gastroenterology HeatherAdministrator   12/20/04 01:16 PM
. * Advances in the Treatment of Chronic Constipation HeatherAdministrator   11/28/04 02:55 PM
. * Symptom patterns in functional dyspepsia and irritable bowel syndrome HeatherAdministrator   11/28/04 02:34 PM
. * Obese Women Face Higher Risk of Colorectal Cancer HeatherAdministrator   11/08/04 04:48 PM
. * Obesity is Associated With Increased Risk of Gastrointestinal Symptoms HeatherAdministrator   10/24/04 07:42 PM
. * Stress Therapy Can Help Irritable Bowel HeatherAdministrator   10/24/04 07:38 PM
. * Relationship Between Colon Ischemia, Irritable Bowel Syndrome HeatherAdministrator   10/11/04 04:15 PM
. * Clinical Update on the Treatment of Constipation in Adults HeatherAdministrator   10/11/04 03:34 PM
. * Racial Differences in the Impact of Irritable Bowel Syndrome on Health-Related Quality of Life HeatherAdministrator   10/11/04 03:25 PM
. * What Differentiates Chronic Constipation From IBS With Constipation? HeatherAdministrator   09/26/04 03:25 PM
. * Treatment options in irritable bowel syndrome HeatherAdministrator   09/26/04 02:57 PM
. * Diagnostic approach to suspected irritable bowel syndrome HeatherAdministrator   09/12/04 03:38 PM
. * Dyssynergic Defecation: Demographics, Symptoms, Stool Patterns, and Quality of Life HeatherAdministrator   09/12/04 03:35 PM
. * Small Intestinal Bacterial Overgrowth - A Framework for Understanding IBS HeatherAdministrator   08/30/04 01:46 PM
. * New views - and some respect - for IBS HeatherAdministrator   08/30/04 01:25 PM
. * Categorization of dysmotility in patients with chronic constipation HeatherAdministrator   08/08/04 02:54 PM
. * Prevalence of IBS according to different diagnostic criteria HeatherAdministrator   08/08/04 02:50 PM
. * Irritable Bowel Can Follow Dysentery HeatherAdministrator   08/08/04 02:37 PM
. * Irritable Bowel Syndrome Remains a Difficult Condition to Manage HeatherAdministrator   07/24/04 02:09 PM
. * Intolerance to visceral distension in functional dyspepsia or irritable bowel syndrome HeatherAdministrator   07/24/04 02:17 PM
. * Bacillary dysentery as a causative factor of irritable bowel syndrome and its pathogenesis HeatherAdministrator   07/24/04 01:42 PM
. * Irritable Bowel Syndrome Linked to High Rates of Various Surgeries HeatherAdministrator   07/11/04 02:15 PM
. * Drug-Free Ways to Treat IBS HeatherAdministrator   07/11/04 01:47 PM
. * Irritable Bowel Syndrome - An Evidence-Based Approach to Diagnosis HeatherAdministrator   06/27/04 01:14 PM
. * Biases Affect Treatment of IBS HeatherAdministrator   06/04/04 06:45 PM
. * Moms with Bowel Symptoms Take Baby to Doctor More HeatherAdministrator   05/25/04 11:53 AM
. * Natural History of Irritable Bowel Syndrome HeatherAdministrator   05/10/04 02:36 PM
. * Intestinal Gas May Contribute to IBS Symptoms HeatherAdministrator   05/10/04 02:29 PM
. * Are Your Bowels Irritable? IBS Awareness Month is Here HeatherAdministrator   04/09/04 07:11 PM
. * Heartburn May Not Reflect Gastroesophageal Reflux Disease Severity HeatherAdministrator   03/30/04 02:43 PM
. * A link between irritable bowel syndrome and fibromyalgia HeatherAdministrator   03/30/04 01:46 PM
. * Diverticular Disease: Electrophysiologic Study and a New Concept of Pathogenesis HeatherAdministrator   03/09/04 11:48 AM
. * New Syndrome Connects Gallbladder Dysfunction And Chronic Diarrhea HeatherAdministrator   03/09/04 11:45 AM
. * Researchers Pioneer Accessible, Cost-Effective Treatments for IBS HeatherAdministrator   03/08/04 06:48 PM
. * Splitting IBS: from original Rome to Rome II criteria HeatherAdministrator   02/10/04 02:35 PM
. * Utilization patterns and net direct medical cost to Medicaid of IBS HeatherAdministrator   02/10/04 02:34 PM
. * Family practitioners' attitudes and knowledge about IBS HeatherAdministrator   02/10/04 02:32 PM
. * The Effect of Somatization on Gastrointestinal and Extraintestinal Symptoms of IBS HeatherAdministrator   01/26/04 03:26 PM
. * Surgery and IBS HeatherAdministrator   01/26/04 03:21 PM
. * IBS Subgroups by Bowel Habit Predominance HeatherAdministrator   01/26/04 03:13 PM
. * Visceral perception thresholds in irritable bowel syndrome HeatherAdministrator   01/07/04 11:56 AM
. * Electric activity of the colon in irritable bowel syndrome HeatherAdministrator   01/07/04 11:52 AM
. * Irritable Bowel Syndrome's Possible Genetic Link HeatherAdministrator   01/07/04 11:40 AM
. * Intestinal gas distribution determines abdominal symptoms HeatherAdministrator   12/16/03 12:27 PM
. * Faecal incontinence - Many treatment options now exist HeatherAdministrator   12/16/03 12:17 PM
. * Abnormal Colonic Propagated Activity in Patients with Constipation HeatherAdministrator   12/16/03 12:07 PM
. * Colonic Propulsive Impairment in Intractable Slow-Transit Constipation HeatherAdministrator   12/16/03 12:03 PM
. * Overlapping upper and lower GI symptoms in IBS patients with constipation or diarrhea HeatherAdministrator   12/01/03 05:51 PM
. * Familial aggregation of irritable bowel syndrome HeatherAdministrator   12/01/03 05:49 PM
. * Outlook affects bowel disorder patients HeatherAdministrator   11/18/03 03:30 PM
. * Doctors unmoved by bowel misery HeatherAdministrator   11/18/03 03:28 PM
. * Travelers' Diarrhoea Can Trigger Irritable Bowel HeatherAdministrator   11/04/03 03:21 PM
. * Mind-Body Technique Eases Kids' Gut Pain HeatherAdministrator   10/30/03 11:17 AM
. * Molecular Alterations In Patients With Irritable Bowel Syndrome HeatherAdministrator   10/20/03 03:46 PM
. * Three in Four People With IBS Also Have Functional Dyspepsia HeatherAdministrator   10/15/03 03:28 PM
. * Infectious Gastroenteritis Linked to Irritable Bowel Syndrome HeatherAdministrator   09/30/03 02:27 PM
. * Association Between Pain Episodes & High Amplitude Pressure Waves in IBS HeatherAdministrator   09/16/03 03:54 PM
. * Constipation and its management HeatherAdministrator   09/16/03 03:41 PM
. * Contributions of suggestion, desire, and expectation to placebo effects in IBS patients HeatherAdministrator   09/16/03 03:28 PM
. * Do published guidelines for evaluation of IBS reflect practice? HeatherAdministrator   08/30/03 02:40 PM
. * Cognitive-behavioral therapy versus education and desipramine versus placebo for IBS HeatherAdministrator   08/12/03 12:54 PM
. * Distinctive features of postinfective irritable bowel syndrome HeatherAdministrator   07/28/03 03:18 PM
. * UCLA/CURE Neuroenteric Disease Program Newsletter HeatherAdministrator   07/23/03 10:38 AM
. * Bacterial Overgrowth in IBS HeatherAdministrator   07/18/03 12:15 PM
. * Diagnosis of irritable bowel syndrome. HeatherAdministrator   07/18/03 11:54 AM
. * Eradication of small intestinal bacterial overgrowth reduces symptoms of IBS HeatherAdministrator   07/18/03 11:44 AM
. * Antibiotics increase functional abdominal symptoms. HeatherAdministrator   07/18/03 11:41 AM
. * Treatment of the irritable bowel syndrome. HeatherAdministrator   07/15/03 11:02 PM
. * Extraintestinal symptoms in IBS and IBD HeatherAdministrator   07/15/03 06:21 PM
. * Postinfectious irritable bowel syndrome. HeatherAdministrator   07/15/03 06:19 PM
. * Dieting severity and GI symptoms in college women. HeatherAdministrator   07/15/03 01:13 PM
. * Functional GI disorders and eating disorders - Relevance of the association HeatherAdministrator   07/15/03 11:14 AM
. * Features of eating disorders in patients with IBS HeatherAdministrator   07/15/03 11:12 AM
. * New and Important Insights Into IBS HeatherAdministrator   07/14/03 03:24 PM
. * The Irritable Bowel Syndrome-Fibromyalgia Connection HeatherAdministrator   07/14/03 03:19 PM
. * Update on Treatment of Functional Gastrointestinal Disorders HeatherAdministrator   07/14/03 02:55 PM
. * Irritable bowel syndrome in primary care: The patients’ and doctors’ views HeatherAdministrator   07/14/03 02:43 PM
. * Inflammatory bowel disease and irritable bowel syndrome: separate or unified? HeatherAdministrator   07/14/03 02:32 PM

Extra information
0 registered and 1 anonymous users are browsing this forum.

Moderator:  Heather 



Permissions
      You cannot post until you login
      You cannot reply until you login
      HTML is enabled
      UBBCode is enabled

Thread views: 796715

Jump to

| Privacy statement Help for IBS Home

*
UBB.threads™ 6.2



LEGAL DISCLAIMER - This website is not intended to replace the services of a physician, nor does it constitute a doctor-patient relationship. Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. You should not use the information on this web site for diagnosing or treating a medical or health condition. If you have or suspect you have an urgent medical problem, promptly contact your professional healthcare provider.

Any application of the recommendations in this website is at the reader's discretion. Heather Van Vorous, HelpForIBS.com, and Heather & Company for IBS, LLC are not liable for any direct or indirect claim, loss or damage resulting from use of this website and/or any web site(s) linked to/from it. Readers should consult their own physicians concerning the recommendations on these message boards.



Home | Shop for IBS | IBS Message Boards | IBS News & Reviews | IBS Support Groups
IBS Diet & Recipes | IBS Books | IBS Supplements | Yoga for IBS | Hypnosis for IBS
IBS Tummy Teas™ | Irritable Bowel Syndrome Glossary

About Us | IBS Links | Search this Site | Site Map | Shipping & Returns | Privacy & Security
Contact Us | For Doctors & Dietitians | Wholesale | Co-packing Services

© 1999-2009, Heather Van Vorous, HelpForIBS.com, Heather & Company for IBS, LLC.
All information & art is proprietary and may not be duplicated.
All rights reserved.

Legal & Medical Disclaimer

Website Design