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Purpose: Prebiotics are defined as substances which selectively promote beneficial gut microbes leading to a health benefit for the host. Limited trials have been carried out investigating their effect on the microbiota composition of individuals afflicted by functional constipation with equivocal outcomes. In a 21-day randomised, controlled clinical trial involving 61 adults with functional constipation, a prebiotic formulation with partially hydrolysed guar gum and acacia gum as its main ingredients, significantly increased complete spontaneous bowel motions in the treatment group. This follow-up exploratory analysis investigated whether the prebiotic was associated with changes to the composition, richness, and diversity of the faecal microbiota. Methods: Participants provided a faecal specimen at baseline and on day 21 of the intervention period. Whole genome metagenomic shotgun sequencing comprehensively assessed taxonomic and functional composition of the microbiota. Results: Linear mixed effects regression models adjusted for potential confounders showed a significant reduction in species richness of 28.15 species (95% CI − 49.86, − 6.43) and Shannon diversity of 0.29 units (95% CI − 0.56, − 0.02) over the trial period in the prebiotic group. These changes were not observed in the control group, and functional composition was unchanged in both groups. Conclusion: In adults with functional constipation, the intake of a prebiotic formulation was associated with a decline of species richness and Shannon diversity. Further research regarding the associations between prebiotics and the composition and function of the gut microbiota is warranted. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to establish the demographic profile of adult patients presenting with constipation and constipation‐related issues to an Australian tertiary hospital ED, investigate ED management and referral pathways in this cohort and determine satisfaction of these aspects of care from a patient's perspective. Methods: This is a single‐centre study conducted in an Australian tertiary hospital ED which sees 115 000 presentations annually. ED presentations of adults aged 18–80 years with symptoms of constipation were evaluated through retrospective electronic medical record audit and follow‐up by survey 3–6 months after their ED presentation. Results: The patients presenting to the ED with constipation had a median age of 48 years (IQR 33.5–63.5) and arrived self‐referred by private transport. Median length of stay was 292 min. 22% of patients reported they had previously attended the ED for the same issue within the previous year. Diagnosis of chronic constipation was inconsistent, with limited supporting documentation. Constipation was largely managed with aperients. Four in five patients were satisfied with ED care; however, 3–6 months post‐ED visit, 92% of patients reported ongoing bowel‐related issues, reflecting the chronic course of functional constipation. Conclusion: This is the first study to investigate the management of constipation in adult patients in an Australian ED setting. It is important that ED clinicians recognise that functional constipation is a chronic condition and many patients have persistent symptoms. There are opportunities for quality‐of‐care improvements including diagnostics, treatment, and referral post‐discharge to allied health, nursing and medical specialist services. [ABSTRACT FROM AUTHOR]

Background. Gastrointestinal symptoms (GIS) in people with Parkinson's disease (PwP) are often underreported and may remain untreated. Constipation is a common nonmotor symptom that can adversely affect health-related quality of life (QoL); however, the impact of other GIS has not been adequately investigated. Objectives. To investigate the relationship between QoL and constipation using the Bristol Stool Chart, bowel movement frequency, and a perceived constipation measure; and to explore the relationship between QoL and other GIS in an Australian PD cohort. Methods. The impact of constipation and other GIS on QoL, as measured using the PDQ-39 scale, was assessed in a cohort of 144 (89 males, 55 females) clinic-attending PwP. Constipation was assessed using the Bristol Stool Chart as well as a composite constipation measure, and the Gastrointestinal Symptom Rating Scale (GSRS) was used to rate other GIS. Covariate corrected linear regression models were utilised to determine significant associations between GIS and QoL scores. Results. Individual and combined constipation measures were significantly associated with poorer QoL (p = 0.032 and p = 0.002 , respectively). Analysis of GSRS symptom domains showed that in addition to symptoms of gastrointestinal hypomotility, a number of other symptoms such as increased eructation and increased flatus were also associated with poorer QoL. Conclusions. The findings point to the importance of GIS as contributor to health-related QoL in PwP. A better understanding of the relationship between GIS and QoL will help facilitate the development of more effective screening and treatment programs to improve symptom management and QoL for PwP. [ABSTRACT FROM AUTHOR]

Introduction: Depression is often an under-recognised feature of Parkinson's disease (PD). It is detrimental to physical and interpersonal functioning, negatively impacting a patient's clinical management, quality of life and well-being. We aimed to identify clinical predictors and management implications of depression in Australian PD patients.Methods: 103 PD and 81 Healthy Control (HC) subjects were evaluated using the Beck Depression Inventory (BDI) and other validated PD motor and non-motor symptom (NMS) tools.Results: Nearly twice as many PD patients were depressed, (38.9% vs 20.1%, p = 0.009), with a corresponding increase in depression severity on the BDI (11.9; standard deviation (SD) 8.8 vs 5.2; SD 5.5, p<0.001), and an odds ratio of 2.4 (95% confidence interval 1.2 - 4.7). Employment appeared to be a relative protective factor for depression, whilst patients requiring support services seemed to be more vulnerable to depression. Rapid Eye Movement Sleep Behaviour Disorder, dyskinesias, impulse control disorder, higher daily levodopa equivalent dose, increased motor severity, as well as catechol-O-methyltransferase inhibitor and amantadine use, all showed associations with depression (p<0.05). Chronic pain, decreased physical activity, constipation and upper gastrointestinal dysfunction presented with an apparent increase in risk for developing depression and increased depression severity. Other NMS were also found to be associated with PD-related depression.Limitations: Potential selection bias of self-reporting data collection from specialist PD clinics in a single metropolitan area.Conclusion: Our findings provide novel insight into the prevalence of depression in PD, possible contributory factors and future treatment strategies targeting depression in PD. [ABSTRACT FROM AUTHOR]

Aim: To determine the nature and extent of interactions between retail pharmacists and families of infants concerned about functional gastrointestinal disorders. Methods: A 15‐question online survey was developed that could be completed by retail pharmacists in approximately 5 min. This survey aimed to obtain information relating to the frequency of interactions with parents of infants seeking advice and/or information about colic, gastro‐oesophageal reflux (GOR) or constipation in pharmacies; what recommendations and/or advice was given by the pharmacists; from where the pharmacists obtained their information and what guidelines/recommendations they would value; and demographic information. Results: A total of 362 pharmacists from every state and territory within Australia completed the survey. Conversations with parents/carers about constipation at least once a week were reported by 85% of pharmacists, with the equivalent percentages for GOR and colic both being 76%. In the case of constipation, medication was recommended in 70% of cases, and a nutritional approach was recommended in 67% of cases. Medication was recommended in 81% of cases of suspected colic, significantly greater than nutritional advice at 50%. For possible GOR, recommendations were similar, with medication being suggested in 66% and nutritional advice in 68%. GOR guidelines were the most sought after, with 42% of pharmacists placing such guidelines as their number one need. Conclusions: This survey indicates the need for greater emphasis to be given to reassurance by health‐care professionals involved in the management of functional gastrointestinal disorders in infancy, as well as consideration of the construction of easily accessible, evidence‐based national guidelines. [ABSTRACT FROM AUTHOR]

Purpose: Constipation is commonly self-managed with over-the-counter laxatives. The study aim was to explore laxative choice, healthcare professional recommendations in laxative selection, and laxative effectiveness when laxatives are used for treatment and for prevention of constipation by community-dwelling adults. Methods: A nationally representative sample of community-dwelling adults in Australia was surveyed. Participants completed an online questionnaire. Z tests for differences in proportions were used to compare the proportion of laxatives by class when used either for treatment or for prevention of constipation by choice of laxative, healthcare professional recommendation, and perceived effectiveness. Results: The questionnaire was completed by 2024 participants. Laxatives were used by 37% (n = 747) of participants with 31.3% using laxatives for treatment, 19.3% for prevention, and 49.7% using laxatives for both purposes. The most common laxatives used for treatment and prevention were contact laxatives (39.8% and 31.1% respectively) and bulk-forming laxatives (34.3% and 44.6% respectively). Of all laxatives used, 56.4% of laxatives were chosen with healthcare professional recommendation, and 53.5% of laxatives were found effective. Conclusion: Laxatives were used both for treatment and for prevention of constipation. However, laxatives are often perceived to be ineffective and healthcare professionals are not always involved in laxative choice. Modified guidelines which address the use of laxatives for both treatment and prevention, and increased healthcare professional involvement in appropriate choice and use of laxatives, may be required to improve constipation management in the community. [ABSTRACT FROM AUTHOR]

Gastrointestinal (GI) problems affect half of Western populations. Symptoms can vary from frequent reflux to irritable bowel syndrome. The Nutrition Care (NC) Gut Relief Formula contains a combination of herbs and nutrients including curcumin, Aloe vera , slippery elm, guar gum, pectin, peppermint oil, and glutamine shown to benefit the GI system. The 16-week pre-post study tested the hypothesis that the NC Gut Relief Formula would be tolerable and effective in improving GI symptoms and gut health in adults with digestive disorders. A total of 43 participants completed the study. After a control phase, participants took 5 g/d and then 10 g/d of the formula for 4 weeks. GI symptoms and GI health were assessed by a series of validated questionnaires, for example, Leeds Dyspepsia Questionnaire, Bristol Stool Chart, Birmingham IBS Symptom Questionnaire, and by intestinal permeability and gut microbiota profile. The NC Gut Relief Formula significantly improved the frequency and severity of upper and lower GI symptoms by 60%-80%, including indigestion, heartburn, nausea, constipation or diarrhea, abdominal pain, and troublesome flatulence, and significantly improved physical functioning, energy levels, mood, and sleep by 60%-80%. All participants with normal stool, 90% with hard stool, and 66% with soft stool recovered from intestinal permeability, evident by normal lactulose to mannitol ratios. The NC Gut Relief Formula generally improved microbial profile, with a marked increase in Lactobacillus , Clostridium , and Faecalibacterium prausnitzii. Almost half of the participants with upper GI symptoms taking proton pump inhibitors for heartburn no longer required proton pump inhibitors at the end of the study. A third of participants were able to reintroduce food triggers, such as fermentable oligosaccharides, disaccharides, monosaccharides, and polyols garlic, onion, and beans, or reflux-causing acidic/spicy foods, for example, citrus, tomato, and caffeine, in their diet after 3 months without symptom aggravation. The NC Gut Relief Formula significantly improved GI symptoms and associated quality of life over 3 months while reducing intestinal permeability, improving the microbial profile, reducing the need for reflux medication, and enabling the consumption of previous food triggers. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to explore referral and triage pathways for paediatric patients referred to an Australian hospital with bowel dysfunction (isolated or mixed bowel and bladder).Methods: We conducted a retrospective audit of patients who attended their first clinic appointment during April to June 2014. Patients were included if they: (i) were a new patient referred for symptoms of constipation, soiling, daytime urinary incontinence or enuresis; and (ii) attended the encopresis, general medicine, continence, gastroenterology, paediatric surgery, urology, renal or Child and Adolescent Mental Health clinic. Patients with an organic cause (e.g. Hirschsprung disease) for their dysfunction were excluded.Results: Of 1485 new patients seen at our targeted clinics, 281 (18.9%) had symptoms of bowel and/or bladder dysfunction. After excluding patients aged younger than 3 years (n = 43) and those with isolated bladder dysfunction (n = 130), 56 were referred for isolated bowel dysfunction and 52 for mixed bowel and bladder dysfunction. The median wait time from referral to first appointment was 3.8 months. Median wait times varied across symptom groups (isolated bowel, 4.6 months; mixed 3.4 months) and clinics (encopresis, 7.7 months; general medicine, 2.5 months). Over a 12-month period, patients attended an average of 3.5 appointments (isolated bowel, mean 3 appointments; mixed, mean 4 appointments).Conclusion: Paediatric patients with symptoms of bowel and bladder dysfunction wait several months to be seen in a public tertiary referral hospital. Alternative pathways for care, such as community-based primary care, need to be explored to improve timely management. [ABSTRACT FROM AUTHOR]

Background: Bowel and bladder problems affect more than 50% of people with Multiple Sclerosis (MS). These problems have a large impact on quality of life and place a significant burden on health systems. Objectives: This study aimed to ascertain the frequency of bladder and bowel problems in a select Australian MS cohort and to investigate the relationships between level of disability, bladder and bowel problems, and fatigue. Methods: Questionnaires on the nature and severity of MS symptoms were distributed to clients attending an Australian MS centre. Log-binomial regression and multiple linear regression models were used to investigate relationships between disability, fatigue, and bladder and bowel problems. Results and conclusions: Of 167 questionnaires distributed, 136 were completed. Bladder problems were reported by 87 (74.4%) respondents, whilst 66 (48.9%) experienced functional constipation and 43 (31.9%) faecal incontinence. This frequency in our select Australian MS population is similar to that reported globally. There was a significant correlation between level of disability and: bladder problems (p = 0.015), faecal incontinence (p = 0.001), fatigue (p<0.001) and constipation (p = 0.016, relative risk: 1.16). Further investigation into the causal relationships between various MS symptoms may be beneficial in the development of novel therapeutic strategies for people with MS. [ABSTRACT FROM AUTHOR]

The antegrade colonic enema (ACE) is a useful management option for patients with difficult defaecatory disorders. However, it requires a high level of self-care, especially in the initial period when patients are establishing their irrigation routines. The following paper discusses the importance of patient selection, education, and outlines potential problems and solutions which may affect irrigation efficacy. [ABSTRACT FROM AUTHOR]

Aim: To describe the prevalence and consultation characteristics of enuresis in Australian paediatric practice and assess for changes over a period of 5 years.Methods: Data collected prospectively by paediatricians (outpatient settings) in 2008 and 2013, as part of the Children Attending Paediatricians Study. Consultations on children aged 5 years or over were included. Consultations in each cohort (2008 and 2013) categorised as either listing or not listing enuresis. Characteristics of the 'enuresis' versus 'non-enuresis' subgroup in each cohort were compared as were the enuresis subgroups 2008 versus 2013.Results: Of 4175 and 4181 consultations in 2008 and 2013, enuresis was reported in 178 (4.3% - 2008) and 193 (4.6% - 2013). Constipation and encopresis were more prevalent in the enuresis versus non-enuresis subgroups (46 (25.8%) vs. 136 (3.4%) for constipation and 25 (14%) vs. 65 (1.6%) for encopresis in 2008; 52 (26.9%) vs. 160 (4%) for constipation and 25 (13%) vs. 78 (2%) for encopresis in 2013, both P < 0.001). The enuresis subgroup had more referrals to multidisciplinary teams (19 (10.7%) vs. 148 (3.7%) - 2008 and 21 (10.9%) vs. 163 (4.1%) - 2013, both P < 0.001) and allied health professionals (29 (16.3%) vs. 230 (5.8%) - 2008; 27 (14%) vs. 178 (4.5%) - 2013, both P < 0.001).Conclusion: The overall frequency of presentation of children for management of enuresis was low. Prevalence/Consultation characteristics of enuresis were comparable over 5 years. Constipation and encopresis were significantly more prevalent in the enuresis subgroups. [ABSTRACT FROM AUTHOR]

Background: Opioid substitution treatment (OST) is often continued long-term and, therefore, opioid-associated symptoms are of interest. Symptoms associated with methadone maintenance treatment (MMT) in men are well described, but there are fewer reports concerning symptoms associated with buprenorphine maintenance treatment (BMT) and very few reports among women.Method: Recipients of BMT (n=113) and MMT (n=184), non-opioid users (n=105) and opioid users not receiving OST (n=87) completed the Patient Assessment of Constipation (PAC-SYM) and a general symptom checklist. Multivariate analysis included other potential moderators of opioid-associated symptoms.Findings: Opioid users reported a higher frequency and severity of symptoms than non-opioid users. Constipation, dry mouth, decreased appetite, sweating and fatigue were highly prevalent in the previous 30days (51-80%). Nausea, itchy skin, trouble urinating, menstrual problems, lightheadedness, blurred vision, heart racing were also common (30-50%). Non-OST opioid users had significantly higher frequency and severity than OST recipients of nausea, vomiting, diarrhoea, decreased appetite, sweating and itchy skin. Sweating was significantly more common in MMT than BMT. Constipation scores were higher in women, otherwise most sex differences were small. Higher PAC-SYM scores were associated with vomiting (OR=1.04) and sweating (OR=1.06). Cannabis use was associated with vomiting (OR=2.19). Constipation (OR=1.07), insomnia (OR=2.5) and depression (OR=2.82) were associated with fatigue.Conclusion: Men and women receiving OST report similarly high rates of somatic symptoms, though less than opioid users not receiving OST. There were few differences between BMT and MMT. Buprenorphine might be preferred where sweating is problematic. Several modifiable factors were identified. [ABSTRACT FROM AUTHOR]

Background: Palliative care guidelines recommend plain radiographs to assess constipation based on the presumption that visible fecal shadowing represents stool retention. Despite this, using plain radiographs in this way is not well validated. Objectives: This work's main aim was to compare clinicians' reports of fecal loading on radiographs. This study also compares clinicians' assessments with radio-opaque marker transit studies and patients' self-reported constipation symptoms. Methods: This study was conducted in a sample of 30 constipated palliative care patients taking laxatives who had all undergone colon transit studies and contemporaneous assessment of constipation symptoms with the Patient Assessment of Constipation Symptom (PAC-SYM) questionnaire. Four separate clinicians independently reported their opinions of fecal loading using a previously developed fecal loading scale. Participant details were summarized and pair-wise inter-rater agreement among all four raters were examined using the Bland-Altman approach. For the comparisons of the clinician-assigned fecal loading score between the radiographic assessment of the normal and slow colon transit time, the nonparametric approach of Mann-Whitney U tests were applied. Spearman's correlation analyses were employed to investigate the association between the clinician-assigned fecal loading score and the patient self-reported PAC-SYM score. Results: The results of this study are very similar to other studies conducted in functional constipation, highlighting systematic disagreement between observers. Further poor correlations were noted between fecal loading scores and colon transit times and with patient self-reported symptoms. Conclusion: These results, when considered with other work in chronic constipation, question the ongoing use of radiographs in the diagnosis of constipation. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to evaluate the impact of the structured bowel management program (SBMP) in an inpatient rehabilitation service.Method: Prospective recruitment of consecutive patients admitted to the rehabilitation unit (n = 100). Each patient was assessed for bowel dysfunction on admission and an individualised SBMP was instituted based on the clinical needs. The assessments were at baseline (T1), and discharge from ward (T2) using validated questionnaires. Program evaluation was at 3-month (T3) post-discharge.Results: Participants were predominantly female (52%), mean age 68 ± 13 years. Almost one-half (43%) had neurological conditions and 41% musculoskeletal problems. At admission, 62% self-reported bowel dysfunction, mainly constipation (82%) and faecal incontinence (FI) (11%). At T2, participants showed significant improvement in bowel habit and stool consistency (Bristol stool chart,p < 0.001); severity of bowel symptoms such as FI (Wexner FI score,p < 0.05); and impact on quality of life (FI Quality of Life (QoL) subscales: “life style” and “coping/behaviour”,p < 0.05 for both). All functional independent measure “motor” and “cognition” subscales improved significantly (p < 0.01 for all), with moderate to large effect sizes (r = 0.5–0.7). No adverse effects were reported.Conclusions: Bowel management should be a priority within rehabilitative services. Evidence-based SBMP can improve bowel symptoms and enhance overall QoL in patients admitted to rehabilitation settings.Implications for RehabilitationBowel dysfunction is common in inpatient rehabilitation settings.A structured bowel management program can improve bowel symptoms and enhance overall QoL in patient.Bowel management should be a priority for patients admitted to rehabilitation settings. [ABSTRACT FROM PUBLISHER]

The objective of this case report is to discuss how an infant's gut microbiome is affected by Caesarean (C-section) delivery and prenatal exposure to multiple antibiotics. Various studies have been reviewed to gather evidence-based information on the effects on gut health and how probiotics can play a role in improving dybiosis. The studying and application of nutritional and environmental medicine has been beneficial in my practice to have a positive impact on my patients. [ABSTRACT FROM AUTHOR]

Background Little is known about laxative use, the association of constipation with laxative use, risk factors for constipation and how each of these changes over time in the community-dwelling elderly. Objective The aim was to explore the prevalence of laxative use and of self-reported constipation, and identify risk factors (including age) associated with constipation, in a cohort of community-dwelling elderly residents. Methods Data from the Australian Longitudinal Study of Ageing (ALSA) was used to compare differences in constipation and laxative use in the community-dwelling elderly between 1992–1993 and 2003–2004. Results Relevant data was available for 239 ALSA participants. The prevalence of self-reported constipation increased from 14% in 1992–1993 to 21% in 2003–2004. There was a corresponding increase in the prevalence of laxative use from 6% to 15% over the same period. At both time points, females reported a higher prevalence of both constipation and laxative use however the female:male prevalence ratios decreased over time indicating higher increases in the prevalence of each among males. Persistent chronic constipation occurred in 9% of the cohort. The association between laxative use and self-reported constipation was poor and laxative use was associated with self-reported constipation in less than a third of cases. Conclusion The prevalence of both constipation and laxative use increases with age in the elderly, and these increases are greater for males than for females. Discrepancies between self-reported constipation and laxative use may suggest sub-optimal management of constipation in the community-dwelling elderly and further work is needed to fully understand this. [ABSTRACT FROM AUTHOR]

Aim To document current practice by dietitians in Australia and Canada in the nutrition management of Parkinson's disease. This will help identify priority areas for review and development of practice guidelines and direct future research. Methods Current practice in the phases of the Nutrition Care Plan was captured using an online survey distributed to Dietitians Association of Australia members and Practice-Based Evidence in Nutrition subscribers through their email newsletters. The results of the diagnosis, intervention and monitoring phases are presented here. Results Eighty-four dietitians responded. There was consistency in practice for nutrition issues that are encountered in other populations, such as malnutrition and constipation. There was more variation in practice in the nutrition issues that are more specific to Parkinson's disease, such as nutrition and meal interactions with medication. A lack of awareness of emerging treatments, such as deep brain stimulation surgery, appears to exist in the responding dietitians. Conclusions The variation in practice that was present for the nutrition issues specific to Parkinson's disease may reflect the lack of quality evidence and subsequently evidence-based guidelines in these areas. Work to provide background information about treatment options and to translate current evidence for the nutrition issues that are specific to Parkinson's disease into practice recommendations should be completed. [ABSTRACT FROM AUTHOR]

Aim Constipation is common, with severe symptoms requiring hospitalisation. Constipation can be a primary (present at admission and requires treatment or investigation) or principal (first listed) diagnosis for hospitalisation. In the USA, constipation is the second most common ambulatory care digestive diagnosis with total costs > US$1.7 billion/year. Incidence of hospitalisation for constipation in children peaks at toilet-training age. This study determined the burden of paediatric constipation to hospital care in Victoria, Australia. Method The Victorian Admitted Episodes Dataset was analysed retrospectively, examining hospital admissions with a primary diagnosis of constipation in the 7-year period 2002/2003 to 2008/2009. Results For children, constipation was recorded as a primary diagnosis in 8688 admissions (3.6/1000 of population). In-hospital prevalence was ∼1.0%. Mean length of stay was 4.4 days (median 1.0, range 0-993, standard deviation 16.7). There were 1121 readmissions in 668 children. Average treatment cost was A$4235/admission (median A$1461, range A$0-$278 816), with annual costs of ∼A$5 505 500. Children in the highest socio-economic area had ∼50% fewer admissions ( P < 0.0001). Predictors of readmission included age 10-18, male gender, rural residence, severe socio-economic disadvantage, public hospital, planned admission, longer length of stay and association with other medical conditions. Conclusions This study identified that constipation in children is a significant cost burden in Victoria (costing public hospitals ∼A$5.5 million/year). Hospitalisation in Victoria is 10-fold higher than in the USA with 10% readmissions within a month. We conclude that strategies aimed at reducing hospitalisation for constipation could result in significant savings for the paediatric public health system in Victoria, Australia. [ABSTRACT FROM AUTHOR]

Aim Constipation is a common medical condition that can lead to a loss of quality of life and increase health care costs. The incidence of constipation rises with increasing age in both sexes. In patients with chronic kidney disease (CKD) on peritoneal dialysis (PD), constipation is associated with peritoneal catheter malfunction and peritonitis, which can result in dialysis modality failure. For patients on PD, constipation needs to be dealt with in a proactive, preventative manner rather than when it becomes a problem. Method A search of electronic nursing, medical and allied health databases including Medline, Ovid, CINAHL, PubMed, Proquest, Wiley, Scopus, Cochrane Library and Evidence-Based Resources (Joanna Briggs Institute) was performed. Keywords used were constipation, peritoneal dialysis, dialysis, chronic kidney disease. Results Five research articles were found that were specific to patients on PD. A meta-analysis is included on the use of laxatives for chronic constipation as laxatives are widely used in PD patients. From the literature it is evident that constipation is a subjective term and, while laxative use is common, it is used as perceived by the patient and their requirements.There are compounding factors that contribute to constipation in the dialysis population such as diet and fluid restriction, use of medications such as phosphate binders and resins for controlling hyperkalaemia. Conclusion Although constipation can have serious consequences for PD patients, there has been little research on best management. Information on chronic constipation management in the general population is helpful, but more research is required, particularly in the PD patient group. [ABSTRACT FROM AUTHOR]

Presents a survey on the experience and response of older people towards constipation in Australia. Focus on the participants' experience over extreme constipation in the form of faecal impaction and obstipation; Discussion of the results regarding the treatment of impaction and obstipation; Aim to inform intervention selection for nurses and other health professionals.

Background: Gastrointestinal (GI) dysfunction is prevalent in Parkinson's disease (PD). Symptoms are evident throughout the disease course, affect the length of the GI tract and impact on patient quality of life and management. We clarify real-life differences in the frequency and severity of GI symptoms in a cohort of PD and healthy control (HC) subjects., Methods: 103 PD patients were compared to 81 HC subjects. Outcome measures collected from validated questionnaires included constipation severity, upper and lower GI symptoms and physical activity., Results: PD patients were three-times more likely to experience constipation than HC subjects, (78.6% vs 28.4%), exhibited a fourfold increase in constipation severity and formed harder stools. PD patients also reported increased symptoms of indigestion, nausea, excessive fullness and bloating, compared to the HCs. A higher mean Leeds Dyspepsia Questionnaire score for PD patients (8.3 (standard deviation (SD) 7.7) vs 4.6 (SD 6.1), p = 0.001)) indicated increased symptom severity. Chronic pain was more frequently reported and correlated with constipation and upper GI dysfunction, being more prevalent and severe in women. Physical activity was notably decreased in the PD cohort (1823.6 (± 1693.6) vs 2942.4 (± 2620.9) metabolic equivalent-minutes/week, p = 0.001) and correlated with constipation severity. PD therapies were associated with increased fullness and bloating and harder stools., Conclusions: PD patients report more prevalent and severe GI dysfunction, although our cohort comprised of many later-stage participants. Earlier recognition of GI dysfunction in PD provides the opportunity to direct treatment for chronic pain and constipation, promote physical activity and rationalise PD therapies for optimal patient care.

Background: Different definitions of constipation have been used to estimate its prevalence in the community but this creates difficulties when comparing results from various studies. This study explores the impact of different definitions on prevalence estimates in the same population and compares the performance of simple definitions with the Rome III criteria., Methods: The prevalence of constipation in a large nationally representative sample of community-dwelling adults was estimated using five simple definitions of constipation and compared with definitions based on the Rome III criteria. The sensitivity, specificity, and positive and negative predictive values, were calculated for each definition using the Rome III criteria as the gold standards for chronic and sub-chronic constipation., Results: Prevalence estimates for the five simple definitions ranged from 9.4 to 58.9%, while the prevalence estimates using the Rome III criteria were 24.0% (95%CI: 22.1, 25.9) for chronic constipation and 39.6% (95%CI: 37.5, 41.7) for sub-chronic constipation. None of the simple definitions were adequate compared to the Rome III criteria. Self-reported constipation over the past 12 months had the highest sensitivity (91.1%, 95%CI: 88.8, 93.4) and negative predictive value (94.5%, 95%CI: 93.1, 96.1) compared to the Rome III criteria for chronic constipation but an unacceptably low specificity (51.3%, 95%CI: 48.8, 53.8) and positive predictive value (37.1%, 95%CI: 34.4, 39.9)., Conclusions: The definition used to identify constipation within a population has a considerable impact on the prevalence estimate obtained. Simple definitions, commonly used in research, performed poorly compared with the Rome III criteria. Studies estimating population prevalence of constipation should use definitions based on the Rome criteria where possible.

The assessment of constipation symptoms is based on history and physical examination. However, the experience is highly subjective perhaps explaining why palliative medicine doctors continue to use plain abdominal radiographs as part of routine assessment of constipation. Previous studies have demonstrated poor agreement between clinicians with this work in palliative care, limited further by disparity of clinicians' experience and training. The aim of this work was to explore whether there was less variation in the assessments of faecal shadowing made by more experienced clinicians compared to their less experienced colleagues. This pragmatic study was conducted across six palliative care services in Sydney (NSW, Australia). Doctors of varying clinical experience were asked to independently report their opinions of the amount of shadowing seen on 10 plain abdominal radiographs all taken from cancer patients who self-identified themselves as constipated. There were 46 doctors of varying clinical experience who participated including qualified specialists, doctors in specialist training and lastly, doctors in their second- and third post-graduate years. Poor agreement was seen between the faecal shadowing scores allocated by doctors of similar experience and training (Fleiss's kappa (FK): RMO 0.05; registrar 0.06; specialist 0.11). Further, when the levels of agreement between groups were considered, no statistically significant differences were observed. Although the doctors did not agree on the appearance of the film, the majority felt they were able to extrapolate patients' experiences from the radiograph's appearance. As it remains challenging in palliative care to objectively assess and diagnose constipation by history and imaging, uniform and objective assessment and diagnostic criteria are required. It is likely that any agreed criteria will include a combination of imaging and history. The results suggest the use of radiographs alone to diagnose and assess constipation in palliative care represents low value care.

Background: Intestinal obstruction and constipation are common conditions in patients with advanced neoplasms. Diatrizoate Meglumine has been used in the management of both these conditions without good quality evidence of its effectiveness and safety., Aim: This audit aimed to assess the usage, effectiveness and adverse effects of Diatrizoate Meglumine for intestinal obstruction and constipation in patients with advanced neoplasms., Design: A retrospective chart review was undertaken. Descriptive statistics were utilised., Setting/participants: All patients with known advanced neoplasms admitted to Mater Health Services and St Vincent's Private Hospital Brisbane between January 2013 and October 2015; who were administered Diatrizoate Meglumine were included., Results: Seventy-one patients received Diatrizoate Meglumine. The most common diagnoses were ovarian or primary peritoneal neoplasms (33.8%). Diatrizoate Meglumine was most commonly used for intestinal obstruction (59.2%). The median dose used per patient episode was 50 mL (range: 15-500 mL). Thirty-two patients (45%) had imaging 4-24 h post-dose with Diatrizoate Meglumine being present in the large intestine in 75% of these images. Intestinal obstruction or constipation resolved in 90% of patients post-dose., Conclusion: Most clinicians used 50 mL of Diatrizoate Meglumine as a single dose and repeated imaging after 4-24 h. Diatrizoate Meglumine was well tolerated and may be effective in resolving intestinal obstruction and constipation in patients with advanced neoplasms. Quality controlled studies are needed to further guide the use of Diatrizoate Meglumine in intestinal obstruction and constipation in patients with advanced neoplasms.

Age-related changes in gastrointestinal symptoms need to be considered in peritoneal dialysis (PD) patients. A diminishing appetite is associated with aging and may be exacerbated by renal failure and PD treatment, meaning that attention to dietary adequacy is important in the older patient. Constipation and its treatment may increase the risk of peritonitis, but is important for comfort as well as trouble-free dialysis. Diverticulosis increases with age, and whilst there may be ethnic differences in the patterns of this condition, there is conflicting evidence regarding the risks of peritonitis associated with asymptomatic disease. Hernias, urinary incontinence, and prolapse are also common and made worse by PD, so it is important to know about these issues prior to starting. Whilst data around these topics are scant and some studies conflicting, further understanding these issues and considering mitigation strategies may improve technique survival and quality of life., (Copyright © 2015 International Society for Peritoneal Dialysis.)

Aim: To evaluate the effect of a new post-operative bowel protocol in total hip and total knee replacement patients., Background: Up to 65% of total hip and total knee replacement patients experience some degree of constipation post-operatively. A lack of robust evidence to guide bowel management and reduce constipation in this cohort was the impetus for this study., Design: A multisite cluster randomised trial in private secondary and tertiary hospitals., Methods: In total 331 patients were recruited across seven Australian hospitals over 13 months. Control participants (n = 171) received routine bowel management whilst intervention participants (n = 160) received bowel management as per the trial protocol., Results: Intervention patients took 6 days less than controls to return to normal bowel function, and were more than seven times more likely to return to normal bowel function by day 5 post operatively. Age, gender and length of pre-operative fasting had no effect on these outcomes., Conclusion: These results support the use of the Murdoch Bowel Protocol(®) for hip and knee replacement patients and may be relevant for other patient groups who experience opioid induced bowel dysfunction., (Copyright © 2014 Elsevier Ltd. All rights reserved.)