Patients with Concomitant Disease Neurologic Diseases

Constipation occurs commonly among patients with other diseases. In many instances, these conditions are the actual cause of an individual's constipation. For example, hypothyroidism is well known to cause constipation. In other cases the associations may be coincidence or may be the result of shared etiologic risk factors. To investigate this possibility, Johanson et al24 examined the Health Care Financing Administration (HCFA) database comprising 11 million Medicare beneficiaries to assess the association of constipation with other coexisting diseases. Not surprisingly, a number of recognized causes of constipation were found to be strongly associated with constipation including laxative abuse [odds ratio (OR) 18.8], Hirschsprung's disease (OR 6.5), intestinal obstruction (OR6.3), and hypothyroidism (OR 1.6). These findings served to corroborate the validity of the results.

Subsequent analysis revealed the largest group of conditions associated with constipation was neurologic and psychiatric disorders. A number of dramatic associations between constipation and neuropsychiatric and spinal diagnoses were observed, including herpes zoster (OR 5.1), depression (OR 6.5), multiple sclerosis (OR 3.9), Parkinson's disease (OR 3.2), vertebral column fracture (OR 10.1), and sprains and strains of the sacroiliac (OR 7.7) region.24 These associations suggest a potential link between central nervous system (CNS) function and constipation. Of particular interest was the strong association between herpes zoster and constipation. The zoster virus resides in the posterior root ganglia and can damage the ganglionic or spinal neurons. This association hints at a possible viral contribution to the onset of constipation among some patients with idiopathic constipation.

The prevalence of constipation among populations of patients with specific neurologic disease has also been studied. Hinds et al25 observed a constipation prevalence rate of 43%, among 280 outpatients with multiple sclerosis regardless of the severity of their disability. Han et al26 examined 72 spinal cord injury patients and found that 31% demonstrated severe constipation and 24% had difficulty evacuating their stool. Han et al further found that anal massage was used by 35%, abdominal massage by 29%, and manual digitation by 18% to assist bowel movements. De Looze et al27 also studied spinal cord injury patients. They found that 58% had constipation and required manual maneuvers or laxatives to facilitate successful defecation. Both quadriplegia, as compared to paraplegia, and anticholinergic medication usage significantly increased the risk of constipation, while the presence of intact rectal sensation did not reduce the risk. Looking at the association between constipation and neurologic disease from another perspective, a population-based study of a cohort of 51- to 75-year-old men in Hawaii found that less than one bowel movement per day predicted future onset of Parkinson's disease with an OR of 2.7 at 24 years of follow-up, with an average onset at 12 years after the initial assessment.28

Finally, a recent study of developmentally delayed individuals demonstrated a high prevalence of constipation among this population as well. Bohmer and colleagues29 studied the bowel habits and laxative use patterns of a random population of 215 individuals with IQs less than 50. The authors defined constipation as less than three bowel movements per week or the need to use laxatives more than three times per week. Even with this relatively strict definition of constipation, they found that 70% of these individuals were constipated. When compared to a control group, the constipated patients were more likely to have cerebral palsy, be nonambu-latory, use anticonvulsants, and have an IQ less than 35. This study further supports the possibility of a shared risk factor between individual neurologic diseases and constipation.

Constipation Prescription

Constipation Prescription

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

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