• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.26 no.2
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• pp.127-133
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• 2023

Purpose: Dyssynergic defecation (DSD) is one of the important causes of chronic constipation in children. We aimed to analyze the clinical features, diagnostic test results, and treatments for DSD in children. Methods: Children diagnosed with DSD using fluoroscopic defecography were enrolled in this study. Clinical data, including the results of colon transit time (CTT) test and biofeedback (BF) therapy, were collected from medical records retrospectively. Results: Nineteen children were enrolled. The median age was 9 years (6-18 years), the median frequency of bowel movement was 1/7 days (1-10 days), the median duration of constipation was 7.0 years (2-18 years), the median age of onset of constipation was 2.5 years (1-11 years). In the CTT test, outlet obstruction type was noted in 10/18 (55.6%), slow transit type in 5/18 (27.8%), and normal transit in 1/18 (5.6%). The median CTT was 52 hours (40-142 hours). Initial medical therapy was performed with the polyethylene glycol 4000, and the response was good in 9/19 (47.4%), fair in 9/19 (47.4%), and poor in 1/19 (5.0%). BF was performed in 8/19, with good results in 6/8 (75.0%) children and failure in 2/8 (25.0%) children. After long-term medical therapy (11/19), 3/5 showed good response with medication alone, 6/8 showed good response with BF and medication combined. Conclusion: DSD should be considered as a cause of chronic constipation in children, especially in those with abnormal CTT test results. BF combined with medical therapy is effective even with age-limited cooperation.

• Journal of Sasang Constitutional Medicine
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• v.35 no.4
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• pp.72-85
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• 2023

Objectives This study was aimed to report a significant improvement of a CKD patient's constipation, diagnosed as 'Soyang type yin depletion pattern' based on Sasang constitutional medicine. Methods The patient had treatment with Sasang constitutional medicine. The treatment was executed three times everyday from January 6th to February 21st of 2023. Clinical improvement was evaluated with Bristol Stool Form Scale, the number of defecation per week, average stool weight per day, the degree of abdominal discomfort and abdomen x-ray. Results The symptoms of constipation, abdominal discomfort, appetite and delirium were improved. Conclusion After the treatment with Sasang constitutional medicine, constipation, abdominal discomfort, appetite, delirium and the general condition of the patient also had improved.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.12 no.sup1
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• pp.111-117
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• 2009

Constipation is one of the most common symptoms that a child visits pediatrician. The general approach to the child with functional constipation includes the following steps; disimpaction, maintenance and withdrawal of medication. There are many drugs which can be applied to children; osmotic agents (lactulose, sorbitol, magnesium hydroxide/citrate, polyethylene glycol with/without electrolytes, sodium phosphate, glycerin), stimulants (senna, bisacodyl, caster oil), lubricant (mineral oil), bulking agent (psyllium, cellulose, glucomannan). At each stage of treatment, one or some of these drug can be applied to the purpose. The author tries to summarize recent studies on drugs for constipation in child, and finally introduces new dugs for constipation which is under investigation.

• Journal of Korea Association of Health Promotion
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• v.3 no.1
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• pp.55-61
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• 2005

Functional constipation is regarded as a long-standing symptomatic manifestation of abnormal defecation expressed by either a reduced frequency of bowel movements and /or an altered act of evacuation. Patients with constipation can be treated with laxatives, diets and regular habits. Thorough evaluation of functional constipation is considered in those in whom conservative treatment with dietary advice and use of laxatives fails. Patients with normal colonic transit and normal anorectal function may only need reassurance, education and dietary advice with fiber supplementation. For constipated patients in whom such treatment modalities fail, laxatives including bulk-forming and osmotic agents may be used Although most laxatives, if used intermittently, are relatively safe, they must be chosen bearing in mind possible side effects, patient compliance and their action mechanisms. A subgroup of patients with slow transit through the colon ay be unresponsive to conventional laxatives, and, in these subjects, a trial with enteroprokinetics and sometimes stimulant laxatives should be attempted. This article presents our view of the assessment and pharmacologic treatment of functional constipation.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.18 no.3
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• pp.193-196
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• 2015

A fecaloma refers to a mass of accumulated feces that is much harder than a mass associated with fecal impaction. Fecalomas are usually found in the rectosigmoid area. A 10-year-old male with chronic constipation was admitted because of increasing abdominal pain. An abdominal computed tomography scan and a simple abdominal x-ray revealed rapidly evolving mechanical obstruction in the small intestine. Most of the fecalomas are successfully treated by conservative methods such as laxatives, enemas and rectal evacuation. When conservative treatments have failed, surgical intervention may be needed. In this case, an emergency operation was performed and a $4{\times}3{\times}2.5cm$ fecaloma was found in the distal ileum. We thus report a case of ileal fecaloma inducing small bowel obstruction in a patient with chronic constipation, who required surgical intervention. When symptoms of acute small intestinal obstruction develop in a patient with chronic constipation, a fecaloma should be considered in differential diagnosis.

• The Journal of Internal Korean Medicine
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• v.39 no.5
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• pp.1052-1060
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• 2018

Objectives: This study reports the effect of herbal medicine to replace laxatives for patients with chronic constipation. Methods: The patients who took laxatives due to long-term constipation were prescribed herbal medicine instead. We assessed whether they could defecate without laxatives and if their bowel habits improved using only herbal medicine. Results: The use of herbal medicine instead of laxatives improved patients' defecation and reduced symptoms such as hard stool, difficulty during defecation, and sensation of incomplete evacuation. Conclusions: Through two cases, we found that herbal medicine is effective for patients who are dissatisfied with laxatives.

• Herbal Formula Science
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• v.23 no.1
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• pp.161-169
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• 2015

Objectives : This study is aimed to report the outcomes of the treatment of a patient with chronic anal fissure during a 8-year period. Methods : Basic patient’s data was analyzed as a CARE guideline. And related psychological state was measured with BAI, STAI-X-II test. Results : The treatment is based on Shanghanlun and the patient reported better outcomes. The main symptoms of the patient were chronic constipation, blood in the stool. The main clinical findings were that the patient’s symptoms got worse during the examination period because of the anxiety of the exam. And loss of appetite and digestive disorders are due to Jue-Yin-Bing(厥陰病) and the clue of bleeding can be found in article 375 in Shanghanlun. The main diagnoses was chronic anal fissure and main interventions were Chijasi-tang according to article 375 in Shanghanlun and counseling on anxiety. As a results bleeding has stopped after taking herbal medicine and constipation has been treated at the same time. After 6 months, the patient performed BAI, STAI-X-II test and scores got lowered indicating decreasing anxiety level. Conclusion : Chijasi-tang with counseling achieved valid positive results to the patient with chronic anal fissure.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.21 no.3
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• pp.196-202
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• 2018

Purpose: Treatment of chronic constipation and fecal impaction is usually outpatient and requires high or frequent doses of laxatives. However, there are children who fail outpatient treatments, sometimes repeatedly, and are ultimately hospitalized. We sought to compare the characteristics of the children who failed outpatient treatment and needed inpatient treatment vs those who achieved success with outpatient treatment, in an effort to identify attributes that might be associated with a higher likelihood towards hospitalization. Methods: In this retrospective cohort study, we reviewed the medical records of all patients aged 0 to 21 years, with chronic functional constipation and fecal impaction seen in the pediatric gastroenterology clinic over a period of 2 years. Results: Total of 188 patients met inclusion criteria. While 69.2% were successfully treated outpatient (referred to as the outpatient group), 30.9% failed outpatient treatment and were hospitalized (referred to as the inpatient group). The characteristics of the inpatient group including age at onset of $3.6{\pm}3.6years$ (p=0.02); black ethnicity (odds ratio [OR] 4.31, 95% confidence interval [95% CI] 2.04-9.09); p<0.001); prematurity (OR 2.39, 95% CI 1.09-5.26; p=0.02]; developmental delay (OR 2.20, 95% CI 1.12-4.33; p=0.02); overflow incontinence (OR 2.26, 95% CI 1.12-4.53, p=0.02); picky eating habits (OR 2.02, 95% CI 1.00-4.08; p=0.04); number of ROME III criteria met: median 4, interquartile range 3-5 (p=0.04) and $13{\pm}13.7$ constipation related prior encounters (p=0.001), were significantly different from the outpatient group. Conclusion: Identification of these characteristics may be helpful in anticipating challenges and potential barriers to effective outpatient treatment.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.24 no.2
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• pp.238-243
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• 2021

Caudal regression syndrome (CRS) is a rare neural tube defect that affects the terminal spinal segment, manifesting as neurological deficits and structural anomalies in the lower body. We report a case of a 31-month-old boy presenting with constipation who had long been considered to have functional constipation but was finally confirmed to have CRS. Small, flat buttocks with bilateral buttock dimples and a short intergluteal cleft were identified on close examination. Plain radiographs of the abdomen, retrospectively reviewed, revealed the absence of the distal sacrum and the coccyx. During the 5-year follow-up period, we could find his long-term clinical course showing bowel and bladder dysfunction without progressive neurologic deficits. We present this case to highlight the fact that a precise physical examination, along with a close evaluation of plain radiographs encompassing the sacrum, is necessary with a strong suspicion of spinal dysraphism when confronting a child with chronic constipation despite the absence of neurologic deficits or gross structural anomalies.

• The Journal of Internal Korean Medicine
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• v.16 no.1
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• pp.40-61
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• 1995

This study was performed to investigate concept, systoms, causes of disease, pathogenic mechanisms, therapies and precriptions about senile constipation through the successive medical literature, recent chinese medical literature and chinese medical joumals. Senile constipation seems to be applicable to dryness syndrom and constipation of insufficiency type, have something to do with kidney(the most), lung, spleen and large intestine. The most principal cause of disease is yin-fluid, the rest deficiency of qi, insufficiency of yang, stagnation of qi and retention of fever etc. There are enriching the blood and moistening dryness in principal therapy, the rest are invigorating qi and loosing the bowel, warming and invigorating the spleen and kidney, regulating the flow of qi and promoting the stagnancy of qi and expelling the pathogenic heat etc. In prescriptions there are Yunjangtang, Jengaektang, Hwanggitang, Jechunjeon, Yukmatang and Majainhwan as the causes of disease, meanwhile are Yungjang-tang, Jechunjeon and Majainhwan in the vulgaris prescriptions. And in medical herbs there are nourishing yin medicines as Rhizoma rehmanniac, Radix ophiopogonis and Radix scrophulariae etc., invigorating qi medicines as Radix astragali, Radix codonopsitis and Radix polygoni multiflori etc, invigorating yang medicines as Caulis cistanchis and Semen psoraleae etc., promoting qi circulating medicines as Radix saussurea, Lignum aquilariae and Radix linderae etc., and reducing fever and therapeutic method to keep the adverse qi flowing downward medicines as Semen cannabis, Rhizoma rhei, Fructus immaturus ponciri, and Cortex magnoliae etc.. Meantime Rhizoma rehmanniae, Radix ophiopogonis, Caulis cistanchis, Radix angelicae gigantis, Semen cannabis, Semen biotae, Semen pruni japonicae and Semen persicae in principal herb-medicines. In clinical reports the process of disease was between 10 to 20 years, the evacuation cycle between 4 to 7 days, generally possessed chronic diseases as hypertension, diabetes, arteriosclerosis and cerebro- vascular disorders etc. and the efficiency rate was more than 90%. The senile constipation is occured in succession or promoted by chronic diseases as obesity, hypertension, diabetes, arteriosclerosis. hrperlipemia, cerebro- vascular disorders etc., so diet-regulating, adequate exercise, proper evacuation-habit and psychologic rest etc. are important more than medicine-treatments.