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Constipation is occurs frequently in subjects with numerous chonic ailments including autism or autistic spectrum disorders and sometimes it's just labelled as "functional".
Overall, constipation is complex and an overall understanding including involvement of "big brain" (central nervous system), "our second brain" (enteric nervous system ) i.e. nervous system in gut) and brain-gut axis may explain why constipation is common among those suffering from autism/ASD.
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Food for thought about constipation
- Definitions of constipation vary and have been changing
- Constipation entails huge health care expense in overall population
- Interventions like dietary changes, fluid intake changes, bowel retraining regimen, massage, toilet posture, physical exercise and relaxation exercises provide safe and low cost options for most patients at least in early phases of management
- All fibers are not similar in metabolic actions and efficacy in bowel health including constipation
- All probiotics for constipation are not created equal
- Biofeedback is effective in constipation involving pelvic floor dyssynergia
- Massage therapy shows promise for management of functional constipation
- A large number of herbal products are being used for relief of constipation across the world and positive preclinical data lends plausibility to their effectiveness
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What is constipation?
Constipation is a symptomatic disorder and not a single disease per say. The prevalence rate of chronic constipation 15% to 20% in North America. A diverse variety of causes play a role in causing and sustaining this disordered bowel function.
While laxatives are used a lot, the multifactorial nature of constipation calls for an integrated or holistic approach to the overall management strategies.
Socioeconomic burden of constipation
- Constipation costs the health care system about $235 million per year with majority of them incurred (55%) from inpatient or in-hospital care.
- Emergency room cost component related to constipation is 23 percent, whereas 16%, and 6% of the expenses involve outpatient physicians and outpatient hospital settings
- Health care cost of children with constipation is $3.9 billion more than those without constipation.
- The definition of constipation is controversial
- Experts do not always agree upon what constipation really means; no wonder they keep revising the “consensus” definition or criteria as is evident from frequent revisions to the ROME criteria, now at Rome III
- Abnormally reduced stool frequency
- Painful or inadequacy of bowel movements
- Stool frequency may be “normal”
Encoparesis v constipation
Is It Leaky Gut or Leaky Gut Syndrome?
Encopresis refers to the stooling in inappropriate places, such as in clothing. In many but not all cases, the inappropriate passage of stools is a manifestation of an overflow incontinence that results from constipation.
Bio-psycho-social model of cause/mechanisms of constipation
No single cause can be pinpointed in majority of the patients. Just like for most functional disorders, the causeative mechanisms are explained by a broad bio-psycho-social model.
Thus the patient’s diseased state is a function of multiple intricate and inter-related factors, including genetic, environmental and psychosocial (e.g., life stress, psychologic state, coping, social support). The interactions between physiologic and psychologic factors are mediated via neurohumoral-immune system as well as the “brain–gut axis".
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Management strategy for constipation
The first step in managing constipation is to exclude a secondary cause for constipation. Both patient and the physician need to be realistic in their expectations since a condition that may have evolved over several years and decades may only be partially amenable to any therapeutic strategy.
Patients whose disorder is complicated by numerous diverse neurologic, biologic, psychologic, and social factors present a bigger challenge. Autism or autistic spectrum disorders are included in this category.
Modern drugs versus Integrative therapies
Since modern drug concept of a single targeted molecule is unlikely to have an impact on more than one factor, an integrated approach and/or use of combination therapies as is common in herbal medicine are more likely to attain success.
Many of the traditional medications/therapies have not undergone clinical trials however, probably because there is no patent involved that would make it interesting to the pharmaceutical companies. At the same time, it is important to ensure the safety of any therapeutic strategy based on existing empiric evidence, clinical experience, and preferably by scientific evidence.
Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health
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Is It Leaky Gut or Leaky Gut Syndrome?
Facebook Dr. Anil Home page AutismItsGutStupid
Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health
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