title: The impact of laxative use upon symptoms in patients with proven slow transit constipation.
abstract: BACKGROUND
  Constipation severity is often defined by symptoms including feelings of complete evacuation, straining, stool frequency and consistency. These descriptors are mostly obtained in the absence of laxative use. For many constipated patients laxative usage is ubiquitous and long standing. Our aim was to determine the impact of laxative use upon the stereotypic constipation descriptors.
  
  
  METHODS
  Patients with confirmed slow transit constipation completed 3-week stool diaries, detailing stool frequency and form, straining, laxative use and pain and bloating scores. Each diary day was classified as being under laxative affect (laxative affected days) or not (laxative unaffected days). Unconditional logistic regression was used to assess the affects of laxatives on constipation symptoms.
  
  
  RESULTS
  Ninety four patients with scintigraphically confirmed slow transit constipation were enrolled in the study. These patients reported a stool frequency of 5.6 ± 4.3 bowel motions/week, only 21 patients reported <3 bowel motions/week. Similarly, 21 patients reported a predominant hard stool at defecation. The majority (90%) of patients reported regular straining. A regular feeling of complete evacuation was reported in just 7 patients. Daily pain and/or bloating were reported by 92% of patients. When compared with laxative unaffected days, on the laxative affected days patients had a higher stool frequency (OR 2.23; P <0.001) and were more likely to report loose stools (OR 1.64; P <0.009). Laxatives did not increase the number of bowel actions associated with a feeling of complete evacuation. Laxative use had no affect upon straining, pain or bloating scores
  
  
  CONCLUSIONS
  The reporting of frequent and loose stools with abdominal pain and/or bloating is common in patients with slow transit constipation. While laxative use is a significant contributor to altering stool frequency and form, laxatives have no apparent affect on pain or bloating or upon a patients feeling of complete evacuation. These factors need to be taken into account when using constipation symptoms to define this population.
authors.affiliation: Department of Human Physiology, School of Medicine, Flinders University, Adelaide, SA 5042, Australia. phil.dinning@flinders.edu.au
authors.forename: Phil G
authors.initials: PG
authors.lastname: Dinning
authors.forename: Linda
authors.initials: L
authors.lastname: Hunt
authors.forename: David Z
authors.initials: DZ
authors.lastname: Lubowski
authors.forename: Jamshid S
authors.initials: JS
authors.lastname: Kalantar
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Cook
authors.forename: Mike P
authors.initials: MP
authors.lastname: Jones
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D003248:Constipation / Q000188:drug therapy* / Q000503:physiopathology; D003672:Defecation; D005260:Female; D005772:Gastrointestinal Transit; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male
chemical_list: D054368:Laxatives
references.citation: Gastroenterol Clin North Am. 2007 Sep;36(3):687-711, x
references.pmid: 17950444
references.citation: Dis Colon Rectum. 2000 Oct;43(10):1419-26
references.pmid: 11052520
references.citation: Int J Colorectal Dis. 1992 Dec;7(4):173-6
references.pmid: 1293236
references.citation: J Nucl Med. 1990 Jun;31(6):985-9
references.pmid: 2348244
references.citation: Dis Colon Rectum. 1997 Aug;40(8):902-6
references.pmid: 9269805
references.citation: Gastroenterology. 2006 Apr;130(5):1480-91
references.pmid: 16678561
references.citation: Neurogastroenterol Motil. 2009 Dec;21 Suppl 2:41-54
references.pmid: 19824937
references.citation: Scand J Gastroenterol. 1997 Sep;32(9):920-4
references.pmid: 9299672
references.citation: Neurogastroenterol Motil. 2009 Dec;21 Suppl 2:1-8
references.pmid: 19824933
references.citation: Gut. 1978 Feb;19(2):146-50
references.pmid: 631630
references.citation: Gut. 1991 Aug;32(8):941-4
references.pmid: 1885077
references.citation: Gut. 1991 Jan;32(1):73-9
references.pmid: 1991641
references.citation: World J Gastroenterol. 2008 May 7;14(17):2631-8
references.pmid: 18461648
references.citation: Am J Gastroenterol. 1996 Jan;91(1):26-32
references.pmid: 8561138
references.citation: Br Med J. 1965 Nov 6;2(5470):1095-9
references.pmid: 5838411
references.citation: Am J Gastroenterol. 2005 Feb;100(2):362-72
references.pmid: 15667494
references.citation: Am J Gastroenterol. 2010 Feb;105(2):403-11
references.pmid: 19888202
references.citation: Gut. 1986 Feb;27(2):164-9
references.pmid: 3005140
references.citation: Gut. 1994 Jun;35(6):798-802
references.pmid: 8020809
references.citation: Gastroenterol Clin North Am. 2010 Sep;39(3):509-27
references.pmid: 20951915
references.citation: Dis Colon Rectum. 1999 Nov;42(11):1401-8; discussion 1408-10
references.pmid: 10566527
references.citation: Dis Colon Rectum. 1986 Oct;29(10):630-4
references.pmid: 3757701
references.citation: Gut. 1996 Jul;39(1):109-13
references.pmid: 8881820
references.citation: Therap Adv Gastroenterol. 2011 May;4(3):159-63
references.pmid: 21694799
references.citation: Am J Gastroenterol. 1999 Jan;94(1):131-8
references.pmid: 9934743
references.citation: Dig Dis Sci. 1989 Aug;34(8):1168-72
references.pmid: 2546720
references.citation: J Clin Gastroenterol. 2004 Sep;38(8):680-5
references.pmid: 15319652
references.citation: Neurogastroenterol Motil. 2010 Dec;22(12):e340-9
references.pmid: 20879994
references.citation: Dig Dis Sci. 1999 Jan;44(1):41-7
references.pmid: 9952221
references.citation: BMJ. 1990 Feb 17;300(6722):439-40
references.pmid: 2107897
references.citation: Gastroenterology. 2009 Feb;136(2):376-86
references.pmid: 19124023
references.citation: Am J Gastroenterol. 2005;100 Suppl 1:S1-4
references.pmid: 16008640
references.citation: Am J Gastroenterol. 2010 Oct;105(10):2228-34
references.pmid: 20502449
references.citation: Scand J Gastroenterol. 2008 Mar;43(3):262-9
references.pmid: 18266173
references.citation: Gut. 1996 Oct;39(4):551-5
references.pmid: 8944564
references.citation: Scand J Gastroenterol. 1997 Nov;32(11):1083-9
references.pmid: 9399387
references.citation: World J Gastroenterol. 2011 Mar 21;17(11):1468-74
references.pmid: 21472106
references.citation: Br Med J. 1976 Jul 24;2(6029):213-4
references.pmid: 974496
references.citation: J Pediatr. 2009 Feb;154(2):258-62
references.pmid: 18822430
references.citation: Gastroenterology. 1982 Sep;83(3):529-34
references.pmid: 7095360