Management of chronic constipation in comorbid conditions

Authors

  • Ravi Shankar Bagepally Department of Medical Gastroenterology, Yashoda Hospitals, Secunderabad, Telangana, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20221500

Keywords:

Constipation, Diabetes, Hypertension, Hypothyroidism, Management

Abstract

Constipation is a common clinical problem in India. It is also a secondary condition in many disorders. This article focused on clinical assessment and evidence-based treatment options for managing chronic constipation in various disorders. A literature search of published medical reports in the English language was performed using PubMed from inception to 2021. The selected articles satisfied the following inclusion criteria: involved human subjects over the age of 18 years and reported at least one of the comorbidities among hypothyroidism, diabetes and hypertension along with chronic constipation. Chronic constipation is one of the most common gastrointestinal symptoms observed in patients with diabetes, hypertension or hyperthyroidism. Constipation in diabetic patients can occur due to several factors such as autonomic dysfunction, dietary habits and medications. The change in the intestinal microbiota because of chronic constipation can also induce cardiovascular events. The association between these changes and increased blood pressure resulting in hypertension had been discussed in this review. Additionally, the link between disturbed gastrointestinal motility and chronic constipation leading to hypothyroidism had also been explored. Furthermore, the pharmacological and non-pharmacological management of chronic constipation in patients with diabetes, hypertension, and hypothyroidism have been discussed. Emphasis has been placed on the changes required in the existing treatment options for diabetes, hypertension and hypothyroidism along with the use of laxatives, dietary fibers, bulking agents, lifestyle changes and other interventions to manage chronic comorbid constipation.

References

Gray JR. What is chronic constipation? Definition and diagnosis. Can J Gastroenterol. 2011;25:7-10.

Abbott. Fact sheet: 22% of Indian adults suffer from constipation: Abbott Gut Health Survey. Available at: https://www.abbott.in/media-center/press-releases/indian-adults-suffer-from-const. Accessed on 15 February 2022.

Sanchez MI, Bercik P. Epidemiology and burden of chronic constipation. Can J Gastroenterol. 2011;25:11-5.

Rajput M, Saini SK. Prevalence of constipation among the general population: a community-based survey from India. Gastroenterol Nurs. 2014;37(6):425-9.

Awad RA. Neurogenic bowel dysfunction in patients with spinal cord injury, myelomeningocele, multiple sclerosis and Parkinson’s disease. World J Gastroenterol. 2011;17(46):5035-48.

Salmoirago-Blotcher E, Crawford S, Jackson E, Ockene J, Ockene I. Constipation and risk of cardiovascular disease among postmenopausal women. Am J Med. 2011;124(8):714-23.

Oh JH, Choi MG, Kang MI, Lee KM, Kim JI, Kim BW, et al. The prevalence of gastrointestinal symptoms in patients with non-insulin dependent diabetes mellitus. Korean J Intern Med. 2009;24(4):309-17.

Ghoshal UC, Sachdeva S, Pratap N, Verma A, Karyampudi A, Misra A, et al. Indian consensus on chronic constipation in adults: a joint position statement of the Indian Motility and Functional Diseases Association and the Indian Society of Gastroenterology. Indian J Gastroenterol. 2018;37(6):526-44.

Elliott WJ, Ram CVS. Calcium channel blockers. J Clin Hypertens (Greenwich). 2011;13(9):687-9.

Webster LR. Opioid-induced constipation. Pain Med. 2015;16(1):16-21.

Battle WM, Snape WJ, Alavi A, Cohen S, Braunstein S. Colonic dysfunction in diabetes mellitus. Gastroenterology. 1980;79(6):1217-21.

Yaylali O, Kirac S, Yilmaz M, Akin F, Yuksel D, Demirkan N, et al. Does hypothyroidism affect gastrointestinal motility? Gastroenterol Res Pract. 2009;2009:529802.

Camilleri M, Ford AC, Mawe GM, Dinning PG, Rao SS, Chey WD, et al. Chronic constipation. Nat Rev Dis Primer. 2017;3:17095.

Hosseinzadeh ST, Poorsaadati S, Radkani B, Forootan M. Psychological disorders in patients with chronic constipation. Gastroenterol Hepatol Bed Bench. 2011;4(3):159-63.

International Diabetes Federation. Fact sheet: South-East Asia. Available at: https://idf.org/our-network/regions-members/south-east-asia/members/94-india.html. Accessed on 15 February 2022.

India state-level disease burden initiative diabetes collaborators. The increasing burden of diabetes and variations among the states of India: the Global burden of disease study 1990-2016. Lancet Glob Health. 2018;6(12):1352-62.

Prasad VG, Abraham P. Management of chronic constipation in patients with diabetes mellitus. Indian J Gastroenterol. 2017;36(1):11-22.

Piper MS, Saad RJ. Diabetes mellitus and the colon. Curr Treat Options Gastroenterol. 2017;15(4):460-74.

Ray G. Evaluation of the symptom of constipation in Indian patients. J Clin Diagn Res. 2016;10(4):1-3.

Neto MFL, Moreno KAM, Graça RCC, Lima SMG. Constipation prevalence in diabetic patients. J Coloproctol (Rio de Janeiro). 2014;34(2):83-6.

Fujishiro M, Kushiyama A, Yamazaki H, Kaneko S, Koketsu Y, Yamamotoya T, et al. Gastrointestinal symptom prevalence depends on disease duration and gastrointestinal region in type 2 diabetes mellitus. World J Gastroenterol. 2017;23(36):6694-704.

Andresen V, Layer P. Medical therapy of constipation: current standards and beyond. Visc Med. 2018;34(2):123-7.

Medspace. Fact sheet: Sodium picosulfate/magnesium oxide/anhydrous citric acid (Rx). Available at: https://reference.medscape.com/drug/prepopik-clenpiq-sodium-picosulfate-magnesium-oxide-anhydrous-citric-acid-999761#10. Accessed on 15 February 2022.

Ishiyama Y, Hoshide S, Mizuno H, Kario K. Constipation-induced pressor effects as triggers for cardiovascular events. J Clin Hypertens (Greenwich). 2019;21(3):421-5.

Yang T, Santisteban MM, Rodriguez V, Li E, Ahmari N, Carvajal JM, et al. Gut dysbiosis is linked to hypertension. Hypertension. 2015;65(6):1331-40.

Koeth RA, Wang Z, Levison BS, Buffa JA, Org E, Sheehy BT, et al. Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis. Nat Med. 2013;19(5):576-85.

Wang Z, Klipfell E, Bennett BJ, Koeth R, Levison BS, DuGar B, et al. Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease. Nature. 2011;472(7341):57-63.

Vermorken A, Andrès E, Cui Y. Chronic constipation-a warning sign for oxidative stress? Aliment Pharmacol Ther. 2015;42(3):385-6.

Linz D, Wirth K, Linz W, Heuer HO, Frick W, Hofmeister A, et al. Antihypertensive and laxative effects by pharmacological inhibition of sodium-proton-exchanger subtype 3-mediated sodium absorption in the gut. Hypertension. 2012;60(6):1560-7.

Rooprai R, Bhatt N, Sainani R, Mayabhate MM. Prevalence of functional constipation and constipation-predominant irritable bowel syndrome in Indian patients with constipation. Int J Basic Clin Pharmacol. 2017;6(2):275-85.

Norton C. Constipation in older patients: effects on quality of life. Br J Nurs. 2006;15(4):188-92.

Kurniawan I, Simadibrata M. Management of chronic constipation in the elderly. Acta Med Indones. 2011;43(3):195-205.

Healthline. Fact sheet: Over-the-counter and prescription constipation medications. Available at: https://www.healthline.com/health/constipation-medication#otc-medications. Accessed on 15 February 2022.

Kanzaria H, Dave AR, Manani Y, Agravat P. A clinical study on hypothyroidism and its management with vidanga. Eur J Biomed Pharm Sci. 2017;4:241-4.

Gwee KA, Ghoshal UC, Gonlachanvit S, Chua ASB, Myung SJ, Rajindrajith S, et al. Primary care management of chronic constipation in Asia: the ANMA chronic constipation tool. J Neurogastroenterol Motil. 2013;19(2):149-60.

Mody R, Guerin A, Fok B, Lasch KL, Zhou Z, Wu EQ, et al. Prevalence and risk of developing comorbid conditions in patients with chronic constipation. Curr Med Res Opin. 2014;30(12):2505-13.

Enck P, Leinert J, Smid M, Köhler T, Schwille-Kiuntke J. Somatic comorbidity in chronic constipation: more data from the GECCO study. Gastroenterol Res Pract. 2016;2016:5939238.

Bennett WE, Heuckeroth RO. Hypothyroidism is a rare cause of isolated constipation: 5-year review of all thyroid tests in a pediatric gastroenterology office. J Pediatr Gastroenterol Nutr. 2012;54(2):285-7.

Zachariah SK, Raja N. Spontaneous perforation of the colon and hypothyroidism: report of a case and review of literature. Gastroenterology Res. 2010;3(3):147-9.

Pustorino S, Foti M, Calipari G, Pustorino E, Ferraro R, Guerrisi O, et al. Thyroid-intestinal motility interactions summary. Minerva Gastroenterol Dietol. 2004;50(4):305-15.

Gut sense. Fact sheet: Is constipation dangerous for my health? Available at: https://www.gutsense.org/constipation/danger.html. Accessed on 15 February 2022.

Forefront health. Fact sheet: Hypothyroidism and constipation: how to “safely” clear up constipation without the dangers of excessive fiber. Available at: http://www.forefronthealth.com/hypothyroidism-and-constipation/. Accessed on 16 February 2022.

Very well health. Constipation and Hypothyroidism. Available at: https://www.verywellhealth.com/constipation-and-hypothyroidism-3233144. Accessed on 16 February 2022.

Vriesman MH, Koppen IJN, Camilleri M, DiLorenzo C, Benninga MA. Management of functional constipation in children and adults. Nat Rev Gastroenterol Hepatol. 2020;17(1):21-39.

Ghoshal UC. Chronic constipation in Rome IV era: The Indian perspective. Indian J Gastroenterol. 2017;36(3):163-73.

Talebi S, Karimifar M, Heidari Z, Mohammadi H, Asbaghi O, Hadi A, et al. The effect of synbiotic supplementation on anthropometric indices, appetite, and constipation in people with hypothyroidism: a randomized, double‐blind, placebo‐controlled trial. Phytother Res. 2020;34(10):2712-20.

Beck DE. Evaluation and management of constipation. Ochsner J. 2008;8(1):25-31.

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Published

2022-05-27

How to Cite

Bagepally, R. S. (2022). Management of chronic constipation in comorbid conditions. International Journal of Research in Medical Sciences, 10(6), 1382–1389. https://doi.org/10.18203/2320-6012.ijrms20221500

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Section

Review Articles