All Title Author
Keywords Abstract

PLOS ONE  2013 

New Onset of Constipation during Long-Term Physical Inactivity: A Proof-of-Concept Study on the Immobility-Induced Bowel Changes

DOI: 10.1371/journal.pone.0072608

Full-Text   Cite this paper   Add to My Lib

Abstract:

Background The pathophysiological mechanisms underlining constipation are incompletely understood, but prolonged bed rest is commonly considered a relevant determinant. Aims Our primary aim was to study the effect of long-term physical inactivity on determining a new onset of constipation. Secondary aim were the evaluation of changes in stool frequency, bowel function and symptoms induced by this prolonged physical inactivity. Methods Ten healthy men underwent a 7-day run-in followed by 35-day study of experimentally-controlled bed rest. The study was sponsored by the Italian Space Agency. The onset of constipation was evaluated according to Rome III criteria for functional constipation. Abdominal bloating, flatulence, pain and urgency were assessed by a 100mm Visual Analog Scales and bowel function by adjectival scales (Bristol Stool Form Scale, ease of passage of stool and sense of incomplete evacuation). Daily measurements of bowel movements was summarized on a weekly score. Pre and post bed rest Quality of Life (SF-36), general health (Goldberg’s General Health) and depression mood (Zung scale) questionnaires were administered. Results New onset of functional constipation fulfilling Rome III criteria was found in 60% (6/10) of participants (p=0.03). The score of flatulence significantly increased whilst the stool frequency significantly decreased during the week-by-week comparisons period (repeated-measures ANOVA, p=0.02 and p=0.001, respectively). Stool consistency and bowel symptoms were not influenced by prolonged physical inactivity. In addition, no significant changes were observed in general health, in mood state and in quality of life at the end of bed rest Conclusions Our results provide evidence that prolonged physical inactivity is relevant etiology in functional constipation in healthy individuals. The common clinical suggestion of early mobilization in bedridden patients is supported as well.

References

[1]  Lembo A, Camilleri M (2003) Chronic constipation. N Engl J Med 349: 1360-1368. doi:10.1056/NEJMra020995. PubMed: 14523145.
[2]  Simrén M (2002) Physical activity and the gastrointestinal tract. Eur J Gastroenterol Hepatol 14: 1053-1056. doi:10.1097/00042737-200210000-00003. PubMed: 12362093.
[3]  Bingham SA, Cummings JH (1989) Effect of exercise and physical fitness on large intestinal function. Gastroenterology 97: 1389–1399. PubMed: 2583406.
[4]  Brown WJ, Mishra G, Lee C, Bauman A (2000) Leisure time physical activity in Australian women: Relationship with well being and symptoms. Res Q Exerc Sport 71: 206–216. doi:10.1080/02701367.2000.10608901. PubMed: 10999258.
[5]  Sullivan SN, Wong C, Heidenheim P (1994) Does running cause gastrointestinal symptoms? A survey of 93 randomly selected runners compared with controls. N Z Med J 107: 328–331. PubMed: 8072729.
[6]  Müller-Lissner S (2002) General geriatrics and gastroenterology: constipation and faecal incontinence. Best Pract Res Clin Gastroenterol 16: 115–133. doi:10.1053/bega.2002.0269. PubMed: 11977932.
[7]  Nassar AP Jr, Queiroz da Silva FM, de Cleva R (2009) Constipation in intensive care unit: Incidence and risk factors. J Crit Care 24: 630.e9–630.e12. PubMed: 19592200.
[8]  Su Y,?Zhang X,?Zeng J, Pei Z,?Cheung RT et al. (2009) New-onset constipation atacute stageafter first stroke incidence, risk factors, and impact on the stroke outcome. Stroke 40: 1304-1309. doi:10.1161/STROKEAHA.108.534776. PubMed: 19228840.
[9]  Cardin F, Minicuci N, Teggia Droghi A, Inelmen EM, Sergi G et al. (2010) Constipation in the acutely hospitalized older patients. Arch Gerontol Geriatr 50: 277-281. doi:10.1016/j.archger.2009.04.007. PubMed: 19481272.
[10]  Donald IP, Smith RG, Cruikshank JG, Elton RA, Stoddart ME (1985) A study of constipation in the elderly living at home. Gerontology 31: 112–118. doi:10.1159/000212689. PubMed: 2987086.
[11]  Kinnunen O (1991) Study of constipation in a geriatric hospital, day hospital, old people’s home and at home. Aging 3: 161–170. PubMed: 1911905.
[12]  Kondo T, Toda Y (1993) Brief physical inactivity prolongs colonic transit time in elderly active men. Int J Sports Med 14: 465–467. doi:10.1055/s-2007-1021212. PubMed: 8300274.
[13]  Meshkinpour H, Selod S, Movahedi H, Nami N, James N et al. (1998) Effects of regular exercise in management of chronic idiopathic constipation. Dig Dis Sci 43: 2379–2383. doi:10.1023/A:1026609610466. PubMed: 9824122.
[14]  Peters HPF, De Vries WR, Vanberge-Henegouwen GP, Akkermans LMA (2001) Potential benefits and hazards of physical activity and exercise on the gastrointestinal tract. Gut 48: 435-439. doi:10.1136/gut.48.3.435. PubMed: 11171839.
[15]  McCallum IJD, Ong S, Mercer-Jones M (2009) Chronic constipation in adults. BMJ 338: 763-766. doi:10.1136/bmj.b763. PubMed: 19304766.
[16]  Longstreth GF, Thompson WG, Chey WD, Nami N, James N et al. (2006) Functional bowel disorders. Gastroenterology 130: 1480-1491. doi:10.1053/j.gastro.2005.11.061. PubMed: 16678561.
[17]  Biolo G,?Agostini F,?Simunic B, Sturma M,?Torelli L et al. (2008) Positive energy balance is associated with accelerated muscle atrophy and increased erythrocyte glutathione turnover during 5 wk of bed rest. Am J Clin Nutr 88: 950–958. PubMed: 18842781.
[18]  Rittweger J, Simunic B, Bilancio G, De Santo NG,?Cirillo M et al. (2009) Bone loss in the lower leg during 35 days of bed rest is predominantly from the cortical compartment. Bone 44: 612-618. doi:10.1016/j.bone.2009.01.001. PubMed: 19168165.
[19]  Kozàkovà M, Malshi E, Morizzo C, Pedri S,?Santini F et al. (2011) Impact of prolonged cardiac unloading on left ventricular mass and longitudinal myocardial performance: an experimental bed rest study in humans. J Hypertens 29: 137-143. doi:10.1097/00004872-201106001-00337. PubMed: 20842050.
[20]  Mazzucco S, Agostini F, Mangogna A, Cattin L, Biolo G (2010) Prolonged inactivity up-regulates cholesteryl ester transfer protein independently of body fat changes in humans. J Clin Endocrinol Metab 95: 2508-2512. doi:10.1210/jc.2009-2561. PubMed: 20228163.
[21]  Kim HJ, Camilleri M, McKinzie S, Lempke MB, Burton DD et al. (2003) A randomized controller trial of prebiotico, VSL # 3, on gut transit and symptoms in diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther 17: 895-904. doi:10.1046/j.1365-2036.2003.01543.x. PubMed: 12656692.
[22]  Cappello C, Tremolaterra F, Pascariello A, Ciacci C,?Iovino P (2013) A randomised clinical trial (RCT) of a symbiotic mixture in patients with irritable bowel syndrome (IBS): effects on symptoms, colonic transit and quality of life. Int J Colorectal Dis 28: 349-358. doi:10.1007/s00384-012-1552-1. PubMed: 22885882.
[23]  Lewis SJ, Heaton KW (1997) Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol 32: 920-924. doi:10.3109/00365529709011203. PubMed: 9299672.
[24]  Pevalin DJ (2000) Multiple applications of the GHQ-12 in a general population sample: an investigation of long-term retest effects. Soc Psychiatry Psychiatr Epidemiol 35: 508-512. doi:10.1007/s001270050272. PubMed: 11197926.
[25]  Zung WW (1973) From art to science. Arch Gen Psychiatry 29: 328–337. doi:10.1001/archpsyc.1973.04200030026004. PubMed: 4724142.
[26]  Amato G, Limongelli P, Pascariello A, Rossetti G, Del Genio G et al. (2008) Association between persistent symptoms and long-term quality of life after laparoscopic total fundoplication. Am J Surg 196: 582-586. doi:10.1016/j.amjsurg.2007.09.038. PubMed: 18466859.
[27]  Ware JE Jr, Kosinski M, Keller SD (1994) Physical and Mental Component Summary Scales: A User’s Manual. Boston: the Health Institute, New England Medical Center.
[28]  Apolone G, Mosconi P (1998) The Italian SF-36 Health Survey: translation, validation and norming. J Clin Epidemiol 51: 1025–1036. doi:10.1016/S0895-4356(98)00094-8. PubMed: 9817120.
[29]  Leung FW (2007) Etiologic factors of chronic constipation: review of the scientific evidence. Dig Dis Sci 52: 313-316. doi:10.1007/s10620-006-9298-7. PubMed: 17219073.
[30]  Harari D, Martin FC, Buttery A, O’Neill S, Hopper A (2007) The older persons’ assessment and liaison team “OPAL”: evaluation and comprehensive geriatric assessment in acute medical inpatient. Age Ageing 36: 670-675. doi:10.1093/ageing/afm089. PubMed: 17656421.
[31]  Charach G, Greenstein A, Rabinovich P, Groskopf I, Weintraub M (2001) Alleviating constipation in the elderly improves lower urinary tract symptoms. Gerontology 47: 72-76. doi:10.1159/000052776. PubMed: 11287730.
[32]  Berardi RS, Lee S (1983) Stercoraceous perforation of the colon. Report of a case. Dis Colon Rectum 26: 283: 286.
[33]  Bliss MR (2004) The rationale for sitting elderly patients in hospital out of bed for long periods is medically unsubstantiated and detrimental to their recovery. Med Hypotheses 62: 471-478. doi:10.1016/j.mehy.2004.01.002. PubMed: 15050092.
[34]  O’Donnell LJD, Virjee J, Heaton KW (1990) Detection of pseudodiarrhoea by simple clinical assessment of intestinal transit rate. BMJ 300: 439–440. doi:10.1136/bmj.300.6722.439. PubMed: 2107897.
[35]  Saad RJ,?Rao SS,?Koch KL, Kuo B,?Parkman HP et al. (2010) Do stool form and frequency correlate with whole-gut and colonic transit? Results from a multicenter study in constipated individuals and healthy controls. Am J Gastroenterol 105: 403–411. doi:10.1038/ajg.2009.612. PubMed: 19888202.
[36]  Feyen BJ, Rao SS (2007) Functional disorders of defecation: evaluation and treatment. Curr Treat Options Gastroenterol 10: 221-230. doi:10.1007/s11938-007-0015-1. PubMed: 17547860.
[37]  Ross DG (1995) Altered bowel elimination patterns among hospitalized elderly and middle-aged persons: quantitative results. Orthop Nurs 14: 25–31. doi:10.1097/00006416-199505000-00006. PubMed: 7761116.
[38]  Klauser AG, Voderholzer WA, Heinrich CA, Schindlbeck NE, Müller-Lissner SA (1990) Behavioral modification of colonic function. Can constipation be learned? Dig Dis Sci 35: 1271-1275. doi:10.1007/BF01536418. PubMed: 2209294.
[39]  Shim L, Prott G, Hansen RD, Simmons LE, Kellow JE et al. (2010) Prolonged Balloon Expulsion Is Predictive of Abdominal Distension in Bloating. Am J Gastroenterol 105: 883–887. doi:10.1038/ajg.2010.54. PubMed: 20179695.
[40]  Harder H, Serra J, Azpiroz F, Malagelada JR (2004) Reflex control of intestinal gas dynamics and tolerance in humans. Am J Physiol Gastrointest Liver Physiol 286: G89–G94. PubMed: 12946941.
[41]  Dainese R, Serra J, Azpiroz F, Malagelada JR (2003) Influence of body posture on intestinal transit of gas. Gut 52: 971–974. doi:10.1136/gut.52.7.971. PubMed: 12801953.
[42]  Tremolaterra F, Pascariello A, Gallotta S, Ciacci C, Iovino P (2013) Colonic gas transit in patients with bloating: the effect of an electromechanical stimulator of the abdominal wall. Tech Coloproctol 17: 405-410. doi:10.1007/s10151-012-0951-1. PubMed: 23207715.
[43]  Guarino M, Cheng L, Cicala M, Ripetti V, Biancani P et al. (2011) Progesterone receptors and serotonin levels in colon epithelial cells from females with slow transit constipation. Neurogastroenterol Motil 23: 575-e210. doi:10.1111/j.1365-2982.2011.01705.x. PubMed: 21481100.

Full-Text

comments powered by Disqus