CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / O objetivo à avaliar a freqÃÃncia e o tamanho de anorretocele em mulheres adultas com evacuaÃÃo obstruÃda, correlacionando-os com paridade, idade e parÃmetros clÃnicos, utilizando cinedefecografia e eletromanometria. Foram avaliadas 45 mulheres adultas, com idade mÃdia de 46,3 anos (23-73) e sintomas de evacuaÃÃo obstruÃda, com escore mÃdio de 13,3 (6-23) pontos, segundo o Sistema de ClassificaÃÃo da Cleveland Clinic para ConstipaÃÃo (SCCC-C). Os parÃmetros avaliados foram idade, dados obstÃtricos, escore do, SCCC-C, dados manomÃtricos e achados de cinedefecografia.. Quinze (33,3%) pacientes eram nulÃparas, 7 (15,6%) primÃparas e 23 (51,1%) multÃparas, com mÃdia de 2,8 (0-11) partos vaginais por paciente. Dezoito (60,0%) pacientes haviam sido submetidas a parto vaginal com episiotomia, sendo verificado feto macrossÃmico em 14 (46,7%) e aplicaÃÃo de fÃrcipe em duas (6,7%) . Foi observada hipertonia esfincteriana em 14 (31,1%) e hipotonia em 8 (17,8%) pacientes. Foi identificado anismus em 13 (28,9%) pacientes. Foram demonstradas anorretoceles em 34 (75,6%) pacientes com tamanho (TAR) mÃdio de 24,8 mm (0 - 64). Foram verificados descenso perineal mÃvel acentuado (DPM) em 36 (80%) pacientes, prolapso mucoso (PM) em 17 (37,8%) e intussuscepÃÃo reto-anal (IRA) em doze (26,7%). NÃo houve correlaÃÃo entre anorretocele e hipertonia esfincteriana (p = 0,7171), anismus (p = 0,4666), IRA (p = 0,6991), PM (p= 0,2279), paridade comparando-se nulÃparas e multÃparas (p =1,000), episiotomia (p = 1,0000), uso de fÃrcipe (p = 1,0000), parto de feto macrossÃmico (p = 1,0000). NÃo houve correlaÃÃo entre TAR e PMR (p = 0,0883), PVM (p = 0,7327), paridade (p = 0,4987) e idade (p = 0,8603). Houve correlaÃÃo entre anorretocele e DPM (p = 0,0275), escore de constipaÃÃo do SCCC-C (p = 0,0082) e hipotonia esfincteriana (p = 0,0141). Conclui-se que a freqÃÃncia de anorretocele foi elevada, nÃo se correlacionou com paridade e idade, associando-se com hipotonia esfincteriana, DPM e constipaÃÃo. / The aim of this study is to analyse the frequence of anorectocele in adult women with obstructed defecation accordind to parity and age by means of cinedefaecography and anorectal eletromanometry. Forty-five adult women complaining of obstructed defecation were evaluated, with mean age of 46.3 years (23-72) and mean SCCC-C score of 13.3 points (6-23). Fifteen (33.3%) patients were nulliparous, seven (15,6%) primiparous and 23 (51,1%) multiparous, with mean parity per patient of 2.8 (0-11), considering only vaginal deliveries. Eighteen (60%) had a history of episiotomy, fourteen (46,7%) delivered macrossomic children and two (6,7%) had history of forceps-assisted delivery. Anal hipertony was verified in fourteen (31,1%) patients, while anal hipotony was present in eight (17,8%). Anismus was identified in thirteen (28,9%) patients. Anorecoceles were demonstrated in 34 (75,6%) patients, with mean size (TAR) of 24,8 mm (0-64). Thirty-six (80%) patients presented excessive perineal descent (DPM), rectal mucosal prolapse (PM) in 17 (37,8%) and rectoanal intussusception (IRA) in twelve (26,7%). There were no correlations between anorectocele and anal hipertony (p = 0,7171), anismus (p = 0,4666), IRA (p= 0,6991), PM (p = 0,2279), parity comparing nulliparous and multiparous patients (p = 1,000), episiotomy (p = 1,0000), forceps assistance (p = 1,0000) and delivery of macrossomic children (p = 1,0000). There were also no correlation between TAR and PMR (p =0,0883), PVM (p = 0,7327), parity (p = 0,4987) or age (p = 0,8603). There were correlations between anorectocele and DPM (p = 0,0275), score of SCCC-C (p =0,0082) and anal hipotony (p = 0,0141). In conclusion, anorectocele frequence is high and doesnât correlate to parity, age but correlates to anal hipotony, DPM andconstipation.

Orientadores: Elizete Aparecida Lomazi, Maria Ângela Reis de Góes Monteiro Antonio / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T20:54:47Z (GMT). No. of bitstreams: 1 Beleli_CeliaAparecidaValbon_M.pdf: 5243648 bytes, checksum: 811389ed5c344cf2a94b3617554d2537 (MD5) Previous issue date: 2013 / Resumo: Constipação é um sintoma comum na prática pediátrica. É usualmente definida em termos da dificuldade da passagem das fezes da consistência e frequência das evacuações. Uma dieta rica em fibras alimentares pode promover efeitos benéficos no tratamento da constipação. Além das fibras, alimentos funcionais, como os prebióticos, têm sido considerados úteis na regulação do hábito intestinal. Prebióticos são definidos como componentes alimentares não digeríveis, que afetam beneficamente o hospedeiro por estimularem de maneira seletiva o crescimento de bactérias potencialmente desejáveis no intestino, principalmente no cólon. Atualmente existem poucos ensaios clínicos avaliando prebióticos no tratamento da constipação em crianças. Este ensaio clínico teve como objetivo avaliar o efeito do Galactooligossacarídeo (GOS) em crianças constipadas. Um ensaio com duração de 75 dias, com intervenção do tipo duplo-cego, controlada por placebo e delineamento "cross over" com 2 sequências de avaliação e 2 tratamentos, placebo e galactooligossacarídeo, incluiu 20 crianças (4 a 16 anos) com constipação funcional definida pelos critérios de ROMA III. As crianças receberam 6g de GOS ou maltodextrina, as soluções foram ingeridas por 30 dias, seguidas de período de "washout" de 15 dias e, após, por mais 30 dias, utilizaram maltodextrina ou GOS, de maneira alternada com o produto ingerido nos primeiros 30 dias. O estudo foi montado segundo um delineamento crossover (GOS e PLACEBO). Onze pacientes foram avaliados de acordo com a sequência GOS/placebo e nove pacientes com a sequência PLACEBO/GOS. O escore de gravidade foi medido no início, 2ª e 4ª semanas em cada experimento. Escores clínicos, elaborados para esse ensaio, foram utilizados para avaliar o efeito dos produtos considerando: frequência das evacuações, presença de dor/desconforto/esforço na evacuação, consistência das fezes e perda de apetite/saciedade precoce. Os escores foram calculados no dia zero (D0), 15° dia (D15) e 30° dia (D30) de estudo, em cada fase do "cross over". Duas avaliações- - do tempo de trânsito oroanal com carvão ativado foram realizadas no D0 e D30 de cada sequência. Análise descritiva através de medidas de posição e dispersão foram realizadas para variáveis numéricas. Para a análise deste estudo utilizou-se ANOVA para medidas repetidas com transformação por postos. O nível de significância adotado para os testes estatísticos foi 5%. O GOS apresentou efeito significativo comparado ao placebo, diminuindo a consistência das fezes com p< 0,0001 e aumentando a frequência das evacuações, p=0,0014. Os valores dos testes de tempo de trânsito oroanal foram significantemente inferiores no período de uso do GOS com p <0,0001. A utilização do GOS em crianças com constipação funcional leve foi efetiva na melhora clínica dos sintomas dessa constipação e pode representar uma medida alternativa na terapêutica dessa condição / Abstract: Constipation is a common symptom in the pediatric clinics. It is usually defined in terms of difficulty of passage of faeces, faecal consistency and frequency of evacuation. A diet containing high amounts in fiber can promote beneficial effects constipation therapy. Beside the fiber, functional foods, such as prebiotics, have been considered useful to regulate bowel movements. Prebiotic is defined as nondigestible food components that affect the host for stimulating selectively growth of potentially beneficial bacteria in the intestines, specially the colon. Nowadays, there are few clinical trials evaluating prebiotic use for relieving constipation symptoms in children. This clinical trial aimed to evaluate the effect of Galactooligossacharide (GOS) on constipated children. The trial consisted of a 75-day period double blind intervention, controlled with placebo and cross over delimitation, with two sequences of evaluation and two treatments, placebo and galactooligossacharide. It included 20 children (4-16 years) with functional constipation defined by the ROMA III criteria. Children have received 6g of GOS or 6g Maltodextrin (placebo), the solution was ingested for 30 days, followed by a washout period of 15 days, and afterwards, 30 more days of GOS or Maltodextrin, alternately with the product ingested in the first 30 days. The study was designed according to crossover delimitation (GOS and Placebo). Eleven patients were evaluated according to the sequence GOS/placebo and nine patients with the sequence Placebo/GOS. A severity score was measured at the beginning, 2nd and 4th week in each experiment. Clinical scores, elaborated for this Trial, were used to evaluate the effect of the products considering: stool frequency, presence of pain/discomfort/effort during evacuation, consistency of stool and loss of appetite or early satiety. Scores were calculated at day zero (D0), 15th day (D15) and 30th day (D30) of the study, in each phase of the "crossover". Oroanal transit evaluation was performed on D0 and D30 of each sequence, by activated charcoal ingestion.- Descriptive analysis trough measures of position and dispersion were realized for numerical variables. ANOVA was used for the analysis of GOS effect. The significance level assumed for the statistical tests was 5%. The GOS presented significant effect compared to placebo, reducing the stool consistency p< 0,0001 and rising the stool frequency, p=0,0014. The value of the oroanal transit time were significant lower in GOS period, p<0,0001. GOS was effective at the improvement of mild constipation symptoms and may represent an alternative option for the therapy of this condition / Mestrado / Saude da Criança e do Adolescente / Mestra em Ciências

No description available.

Introduction Occult constipation (OC) – a subtype of constipation causing chronic or recurring gastrointestinal symptoms in the absence of classic symptoms of overt constipation – is a differential diagnosis that should be considered in patients with gastrointestinal symptoms of unclear etiology. Previous studies have investigated the symptomatology of OC and compared treatment regimens but to our knowledge there have been no studies comparing symptomatology with treatment outcomes to investigate whether some symptoms could be related to a better prognosis. Aim The aims of this study were to describe the symptoms present in patients with OC as well as investigate possible association between symptoms and treatment outcomes. Method This was a retrospective review of patient records including 88 patients under 18 years old with diagnosed constipation treated by Dr. Magnus Liljedahl at Gävle Hospital between 2017 and 2019. Results Out of the 88 patients included in the study, six (6.8 %) were classed as having suspected OC, 18 (20.5 %) confirmed OC and 44 (50.0 %) overt constipation. The most common symptoms in patients with OC were abdominal pain, fatigue, headache, back pain, and nausea. On follow-up, 16 patients with OC were symptom-free and three had symptoms remaining. When comparing symptomatology of OC with treatment outcomes no statistically significant differences were seen between the groups. Conclusion This study gives an overview of the symptoms seen in OC but limited information on any association between symptomatology and treatment outcomes. It does, however, emphasize that OC is a differential diagnosis in patients with gastrointestinal symptoms of unclear etiology.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban Institute of Technology, 2006. / Chronic Idiopathic Constipation (CIC) is a common patient complaint (Browning 1999) and as such is defined as : “Constipation” being the infrequent or difficult evacuation of faeces, “idiopathic”, denoting the condition occurs in the absence of any known cause and “chronic”, implying a problem that has persisted for a long time (Anderson 1989). It has been suggested that the bony subluxation or motion segment dysfunction in the spine, could produce these symptoms (e.g. altered visceral function) in the segmentally related visceral structures (Korr 1976, Nansel and Slazak 1995, Budgell 2000). In support of this three case reports in the literature suggest that spinal manipulative therapy to effect removal of these bony subluxations or motion segment dysfunctions, may relieve chronic idiopathic constipation (Hewitt 1993, Marko 1994, Redly 2000). However all three cases involved a single patient case analysis, where patients received spinal manipulation and a vast improvement in bowel function within three weeks of the initiation of the intervention was noted. Only one case report measured global wellbeing outcomes and was able to document a steady increase in the patient’s sense of wellbeing (Redly 2000). As a result of the above evidence in the literature, the researcher was led to the following hypotheses regarding spinal manipulation and chronic idiopathic constipation: • That spinal manipulation would affect a decrease in the subject’s abdominal pain intensity and level of constipation and an increase in the subject’s sense of wellbeing and spinal range of motion. • That placebo would affect an increase in the subject’s abdominal pain intensity and level of constipation and a decrease in the subject’s sense of wellbeing and spinal range of motion. • That spinal manipulation would be more effective than placebo in bringing about a decrease in the subject’s abdominal pain intensity and level of constipation and an increase in the subject’s sense of wellbeing and spinal range of motion. / M

Constipação é compreendida como um problema crônico relacionado a uma desordem multifuncional que afeta cerca de 20% da população mundial, sendo mais prevalente em mulheres e em idosos. Objetivos: Verificar a prevalência de constipação intestinal (CI) em idosos residentes no município de São Paulo, os fatores associados a essa condição e a relação dessa com sua qualidade de vida.Métodos: Trata-se de um estudo transversal que utilizou a base de dados do Estudo SABE (Saúde, Bem estar e Envelhecimento) do ano de 2010 com uma amostra probabilística de 1345 idosos ( 60 anos) de ambos os sexos, residentes no município de São Paulo. A regressão logística foi utilizada para identificar os fatores associados à CI. A análise da qualidade de vida se deu através de diferenças de médias das variáveis verificando seu impacto quando relacionada a CI. Scores acima da mediana, foram considerados como uma melhor QV. Resultados e Conclusão: Prevalência de CI em pessoas idosas é de 15,24%. Os fatores associados encontrados foram dor articular, osteoporose, uso de laxantes e opióides e, em mulheres, antidepressivos e diuréticos. Ingestão de embutidos e baixa consumo de líquidos (inferior a 3 copos por dia) também se mostraram risco para CI. Na análise da qualidade de vida, observou-se uma menor QVRS na avaliação do componente físico (CF) para os idosos constipados. Para ambos os sexos a média observada foi de 47,6 sendo nos homens, a média para CI 45,5 e nas mulheres, 43,7. A idade para o CF da QVRS, apresenta maior destaque, observando-se uma piora na QV do CF para os idosos constipados ao longo dos anos (45,2 e 38,2). / Introduction: Constipation is understood as a chronic problem related to a multi-functional disorder that affects about 20% of the world population, being more prevalent in women and in the elderly. Objective: Check the prevalence of constipation in elderly people living in São Paulo, the factors associated with this condition and the relationship of this with their quality of life. Methods: This is a cross-sectional study using the SABE Study database (Health, Wellbeing and Aging) of 2010 with a probabilistic sample of 1345 elderly ( 60 years) living in São Paulo city, both male and female. Logistic regression was used to identify factors associated with IC. The analysis of quality of life was through differences in mean variables checking its impact when related to IC. Scores above the median were considered as a better QOL. Results and Conclusion: IC prevalence in older people is 15.24%. The associated factors were joint pain, osteoporosis, use of laxatives and opioids, and in women, antidepressants and diuretics. Ingestion of embedded and low fluid intake (less than 3 cups per day) also showed risk for IC. In the analysis of quality of life, we observed a lower the HRQoL in evaluating the physical component (CF) for constipated elderly. For both sexes the observed average was 47.6. In men, the average for IC were 45.5 and women 43.7. The age for CF related to HRQoL, is more prominent, observing result in a diminished QOL for the elderly constipated over the years (45.2 and 38.2).

Introdução: Os idosos representam um segmento demográfico crescente tanto nos países desenvolvidos como nos em desenvolvimento. A constipação intestinal é um sintoma relatado por 24 a 40% desses indivíduos, afetando 26% dos homens e 34% das mulheres. O consumo de uma dieta rica em fibras alimentares e líquidos ajuda na diminuição das queixas relacionadas à constipação intestinal funcional. Os idosos necessitam de atenção especial com intervenções dietéticas diferenciadas por meio de ações educativas específicas. Objetivo: Analisar os efeitos do aconselhamento nutricional centrado no cliente, em idosos com constipação intestinal funcional matriculados em ambulatório geriátrico. Métodos: O estudo foi experimental do tipo ensaio clínico aleatorizado realizado entre abril de 2002 e novembro de 2003. Os idosos foram alocados em grupo intervenção (n=19) e controle (n=21) e os dois grupos participaram de sete consultas mensais. O aconselhamento nutricional centrado no cliente foi o modelo educativo adotado nas consultas com o grupo intervenção. Esse modelo considera a educação como o processo de ensino, treinamento e facilitação, que permite a troca de informações entre o educador e o educando, por meio de uma linguagem entendível, dentro de um ambiente que conduz ao aprendizado. As variáveis analisadas foram: Índice de Massa Corporal (IMC), prática de atividade física, consumo alimentar (energia, carboidratos, lipídios, grupo das frutas, das leguminosas, ingestão de líquidos, grupo dos cereais, consumo de fibras alimentares), uso de medicamentos total e laxante e as queixas que caracterizam a constipação intestinal funcional. O consumo alimentar foi avaliado pelo recordatório de 24 horas em medidas caseiras e a atividade física pelo Questionário de Baecke. Os dados foram analisados por meio da Análise de Variância de Medidas Repetidas (paramétrica ou não paramétrica) e método de Bonferroni. O nível de significância adotado para os testes foi de 5%. Resultados: Os idosos mais jovens do grupo controle eram mais pesados que os mais velhos desde o início do acompanhamento (p=0,001) e os dois grupos não alteraram a prática de atividade física. O grupo intervenção aumentou o consumo de líquidos a partir da quarta consulta até o final do seguimento quando comparado à entrevista inicial (p=0,031) e, no que se refere à ingestão de leguminosas, observou-se aumento no consumo na quarta (p=0,028) e sexta (p=0,042) consultas na comparação intergrupos. Em relação ao uso de medicamentos total, tanto o grupo controle quanto o grupo intervenção não modificaram seu consumo (p=0,650), por outro lado, o grupo controle consumiu mais laxantes durante o acompanhamento quando comparado ao grupo intervenção (p=0,018). Os dois grupos apresentaram redução das queixas que caracterizam a constipação intestinal funcional durante o seguimento. Conclusões: Os resultados desse estudo indicam que o aconselhamento centrado no cliente é eficaz como uma abordagem educativa para a mudança de comportamento alimentar e conseqüente diminuição das queixas intestinais que caracterizam a constipação intestinal funcional. / Introduction: The elderly represent a growing demographic line not only in the developed countries but also the ones in developing. The bowel constipation is a related symptom for 24 to 40% of those persons, affecting 26% men e 34% women. The consumption of diet full in dietary fibers and liquids helps on decreasing of claims related to functional intestinal constipation. The elderly need to a special attention with diversified dietetics intervention through specific educated actions. Objective: Analyze the effects of client-centered nutritional counseling, in elderly with functional bowel constipation enrolled in geriatric ambulatory. Methods: The studying was experimental as a randomized clinic trial carried out between April 2002 and November 2003. Elderly were assigned in intervention group (n=19) and control (n=21) and both groups participated of seven consults, one per month. The client-centered nutritional counseling was the educating model adopted in consults with the intervention group. That model takes into account the education as the process of teaching, training and make it easy, that allows the changing of information between the educator and the student through understanding language inside of a place that lead to learning. The variables analyzed were: Body Mass Index (BMI), practice of physical activity, food intake (energy, carbohydrate, lipids, group of fruits, group of leguminous, ingestion of liquids, group of cereals, intake of dietary fibers), using of total drugs and laxatives and the claims that characterizes the functional bowel constipation. The food intake was evaluated with 24 hours recall on household measures and the physical activity by Baecke Questionnaire. The data were examined critically through Analyses of Variance With Repeated Measures (parametric and non-parametric) and Bonferroni's method. The significance level adopted to the tests was 5%. Results: The youngest elderly of control group were heavier than the oldest since the beginning of accompanying (p=0,001) and both group didn't change the practicing of physical activity. The intervention group increased the consumption of liquids since of fourth consult up the ending of segment when compared with initial interview (p=0,031) and, in what refers to ingestion of leguminous, it was observed an increasing in consumption in forth (p=0,028) and sixth (p=0,042) consults in the comparing between the groups. Relating the using of total drugs, not only the control group but also intervention group didn't change their consumption (p=0,650), on the other hand, the control group consumed more laxatives during the accompanying when compared to intervention group (p=0,018). Both groups presented reduction of claims that characteristic the functional bowel constipation during the segment. Conclusions: The results of that studying indicate that the client-centered counseling is efficient as an educative approach to the changing of alimentary behavior and consequent reduction of intestinal claims that characterize the functional bowel constipation.

Orientador: Wellington Monteiro Machado / Banca: Carlos Roberto Victória / Banca: Sandra Maria Barbalho / Resumo: No presente estudo, foi avaliado a influência do sintoma predominante ou somatório de sintomas da constipação funcional (CF), na resposta desta ao tratamento com fibra dietética (FD). Setenta e um pacientes com diagnóstico de CF foram estudados, sete homens e sessenta e quatro mulheres, idade média de 44 anos. Todos previamente submetidos a rigoroso exame médico, para exclusão de constipação orgânica e a seguir entrevistados por meio de questionário e ficha clinica, onde eram caracterizados os diferentes sintomas da CF (infreqüência evacuatória, fezes ressecadas, esforço evacuatório, sensação de evacuação incompleta e auxílio digital para evacuação). Após esta fase, os pacientes eram colocados num programa de ingestão de fibra a base de farelo de trigo, onde doses crescentes eram adicionadas a cada 15 dias, até que melhorasse a constipação ou o caso fosse considerado como refratário a tratamento. A utilização de fibras apresentou resultados bastante favoráveis na maioria dos constipados (>85%). Não foi possível, contudo, detectar influência evidente dos sintomas predominantes ou do seu somatório, no desfecho do tratamento. Investigação paralela do tempo de duração da constipação, também não revelou associação entre duração e os efeitos da FD. É possível, que a pouca capacidade discriminativa dos diferentes sintomas sobre o efeito da FD na CF, encontrado em nosso estudo, tenha decorrido parcialmente do número limitado de indivíduos participantes de alguns dos subgrupos de sintoma. Outro fator contribuinte relevante, reconhecido por vários autores, é a dificuldade em separar subgrupos homogêneos de desordens funcionais baseado, quer em aspectos clínicos, fisiopatológicos ou psicopatológicos, o que certamente prejudica uma abordagem terapêutica específica. / Abstract: The aim of this study was to evaluate the influence of the main symptom or the amount of symptoms of functional constipation (FC) in response to the treatment with dietetic fiber (FD). Seventy one FC patients were studied, seven men and sixty four women, 44 years old in average. All patients were submitted to medical evaluation to the exclusion of organic constipation. After this they answered a clinical record and they where classified according to different symptoms (evacuate infrequency, parched fecal, evacuation effort, incomplete evacuation sensation, and digital assist to evacuate). After this phase the patients started a fiber consume program (with wheat bran). The fiber quantity was increased every 15 days, until the patients improved the constipation or the patient case was assumed unsuccessful to the treatment. The fiber consume showed favorable results in most of constipated patients (>85%). The detection of the influence of the predominant symptoms or in the sum of the symptoms to conclude the treatment was not clear. A parallel investigation of constipation time duration did also not reveal association between this time and the fiber effects. It is possible that the small number of individuals in this study did not allow the discrimination of different symptoms in the results with fiber utilization in FC. Another relevant issue is that it is difficult to separate functional disorder homogeneous subgroups based in clinical, physiopathologic or psychopathologic aspects, corroborating many authors. This difficulty also interferes with a suitable therapeutic intervention. / Mestre

Whole fruits, grains and vegetables contain thousands of potential disease-fighting, healthpromoting nutrients. These foods play a critical role in bowel function, especially in the elderly. Strong epidemiological evidence has shown that greater amounts of crude dietary fibre are associated with a lesser prevalence of constipation and other gastrointestinal disorders. Constipation usually presents as a variety of symptoms, including reduced frequency of defaecation and impacted forms of stools and/or increased effort required to defaecate. Constipation is a problem that could affect any person at any time in his or her life, but in the elderly is more prevalent.Although anecdotal reports and dietary advice have suggested the use of kiwifruit as a laxative in humans, there are, at present no data available to support this. Kiwifruit is reported as the most nutrient-rich of the top 27 fruits eaten in the world today. The laxative property of kiwifruit could provide a natural remedy for constipation and would be cheaper than the laxatives on the market.Objective: The main objective of this study was to investigate if kiwifruit can act as a laxative, especially in elderly people.Study Design and Methods: This study was carried out in two stages, as a pilot and then a main study. In the pilot study, 71 participants (aged 18 - 50y) were divided into Group I and Group II. Group I made no changes to their normal diet for a six weeks period, while Group II were asked to add one kiwifruit for every 30kg body weight per day to their diet for a six week period. After the six weeks, the two experimental groups crossed over, maintaining the dietary regime followed by the other group for a further six weeks. So each subject was his or her own control. Daily recording of the frequency and characteristics of the stool were made by the participants in a diary. In the main study, 42 participants (aged 60 years and over) carried out the same dietary regime as the pilot study subjects. Elderly subjects of Group I made no changes to their diet, but was asked to record their daily frequency and characteristics of their stool for 3weeks. Group II subjects ate one kiwifruit for every 30kg body weight per day for a period of 3weeks. After the three weeks period, the two groups crossed over.Results: It was found from the pilot study that kiwifruit consumption was associated with significant softening of the stool (P<0.001); a significant increase in bulking of the stool (P=0.034) and the ease of bowel movement was improved (P<0.001). For the main study, kiwifruit consumption also showed softening of the stool (P<0.001) and the ease of bowel movement was improved (P<0.001), there was a slight but significant increase in bowel frequency (P=0.012) and the bulking of stool (P=0.002).Conclusion: The results from this study provide evidence that consumption of kiwifruit enhances laxation and that bowel function can be improved through changes in diet, both for younger and elderly people.

Constipation is a serious problem in the pediatric population and often requires medical management with laxatives and enemas. Participants (2-10 years of age, n=13) with a history of mild constipation were assigned randomly to a fibre treatment or placebo group. After three weeks, subjects were crossed over to the other treatment. Pea hull fibre (4.0-7.6 g/day = 3.6-6.8 g/day of dietary fibre) was added to snack foods and an inulin supplement (5.0 g/day = 4.5 g/day of dietary fibre) was given, whereas the placebos were non-fortified snacks and maltodextrin (5.0 g/day).<p> Subjects or their parents documented stool frequency, stool consistency, occurrence of abdominal pain and intake of snack foods and the supplement. Over the final two weeks, there was a trend towards an increase in the mean number of daily bowel movements in the fibre treatment group compared to the placebo group (n=11, 0.68 ± 0.18 vs. 0.59 ± 0.26, p=0.064). Exclusion of one subject with diarrhea-type stools led to a significant difference between groups (n=10, 0.54 ± 0.18 vs. 0.67 ± 0.22, p=0.002). Stool consistency, using the Bristol Stool Form Rating Scale, showed no significant differences in stool consistency between groups (p=0.379) nor was there a difference in the incidences of abdominal pain (p=0.129). Not all subjects experienced abdominal pain. The inulin supplement (91% compliance rate; 1 serving per day) was consumed more consistently than were the snack foods fortified with pea hull fibre (77% compliance rate; 2 servings per day). There were no significant differences in the intake of the snacks or supplement when the placebo and treatment groups were compared. Energy intake was significantly lower during the fibre treatment period compared to placebo (n=12, 1307 ± 296 kcal/day vs. 1441 ± 285 kcal/day, p=0.035). The addition of pea hull fibre to typical snack foods and an inulin supplement to beverages were well accepted by children and no adverse effects were reported. Fibre fortification of snack foods with pea hull fibre and fibre supplementation of beverages with inulin may provide an alternative means to treat pediatric constipation.