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Currently recommended treatments of childhood constipation are not evidence based: a systematic literature review on the effect of laxative treatment and dietary measures

The review found that there was insufficient evidence to show that laxatives were superior to placebo for treating constipation in children and that no one laxative could be recommended over any other. Although the review was limited in some respects, in particular the failure to address statistical heterogeneity, the authors' cautious conclusions appear justified.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Irritable Bowel Syndrome in Adults: Diagnosis and Management of Irritable Bowel Syndrome in Primary Care [Internet]

This guideline covers areas relevant to the diagnosis and management of irritable bowel syndrome (IBS) reflecting the complete patient journey, from the person presenting with IBS symptoms, positive diagnosis and management, targeted at symptom control. The guideline incorporates Cochrane reviews, published NICE clinical and public health guidance, Health Technology Assessment reports, systematic and health economic reviews produced by the National Collaborating Centre for Nursing and Supportive Care. Recommendations are based on clinical and cost effectiveness evidence, and where this is insufficient, the GDG used all available information sources and experience to make consensus recommendations using nominal group technique.

NICE Clinical Guidelines - National Collaborating Centre for Nursing and Supportive Care (UK).

Version: February 2008
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Constipation in Children and Young People: Diagnosis and Management of Idiopathic Childhood Constipation in Primary and Secondary Care

Without early diagnosis and treatment, an acute episode of constipation can lead to anal fissure and become chronic. By the time the child or young person is seen they may be in a vicious cycle. Children and young people and their families are often given conflicting advice and practice is inconsistent, making treatment potentially less effective and frustrating for all concerned. Early identification of constipation and effective treatment can improve outcomes for children and young people. This guideline provides strategies based on the best available evidence to support early identification, positive diagnosis and timely, effective management. Implementation of this guideline will provide a consistent, coordinated approach and will improve outcomes for children and young people.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: 2010
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Treatments for Constipation: A Review of Systematic Reviews [Internet]

Constipation has many definitions and is often described differently depending on the population queried. Physicians may define constipation as a reduction in the frequency of bowel movements to fewer than three times per week while patients identify more with the symptoms associated with constipation such as difficulty passing stool, hard stool consistency, feelings of abdominal cramping, and feelings of incomplete stool passage. Causes of constipation may be primary (idiopathic) or secondary to other factors such as diet, medication, or medical conditions. Constipation can affect anyone as a minor annoyance but up to a quarter of the population experiences it chronically or severely. It can substantially affect quality of life and be debilitating. It is estimated that between 2% to 27% of the population are affected depending upon the definition of constipation used.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: November 17, 2014
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Drug Class Review: Constipation Drugs: Final Report [Internet]

Chronic constipation is a disorder characterized by unsatisfactory defecation that results from infrequent stools, difficult stool passage, or both over a time period of at least 12 weeks. In this report, we review the general and comparative effectiveness, safety, and tolerability of drugs for chronic constipation. Our review covers the use of the following in adults and children with chronic constipation and Irritable Bowel Syndrome, constipation-predominant (IBS-C): docusate calcium, docusate sodium, lactulose, lubiprostone, polyethylene glycol 3350, psyllium, and tegaserod.

Drug Class Reviews - Oregon Health & Science University.

Version: September 2007
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Depression in Adults with a Chronic Physical Health Problem: Treatment and Management

This clinical guideline was commissioned by NICE and developed by the National Collaborating Centre for Mental Health. It sets out clear, evidenceand consensus-based recommendations for healthcare staff on how to treat and manage depression in adults with a chronic physical health problem.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2010
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Interventions for treating constipation in pregnancy

The term 'constipation' is defined as difficulty in passing stool and reduced frequency of bowel movements. It is characterised by discomfort, excessive straining, hard or lumpy stools, a sensation of incomplete evacuation, and infrequent bowel movements. Constipation is a common symptom experienced during pregnancy. This can result from a combination of factors, including changes in hormones during pregnancy affecting the digestive system, reduced physical activity and changes in dietary habits during pregnancy. In addition, as the baby grows it can press on the mother's intestines and cause digestive delays/obstructions.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Interventions for treating constipation in pregnancy

Mild laxatives help relieve constipation in pregnancy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Interventions for treating postpartum constipation

Women may experience constipation during the postpartum period. Consipation is defined as a functional bowel disorder that is characterised by pain and discomfort, straining, hard lumpy stools and a sense of incomplete bowel evacuation. Haemorrhoids, pain at the episiotomy site, effects of pregnancy hormones and iron supplementation can increase the risk of postpartum constipation; as can damage to the anal sphincter or pelvic floor muscles during childbirth. It is a source of concern to the new mother who is recovering from the stress of delivery. The discomfort does not only affect the mother's health, but also impacts on the new baby's well‐being, since it needs most of the mother's attention at this time.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Management of faecal incontinence and constipation in adults with central nervous system diseases

Individuals with central nervous system disease or injury have a much higher risk of loss of bowel control and severe constipation than other people. This is called neurogenic bowel dysfunction (NBD). It can be very difficult to treat constipation without causing bowel leakage, or to prevent bowel leakage without causing constipation. The time spent on emptying the bowel is nearly always much greater for these individuals. Bowel problems like this cause a lot of anxiety and distress and can reduce the quality of life of those who suffer them. This review of research about NBD could be of interest to individuals with any damage to the central nervous system caused by disease or injury, or present at birth, which has a long term effect on how their bowel works.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Gastrointestinal Complications (PDQ®): Health Professional Version

Expert-reviewed information summary about constipation, impaction, bowel obstruction, and diarrhea as complications of cancer or its treatment. The management of these problems is discussed.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: January 4, 2016

Lactose Intolerance and Health

We systematically reviewed evidence to determine lactose intolerance (LI) prevalence, bone health after dairy-exclusion diets, tolerable dose of lactose in subjects with diagnosed LI, and management.

Evidence Reports/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: February 2010
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Nutrition in Cancer Care (PDQ®): Health Professional Version

Expert-reviewed information summary about the causes and management of nutritional problems that occur in patients with cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: January 8, 2016

Antenatal Care: Routine Care for the Healthy Pregnant Woman

The original antenatal care guideline was published by NICE in 2003. Since then a number of important pieces of evidence have become available, particularly concerning gestational diabetes, haemoglobinopathy and ultrasound, so that the update was initiated. This update has also provided an opportunity to look at a number of aspects of antenatal care: the development of a method to assess women for whom additional care is necessary (the ‘antenatal assessment tool’), information giving to women, lifestyle (vitamin D supplementation, alcohol consumption), screening for the baby (use of ultrasound for gestational age assessment and screening for fetal abnormalities, methods for determining normal fetal growth, placenta praevia), and screening for the mother (haemoglobinopathy screening, gestational diabetes, pre-eclampsia and preterm labour, chlamydia).

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: March 2008
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Systematic Reviews in PubMed

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