Preview

Ambulatornaya khirurgiya = Ambulatory Surgery (Russia)

Advanced search

A modern approach to the treatment of constipation and preparation of the intestine for instrumental examination in outpatient coloproctology

https://doi.org/10.21518/akh2025-010

Abstract

Introduction. In outpatient coloproctology, when preparing the intestine for instrumental examination, great importance is attached to the effective treatment of constipation and elimination of coprostasis.

Aim. To evaluate the clinical efficacy of the rectal laxative to eliminate coprostasis caused by constipation and prepare the distal intestine for instrumental examination in coloproctological patients on an outpatient basis.

Materials and methods. The study included 135 patients with manifestations of functional constipation and coprostasis, who were divided into three groups. Oral laxatives were used empirically in 41 patients (group 1). Standard cleansing enemas were performed in 49 patients (group 2). The combined rectal laxative (group 3) was used in 45 patients. The quality of training was assessed based on the unified Boston scale. Subsequently, within the study groups, in 60 patients with various proctological diseases of benign genesis, identified during the examination, complex treatment of constipation was continued using the above methods.

Results and discussion. The best results were obtained when preparing the intestines with the rectal laxative (group 3 patients). In this case, the number of patients with excellent and good training was 95.5%. At the stage of subsequent treatment of chronic constipation in coloproctological patients with laxative Lax Canon, 82.8% of patients showed the formation of softened feces (type 3 and 4) or mushy stools (type 5 and 6). This exceeded similar results obtained in the treatment of constipation with oral laxatives (39.3%) or through cleansing enemas (74.7%).

Conclusion. The use of the rectal laxative in outpatient coloproctology makes it possible to eliminate coprostasis as quickly as possible and in 95.5% of cases to qualitatively prepare the distal parts of the intestine for instrumental examination. The use of the studied agent in the complex treatment of chronic constipation in proctological patients helps restore regular bowel movements in 90% of cases.

About the Authors

B. M. Belik
Rostov State Medical University
Russian Federation

Boris M. Belik, Dr. Sci. (Med.), Head of the Department of General Surgery,

29, Nakhichevansky Lane, Rostov-on-Don, 344022



A. N. Kovalev
Rostov State Medical University; International Medical Center “URO-PRO”
Russian Federation

Aleksei N. Kovalev, Cand. Sci. (Med.), Assistant of the Department of General Surgery, 29, Nakhichevansky Lane, Rostov-on-Don, 344022;

Surgeon-Coloproctologist, 108, Imeni 40-letia Pobedy St., Krasnodar, 350901



V. F. Babiev
Rostov State Medical University
Russian Federation

Vartan F. Babiev, Cand. Sci. (Med.), Associate Professor of the Department of General Surgery,

29, Nakhichevansky Lane, Rostov-on-Don, 344022



V. V. Skorlyakov
Rostov State Medical University
Russian Federation

Vladimir V. Skorlyakov, Cand. Sci. (Med.), Associate Professor of the Department of General Surgery, 

29, Nakhichevansky Lane, Rostov-on-Don, 344022



S. Yu. Efanov
Rostov State Medical University
Russian Federation

Sergey Yu. Efanov, Cand. Sci. (Med.), Associate Professor of the Department of General Surgery, 

29, Nakhichevansky Lane, Rostov-on-Don, 344022



A. V. Rodakov
Rostov State Medical University
Russian Federation

Andrei V. Rodakov, Cand. Sci. (Med.), Assistant of the Department of General Surgery,

29, Nakhichevansky Lane, Rostov-on-Don, 344022



A. A. Kryachko
International Medical Center “URO-PRO”
Russian Federation

Andrei A. Kryachko, Cand. Sci. (Med.), Surgeon-Coloproctologist,

108, Imeni 40-letia Pobedy St., Krasnodar, 350901



References

1. Iturrino JC, Lemdo JA. Constipation. In: Feldman M, Friedman LS, Brandt LG (eds.). Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 11th ed. Elsevier; 2020, pp. 250–275.

2. Drossman DA. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Feature and Rome IV. Gastroenterology. 2016;150(6):1262–1279.e2. https://doi.org/10.1053/j.gastro.2016.02.032.

3. Miyamoto T, Nakajima I, Arikawa T, Miyamoto M. Bowel movement frequency and difficult defecation using constipation assessment scale in patients with isolated REM sleep behavior disorder. Clin Park Relat Disord. 2024;11:100269. https://doi.org/10.1016/j.prdoa.2024.100269.

4. Belik BM, Kovalev AN. Modern approach to the choice oflaxative agent in surgical interventions in outpatient coloproctology. Ambulatornaya Khirurgiya. 2022;19(2):96–105. (In Russ.) https://doi.org/10.21518/1995-1477-2022-19-2-96-105.

5. Mearin F, Lacy BE, Chang L, Chey WD, Lembo AJ, Simren M, Spiller R et al. Bowel Disorders. Gastroenterology. 2016;150(6):1393–1407.e5. https://doi.org/10.1053/j.gastro.2016.02.031.

6. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional Bowel Disorders. Gastroenterology. 2016;130(5):1480–1491. https://doi.org/10.1053/j.gastro.2005.11.061.

7. Bharucha AE, Lacy BE. Mechanisms, Evaluation, and Management of Chronic Constipation. Gastroenterology. 2020;158(5):1232–1249.e3. https://doi.org/10.1053/j.gastro.2019.12.034.

8. Шелыгин ЮА (ред.). Колопроктология: клинические рекомендации. М.: ГЭОТАР-Медиа; 2020. 528 с. Режим доступа: https://static-ru.insales.ru/files/1/5442/12145986/original/koloprokt_klin_rek.pdf.

9. Zhao Q, Chen YY, Xu DQ, Yue SJ, Fu RJ, Yang J et al. Action Mode of Gut Motility, Fluid and Electrolyte Transport in Chronic Constipation. Front Pharmacol. 2021;12:630249. https://doi.org/10.3389/fphar.2021.630249.

10. Shakurov AF, Karpukhin OYu. Surgery of chronic colonic constipation. Creative Surgery and Oncology. 2013;(1-2):67–72. (In Russ.) Available at: https://www.surgonco.ru/jour/article/view/161.

11. Galagudza MM, Uspensky YuP, Fominykh YuA, Butko DYu. Pathogenesis of Disorders of the Motor Function of the Large Intestine in Functional Constipation. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2024;34(3):24–37. (In Russ.) https://doi.org/10.22416/1382-4376-2024-34-3-24-37.

12. Lazebnik LB, Turkina SV, Golovanova EV, Ardatskaya MD, Ostroumova OD, Komissarenko IA et al. Constipation in adults. Experimental and Clinical Gastroenterology. 2020;175(3):10–33. (In Russ.) https://doi.org/10.31146/1682-8658-ecg-175-3-10-33.

13. Privorotsky VF, Luppova NE. Modern approaches to the treatment of functional constipation in children. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2009;19(1):59–65. (In Russ.) Available at: http://old-gastro-j.ru/article/63-sovremennyie-podhodyi-klecheniyu-funktsionalnyih-zaporov-u-detey-br/show/full/.

14. Forootan M, Bagheri N, Darvishi M. Chronic constipation: A review ofliterature. Medicine. 2018;97(20):e10631. https://doi.org/10.1097/MD.0000000000010631.

15. Berman L, Aversa J, Abir F, Longo WE. Management of disorders of the posterior pelvic floor. Yale J Biol Med. 2005;78(4):211–221. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC2259151/.

16. Ford AС, Moayyedi P, Lacy BE, Lembo AG, Saito YA, Schiller LR et al. American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation. Am J Gastroenterol. 2014;109(Suppl. 1):S2–S26. https://doi.org/10.1038/ajg.2014.187.

17. Belik BM, Kovalev AN. Experience of homeopathic ointment during the non-surgical treatment for acute hemorrhoids in the outpatient settings. Ambulatornaya Khirurgiya. 2022;19(1):98–106. (In Russ.) https://doi.org/10.21518/1995-1477-2022-19-1-98-106.

18. Belik BM, Kovalev AN, Khatlamadzhiyan AL. Administration of phlebotropic drugs during complex treatment of acute hemorrhoids. Koloproktologia. 2018;(2):48–53. (In Russ.) https://doi.org/10.33878/2073-7556-2018-0-2-48-53.

19. Belik BM, Kovalev AN. Effectiveness of minimally invasive and surgical methods of treatment of chronic hemorrhoids using phlebotonics. Koloproktologia. 2023;22(2):49–56. (In Russ.) https://doi.org/10.33878/2073-7556-2023-22-2-49-56.

20. Achkasov SI, Aleshin DV. Surgery of slow-transit constipation at the fork. Koloproktologia. 2018;(2):7–13. (In Russ.) https://doi.org/10.33878/2073-7556-2018-0-2-7-13.

21. Belik BM, Kovalev AN. The use of autologous platelet-rich plasma in the complex treatment of anal fissure combined with anal sphincter spasm in non-hospital settings. Koloproktologia. 2022;21(1):50–59. (In Russ.) https://doi.org/10.33878/2073-7556-2022-21-1-50-58.

22. Ivashkin VT, Shelygin YuA, Maev IV, Sheptulin AA, Aleshin DV, Achkasov SI et al. Clinical Recommendations of the Russian Gastroenterological Association and Association of Coloproctologists of Russia on Diagnosis and Treatment of Constipation in Adults. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2020;30(6):69–85. (In Russ.) https://doi.org/10.22416/1382-4376-2020-30-6-69-85.

23. Zaichikova MS. Laxatives. Monitoring of pharmacy sales. Novaya Apteka. 2015;(1-7):16–18. (In Russ.) Available at: https://elibrary.ru/ucicuh.

24. Drozdov VN, Karnouh KI, Serebrova SY, Komissarenko IA, Starodubtsev AK. Possibilities of sodium picosulfate application in constipation pharmacotherapy in functional intestinal disorders. Meditsinsky Sovet. 2019;(3):92–97. (In Russ.) https://doi.org/10.21518/2079-701X-2019-3-92-97.

25. Веселов ВВ, Федоров ЕД, Иванова ЕВ, Никифоров ПА, Агапов МЮ, Блашенцева СА и др. Подготовка пациентов к эндоскопическому исследованию толстой кишки: клинические рекомендации. 3-е изд., перераб. и доп. М.; 2017. 78 с. Режим доступа: https://endoscopia.ru/wp-content/uploads/2024/07/Klin_Rec_3izdanie.pdf.

26. Hanzel J, Sey M, Ma C, Zou G, East JE, Siegel CA et al. Existing Bowel Preparation Quality Scales Are Reliable in the Setting of Centralized Endoscopy Reading. Dig Dis Sci. 2023;68(4):1195–1207. https://doi.org/10.1007/s10620-022-07729-9.

27. Parmar R, Martel M, Rostom A, Barkun AN. Validated Scales for Colon Cleansing: A Systematic Review. Am J Gastroenterol. 2016;111(2):197–205. https://doi.org/10.1038/ajg.2015.417.

28. Calderwood AH, Jacobson BC. Comprehensive validation of the Boston Bowel Preparation Scale. Gastrointest Endosc. 2010;72(4):686–692. https://doi.org/10.1016/j.gie.2010.06.068.

29. Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol. 1997;32(9):920–924. https://doi.org/10.3109/00365529709011203.

30. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473–483. Available at: https://www.sobtell.com/images/questions/1505632884-ConceptualFrameworkandItemSelectionSF36.pdf.

31. Allescher HD. Laxatives and prokinetics – good or bad? In: Ewe K, Eckardt VF, Enck P. (eds.). Constipation and anorectal insufficiency. Falk Symposium 95. Springer; 1997, pp. 121–129. Available at: https://link.springer.com/book/9780792387275.

32. Baryshnikova GA, Chorbinskaya SA, Stepanova II, Blokhina OE. Potassium and magnesium deficiency, its role in cardiovascular disease development and possibilities of correction. Consilium Medicum. 2019;21(1):67–73. (In Russ.) Available at: https://cyberleninka.ru/article/n/defitsit-kaliya-i-magniya-ih-rol-v-razvitii-serdechno-sosudistyh-zabolevaniy-i-vozmozhnost-korrektsii/viewer.


Review

For citations:


Belik B.M., Kovalev A.N., Babiev V.F., Skorlyakov V.V., Efanov S.Yu., Rodakov A.V., Kryachko A.A. A modern approach to the treatment of constipation and preparation of the intestine for instrumental examination in outpatient coloproctology. Ambulatornaya khirurgiya = Ambulatory Surgery (Russia). 2025;22(1):168-178. (In Russ.) https://doi.org/10.21518/akh2025-010

Views: 505


ISSN 2712-8741 (Print)
ISSN 2782-2591 (Online)