Page 45 - Summer2018

“modulated through several separate systems, four years old have the second highest rate of Many central
including neural, endocrine and [intestinal] total neurological deaths across twenty Western
luminal factors” —and a disturbance in any countries, and the death rate increased by 82 nervous
15
of these systems can contribute to constipation. percent from 1989 to 2010. Parkinson’s dis- system
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So-called “secondary” constipation is the result ease (PD), for example, is not only the second disorders are
of organic or systemic disease—including neu- most common neurodegenerative disease in
rological disorders—or medications (see Table American adults but is expected to double by associated
1) or more than one of these. 11,13 Many central 2040. As many as 50 to 80 percent of individu- with
19
nervous system disorders are associated with als with PD experience constipation. In fact, constipation
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constipation in adults, including Parkinson’s constipation often precedes PD and may even
disease, Alzheimer’s disease and multiple be predictive of PD occurrence. in both adults
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sclerosis. In children, autism spectrum dis- Meanwhile, ASD and other pervasive and children.
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orders (ASDs) and their gastrointestinal (GI) developmental disorders (PDDs) are exacting
component have garnered particular attention. a heavy toll on children. In the U.S., ASD is
Clinicians report that ASDs are “an order of about eighty-five times more common in today’s
magnitude more common in the constipation middle-school children than it was in their par-
clinic than in the general population.” 17 ents’ generation, with recent reports estimating
21
that ASD affects one in fifty-nine children or
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NEUROLOGICAL DISORDERS even as many as one in thirty-six. Many chil-
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The explosion of neurological disorders in dren with ASD suffer from GI symptoms, with
both adults and children in recent decades— a prevalence of constipation ranging from 4.2
which is likely due to environmental factors—is to 45.5 percent, depending on the study. Those
24
especially pronounced in the United States. numbers may be underestimates, given that
18
Adults in the U.S. ages fifty-five to seventy- clinicians reportedly fail to recognize constipa-

TABLE 1: MEDICATIONS ASSOCIATED WITH CONSTIPATION

Class of medication Subcategories and/or examples
Analgesics Opiates, nonsteroidal anti-inflammatory agents
Anticholinergic agents Antidepressants (tricyclic), antiparkinsonian drugs, an-
tipsychotics, antispasmodics, antihistamines
Anticonvulsants Carbamazepine
Antihypertensives Antiarrhythmics, beta-adrenoceptor antagonists, calcium
channel blockers, centrally acting (e.g., Clonidine), diuretics
Bile acid sequestrants Cholestyramine, colestipol
Cation-containing agents Aluminum- and calcium-containing antacids and
supplements, bismuth, iron supplements, lithium
Chemotherapy agents Alkylating agents, vinca alkaloids
Endocrine medications Pamidronate and alendronic acid
5-HT3 receptor antagonists Ondansetron
Miscellaneous compounds Barium sulfate, oral contraceptives, polystyrene resins
Other antidepressants Monoamine oxidase inhibitors
Other antiparkinsonian drugs Dopamine agonists
Other antipsychotics Clozapine, haloperidol, risperidone
Other antispasmodics Mebeverine, peppermint oil
Sympathomimetics Ephedrine, terbutaline
Adapted from: Bharucha et al. American Gastroenterological Association technical review on constipation.
Gastroenterology 2013;144(1):218-238.

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