-IBIS-1.7.6-
tx
digestive system
constipation
Physical Therapies

exercise

regular aerobic exercise: preventive
(Bingham SA, Cummings JH. Gastroenterology. 1989 Dec;97(6):1389-1399; Oettl GJ. Gut. 1991 Aug;32(8):941-944; Rao SS, et al. Am J Physiol. 1999 May;276(5 Pt 1):G1221-1226; Wilson JA. Constipation in the elderly. Clin Geriatr Med. 1999 Aug;15(3):499-510; Myers AM, et al. J Gerontol A Biol Sci Med Sci. 1999 Sep;54(9):M456-466.)
• encourage regular time on toilet each day


hydrotherapy

constitutional hydrotherapy
sitz bath: alternating
castor oil packs
cool water enema: for atonic colon - hold 1 min., or cool (75° F) sitz bath, 3-8 min.
warm water enema: for spastic colon, with warm compress to abdomen, full hot bath 15-20 min.
heating compress: abdomen
cold sitz bath
• wet sheet pack: stage 3


manipulation

• spine: check and align T9-L3 check for lung reflex at T1-T3
• Spondylotherapy: for atonic colon : concussion T1,T2,T3, sine one electrode L2, 2nd electrode rectal sphincter, 20-30 min., 3x/wk for spastic colon : concussion T11, sine T10 and abdomen
massage: abdominal
• abdominal manipulation
• Chapman's reflex: check and treat lateral thigh from trochanter to 1" above
patella; upper 5th - cecum, middle three 5ths -ascending colon, last 5th - transverse colon; then check and treat area from L2 across to iliac crest both sides


electrical and oscillating

sine: one electrode L2, other electrode over different parts of colon, surging but not rapid


footnotes

Bingham SA, Cummings JH. Effect of exercise and physical fitness on large intestinal function. Gastroenterology. 1989 Dec;97(6):1389-1399.
Abstract: The effect of exercise on large intestinal function has been determined in 14 healthy but normally sedentary men and women, aged 22-34 yr while on a constant diet. For an initial 3-5-wk period (control) no activity was allowed. Six subjects then undertook a 9-wk training schedule by the end of which they were capable of jogging for 1 h per day, 5 days a week. A further 6 subjects undertook a similar training schedule that lasted for only 7 wk, at the end of which they were jogging for 45 min per day. Finally, 2 subjects were studied continuously while taking light exercise for 6 wk and then jogging for a further 3 wk. Physical fitness was monitored and showed significant changes with maximum aerobic capacity increasing from 2.4 +/- 0.5 to 3.1 +/- 0.4 L/min, maximum heart rate after a step test falling from 152 +/- 8 to 129 +/- 5 beats per minute, and resting pulse rate also falling from 56 +/- 4 to 50 +/- 5 beats per minute. High-density lipoprotein cholesterol also increased significantly. Colonic function was assessed by measurement of stool weight and transit time, using the continuous radiopaque marker technique, fecal pH, nitrogen excretion, and ammonia concentration. No change was observed overall in mean daily fecal weight [124 +/- 39 (control) and 129 +/- 49 g/day (exercise)], transit time [55 +/- 20 (control), 54 +/- 23 h (exercise)], nor in fecal frequency, dry stool weight, pH, ammonia, or total nitrogen excretion. Significant changes did occur in 5 individuals with significant slowing of transit time in 2 and speeding up in 3. Overall transit time increased in 9 subjects and decreased in 5; hence, when diet is constant, exercise has marked effects on physical fitness but no consistent effect on large bowel function.

Meshkinpour H, Selod S, Movahedi H, Nami N, James N, Wilson A. Effects of regular exercise in management of chronic idiopathic constipation. Dig Dis Sci. 1998 Nov;43(11):2379-2383.

Myers AM, Malott OW, Gray E, Tudor-Locke C, Ecclestone NA, Cousins SO, Petrella R. Measuring accumulated health-related benefits of exercise participation for older adults: the Vitality Plus Scale. J Gerontol A Biol Sci Med Sci. 1999 Sep;54(9):M456-466.

Oettl GJ. Effect of moderate exercise on bowel habit. Gut. 1991 Aug;32(8):941-944.
Abstract: Ten healthy volunteers (six men and four women, aged 22-41 years) were studied in a crossover trial. The study was divided into three one week periods. During each period the subjects either ran on a treadmill, cycled on a bicycle ergometer, or rested in a chair for 1 hour every day. The exercise was performed at two thirds predicted maximum heart rate (equivalent to 50% VO2 max). The sequences were rotated; no studies were performed in the perimenstrual period. Transit was measured by the method of measuring the excretion of a single dose of radio-opaque markers; all stools were collected, weighed, and x rayed after the ingestion of radio-opaque markers. Dietary fibre and fluid intake were measured on the fourth day of each test period by 24 hour record. Lifestyle was otherwise unchanged. Transit time was dramatically accelerated by moderate exercise (both jogging and cycling); however, stool weight, defecation frequency, dietary fibre intake, and fluid intake did not change significantly. Whole gut transit changed from 51.2 hours (95% confidence intervals 41.9 to 60.5) at rest to 36.6 hours (31.6 to 39.2) when riding and 34.0 hours (28.8 to 39.2) when jogging. Riding and running both differed significantly from resting (p less than 0.01); the difference between riding and running was not significant.

Rao SS, Beaty J, Chamberlain M, Lambert PG, Gisolfi C Effects of acute graded exercise on human colonic motility. Am J Physiol. 1999 May;276(5 Pt 1):G1221-1226.
Abstract: Whether physical exercise stimulates colonic motility is unclear. Our aim was to determine the immediate effects of graded exercise on colonic motility. Colonic motility was recorded at six sites in 11 untrained subjects, by colonoscopically placing a solid-state probe. Subjects were free to ambulate. The next day, subjects exercised on a bicycle at 25, 50, and 75% of peak oxygen uptake for 15 min, with each followed by a 15-min rest. Motor patterns, motility indexes, and regional variations before, during exercise, during rest, and during postexercise periods were compared. During exercise, there was an intensity-dependent decrease (P < 0.001) in the number and area under the curve of pressure waves. The incidence of propagated or simultaneous pressure waves and cyclical events also decreased (P < 0.05). After exercise, the pressure activity reverted to baseline, but the number and amplitude of propagated waves increased (P < 0.01), whereas the simultaneous waves and cyclical events remained lower. Acute graded exercise decreases colonic phasic activity. This may offer less resistance to colonic flow, whereas the postexercise increase in propagated activity may enhance colonic propulsion.

Wilson JA. Constipation in the elderly. Clin Geriatr Med. 1999 Aug;15(3):499-510. (Review)