Regular physical exercise has long been considered in the management of chronic constipation. This recommendation is probably based on the assumption that exercise shortens the transit time through the gastrointestinal tract. However, on the basis of previous studies, the effect of exercise on the transit remains controversial at best. Therefore, it was the goal of the present study to assess the influence of regular physical exercise, what average people may consider routine exercise, in the management of chronic idiopathic constipation. The study population consisted of eight patients, seven women and a man, with chronic idiopathic constipation. They were studied for six weeks, including two weeks of rest and four weeks of regular exercise. Patients had a submaximal exercise test, before and after the exercise period, to determine their rate of perceived exertion (RPE), the target heart rate, and the intensity of exercise they can perform. In addition to their routine daily activities, they exercised 1 hr a day, five days a week according to their performance at the initial exercise tolerance test. They kept a daily activity log and maintained their normal dietary intake during this period. The patients overall physical activity was assessed by a pedometer. They also maintained a diary of the number and consistency of their bowel movements and the amount of straining required for defecation. The impact of exercise on constipation was assessed by utilizing an index that took into consideration all three parameters of bowel function. Results of the study revealed that patients covered 1.8+/-0.33 and 3.24+/-0.28 miles/day in the rest period and during the exercise period, respectively (P = 0.007). The intensity of exercise may have improved the level of training as reflected on the mean maximum time before and after exercise period (P = 0.039). This level of exercise did not improve their constipation indices, which were 9.11+/-0.65 and 8.57+/-1.08 in the rest and exercise periods, respectively (P = 0.68). In conclusion, physical activity, to the extent that people consider "regular exercise," does not play a role in the management of chronic idiopathic constipation.
Relief efforts started soon after the earthquake, but organized search and rescue missions were absent during the first 24 hours after the disaster. Once on their way, these missions were paralyzed by the chaos that ruled the first few days of the event, the harsh terrain, and the cold weather. Rubble removal and rescue of the trapped became secondary to transfer of the injured to hospitals. Most of the injured people were originally taken to Kerman city for stabilization before they were flown to other cities in Iran for further medical care. The hospitals in Kerman city were greatly burdened by this task. However, they performed heroically given scarce resources and staff, especially during the initial days of the disaster. By the second week of the disaster, field hospitals were operational in Bam and were able to provide care for people, relieving the pressure on Kerman city.
1) None of the four parameters of a conventional anorectal manometry can accurately separate patients with neurogenic incontinence from those with secondary forms of the disorder. 2) The anorectal motility index presented here can accurately separate the two groups. 3) This index is superior to the standard anorectal manometry in evaluating patients with fecal incontinence.
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