# Functional Constipation — GCMD Library living collection

Everything in the library about functional constipation — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 76 cited statements

## Episodes
### Case-Based Learning
- [Laparoscopic Segmental Colectomy for Functional Constipation](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504) — video · 4:52 · [machine version](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504.md)

### In-Depth Reviews
- [Functional constipation refractory to medical management: The colon is the problem](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987) — podcast · 16:30 · [machine version](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987.md)

### Patient & Family Education
- [How to Administer a Rectal Irrigation at Home](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744) — video · 5:36 · [machine version](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744.md)

## Chapters
- [0:05](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=5) Case presentation and preoperative evaluation (Ep 1)
- [0:53](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=53) Port placement and initial dissection (Ep 1)
- [2:00](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=120) Colonic mobilization and specimen extraction (Ep 1)
- [3:22](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=202) Colorectal anastomosis and integrity testing (Ep 1)
- [4:19](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=259) Postoperative course and summary (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=0) Introduction and Clinical Rationale for Rectal Irrigations (Ep 2)
- [2:00](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=120) Required Supplies and Equipment (Ep 2)
- [3:00](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=180) Step-by-Step Irrigation Procedure (Ep 2)
- [4:30](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=270) Troubleshooting Common Problems (Ep 2)
- [5:00](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=300) Warning Signs and When to Seek Medical Help (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=0) Introduction to medically refractory constipation and historical surgical variability (Ep 3)
- [1:41](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=101) Collaborative diagnostic protocol: contrast enema, ARM, and ruling out Hirschsprung disease (Ep 3)
- [5:33](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=333) Colonic manometry and classification of dysmotility patterns (Ep 3)
- [8:40](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=520) The Malone ACE procedure as universal treatment and study hypothesis (Ep 3)
- [11:53](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=713) Study results: 86% success rate and failure analysis (Ep 3)
- [14:28](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=868) Future directions: identifying ACE failure risk factors and pelvic floor optimization (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Rectal biopsy and anorectal manometry were both normal in this patient with functional constipation." (clinical) [Ep 1 · 0:10](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=10)
- "Colonic manometry identified a 40 centimeter segment of dysmotile colon." (clinical) [Ep 1 · 0:18](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=18)
- "Contrast enema demonstrated a grossly dilated distal colon." (clinical) [Ep 1 · 0:23](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=23)
- "The authors have previously published a systematic approach to management of children with severe functional constipation, with patients classified into groups; this patient's findings were consistent with Group D." (guideline) [Ep 1 · 0:27](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=27)
- "Initial Malone appendicostomy improved symptoms, but after several months the patient began suffering from impactions despite multiple colonic irrigation regimens." (clinical) [Ep 1 · 0:37](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=37)
- "Preoperative bowel preparation was used to ensure decompression of the distal colon at laparoscopy." (clinical) [Ep 1 · 0:53](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=53)
- "A 5 millimeter optical port is placed supraumbilically and to the left to avoid injury to the appendicostomy." (clinical) [Ep 1 · 1:01](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=61)
- "The left colon demonstrated a grossly dilated redundant sigmoid colon which funnels into a more normal caliber rectum above the peritoneal reflection." (clinical) [Ep 1 · 1:13](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=73)
- "Dissection begins at the pelvic brim using a vessel sealing device to create a mesenteric window, proceeding in a caudal direction and staying close to the bowel." (clinical) [Ep 1 · 1:22](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=82)
- "The position of the ureters is established to ensure they lie away from the dissection plane." (clinical) [Ep 1 · 1:32](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=92)
- "Once normal caliber colon is encountered above the peritoneal reflection, the rectum is transected using an endoGIA stapler." (clinical) [Ep 1 · 1:41](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=101)
- "Several staple fires may be needed depending on the degree of dilatation." (clinical) [Ep 1 · 1:48](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=108)
- "After stapling, verification is performed to ensure that the ureter has not been inadvertently caught in the staple line." (clinical) [Ep 1 · 1:52](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=112)
- "In this case, taking down the splenic flexure was not required to achieve sufficient mobility of the normal caliber colon to reach the pelvis." (clinical) [Ep 1 · 2:06](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=126)
- "The right lower quadrant port incision is extended to approximately 2.5 centimeters for specimen extraction." (clinical) [Ep 1 · 2:28](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=148)
- "A wound protector is applied to the right lower quadrant port site during specimen extraction." (clinical) [Ep 1 · 2:40](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=160)
- "The anvil component of an EEA circular stapler is placed into the lumen of the healthy colon and secured with a prolene purse string suture." (clinical) [Ep 1 · 2:46](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=166)
- "After returning the colon to the peritoneal cavity, a laparoscopic cap is applied over the wound protector to allow reestablishment of pneumoperitoneum." (clinical) [Ep 1 · 2:58](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=178)
- "The orientation of the colon is examined to ensure there is no twist as it passes into the pelvis." (clinical) [Ep 1 · 3:11](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=191)
- "After resection, the colon should lack redundancy and form a direct path into the pelvis." (clinical) [Ep 1 · 3:17](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=197)
- "The rectum is calibrated using scissors that come with the circular stapling device." (clinical) [Ep 1 · 3:22](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=202)
- "The EEA trocar is deployed adjacent to the rectal staple line until the orange tying area is seen." (clinical) [Ep 1 · 3:26](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=206)
- "The anvil is engaged into the trocar until a characteristic snap is felt." (clinical) [Ep 1 · 3:41](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=221)
- "The EEA device is closed until appropriate tissue compression is attained before firing." (clinical) [Ep 1 · 3:49](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=229)
- "Two complete doughnuts of colonic tissue should be present after firing, indicating a satisfactory anastomosis." (clinical) [Ep 1 · 3:55](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=235)
- "The integrity of the anastomosis is examined by filling the pelvis with saline and insufflating air into the rectum; absence of bubbling indicates no leak." (clinical) [Ep 1 · 4:04](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=244)
- "The patient was discharged on the 4th postoperative day following resumption of bowel function and establishment of diet and appendicostomy flushes." (clinical) [Ep 1 · 4:19](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=259)
- "The flush regimen was dramatically improved after resection, with plans to attempt transition to oral laxatives." (clinical) [Ep 1 · 4:26](https://library.globalcastmd.com/watch/laparoscopic-segmental-colectomy-for-functional-constipation-6504?t=266)
- "Emily Rice is a nurse with the Division of Colorectal and Pelvic Reconstruction at Children's National Hospital." — Emily Rice (clinical) [Ep 2 · 0:00](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=0)
- "Rectal irrigations can help a child empty their colon of stool and gas." — Emily Rice (clinical) [Ep 2 · 1:00](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=60)
- "Children who suffer from Hirschsprung disease or functional constipation have colons that may not move stool through the body as quickly as it should, a condition called dysmotility." — Emily Rice (clinical) [Ep 2 · 1:08](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=68)
- "When stool sits in the colon for too long, it can cause bacteria to grow and can lead to enterocolitis, which is an inflammation of the colon." — Emily Rice (clinical) [Ep 2 · 1:25](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=85)
- "Rectal irrigations help keep a child healthy and safe by preventing and treating enterocolitis." — Emily Rice (clinical) [Ep 2 · 1:40](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=100)
- "Irrigations put salt water (saline) into the colon to help clean the stool out and prevent infection." — Emily Rice (clinical) [Ep 2 · 1:50](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=110)
- "If a child has a history of Hirschsprung disease and is showing signs of enterocolitis or dehydration, caregivers should perform an irrigation and immediately contact the medical team or pediatrician." — Emily Rice (guideline) [Ep 2 · 2:00](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=120)
- "A 24-french silicone Foley catheter is used for rectal irrigations in children one year of age or older." — Emily Rice (clinical) [Ep 2 · 2:40](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=160)
- "A 20-french silicone catheter is used for children under one year of age." — Emily Rice (clinical) [Ep 2 · 2:52](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=172)
- "The irrigation procedure uses 20 milliliters of saline per flush." — Emily Rice (clinical) [Ep 2 · 3:10](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=190)
- "The child should be positioned on their back with knees bent and pulled up towards their chest to visualize the anus and allow stool and gas to exit the colon." — Emily Rice (clinical) [Ep 2 · 3:25](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=205)
- "The Foley catheter should be gently inserted into the rectum about 4-6 inches." — Emily Rice (clinical) [Ep 2 · 3:50](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=230)
- "Slowly turning and moving the catheter back and forth in the rectum may help find pockets of stool that are stuck in the colon." — Emily Rice (clinical) [Ep 2 · 4:10](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=250)
- "It is important to wait between each flush for fluid to drain out of the rectum and to ensure 20 milliliters is returned from each flush before repeating." — Emily Rice (clinical) [Ep 2 · 4:35](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=275)
- "Irrigation can continue until the fluid draining from the catheter is clear." — Emily Rice (clinical) [Ep 2 · 4:48](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=288)
- "The catheter should not be inserted all the way to the end and should not be forced; when gently advanced, it will easily follow the pathway or curve of the colon." — Emily Rice (clinical) [Ep 2 · 4:55](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=295)
- "If saline is pushed in but no water or stool comes back out, the catheter should be pulled out a little bit then gently pushed back in." — Emily Rice (clinical) [Ep 2 · 5:15](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=315)
- "If no saline or stool returns with irrigation, check the catheter for blockage by food or thick stool, as stool can block the tiny holes at the tip of the catheter." — Emily Rice (clinical) [Ep 2 · 5:25](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=325)
- "Massaging the child's belly or having them change positions may help if there is no return of fluid." — Emily Rice (clinical) [Ep 2 · 5:40](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=340)
- "If there is still no return after troubleshooting, caregivers should contact the medical team or pediatrician." — Emily Rice (guideline) [Ep 2 · 5:48](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=348)
- "Signs of enterocolitis include fever, a swollen or large belly, foul-smelling stool, or no stool output in 24 hours." — Emily Rice (clinical) [Ep 2 · 6:05](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=365)
- "Signs of dehydration include not urinating as much as normal, fewer wet diapers than usual, a dry or sticky mouth, few or no tears when crying, sunken eyes, cool skin, irritability, dizziness, or being more tired than usual." — Emily Rice (clinical) [Ep 2 · 6:20](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=380)
- "If a child develops signs of enterocolitis or dehydration, caregivers should call the medical team or pediatrician immediately." — Emily Rice (guideline) [Ep 2 · 6:00](https://library.globalcastmd.com/watch/how-to-administer-a-rectal-irrigation-at-home-6744?t=360)
- "Functional constipation makes up 10% of all pediatric office visits." (host_summary) [Ep 3 · 0:45](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=45)
- "Functional constipation accounts for 25% of pediatric gastroenterology specialist visits." (host_summary) [Ep 3 · 0:50](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=50)
- "Medically refractory constipation massively impacts children's health-related quality of life (HRQOL), causing chronic intense pain, severe bloating, and social withdrawal." (clinical) [Ep 3 · 1:00](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=60)
- "Historical surgical options for refractory constipation included major colonic resection and ostomy creation, sometimes permanent, without a standard protocol." (clinical) [Ep 3 · 1:22](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=82)
- "The protocol assumes the root problem in medically refractory constipation lies in the colon's physical motility function." (clinical) [Ep 3 · 2:14](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=134)
- "Contrast enema defines the degree of rectosigmoid dilation, colonic redundancy, and overall stool burden but does not predict the exact laxative dose needed." (clinical) [Ep 3 · 2:48](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=168)
- "Anorectal manometry (ARM) measures resting sphincter pressure, defecation dynamics, and the recto-anal inhibitory reflex (RAIR)." (clinical) [Ep 3 · 3:40](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=220)
- "An absent recto-anal inhibitory reflex (RAIR) on ARM strongly indicates Hirschsprung disease and requires stopping the functional constipation workup." (clinical) [Ep 3 · 3:56](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=236)
- "Hirschsprung disease is a structural congenital problem where nerve cells are missing from bowel wall segments; treating it as functional constipation leads to serious complications." (clinical) [Ep 3 · 4:11](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=251)
- "ARM can detect pelvic floor dysynergia (muscles don't relax or tighten during defecation) and anal sphincter achalasia, which may require biofeedback therapy or botulinum toxin injection." (clinical) [Ep 3 · 4:33](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=273)
- "Colonic manometry (CMN) is the preferred method in this protocol for assessing colonic motility because it directly measures contractile activity segment by segment, explaining why transit is slow." (clinical) [Ep 3 · 5:53](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=353)
- "CMN measures pressure waves after fasting, after a meal stimulus, and after stimulant laxative (bisacodyl) administration." (clinical) [Ep 3 · 6:24](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=384)
- "High-amplitude propagated contractions (HAPCs) are strong coordinated muscle waves that sweep down long colonic segments and are the key drivers of effective fecal propulsion leading to bowel movements." (clinical) [Ep 3 · 6:47](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=407)
- "Group 1 dysmotility (59% of study cohort) showed slow overall motility but HAPCs were still present throughout the colon." (clinical) [Ep 3 · 7:33](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=453)
- "Group 2 dysmotility (23% of cohort) had segmental dysmotility where HAPCs started normally but stopped propagating forward, usually in the sigmoid colon." (clinical) [Ep 3 · 7:59](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=479)
- "Group 3 dysmotility (18% of cohort) was classified as diffusely inert colon, showing no HAPCs anywhere even after meal and stimulant laxative." (clinical) [Ep 3 · 8:19](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=499)
- "The Malone appendicostomy (ACE procedure) is performed laparoscopically using the appendix to create a small continent channel, usually hidden in the belly button, providing access to the beginning of the large intestine for antegrade continence enemas." (clinical) [Ep 3 · 9:21](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=561)
- "Antegrade enemas flow with normal direction from the top of the colon downward, unlike retrograde rectal enemas that push fluid upward against gravity and impacted stool." (clinical) [Ep 3 · 9:42](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=582)
- "ACE flushes are typically performed daily or every other day." (clinical) [Ep 3 · 10:05](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=605)
- "If initial ARM showed high sphincter resting pressures or pelvic dysynergia, botulinum toxin injection into the anal sphincter was performed during ACE surgery to help it relax and prevent flush retention." (clinical) [Ep 3 · 10:41](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=641)
- "The study cohort started with 196 children referred for refractory constipation; using the rigorous protocol, 22 patients were identified as having colonic motility disorder as the underlying cause." (clinical) [Ep 3 · 11:19](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=679)
- "The 22 patients had a median age of 10 years." (host_summary) [Ep 3 · 11:35](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=695)
- "19 out of 22 patients (86%) responded well to antegrade flushes via ACE." (clinical) [Ep 3 · 11:55](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=715)
- "Of the 19 successful cases, 17 reported zero soiling accidents with the flushes, and 2 reported only occasional minor accidents." (clinical) [Ep 3 · 12:03](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=723)
- "Even a colon that doesn't contract well on its own can function adequately if emptied regularly and effectively from above via antegrade flushes." (opinion) [Ep 3 · 12:38](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=758)
- "Three patients (14%) failed antegrade flush treatment and required colon resection within approximately 6 months after ACE procedure." (clinical) [Ep 3 · 13:01](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=781)
- "Of the 3 ACE failures, 2 were from the segmental dysmotility group and 1 from the slow motility with HAPCs present group; none were from the diffusely inert colon group." (clinical) [Ep 3 · 13:19](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=799)
- "Several previous reports suggest underlying pelvic floor dysynergia might be a key risk factor for ACE flushes not working well." (host_summary) [Ep 3 · 14:40](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=880)
- "If a child reflexively tightens pelvic floor muscles when large flush volumes come down, they might retain fluid, leading to pain, leakage, and treatment failure." (clinical) [Ep 3 · 14:50](https://library.globalcastmd.com/watch/functional-constipation-refractory-to-medical-management-the-colon-is-the-problem-13987?t=890)

## Changelog
- Sep 12: 3 items added automatically

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