***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Moxibustion is an ancient traditional medicine using burning mugworts to stimulate acupuncture points . The aim of this study was to investigate the safety and efficacy of moxibustion for the treatment of constipation using a r and omized , sham-controlled , participant-blinded , pilot trial . Methods Twenty-six participants ( identified with either qi ( vital energy ) deficiency or qi excess syndrome ) were r and omly divided into either a moxibustion or sham group . Participants were treated with real or sham moxibustion at 4 acupuncture points , ST23 and ST27 , bilaterally , 3 times per week for four weeks . The primary outcome was the frequency of defecations ; secondary outcomes were the Bristol stool form scale ( BSS ) and the constipation assessment scale ( CAS ) . Results Of the 26 participants that were r and omized , 24 completed the study .  Defecation frequency , BSS , and CAS showed no difference between the moxibustion and sham groups . The differences were -0.25 ( 95 % CI : -2.08 , 1.58 , p = 0.78 ) , -1.22 ( 95 % CI : -2.7 , 0.26 , p = 0.1 ) , 0.91 ( 95 % CI : -1.46 , 3.28 , p = 0.44 ) in defecation frequency , BSS , CAS , respectively . The defecation frequency increased from an average of 3.3 to 4.6 times per week in the moxibustion group ( 1.5[-0.5 , 2 ] , p = 0.06 ) and from 2.7 to 3.7 stools per week in the sham group ( 1[-1 , 2 ] , p = 0.15 ) after four weeks of treatment . The difference between participants with a deficiency or an excess syndrome , determined based on assessment of sweat , facial features , pain , body energy , and pulse type , was significant in only defecation frequency . The difference was 3.3 ( 95 % CI : 0.41 , 6.19 , p = 0.03 ) . Conclusion Moxibustion treatment appears safe , but showed no positive effect on constipation . The effectiveness of moxibustion treatment may depend on the syndrome pattern , and further long-term studies with a larger number of subjects are warranted . Trial registration Clinical Research Information Service , BACKGROUND & AIMS Probiotics is an emerging therapeutic agent which may alleviate the symptoms of constipation . We evaluated the effectiveness of microbial cell preparation ( Hexbio ( ® ) ) containing fructooligosaccharide , Bifidobacterium and Lactobacillus in improving stool frequency and symptoms of chronic constipation . METHODS A total of 120 constipated adults diagnosed using Rome III criteria were r and omized and given either microbial cell preparation or placebo to be consumed twice daily . Follow-up was done after a 7-day intervention based on a question naire which includes an assessment of symptom profile and a stool diary . RESULTS During the intervention period , the stool frequency was higher ( p = 0.001 ) in the treatment group . Subjects experienced less straining ( p = 0.001 ) and sensation of incomplete evacuation ( p < 0.001 ) , as well as improved stool consistency ( p < 0.001 ) compared to the placebo group . While a higher proportion of subjects in the treatment group had a reduction in anorectal blockage sensation and having to defecate by manual maneuvers , the differences were not statistically significant . CONCLUSION The results suggest that microbial cell preparation is effective in improving stool frequency and stool consistency . Furthermore , it could reduce the symptoms of straining and sensation of incomplete evacuation in adults with chronic functional constipation . MREC REG NO 866.59 ( IRB , UMMC , Malaysia ) CONTEXT Constipation is a very common symptom in the general population . One way of non-pharmacological treatment of constipation is through the addition of probiotics to food . OBJECTIVES The aim of this study was to evaluate de effect of the consumption of a fresh cheese , enriched with Bifidobacterium lactis Bi-07 on the symptoms of constipated women . METHODS A r and omized controlled trial , carried out in the Basic Health Units of Guaporé 's City - RS/Brazil , between January and May 2012 , with 30 constipated women . The patients were r and omized into two groups whom received , for 30 days , 30 g of fresh cheese enriched with Bifidobacterium lactis Bi-07 ( n = 15 ) or regular fresh cheese ( n = 15 ) . Constipation symptoms were evaluated according to ROMA III Consensus , before and after the nutritional intervention . Also , data of clinical and anthropometric characteristics of the individuals were collected . Accepted level of significance 5 % ( P≤0,05 ) . RESULTS The medium age of the studied population was 37,5±14,4 years in the intervention group and 40,8±12,8 years in the control group . After 30 days we observed that the ingestion of fresh cheese enriched with Bifidobacterium lactis Bi-07  promoted benefic effects on the symptoms of strength to evacuate . CONCLUSION The consumption of 30g/day of a fresh cheese enriched with Bifidobacterium lactis Bi-07 has beneficial effects on constipation symptoms BACKGROUND & AIMS Although stimulant laxatives have been used for many years to treat patients with constipation , their clinical value has been question ed , and there have been few high- quality trials to assess their efficacy . We tested the efficacy and safety of 4 weeks of treatment with oral bisacodyl tablets in patients with chronic constipation , defined by Rome III criteria . METHODS This r and omized , double-blind , placebo-controlled , parallel-group study was conducted in 27 centers in the United Kingdom . After a 2-week baseline period without study medication , patients were r and omly assigned , in a 2:1 ratio , to groups that were given 10 mg bisacodyl ( n = 247 ) or placebo ( n = 121 ) , once daily , for 4 weeks . Patients used an electronic diary each day to record information relating to their constipation . RESULTS The mean ( ± st and ard error of the mean [ SEM ] ) number of complete spontaneous bowel movements ( CSBMs ) per week during the treatment period increased from 1.1 ± 0.1 in both groups to 5.2 ± 0.3 in the bisacodyl group and 1.9 ± 0.3 in the placebo group ( P < .0001 ) . All secondary end points ( number of complete spontaneous bowel movements for each single week , number of spontaneous bowel movement ( SBMs ) , and constipation-associated symptoms ) differed significantly between groups , demonstrating efficacy for bisacodyl ( P < .0001 ) . Compared with baseline , there was a statistically significant improvement in the overall Patient Assessment of Constipation quality of life ( PAC-QOL ) score and all subscales ( satisfaction , physical discomfort , psychosocial discomfort , worries and concerns ) in the bisacodyl-treated patients , compared with those that received placebo ( P ≤ .0070 ) . Treatment with bisacodyl was well-tolerated . CONCLUSIONS Oral bisacodyl is an effective and well-tolerated treatment for patients with chronic constipation . It improves bowel function , constipation-related symptoms , and disease-related QOL Background and Aim Partially hydrolyzed guar gum ( PHGG ) is a water-soluble , non-gelling dietary fiber with a wide range of uses in clinical nutrition . The aim of this prospect i ve study was to investigate the effect of guar gum on colonic transit time ( CTT ) and symptoms of chronic constipation . Methods We enrolled patients fulfilling Rome III criteria for chronic constipation . CTT was measured before and at the end of treatment . After a 2-week run-in period , patients received 5 mg PHGG daily for 4 weeks . During study period , patients kept daily symptoms , stool and laxative usage diaries . They also recorded their symptom-related satisfaction weekly and treatment adverse events . Results Forty-nine patients received treatment ; 39 ( 80 % ) completed the study . Treatment significantly reduced colon transit time , from 57.28 ± 39.25 to 45.63 ± 37.27 h ( p = 0.026 ) , a reduction more prominent in slow transit patients ( from 85.50 ± 27.75 to 63.65 ± 38.11 h , p = 0.016 ) . Overall , the weekly number of complete spontaneous and spontaneous bowel movements increased significantly ( p < 0.001 ) ; the latter correlated significantly with the acceleration of CTT in the overall population and in slow transit patients ( B = 0.382 ; p = 0.016 and B = 0.483 ; p = 0.023 , respectively ) . In addition , the number of bowel movements with straining decreased ( p < 0.001 ) and stool form improved ( p < 0.001 ) , while days with laxative intake and days with abdominal pain decreased ( p = 0.001 and p = 0.027 , respectively ) . Conclusion Four-week PHGG use accelerates colon transit time in patients with chronic constipation , especially in those with slow transit , and improves many of their symptoms including frequency of bowel movements Background : Treatment of chronic constipation is creating one of the major problems for doctors and patients . Pyridostigmine increases the gastrointestinal motility through the effects on cholinesterase . It seems that this mechanism can reduce chronic constipation . The aim of this study was to compare the effects of pyridostigmine and bisacodyl on chronic constipation . Methods : This study was conducted on 68 patients who suffered from chronic constipation . Patients were r and omly divided into two groups of Pyridostigmine and bisacodyl  in which each consisted of 34 patients , respectively . Bristol stool form score , straining defecation , the time of defecation , the number of defecation per week , sense of incomplete evacuation and self-digitation were collected by means of question naires and the data were compared . Results : Sixty-eight patients with the mean age of 68.12±84.49 were studied . The mean difference in the frequency of defecation per week , VAS score , the time to defecation and the Bristol Stool form Scale in pre and post-treatment were 4.33±1.88 , 5.96±2.29 , 12.30±7.95 min and 2.10±0.95 in pyridostigmine group and 2.96±1.81 , 4.06±2.22 , 6.67±5.23 min and 1.41±0.84 in bisacodyl group , respectively . The significant difference was observed in both pyridostigmine and bisacodyl groups ( P=0.005 , P=0.002 , P=0.002 and P=0.005 , respectively ) . 60 % and 32.3 of patients in pyridostigmine and bisacodyl groups recovered from self-digitations , respectively . In pyridostigmine and bisacodyl groups , 66.7 % and 32.3 of them had improvement in the sense of incomplete defecation , respectively . Conclusion : Pyridostigmine and bisacodyl significantly improved the symptoms of chronic constipation similarly 1 . This was an 18-week prospect i ve , r and omised , double-blind , placebo-controlled clinical study on a Chinese herbal medicine -- ma zi ren wan (MZRW)--for the treatment of functional constipation . 2 . 120 subjects with functional constipation ( Rome III criteria ) were r and omised ( 60 per arm ) into the MZRW and placebo groups . Respective responder rates for the two groups were 43.3 % and 8.3 % during treatment , and 30.0 % and 15.0 % in the follow-up period ( p<0.05 ) . The MZRW group was superior to the placebo group in terms of increased complete spontaneous bowel movement as well as reduction in severity of constipation , straining at evacuation , and use of rescue therapy . No serious adverse effects were reported . 3 . The dose of MZRW ( 7.5 g bid ) was determined in a separate clinical trial . This study entailed a dose determination study and then a placebo-controlled clinical trial and can be a good reference for future studies Introduction Constipation may be primary or secondary . Pathophysiologic subtypes of primary constipation are dyssynergic defecation ( DD ) , slow ( STC ) , and normal transit constipation ( NTC ) . Clinical subtypes are functional constipation ( FC ) and constipation predominant IBS ( C-IBS ) . Aims The objectives of this paper are to study the clinical profile , categorize and compare various subtypes of primary constipation , and to assess the success of biofeedback therapy ( BFT ) in a non-r and omized , uncontrolled open-label study among patients with DD . Material and Methods Consecutive constipation patients ( April 2011 to December 2012 ) were evaluated . Patients < 18 years and secondary constipation were excluded . FC and C-IBS were classified by Rome III module . All patients , after excluding secondary constipation 
    Output:
    
We conclude that adults with functional constipation have significant variation in stool frequency and form , explained in part by geography and study design