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Biomedical subjects

V Loening-Baucke

Publications and source records attributed to V Loening-Baucke.

At least 19 recordsLinked to original sources
PubMed1996

Biofeedback training in children with functional constipation. A critical review.

Many uncontrolled studies suggest that biofeedback training is an effective adjunctive therapy in improving the outcome of functional constipation and/or encopresis in children. This could not be confirmed in controlled studies. Adding biofeedback training after conventional treatment had failed did not provide benefits. The results of biofeedback treatment in children with functional constipation and/or encopresis are disappointing.

Biofeedback, Psychology↗
PubMed1996

Anteriorly located anus: is constipation caused by abnormal location of the anus?

Anteriorly located anus (ALA) is frequently associated with severe constipation accompanied by defecation pain. Between 1988 and 1994, the authors treated 27 children (26 girls, 1 boy; age range, 0 to 11 years) to surgically correct ALA. The operation was performed according to a uniform protocol to longitudinally divide the internal sphincter muscle from the anal skin level to 2 cm above the dentate line on the posterior wall of the anorectum. For anal reconstruction, any of the conventional procedures was employed. Twenty-two of the 27 patients have had follow-up in our clinic for 12 months to 6 years (mean, 2.75 years). Eighteen are completely free of constipation and defecation pain and have regular spontaneous bowel movements. The other four require occasional use of enemas or laxatives. Anal incontinence did not occur in any patient. The results of this study suggest that abnormal function of the internal sphincter is the most likely cause of constipation or defecation pain in patients with ALA and that internal sphincterotomy is the cornerstone of surgical treatment.

Anal Canal↗
PubMed1996

Balloon defecation as a predictor of outcome in children with functional constipation and encopresis.

OBJECTIVE: To evaluate whether the ability to defecate a rectal balloon might predict 12-month recovery in children with functional constipation and encopresis. METHODS: We evaluated the ability to defecate within 5 minutes a 100 ml waterfilled rectal balloon by 20 healthy children and 139 children with functional constipation and encopresis. RESULTS: All healthy children and only 47% of the patients were able to defecate the balloon. Twelve months after the start of treatment, 51% of patients able to and 34% of patients unable to defecate the balloon had recovered (p < 0.03). Logistic regression revealed that the ability to defecate the balloon and a history of secondary encopresis were related to recovery (p < 0.04). Patients who were unable to defecate the balloon or who did not recover had significantly more impairment in anorectal functions than those who were able to defecate the balloon or who did recover. The ability of the balloon defecation test to predict recovery had a sensitivity of 57%, a specificity of 60%, a positive predictive value of 0.51, and a negative predictive value of 0.66. CONCLUSION: Children with functional constipation and encopresis who were able to defecate the rectal balloon were twice as likely to recover. Even though there was a clinically significant difference in the recovery rates between patients who could and those who could not defecate the balloon, calculation of predictive values showed that the balloon defecation test could not reliably predict recovery.

Anal Canal↗
PubMed1996

Encopresis and soiling.

Constipation, encopresis, and fecal incontinence are common problems in children. Constipation can have a variety of causes, such as organic and anatomic causes or intake of medication. Encopresis is the involuntary loss of formed, semiformed, or liquid stool into the child's underwear in the presence of functional (idiopathic) constipation in a child 4 years of age or younger. Fecal incontinence is fecal soiling in the presence of an organic or anatomic lesion, such as Hirschsprung's disease, anal malformation, anal surgery or trauma, meningomyelocele, and some muscle disease. This article reviews the symptoms of functional constipation in young children and the symptoms of functional constipation and encopresis in older children, presents the differential diagnosis of constipation with or without fecal incontinence, describes the evaluation and treatment of these children, and reports on treatment outcome.

Adolescent↗
PubMed1995

Is the afferent pathway from the rectum impaired in children with chronic constipation and encopresis?

BACKGROUND & AIMS: Rectal sensations to balloon distention are impaired in children with chronic constipation and encopresis. The impairment of rectal sensation, which is often persistent and is related to nonrecovery, could be caused by a defect in the visceral afferent pathways. The aim of this study was to test whether the afferent pathway from the rectum is impaired in children with constipation and encopresis. METHODS: Fifteen healthy children and 15 children with constipation and encopresis were studied. Cerebral evoked potentials (EPs) were studied by averaging results of 100 rectal distentions, which used 10, 20, and 30 mL air. EPs were recorded from Cz' to Fz. RESULTS: Two different types of EPs were recorded in each control subject and each child with constipation and encopresis. One EP had an early onset and showed multiple positive and negative peaks. The other EP had a much later onset and was triphasic. Early-onset EPs were recorded with significantly smaller distention volumes than the late-onset EPs. N1 and P2 latencies of the early-onset EPs and NI, PI, and NII latencies of the late-onset EPs were significantly prolonged in children with constipation and encopresis compared with controls. CONCLUSIONS: The prolonged latencies suggest a defect in the afferent pathway from the rectum in children with chronic constipation and encopresis.

Adolescent↗
PubMed1995

Study of the afferent pathways from the rectum with a new distention control device.

Quantitative studies of the afferent pathways from hollow viscera have been limited by the lack of an easily controlled, reproducible visceral stimulus. We adapted a slow distention device to allow for rapid distention to study the afferent pathways from the rectum. The device produced a pressure increase of 10 mm Hg in 42 msec and of 20 mm Hg in 60 msec. We recorded cerebral evoked potentials (EPs) after rectal balloon distention in 17 healthy subjects. Several averages of 25 to 50 rectal distentions at 0.17-Hz frequency were recorded. The responses consisted of multiple peaks within 200 msec after stimulation. The mean latency of the initial positive peak was 44 msec, suggesting that a myelinated pathway was stimulated with mechanical rectal distention. Our device produced reliable and repeatable EPs that were independent of balloon characteristics or rectal pressures. EP recording after rectal stimulation may become a useful technique for the physiologic investigation of disorders such as fecal incontinence, constipation, irritable bowel syndrome, and chronic intestinal pseudo-obstruction.

Adult↗
PubMed1995

Biofeedback treatment for chronic constipation and encopresis in childhood: long-term outcome.

OBJECTIVE: Abnormal defecation dynamics often are present in children with chronic constipation and encopresis. Patients who learned normal defecation dynamics with biofeedback treatment had improved short-term outcome. The aim of our research was to evaluate if biofeedback treatment improved long-term outcome. DESIGN: One hundred twenty-nine children with constipation, encopresis, and abnormal defecation dynamics were treated conventionally; 63 of them received additional biofeedback training directed towards teaching normal defecation dynamics. RESULTS: At follow-up (4.1 +/- 1.5 years), 86% of conventionally treated patients and 87% of biofeedback-treated patients had improvement in encopresis; 62% of conventionally treated patients, 50% of successful biofeedback-treated patients, and 23% of unsuccessful biofeedback-treated patients had recovered from chronic constipation and encopresis. Recovery rates were similar for conventionally treated patients and biofeedback-treated patients who learned normal defecation dynamics (P > .2) but significantly lower for unsuccessful biofeedback-treated patients (P < .02). Length of follow-up was significantly related to recovery (P < .01). CONCLUSION: Learning normal defecation dynamics with biofeedback training did not increase long-term recovery rates in children with chronic constipation, encopresis, and abnormal defecation dynamics above those achieved with conventional treatment alone.

Adolescent↗
PubMed1995

Functional constipation.

Constipation is a common problem in children. Most patients have functional constipation, with or without soiling. The treatment program for functional constipation includes various forms of behavioral therapy and psychological approaches, and consists of education, disimpaction, prevention of reaccumulation of stools with fiber and laxatives, and reconditioning to normal bowel habits with frequent toileting. Most patients experience dramatic improvement in constipation and soiling. Complete recovery, defined as three or more bowel movements per week with no soiling while off laxatives, is seen less frequently, and often requires years of treatment.

Algorithms↗
PubMed1994

Management of chronic constipation in infants and toddlers.

Infants and toddlers with constipation usually have a history of infrequent, hard and painful bowel movements, often accompanied by screaming and stool-holding maneuvers. Encopresis, the intermittent and involuntary passage of formed-to-liquid feces, is common. Although constipation most often has a functional cause, the history and physical examination should rule out anatomic, endocrinologic, metabolic or neurologic causes. Hirschsprung's disease--aganglionic megacolon--is a congenital cause of severe constipation that occurs in one of every 5,000 births. Treatment consists of fecal disimpaction, laxatives to prevent future impaction, promotion of regular bowel habits and, finally, toilet training. Parents should be reassured that although this disorder is not life-threatening, several months to years of supportive intervention may be required for effective treatment.

Child, Preschool↗
PubMed1994

Evaluation of the motor and sensory components of the pudendal nerve.

Extensive neurophysiological investigations consisting of different techniques to evaluate the efferents and afferents of the pudendal nerve were carried out in 27 healthy subjects. These investigations included motor evoked potential recordings from the external anal sphincter in response to magnetic stimulation of the cortex and lumbosacral roots, measurement of sacral reflex latency to magnetic and electrical stimulation, and cortical sensory evoked potential recording after stimulation of the dorso-genital nerve and anal canal. Motor latencies after transcranial magnetic stimulation to the anal sphincter were 25.1 +/- 2.9 msec at rest and 20.9 +/- 2.0 msec with voluntary sphincter contraction (facilitation). Motor latency after lumbosacral root stimulation was 3.7 +/- 1.0 msec. Mean sacral reflex latency after magnetic stimulation was 43.8 +/- 11.2 msec and was significantly longer than after electrical stimulation (37.0 +/- 7.2 msec; P < 0.05). P1 latency of the sensory evoked potentials after dorso-genital nerve stimulation was 40 +/- 3 msec and was significantly shorter than after anal stimulation 46 +/- 3 msec (P < 0.01). Evoked potential recording allows us to study both upper and lower motor neuron components to the anal sphincter. The present study paves the way for the combined application of these tests in the evaluation of disorders of the pelvic floor.

Adult↗
PubMed1994

Constipation in children.

Chronic constipation with or without fecal soiling remains an important cause of childhood morbidity. A number of articles have appeared in the past year to advance our understanding of the pathophysiology, treatment, and long-term outcome of functional constipation and to give us a new treatment approach for intractable constipation in children. Hirschsprung's disease has been localized to chromosome 10. In addition, the number of children with preoperative enterocolitis of Hirschsprung's disease has decreased, most likely due to the availability of anorectal manometry and better staining methods of the rectal biopsies, which has resulted in earlier diagnosis. The mean age at diagnosis decreased to 2.6 months. Neuronal intestinal dysplasia does not appear to be a unique clinicopathologic entity.

Age Factors↗
PubMed1994

Assessment, diagnosis, and treatment of constipation in childhood.

The evaluation of chronic constipation with or without fecal soiling in children must begin with a careful history and physical examination. Constipation and fecal soiling is caused in fewer than 10% of patients by anatomic, neurologic, endocrine, or metabolic conditions. No specific organic cause can be found in more than 90% of affected children, but anorectal functions--such as rectal sensation, rectal contractility, and relaxation of the external anal sphincter and pelvic floor muscles during straining for defecation--are impaired. Most patients will benefit from a program designed to clear fecal impaction with enemas, prevent fecal impaction with enemas, prevent fecal impaction with laxatives, and promote regular bowel habits with scheduled toilet sittings.

Child↗
PubMed1993

Chronic constipation in children.

The evaluation of chronic constipation with or without encopresis must begin with a careful history. The intervals between bowel movements and the size and consistency of stools deposited into the toilet should be noted. Encopresis may be manifested as dirtying the underwear. The physical examination should include a rectal and neurological examination. No specific organic cause can be found in the majority of children. One or several anorectal physiological abnormalities have been found by us and others in 95% of children with idiopathic constipation. These abnormalities include impaired rectal and sigmoid sensation and decreased rectal contractility during rectal distention. The external anal sphincter and pelvic floor muscles may be abnormally contracted during straining for defecation, and the child may be unable to defecate a rectal balloon. Most patients will benefit from a program designed to clear stools, to prevent further impaction, and promote regular bowel habits. Fifty percent of patients will be cured after 1 year and 65%-70% after 2 years.

Child↗
PubMed1993

Constipation in early childhood: patient characteristics, treatment, and longterm follow up.

Little is known about chronic constipation in infants, toddlers, and preschool children and longterm outcome after treatment. The symptoms of 174 children < or = 4 years of age, who were evaluated for chronic constipation, are reported in this study together with the long-term outcome in 90 of them. Initial symptoms were infrequent bowel movements in 58%, painful bowel movements in 77% often with screaming, and severe stool withholding manoeuvres in 97%. The treatment of chronic idiopathic constipation consisted of education, faecal disimpaction, prevention of future impaction, and promotion of regular bowel habits with dietary fibre and milk of magnesia, and finally toilet training of the preschool child. Longterm outcome could be evaluated in 90 patients (52%) (mean (SD) 6.9 (2.7)) years after initial evaluation. Fifty seven children (63%) had recovered, defined as no soiling with > or = 3 bowel movements per week, while not receiving treatment. The recovery rate of children < or = 2 years of age was significantly higher than in children > 2 to 4 years of age. Thirty three children (37%) had not recovered. Constipation recurred as soon as laxatives were discontinued in 31 (94%) of them. Laxatives were still used by 33% of the children who had not recovered, 39% had < 3 bowel movements per week, 48% had faecal soiling, 45% had stool withholding, 27% complained of abdominal pain, 73% passed large stools, and 45% still on occasions clogged the toilet with their large stools. Symptoms of chronic constipation persisted in one third of our patients, 3-12 years after initial evaluation and treatment. Children who had not recovered deserve continued follow up, to reinforce and adjust treatment and to prevent faecal soiling.

Age Factors↗
PubMed1992

Further evaluation of the afferent nervous pathways from the rectum.

To evaluate the visceral afferents from the rectum, we recorded cerebral evoked potentials (EPs) in 26 healthy subjects after electrical stimulation of the rectum, pudendal nerve, and posterior tibialis nerve. We found two distinctly different EPs after rectal stimulation, with differences in latencies and pattern. In 13 subjects (group 1), the EP after rectal stimulation had multiple prominent peaks with early onset latencies ranging from 22 to 29 ms (mean 26 ms). In 13 subjects (group 2), the EP after rectal stimulation had a trifid configuration due to a very prominent negative peak between 97 and 108 ms (mean 101 ms) and longer onset latencies ranging from 50 to 61 ms (mean 55 ms). Latencies after pudendal nerve and posterior tibialis nerve stimulation were similar in the two groups. On further study, we found that both types of afferent pathways are present in the distal colon, since both types of EPs were found in the same subjects either in the rectum or in the rectum and sigmoid. We speculate that the early onset EP is a visceral pathway using the same afferents as the pudendal nerve because the early onset EP after rectal stimulation appears similar in number of peaks and interpeak latencies to EPs recorded after pudendal nerve stimulation, and the late onset EP is a visceral pathway using afferents along the pelvic nerve. Early onset EPs were also recorded after sigmoid stimulation, suggesting that both kinds of EPs are visceral afferents.

Adult↗
PubMed1991

Lichen sclerosus et atrophicus in children.

The symptoms, findings, associated conditions, and treatment of lichen sclerosus et atrophicus were studied in 10 girls and one boy. Lichen sclerosus et atrophicus is a benign but chronic condition of the anogenital area of girls and, less frequently, of boys. The characteristic lesions are hypo-pigmented plaques in a figure-of-8 pattern surrounding the vulva and anus and often involving the natal cleft. The affected hypopigmented skin is sharply demarcated from the normal skin. Hemorrhagic, bullous lesions are uncommon. Fissures and ulcers are seen on the labia, between the labia, and on the perineum, anus, and natal cleft in many children and on the glans penis in boys. Lichen sclerosus et atrophicus causes painful defecation and anal and vulval bleeding. In two patients, one girl and one boy, anal stenosis due to lichen sclerosus et atrophicus and laxative treatment developed. Lichen sclerosus et atrophicus mimics sexual abuse and has led to false accusation and investigations. The anogenital lesions cleared in three patients at the ages of 9, 11, and 12 years, but lesions can persist into adulthood.

Anus Diseases↗
PubMed1991

Persistence of chronic constipation in children after biofeedback treatment.

We investigated the efficacy of biofeedback treatment and evaluated anorectal factors that might be responsible for persistence of chronic constipation with or without encopresis in a group of 38 children with abnormal contraction of the pelvic floor during straining and persistence of chronic constipation with encopresis after conventional treatment. Nine children were unsuccessful in learning to relax the pelvic floor during straining with biofeedback treatment, and one patient had contraction of the pelvic floor on follow-up despite successful biofeedback treatment; none recovered. Twenty-eight children were able to relax the pelvic floor on follow-up; 14 recovered and 14 did not recover from chronic constipation. Nonrecovered patients who learned to relax the pelvic floor had significantly decreased rectal and anal responsiveness to rectal distension as compared to recovered patients during the initial and follow-up anorectal manometric study. Psychological factors such as social competence and behavior problems did not appear to be responsible for recovery or nonrecovery from chronic constipation and encopresis.

Adolescent↗