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At least 487 records · Page 27Linked to original sources
PubMedDate not supplied

Clinical and radiological postoperative evaluation of posterior sagittal anorectoplasty in patients with upper and intermediate anorectal malformations.

The PSARP is today the most-used surgical technique for correction of high and intermediary anorectal malformations. There is much controversy in the literature about the post-operative evaluation of these cases. We studied 27 cases of anorectal malformations from clinical and radiological aspects, in order to analyse: 1. Fecal continence 2. Relationship between post-operative fecal continence and the associated sacral anomalies 3. Relationship between the radiological evaluation by defecogram and fecal continence From the analysis of the cases, we concluded: 1. Fecal continence was achieved in 48.14% of the cases; partial continence in 25.92%; and fecal incontinence in 25.92% of the cases. 2. The presence of fecal incontinence was directly related to the associated sacral anomalies.

Child↗
PubMed2001

Predictive value of impaired evacuation at proctography in diagnosing anismus.

OBJECTIVE: We aimed to determine the positive predictive value of impaired evacuation during evacuation proctography for the subsequent diagnosis of anismus. SUBJECTS AND METHODS: Thirty-one adults with signs of impaired evacuation (defined as the inability to evacuate two thirds of a 120 mL contrast enema within 30 sec) during evacuation proctography underwent subsequent anorectal physiologic testing for anismus. A physiologic diagnosis of anismus was based on a typical clinical history of the condition combined with impaired rectal balloon expulsion or abnormal surface electromyogram. RESULTS: Twenty-eight (90%) of the 31 patients with impaired proctographic evacuation were found to have anismus at subsequent physiologic testing. Among the 28 were all 10 patients who evacuated no contrast medium and all 11 patients with inadequate pelvic floor descent, giving evacuation proctography a positive predictive value of 90% for the diagnosis of anismus. A prominent puborectal impression was seen in only three subjects during proctography, one of whom subsequently showed no physiologic sign of anismus. CONCLUSION: Impaired evacuation during evacuation proctography is highly predictive for diagnosis of anismus.

Adult↗
PubMed2002

A practical guide to the diagnosis and management of fecal incontinence.

Many physicians are unaware that fecal incontinence is often correctable. With appropriate and relevant diagnostic tests, medical treatment and/or surgical correction often leads to good functional results. General guidelines for diagnosis, evaluation, and management of fecal incontinence are provided. There are many causes of fecal incontinence, with obstetrical trauma being one of the most frequent. A detailed history, documentation of sphincter injury, and thorough physical examination will identify the cause of the problem in most patients. Management involves the use of antidiarrheal medication and fiber products, biofeedback, or enemas. A qualified surgeon should be consulted during the course of the patient's evaluation, particularly when medical therapy is unsuccessful. Knowledge of the appropriate diagnosis, evaluation, and management of fecal incontinence may result in more patients seeking medical attention and thus improving their quality of life.

Antidiarrheals↗
PubMedDate not supplied

Faecal incontinence in adults.

Faecal incontinence is a distressing condition, which adversely affects the quality of life of adults of all ages. It is often preventable and easily treatable once a diagnosis has been made. Nurses should provide support and information for patients and their families and ensure they understand the causes of faecal incontinence and the treatment regimens available.

Adult↗
PubMed1999

[Radiologic diagnosis of chronic constipation and outlet obstruction].

The aim of this review article is to present the role and extent of gastrointestinal radiology in adults with chronic obstipation and stool outlet obstruction. The radiological investigations are well established second-line diagnostic procedures. Special attention is given to the indications as well as to the imaging techniques which include barium enema, measurement of colon transit time and dynamic colpocystorectoviscerography. New emerging modalities such as functional MR Imaging provide an objective, unifying diagnostic approach to the pelvic floor and the colon. This will contribute to an improved perception of the composite entity of the pelvic floor and of the interactions of its adjacent structures. Consequently the longstanding "compartmentalization" practiced by the different medical specialties might be avoided in the future.

Adult↗
PubMed1999

Chronic neurogenic lesions of the external anal sphincter and abdomino-perineal dyssynergia in chronic constipation.

BACKGROUND: Neuropathy of the pudendal nerves which may be found in constipated patients has been considered the result of pelvic floor descent due to the repetitive acts of straining at stool. However, the relationship between abdominopelvic dyssynergia, which may lead to repetitive acts of straining and neurophysiopathologic alterations of the pelvic floor has not yet been fully elucidated. AIM: Of this study was to assess the relationship between neurophysiologic alterations of the external anal sphincter, patterns of altered evacuation and defaecographic pelvic floor physiology in 32 patients with chronic idiopathic constipation. RESULTS: At electromyography partial muscle denervation, identified as chronic neurogenic lesions of the external anal sphincter, were found in 19% and dyssynergia (co-contraction of external anal sphincter and abdominal muscles) in 34% of the investigated subjects. Patients with different electromyography patterns did not differ as far as concerns symptoms of altered evacuation, bowel frequency, use of digital manoeuvres, age, and duration of symptoms. The presence of neurophysiologic alterations was significantly associated with altered defaecographic findings: reduced ano-rectal angle at rest in chronic neurogenic lesions and abdomino-pelvic dyssynergia (p < 0.01); excessive pelvic floor descent in the presence of chronic neurogenic lesions (p < 0.05). CONCLUSIONS: In chronically constipated patients symptoms of altered defaecation do not appear to be related to abdomino-pelvic dyssynergia and/or chronic neurogenic lesion of the external anal sphincter and do not show any association with defaecographic alterations. These results suggest that straining at evacuation can be induced by additional factors other than abdomino-pelvic dyssynergia and chronic neurogenic lesions and that these two alterations have different pathogenetic mechanisms.

Abdominal Muscles↗
PubMed2000

[Gastrointestinal surgery and gastroenterology. IX. Obstipation: etiology and diagnosis].

Constipation and disordered defaecation are symptoms, not disease entities. Usually these symptoms are not caused by organic abnormalities, but by disordered motility of the colon and pelvic floor. Both decreased colonic motility (inertia coli) and increased frequency and amplitude of haustrating colonic contractions in the context of an irritable bowel syndrome may lead to constipation. A third important functional cause of constipation is by paradoxical straining of the pelvic floor muscles during (attempts to) defaecate: anismus. In the diagnosis of constipation the primary aim usually is the exclusion of organic disorders. A plain abdominal X-ray and measurement of colonic transit with radiopaque particles will provide information about the severity of the constipation. Defaecography is indicated primarily if disordered faecal expulsion exists. Anorectal manometry is relevant when Hirschsprung's disease is suspected.

Constipation↗
PubMedDate not supplied

Subtotal colectomy for colonic inertia.

The aim of this study was to assess the outcome of subtotal colectomy for colonic inertia (idiopathic slow transit constipation) that was resistant to laxative treatment. Twenty-four patients, 19 women and 5 men, with a mean age of 37 years, underwent subtotal colectomy with ileorectal or ascendo-rectal anastomosis. All patients were available for follow-up, with a mean follow-up of 23 months. Bowel frequency was significantly increased from 1.4+/-0.9 times per week to 22.8+/-9 times per week (average 3.2/day) after surgery (P <0.0001). The incidence of abdominal pain was decreased from 75% to 17%, as well as the severity (P <0.0001). Two patients who underwent ascendo-rectal anastomosis developed recurrent constipation. Two patients used antidiarrheal medication regularly. There was no major postoperative morbidity. Five patients were re-admitted due to small bowel obstruction; four received successful conservative management, and one required enterolysis. 'Excellent' or 'good' outcomes were reported by 21 patients (87.5%). Subtotal colectomy with ileorectal anastomosis produces satisfactory results in the majority of patients with proven colonic inertia.

Adult↗
PubMed2001

Rectal prolapse.

Explore the source record for details and available documents.

Defecography↗
PubMed2001

[Complex radiologic investigation for disorders of defecation in children].

The work presents findings obtained by the radial examination of the anorectal area including routine methods such as irrigography and balloon proctography as well as modern technologies such as endorectal ultrasonography with a transducer of high resolution (7.5 MHz) and computed tomography in 250 children with more common syndromes in colonoproctology: constipation and incontinence of feces. Results of the endosonographic investigation of the normal sphincter apparatus in children are described. It is confirmed that endosonography is of great importance for the detection of the isolated intumescence of the anal sphincter. Computed tomography is also necessary for traumas of the anorectal area in children.

Adolescent↗
PubMed2001

Recent concepts in fecal incontinence.

Fecal incontinence is an inability to defer release of gas or stool from the anus and rectum by mechanisms of voluntary control. It is an important medical disorder affecting the quality of life of more than 2% of the US population. The most common contributing factors include previous vaginal deliveries, pelvic or perineal trauma, previous anorectal surgery, and rectal prolapse. Many physicians lack experience and knowledge related to pelvic floor incontinence disorders, but advancing technology has improved this knowledge. Increased experience with endoanal ultrasound and endoanal magnetic resonance imaging have given us better understanding of the anatomy of the anal canal, and new techniques with muscle translocation and artificial neosphincters and neuromodulation have expanded our armamentarium of options for restoring continence.

Aged↗