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PubMed2004

[Transperineal repair of rectocele with prosthetic mesh. A prospective study].

PURPOSE: To assess the long term results of a transperineal repair of rectocele with a prosthetic mesh and the criteria for selecting the patients. METHODS: Twenty-five consecutive patients (median age: 60 years) with a symptom-giving rectocele have been operated upon. Indication for surgery was: an obstructed defecation (N = 22); a fecal incontinence (N = 1); a pelvic heaviness with dyspareunia (N = 1) or a severe rectal syndrome (N = 1). Patients were evaluated by physical examination and, preoperatively, by defecography and anorectal manometry. The rectovaginal septum was repaired, through a perineal approach, with an absorbable (N = 5) or non absorbable (N = 20) prosthetic mesh. Long term results were assessed after a median follow-up of 45 (range 12-120) months by physical examination and a standardized questionnaire. The presence of the following three symptoms was evaluated: feeling of incomplete emptying, prolonged and unsuccessful straining at stool, digital assistance. Outcome was considered as successful when none of these symptoms were present, as good when minor emptying difficulties persisted, as moderate when emptying difficulties were associated with straining, as a failure when the symptomatic triad was unchanged. A general satisfaction score was established. RESULTS: All the patients had the defect of the rectovaginal septum corrected. Four patients had a low residual rectocele associated, in two cases, with a rectal prolapse subsequently treated by a Delorme's operation. Outcome in patients complaining of obstructed defecation was considered excellent or good in 80% of patients, moderate in 9% and poor in 9%. Subjective scoring showed a significantly better result in cases of success. Among 11 incontinent patients, seven (63.5%) improved or regained full continence. Dyspareunia in three cases was corrected. Age, parity, digital assistance, previous gynecologic surgery, use of laxatives, size of rectocele, type of mesh, anatomical result of repair had no significant prognostic value. On the other hand, in patients with obstructed defecation, clinical and manometric signs of anal hyperactivity of the pelvic floor or anismus (N = 4) were significantly related to a poor result (P < 0.001). CONCLUSION: Surgical repair with a prosthetic mesh is an efficient therapy in patients with obstructed defecation and/or incontinence caused by a rectocele. Clinical and defecographic parameters have no influence on outcome. Preoperative manometric data may help in selecting patients. In case of anal hyperactivity or anismus, given the risk of functional failure, behavioral retraining must be considered as first-line treatment.

Adult↗
PubMed1999

Experimental model of enterotoxigenic Escherichia coli infection in pigs: potential for an early recognition of colibacillosis by monitoring of behavior.

The hypothesis that altered behavior is a sign for an early recognition of disease was tested. The experiment was conducted to evaluate the behavioral patterns of pigs in a model of postweaning colibacillosis. Twenty-five weaned pigs (from a herd that was previously found to be highly susceptible to F4+ Escherichia coli strains) were randomly assigned into 5 groups, kept in isolated pens under the controlled ambiental conditions. One day after weaning, the pigs from three groups were intragastrically inoculated (via orogastric tube) with either F4ac+ (1466 or 2407) or F4- (1467) nonenterotoxigenic E. coli (non-ETEC) strains, respectively. The pigs from the fourth group were inoculated with F4ac+ ETEC strain M1823 and the remaining 5 pigs that received broth containing 1.2% sodium bicarbonate were kept as noninoculated controls. The pigs were examined daily and the frequency and duration of their behavioral patterns, such as eating, drinking, lying, standing, urinating, defecating, rooting and playing were monitored for 300 h during a period of 10 days. In this model, three conditions were also observed in F4-susceptible pigs: (1) acute fatal diarrheal disease; (2) moderate diarrhea and weight loss and (3) no diarrhea and weight loss. The incidence (both frequency and duration) of defecating was significantly higher (P < 0.05) in pigs inoculated with F4ac+ ETEC strain M1823 as compared to that of noninoculated (control) pigs. Pigs inoculated with F4ac+ non-ETEC strain 1466 had a significantly lower frequency of eating (P < 0.05) and frequency/duration of drinking (P < 0.05) than did the controls. The 1466-inoculated pigs, had an increased diarrhea score, but frequency/duration of defecating was not significantly different. Pigs inoculated with F4ac+ non-ETEC strain 2407 spent more time in lying (P < 0.05) than did noninoculated pigs. Conversely, the pigs that received F4- non-ETEC strain 1467 laid shorter (P < 0.05) and ate/drank less frequently (P < 0.05) than the controls. It was concluded that the changed occurrence of defecating and eating in pigs that were inoculated with either F4ac+ ETEC (M1823) or non-ETEC (1466) strain. respectively, was consistent with the pending clinical disease, i.e. postweaning colibacillosis.

Animals↗
PubMed1998

Efficacy of senna versus lactulose in terminal cancer patients treated with opioids.

The best laxative for terminal cancer patients treated with opioids still remains to be determined. This comparative study was conducted with the objective of determining treatment and cost efficiency for senna and lactulose in terminal cancer patients treated with opioids. The methodology used a randomized, open, parallel group design. The study was conducted in the Palliative Care Unit in one Madrid Health Care District. Ninety-one terminal cancer patients were randomized into two groups: A = treated with senna (starting with 0.4 mL daily), and B = treated with lactulose (starting with 15 mL daily) for a 27-day period. The main outcome measures were defecation-free intervals of 72 hr, days with defecation, general health status, and treatment cost. Laxative efficacy was analyzed through t test and analysis of variance. No difference was found between the laxatives in defecation-free intervals or in days with defecation. The final scores for general health status were similar in both groups. Given that the two treatments have similar efficacy and adverse effects, a recommendation is made for the use of senna because its cost is lower than lactulose.

Adult↗
PubMed1980

alpha-MSH- and novelty-induced emotional responses in rats: associated changes in plasma corticosterone and brain catecholamines.

In a series of experiments it was demonstrated that defecation responses induced in rats by exposure to novel environments did not habituate if the animals were treated with alpha-melanocyte stimulating hormone (alpha-MSH). The MSH-treated rats sustained high defecation responses on 6 successive days of exposure, whereas control rats habituated. The role of plasma 11-hydroxycorticosterone (11-OHCS) levels and brain catecholamines (CAs) in this novelty-induced defecation following alpha-MSH administration was also investigated. Baseline studies showed that MSH treatment alone increased plasma 11-OHCS levels in the resting condition and lowered brain dopamine (DA) but not norepinephrine (NE) concentrations. It was found, however, that plasma 11-OHCS levels in MSH-treated rats were not significantly increased on successive days of combined MSH and novelty treatments but that whole brain DA and NE concentrations were both lowered. A strong negative correlation was observed between defecation responses and brain DA concentrations on successive days of the joint MSH and novelty treatment. In all the experiments alpha-MSH treatment had no effect on step-down activity.

11-Hydroxycorticosteroids↗
PubMedDate not supplied

Biofeedback: its role in the treatment of chronic constipation.

Constipation accounts for more than 2.5 million physician visits a year. Treatment of constipation has been a long-standing and costly problem. Affecting approximately 4.5 million Americans, predominantly women and the elderly, constipation can be persistent and difficult to manage. With the great number of laxative products available, more than $350 to $400 million is spent on over-the-counter laxatives each year. In addition to a complete history and physical examination, tests of anorectal function are useful in the assessment of defecation disorders. Approximately 50% of patients exhibit uncoordinated or dyssynergic defecation patterns. Biofeedback therapy may improve the symptoms of these patients. Biofeedback therapy is labor-intensive, expensive, and available only at a few centers. Although the concept of dyssynergic defecation has existed for only a few years, its therapy, based on neuromuscular conditioning, is gaining recognition. The biofeedback program from one Midwestern tertiary care center is described. Although much still needs to be learned regarding the etiology and pathophysiology of dyssynergic defecation, its management with biofeedback is shown to be efficacious and may prove to be the treatment of choice for patients with this dysfunction of the pelvic floor.

Biofeedback, Psychology↗
PubMed2004

The diameter of the rectum on ultrasonography as a diagnostic tool for constipation in children with dysfunctional voiding.

PURPOSE: We proved the accuracy of the transverse diameter of the rectum on ultrasonography as an additional parameter for diagnosing constipation in children with lower urinary tract dysfunction. MATERIALS AND METHODS: The diameter of the rectum on bladder ultrasonography in a constipated group of patients with dysfunctional voiding was compared to this diameter in a control group of patients with a normal defecation pattern. A total of 49 children were included. Group 1 consisted of 23 patients with a positive history of dysfunctional voiding and, according to pediatric gastroenterological practice, constipation. Control group 2 consisted of 26 patients without lower urinary tract dysfunction and a normal defecation pattern. In each group a defecation questionnaire was administered and physical examination of the abdomen was done. In all patients a 7.5 MHz probe was used to measure the transverse diameter of the rectum behind the bladder on ultrasonography. The probe was applied on the abdominal skin approximately 2 cm above the symphysis. Measurement was performed with a filled bladder at an angle of about 15 degrees downward from the transverse plane. RESULTS: In constipated group 1 the mean diameter of the rectum was 4.9 cm (95% CI 4.4 to 5.3). In the control group the mean diameter of the rectum was 2.1 cm (95% CI 1.8 to 2.4). In group 1 the diameter of the rectum was significantly larger than in group 2 (p < 0.001). None of the patients had a sensation to defecate during the investigation. There was no significant difference in age between the 2 groups (p = 0.20) and no significant difference between them in the period between the last time that stool was passed prior to the time of rectal measurement (p = 0.16). CONCLUSIONS: The transverse diameter of the rectum measured by lower abdominal ultrasound provides an additional accurate parameter with which to diagnose constipation in patients with nonneurogenic bladder-sphincter dyssynergia.

Adolescent↗
PubMed1998

Dynamic MR defecography with a superconducting, open-configuration MR system.

PURPOSE: To evaluate dynamic magnetic resonance (MR) defecography performed with a superconducting, open-configuration system in diagnosis of defecation disorders. MATERIALS AND METHODS: Five healthy volunteers and 15 patients with defecation disorders were studied with MR defecography performed with a superconducting, open-configuration system; the patients also underwent fluoroscopic defecography. Before MR imaging, the rectum was filled with 300 mL of mashed potatoes mixed with 1.5 mL of gadopentetate dimeglumine. T1-weighted gradient-echo images were acquired every 2 seconds in the midsagittal plane with the patient at rest, at maximal contraction of the anal sphincter, during straining, and during defecation. RESULTS: MR defecography permitted analysis of the anorectal angle, anal canal, puborectal muscle, and descent of the pelvic floor. Owing to the high signal intensity of the intraluminal contrast material, the rectal walls were well demonstrated on the MR images, permitting visualization of intussusception and rectocele. Concomitant demonstration of structures surrounding the anorectal canal was helpful in assessment of spastic pelvic floor syndrome and descending perineum syndrome. MR defecography was superior to fluoroscopic defecography and allowed detection of all clinically relevant pathologic conditions except for one. CONCLUSION: Dynamic MR defecography is an attractive alternative for evaluation of defecation disorders.

Aged↗
PubMed2002

[Investigation of actual use of laxatives and application to the active drug information offer in drug control guidance].

On the therapy of constipation, there are few reports that surveyed the actual circumstance of patients taking laxatives and the effectiveness of the drug. In this study, we investigated the contents in prescription, the actual conditions of administration of laxatives, and the subjective symptoms of inpatients in all wards of Kanazawa University hospital (2000. 12.1-2000. 12. 10). As a result of the investigation, the percentage of patients prescribed some laxatives was found to be about 31.5% (274) of all hospitalized patients (871), and among them about 16% (43) of the patients had some problems in defecation control. One of the causes leading to the problems for some patients (11) among them seemed to be due to the lesser amount of magnesium oxide taken per day. Then, in the ophthalmology ward we further investigated the proper use of laxatives and the defecation condition of the patient using a questionnaire paper and a record paper (20 cases). Patients became constipated by hospitalization, and although being administered some laxatives, they were often insufficient to control the defecation. Some patients (7) with changeable defecation control could be improved by change or addition of prescription. Pharmacist concerned 5 cases of patients with change or addition of prescription. This study indicates that pharmacists should actively offer information and rational usage of laxatives to doctors and patients.

Cathartics↗
PubMed1998

Feces, flies, and fetor: findings from a Peruvian shantytown.

Sanitary disposal of feces is vital to combat childhood diarrhea, and its promotion is key to improving health in developing countries. Knowledge of prevailing feces disposal practices is a prerequisite to formulation of effective intervention strategies. Two studies were conducted in a shantytown area of Lima, Peru. First, information was gathered through in-depth interviews with mothers and structured observations (4 hours) of young children and their caretakers. Data on beliefs and practices related to feces disposal behaviors were obtained. Excreta were deposited by animals or humans in or near the house in 82% of households observed. Beliefs about feces depended on their source and were reflected in how likely the feces were to be cleared. While 22% of children aged > or = 18 months were observed to use a potty for defecation, 48% defecated on the ground where the stools often remained. Although almost all children were cleaned after defecation, 30% retained some fecal matter on their body or clothes. Handwashing after the child's defecation was extremely rare for both children (5%) and caretakers (20%). The hygienic disposal of feces poses problems in this type of community. Nevertheless existing practices were found that show promise for promotion on a wider scale, including greater use of potties.

Feces↗
PubMed2003

Evaluation of the effects of penicillin G potassium and potassium chloride on the motility of the large intestine in horses.

OBJECTIVE: To evaluate effects of IV administration of penicillin G potassium (KPEN) or potassium chloride (KCl) on defecation and myoelectric activity of the cecum and pelvic flexure of horses. ANIMALS: 5 healthy horses. PROCEDURE: Horses with 12 bipolar electrodes on the cecum and pelvic flexure received KPEN or KCl solution by IV bolus 4 hours apart. Each horse received the following: 2 X 10(7) U of KPEN (high-dose KPEN) followed by 34 mEq of KCl (high-dose KCl), 1 X 10(7) U of KPEN (low-dose KPEN) followed by 17 mEq of KCl (low-dose KCl), high-dose KCl followed by high-dose KPEN, and low-dose KCl followed by low-dose KPEN. Number of defecations and myoelectric activity were recorded for 60 minutes. The first three 5-minute segments and first four 15-minute segments of myoelectric activity were analyzed. RESULTS: Number of defecations during the first 15-minute segment was greater after high-dose KPEN treatment than after high-dose or low-dose KCl treatment. Compared with reference indexes, myoelectric activity was greater in the pelvic flexure for the first 5-minute segment after high-dose KCl treatment, in the cecum and pelvic flexure for the first 5-minute segment and in the pelvic flexure for the first 15-minute segment after low-dose KPEN treatment, and in the pelvic flexure for the first and second 5-minute segments and the first three 15-minute segments after high-dose KPEN treatment. CONCLUSIONS AND CLINICAL RELEVANCE: IV administration of KPEN stimulates defecation and myoelectric activity of the cecum and pelvic flexure in horses. Effects of KPEN may be beneficial during episodes of ileus.

Animals↗
PubMed1977

Effects of age, sex, and brightness of rield on open-field behaviors of rats.

48 male and 48 female Holtzman rats, ages 50, 100, and 150 days, were tested in a black or white open field to determine the effect of varying brightness of the field upon ambulation and defecation scores. There were significant negative correlations between all ambulation and defecation scores, except for the 50-day-old animals. Ambulation scores decreased over trials for all animals; defecation scores remained the same. Trials did not interact with age, sex, or brightness on either measure. In both fields females crossed more squares than males at ages 100 and 150 days, but there were no sex differences in ambulation at age 50 days. Most notable was a sex difference as a function of brightness of field; whereas male scores did not differ, females ambulated significantly more and tended to defecate less in the white field. Results are described in terms of the need for standardization of the open field.

Age Factors↗
PubMed1995

Treatment of internal rectal intussusception in patients with chronic constipation.

BACKGROUND: The significance of internal rectal intussusception (rectal invagination) in chronic constipation dominated by symptoms of obstructed defecation is not fully clarified. METHODS: Seventeen consecutive patients with chronic constipation and a history of obstructed defecation with internal rectal intussusception demonstrated by defecography were treated by perineal rectopexy. RESULTS: Of 15 patients followed up for more than 2 years defecography showed total disappearance of the intussusception in 12. Five of these claimed substantial improvement (42%; 17-72%). Three of four patients with concomitant anal incontinence became fully or partly continent after the rectopexy. CONCLUSION: In some patients with chronic constipation, dominated by symptoms of obstructed defecation, rectal invagination may be an aggravating factor. The study indicates that rectal invagination does not seem to be the cause but rather a consequence of the obstructed defecation. In selected patients, including those with concomitant faecal incontinence, surgical treatment of the intussusception by a minor procedure may be indicated.

Constipation↗
PubMedDate not supplied

Precipitants of constipation during early childhood.

BACKGROUND: Childhood constipation is a common problem, accounting for 3% of visits to pediatric clinics and 30% of visits to pediatric gastroenterologists. Estimates of the prevalence of childhood constipation vary from 0.3% to 28% with younger children being affected most often. We were unable to find any studies that specifically examine the causes of constipation in young children. Our objective of the study was to determine precipitants to constipation during early childhood. METHODS: Findings from 125 families visiting their primary care physician for the first time with a child aged between 2 and 7 years with the complaint of constipation were compared with findings from 95 children between 2 and 7 years without any history of constipation. Parents answered questions concerning family history, toilet training, and bowel habits. Parents of constipated children were asked to describe events that occurred during the 3 months before the onset of constipation and whether these events contributed to the child's constipation. RESULTS: The age and sex of children who did and did not suffer from constipation were comparable (P > .3). When compared with control children, constipated children were no more likely to have a parent (30% vs 40%, P = .14) or sibling (17% vs 14%, P = .54) with a history of constipation. Constipated children did not begin toilet training earlier than did control children (28 +/- 7 vs 27 +/- 6 months, P = .30). When compared with parents of control children, parents of constipated children reported more difficulties with toilet training (P < .001). Parents of constipated children indicated their children had more difficult and more painful defecation experiences than did parents of control children (P < .001), and constipated children were more likely to express worry about future painful defecation than were control children (P < .001). Parents of constipated children described a number of events that occurred before the onset of constipation; however, they did not consider many of the events important contributors to the constipation. Painful defecation was the event most often reported as causing the constipation. CONCLUSION: Painful defecation is the primary precipitant of constipation during early childhood. Parents should be counseled to be attentive to such experiences and taught to intervene quickly to lessen the risk that their child will develop persistent constipation or fecal soiling.

Child↗
PubMed1984

Modulation of the digestive-lysosomal system in Paramecium caudatum. I. Effects of temperature.

The heterophagic pathway of the digestive-lysosomal system in axenically grown Paramecium caudatum is divisible into vacuole formation, vacuole acidification-condensation, lysosomal fusion-digestion and defecation. These four processes can be separated in time, thus permitting the study of the effects of temperature on each process. The optimal growth temperature for this cell was 27 degrees C. The rate of digestive vacuole (DV) formation at varying temperatures was represented by a skewed bell-shaped curve having an optimum between 28 and 30 degrees C. The time course for the acidification-condensation step was lengthened below 26 degrees C, but was not accelerated above this temperature. The rate but not the extent of vacuole condensation was decreased at 19 and 22 degrees C. Temperature increase above 22 degrees C shortened, slightly, the duration of the lysosomal fusion-digestion process, whereas below 22 degrees C small temperature decreases greatly extended this period. Within a given experiment the rates of defecation were proportional to temperatures above 17 degrees C. However, these rates varied widely among different experiments. Interestingly, the activation energies for both the formation and defecation processes averaged 19 kcal/mol. Furthermore, Paramecium appeared to readily adapt to environmental temperature changes, since the length of the processing periods and the rates of defecation were similar in cells with or without a 24 h acclimation. These results indicated that the four processes in the digestive cycle in P. caudatum are distinct but each is energy-dependent.

Animals↗
PubMed1981

[Evaluation of the basic characteristics of rat behavior in the "open field" test].

Heart rate, motor activity and defecation were studied in rats of the Wistar strain in 10 successive one-hour "open field" tests. Defecation and heart rate parameters decreased monotonously both from test to test and throughout one session. In motor activity a second rise was recorded at 6--12th minutes against the background of a gradual decline. A positive correlation between the total value of defecation and the heart rate in 2nd-3rd minutes of the first test was observed. At the 13th minute the motor activity positively correlated with the heart rate. Significant negative correlation between motor activity and total value of defecation appeared only at 10--11th minutes of the first test. A conclusion is drawn on twofactorial motivational basis of rats' behaviour in the "open field" test.

Animals↗
PubMed1964

BEHAVIORAL-NEUROCHEMICAL CORRELATION IN REACTIVE AND NONREACTIVE STRAINS OF RATS.

Male and female rats of the Maudsley reactive and Maudsley nonreactive strains were tested in the open-field to obtain ambulation and defecation scores. They were later killed, and their brains were dissected into five portions and analyzed for serotonin. Males defecated more and ambulated less than females, and nonreactive males ambulated more and defecated less than reactive males. These behavioral differences were significant (p .05). A statistically significant difference was found for the amounts of serotonin in specific regions of the brain between males and females (males higher) and between reactive and nonreactive males (reactive higher). Significant negative correlations between serotonin values in specific regions of brain and ambulation scores were found in these animals viewed as a group or even within a given strain and sex.

Animals↗
PubMed1976

Differential behavioral responses of male and female adult rats treated with five psychotropic drugs in the neonatal stage.

Male and female rats received during infancy either handling or injections of saline, phenobarbital, haloperidol, diazepam, chlorpromazine, and amphetamine. On reaching adulthood, the behavior of these animals was measured in an open-field arena and in a Lashley III maze. Saline injections per se affected the behavior of males but were unable to change that of females. The drugs provoked increased ambulation and/or decreased defecation of males in the open field, whereas with the females the opposite was observed, that is, a decreased ambulation and/or an increased defecation. Consequently, the early drug treatments abolished the sexual differences normally observed in ambulation and defecation of rats. Four of the 5 drugs tested deteriorated the maze performance of both male and female rats.

Amphetamine↗
PubMed1980

Sympathetic activity in the recto-rectal reflex of the guinea pig.

In the guinea pig, defecation is controlled by the myenteric plexus, whose activity is modulated by the sacral spinal and supraspinal centers. The purpose of this study is to clarify the control of defecation reflex by sympathetic nerves. The propulsive contractions of the rectum produced by rectal distension (recto-rectal excitatory reflex response) were abolished after transection of the Th 13 and/or L 4 segment. This response was reproduced again after removal of the lumbar segments (L1--4), division of the lumbar dorsal roots (L1--4), the lumbar splanchnic nerves or lumbar colonic nerves (LCN). The frequency of efferent discharges of LCN was increased slightly by rectal distension and remarkably increased after Th 13 and/or L 4 transection. Thus, there occurs during the recto-rectal reflex not only mucosal intrinsic reflex and sacral excitatory reflex via the pelvic nerves but also a lumbar inhibitory reflex via the colonic nerves, whose center may be located in the upper lumbar segments. But, the activity of the inhibitory center was depressed by the supraspinal center, so that an excitatory reflex is produced more dominantly than an inhibitory one in normal animals. All these extrinsic reflexes coordinate the activity of the myenteric plexus in defecation reflex.

Action Potentials↗