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PubMed1999

Manometric tests of anorectal function in healthy adults.

OBJECTIVE: Although tests of anorectal function are useful in the assessment of defecation disorders, there is inadequate and inconsistent information regarding normative data. Also, there are discrepancies in manometric techniques and data interpretation. Our aim was to perform a comprehensive evaluation of anorectal function in healthy adults. METHODS: We used a 6-mm diameter probe containing six radially arrayed microtransducers, and a 4-cm-long latex balloon for performing anorectal manometry in 45 healthy subjects who were controlled for gender and age. Sequentially, subjects were asked to squeeze, bear down, or blow up a party balloon. Subsequently, rectal sensation, rectal compliance, and rectoanal reflexes were assessed simultaneously by performing intermittent phasic balloon distentions. Additionally, balloon defecation, pudendal nerve latency, and saline continence tests were performed. RESULTS: In men, the anal sphincter was longer (p < 0.05) and squeeze sphincter pressure and squeeze duration were higher (p < 0.01), but resting sphincter pressure was similar to that in women. When bearing down, although not significant, the defecation index was higher in men. Distinct thresholds for rectal sensation were identified but there was no gender difference. Likewise, rectal compliance and balloon expulsion time were similar. However, during saline infusion, the onset of first leak and total volume retained were higher (p < 0.001) and pudendal nerve latency was shorter (p < 0.05) in men. Overall, parity or age did not influence anorectal function. CONCLUSIONS: This study represents the most comprehensive age- and gender-controlled assessment of anorectal function using solid state technology. Gender influences some parameters of anorectal function. Our results could serve as a valuable resource of normative data.

Action Potentials↗
PubMed2000

Coloanal motor coordination in association with high-amplitude colonic contractions after pharmacological stimulation.

OBJECTIVE: The rectoanal inhibitory reflex facilitates defecation by relaxation of the internal anal sphincter during rectal distention by gas or stool. Defecation is sometimes preceded by high-amplitude propagated contractions (HAPCs). Our objective was to seek evidence for motor coordination between human colonic and anal sphincter functions. METHODS: As part of a study of alpha2 modulation of colonic and anal motor functions in 32 healthy volunteers, we studied the relationship between high HAPCs and anal sphincter pressure with colonic manometry, barostat, and a Dent sleeve in the anal canal. RESULTS: Twenty-two HAPCs were observed; in 19/22 HAPCs there was optimal positioning of the Dent sleeve to assess the anal sphincter. Eighteen of 19 HAPCs occurred postprandially; 14 HAPCs occurred after administration of yohimbine, three after clonidine, and one before any drug administration. Seven followed experimental balloon distention. Anal sphincter relaxation occurred (14 +/- 4 s) before the recorded onset of HAPC in the descending colon and 88 +/- 7 s before the arrival of the HAPC in the rectum. After or during the HAPCs, anal sphincter pressure decreased by 40 +/- 4% and increased by 56 +/- 8% in the postrelaxation phase. CONCLUSIONS: The close temporal association between anal sphincter relaxation and onset of HAPC in the descending colon suggests a coloanal reflex that may facilitate defecation during mass movements independently of the rectoanal inhibitory reflex.

Adrenergic alpha-Agonists↗
PubMed1993

Inhibitory activity of camptothecin derivatives against acetylcholinesterase in dogs and their binding activity to acetylcholine receptors in rats.

A camptothecin derivative, 7-ethyl-10-[4-(1-piperidino)-1-piperidino]carbonyloxycamptothecin (CPT-11), shows a potent antitumour activity in experimental tumour models and in clinical trials. However, CPT-11 induced early diarrhoea and vomiting at high dose levels in clinical studies and showed an acetylcholine-like action on the guinea-pig ileum and trachea. In the present study, we investigated the activities of camptothecin derivatives in inhibiting acetylcholinesterase (AChE) and in binding to muscarinic acetylcholine receptors (AChR). CPT-11 inhibited AChE and binding of the specific ligand to AChR with respective 50% inhibition concentrations of 0.2 and 5 microM. These inhibitions were induced by camptothecin derivatives having an amino group at the C-10 position (or the C-4 position of hexacyclic derivatives), but were not or were only slightly induced by the others. Early defecation and vomiting in dogs were observed after intravenous injection of DU-6596 and DU-6888, two hexacyclic derivatives having the aminomethyl group at the C-4 position, and of CPT-11. DU-6174, however, which has a hydroxy group at this position, induced no early defecation and little vomiting. Plasma concentrations of CPT-11, DU-6596 and DU-6888 after intravenous treatment at doses causing such early adverse effects were maintained for 1 h or longer at levels sufficient to inhibit AChE. These results suggest that the inhibition of AChE by camptothecin derivatives with an amino group at the C-10 position (or the C-4 position) relates to the early defecation or diarrhoea and vomiting.

Animals↗
PubMed1994

SR 48968 selectively prevents faecal excretion following activation of tachykinin NK2 receptors in rats.

We tested the ability of SR 48968, (S)-N-methyl-N(4-(4-acetylamino-4-phenylpiperidino)-2-(3,4-dichloropheny l)butyl ) benzamide, a non-peptide antagonist highly selective for tachykinin NK2 receptors, to prevent defecation induced in rats by several agents. The tachykinin agonists substance P, [MePhe7]neurokinin B and [beta-Ala8]neurokinin A (4-10) all promoted defecation and increased faecal water content, the last compound being over ten times more potent than the other two (intraperitoneal dose inducing the excretion of 1 g faeces dry weight = 6.7 micrograms kg-1). SR 48968 given either orally (p.o.) or subcutaneously (s.c.) was similarly potent in dose-dependently inhibiting faecal output stimulated by the selective NK2-agonist [beta-Ala8]neurokinin A (4-10) (doses causing 50% inhibition 0.4 microgram kg-1, p.o. and 0.3 microgram kg-1, s.c.). This inhibition was long-lasting (more than 18 h after 1 microgram kg-1 SR 48968 either s.c. or p.o.). At the higher doses tested, SR 48968 also significantly prevented the increase in faecal water content produced by [beta-Ala8]neurokinin A (4-10). In rats treated with SR 48968, stimulation of faecal output by the alpha 2-adrenergic antagonist idazoxan and by salmonella endotoxin (LPS), but not by the 5-HT1A agonist 8-hydroxy-2-(di-n-propylamino) tetralin, 5-HT, carbachol or platelet-activating factor, was partially prevented. The present results suggest that activation of intestinal NK2 receptors, either directly by the selective agonist [beta-Ala8]neurokinin A (4-10) or indirectly through the release of endogenous neurokinin A (by idazoxan or LPS), promotes defecation, presumably as a consequence of increased gut motility or secretion, or both. SR 48968 should therefore be useful for studying the role of neurokinin A-dependent mechanisms in health and disease, including those of the gastrointestinal system, and possibly for developing new therapeutic agents.

Animals↗
PubMed1996

A novel method for the preclinical assessment of rectal irritation.

The purpose of this study concerns a novel method for preclinical assessment of rectal irritation caused by suppositories introduced into the rectum. Rectal irritation was assessed by the balloon method in fasting conscious rats. This method is based on measuring rectal contractions due to possible irritation caused by the presence of drugs and adjuvants in the suppository. In control experiments (vehicle only), significant rectal contractions were not observed in a range of pH 1.5-11.0 and osmotic pressure 70-2000 mOsm kg-1 H2O, respectively. On the other hand, strong contractions were observed after rectal administration of an aqueous solution of 50% glycerin, 100 mM sodium caprate or 25 mM sodium cholate. The intensity of contraction after rectal administration of sodium caprate or sodium cholate was dependent on the concentration in the dosing solution. In addition, the effect of sodium caprate and sodium cholate on rat rectal mucosa was investigated by optical light microscopy. Although slight or moderate alteration such as the presence of mucinous substance in lumen and congestion, oedema and haemorrhage of the rectal membrane 20 min after rectal administration, there was no major damage to the rectal mucosa. There was a correlation between the median score for mucinous substance in lumen and mean intensity of rectal contraction. For comparative purposes, defecating sensations, pain, itch, burning sensations, and awareness of the presence of a foreign body after administration of suppositories containing 0, 1, 2 and 4% sodium caprate were examined in eight healthy volunteers. The defecating sensation in the human subjects correlated with the intensity of rectal contraction in rats. The results suggest that rectal contraction in conscious rats could be a useful index for prediction of a defecating sensation in man.

Adult↗
PubMed1987

Effect of four days of preoperative lactulose on posthaemorrhoidectomy pain: results of placebo controlled trial.

The effect of four days of preoperative lactulose on posthaemorrhoidectomy pain was studied in a prospective double blind randomized trial. All patients received lactulose on admission to hospital, 20 received lactulose for four days before admission, and 22 received placebo. The preoperative lactulose treatment group suffered significantly less pain on defecation for the first four days that they opened their bowels (visual analogue scores in cm: day 1, 4.4 v 5.9; day 2, 4.1 v 6.3; day 3, 4.5 v 6.1; day 4, 4.6 v 6.5), suffered significantly less pain during the first two 24 hour periods after defecation (visual analogue scores in cm: day 1, 5.0 v 7.0; day 2, 3.9 v 6.1), and required significantly less analgesia daily after defecation (0.76 g paracetamol/day v 1.29 g paracetamol/day). These results show that lactulose given for four days preoperatively reduces pain after haemorrhoidectomy.

Clinical Trials as Topic↗
PubMed1991

How bad are the symptoms and bowel dysfunction of patients with the irritable bowel syndrome? A prospective, controlled study with emphasis on stool form.

Since it is not known whether the symptoms and bowel function of patients with the irritable bowel syndrome are truly abnormal we used diaries and frequent telephone interviews over a 31 day period to assess symptoms, defecation, and stool types in 26 unselected female hospital patients with the irritable bowel syndrome, 27 women who admitted to recurrent colonic pain but had not consulted a doctor (non-complainers), and 27 healthy control subjects. Unexpectedly, abdominal pain and bloating occurred in most of the control subjects. Pain, however, was six times more frequent in the patients and was more often considered severe. Bloating occurred three times more often. Defecation was more frequent, more erratic in timing and stool form, and more likely to produce stools of extreme forms, indicating rapid fluctuations in intestinal transit time. Urgency was four times more prevalent in patients than control subjects. Straining to finish defecating was nine times more prevalent and was often accompanied by feelings of incomplete evacuation--a combination which could lead to the misdiagnosis of constipation. The normal relation between stool form and the above symptoms was distorted, possibly due to rectal irritability. Non-complainers were intermediate between patients and control subjects in almost every parameter but were closer to control subjects than to patients. Patients with the irritable bowel syndrome have real cause for complaint and their bowel function is truly abnormal.

Abdominal Pain↗
PubMed1991

Outlet obstruction constipation (anismus) managed by biofeedback.

Fifteen subjects presenting with intractable constipation due to obstructive defecation, mean (SEM) duration 8.8 (1.8) years, had the inappropriate contraction and electromyographic changes in the pelvic floor muscles and external and sphincter typical of this condition. An electromyographically derived index was used to grade its severity. A self applied biofeedback device was used to allow electromyographic recording of the abnormal external anal sphincter. The subjects were encouraged to reduce the abnormal electromyographic activity on straining after instruction and training. The procedure was intended as a relearning process in which the non-relaxing activity of the pelvic floor was gradually suppressed. Biofeedback training was maintained on a domiciliary basis for a mean time of 3.1 weeks and resulted in a significant reduction in the anismus index (mean (SEM) 69.9 (7.8)% before biofeedback, mean 14 (3.9)% after biofeedback, p less than 0.01). There was an associated reduction in the time spent straining at stool and in the difficulty of defecation and an increased frequency of defecation. Defecatory video proctograms in six subjects showed improvements in the anorectal angle during straining and evacuation. The clinical benefit to the patients persisted after a mean follow up of 6.2 months.

Adult↗
PubMed1998

Galacto-oligosaccharides relieve constipation in elderly people.

The aim of the study was to investigate whether galacto-oligosaccharides (GOS) relieve constipation in elderly people. The final study population consisted of 14 female subjects, mean age 79.6 (69-87) years, who suffered from constipation. The study was a double-blind two-period cross-over study. Both study periods lasted 2 weeks. The subjects ingested either 2 control yoghurts or 2 GOS-containing yoghurts daily. The yoghurts were otherwise similar, but the daily dose of GOS (Elix'or, BWP, Holland) from the GOS yoghurt was 9 g. The regular use of laxatives was stopped during the study periods and laxatives were used only when necessary. All the subjects reported the function of their intestines daily in a questionnaire. The defecation frequency per week (mean, range) was higher during the GOS period (7.1, 3-15) than during the control period (5.9, 1-14). GOS had no statistically significant effect on the use of laxatives, the consistency of feces or the ease of defecation, although GOS seemed to make defecation easier (p = 0.07). The adverse gastrointestinal symptoms were similar during both the control and the GOS periods. GOS seem to relieve constipation in most elderly people but the responses differ individually.

Aged↗
PubMed2004

Disposal of children's faeces and implications for the control of childhood diarrhoea.

Unhygienic disposal of children's faeces is one of the key factors responsible for the high incidence of childhood diarrhoea in developing countries. The aim of this project was to study household behaviours relating to the disposal of faeces of children under the age of five. The study was conducted in Ife South Local Government Area of Osun State, Nigeria, where 320 households, containing 540 mothers with children under the age of five were randomly selected. Data was collected by observation using a schedule specifically designed for the study. Our findings show that while over 80% of children under the age of seven months defecated on a napkin, the majority of older children (over seven months of age) defecated on either the floor of the household and their surroundings or outside in the household's vicinity. Mothers usually cleaned up the children's faeces which were then thrown into a pit latrine. In some cases dogs were used to clean up the faecal matter on the floor. In either case faecal residue remained on the floor. The authors recommend educational interventions to change the unhygienic practices relating to clean up and disposal of children's faeces. The interventions include encouraging children to defecate in plastic chamber pots, promoting the practice of hand washing with soap and water after cleaning up the children's faeces and the construction of affordable and ventilated latrines by members of the communities.

Adult↗
PubMed2000

[Delayed emesis induced by the chemotherapeutic agent doxorubicin hydrochloride in dogs].

The occurrence of delayed emesis induced 24 h after the administration of a non-platina chemotherapeutic agent, doxorubicin hydrochloride (doxorubicin), as well as behaviors such as feeding, drinking and defecation were examined in dogs. A single intravenous administration of 2 mg/kg doxorubicin induced emesis within 24 h of administration in some dogs, while delayed emesis was observed 24 h after administration in all dogs. This delayed emesis emerged strongly at day 3 or 4 and decreased at day 5. Hypophagia, the decreased frequency of drinking and the increased frequency of defecation were induced shortly after delayed emesis. Twenty-four hours after the administration of doxorubicin, a daily dose of 0.3 and 1 mg/kg/day, p.o. azasetron, a 5-HT3 antagonist, was administered for 4 days. Doxorubicin-induced delayed emesis was observed to decrease by about 30 and 50%, respectively. This result suggests that 5-HT3 receptors play a role in the mechanism of delayed emesis. Azasetron was found to improve the increased frequency of defecation, but exerted no obvious effect on hypophagia or on the decreased frequency of drinking. Taken together, we suggest that doxorubicin-induced emesis in dogs is a useful method to study further the mechanisms of delayed emesis and to investigate novel therapeutic agents against delayed emesis.

Animals↗
PubMed1993

Pharmacological properties of KF18259, a novel 5-HT3-receptor antagonist, in rats: inhibition of the distal colonic function.

We investigated the effects of KF18259 (endo-(8-methyl-8-aza- bicyclo[3.2.1]oct-3-yl)-1-isobutyl-2-oxo-1,2-dihydro-4-quinolinecarboxyl ate hydrochloride), a novel 5-HT3-receptor antagonist, in a variety of rat models, which are assumed to be mediated via 5-HT3 receptors, in comparison with those of YM060 ((R)-5-[(1-methyl-3-indolyl)carbonyl]-4,5,6,7-tetrahydro-1H- benzimidazole hydrochloride), granisetron and ondansetron. KF18259 inhibited wrap-restraint stress-induced defecation. The doses of KF18259 to inhibit wrap-restraint stress-induced defecation were lower than those to inhibit the 5-HT-induced von Bezold-Jarisch reflex and the cisplatin-induced slowing of gastric emptying. In contrast, the doses of YM060, granisetron and ondansetron to inhibit these three responses were similar. Moreover, KF18259 inhibited the wrap-restraint stress-induced propulsive motility of the proximal and distal colon. The effect of KF18259 on the distal colon was as potent as that on defecation and was more potent than that on the proximal colon. These results indicate that KF18259 potently inhibits the distal colonic function. KF18259 may be a useful tool for the discrimination of the 5-HT3-receptors located on the distal colon and other tissues.

Animals↗
PubMed1992

[A study of the defecography].

Defecography, the radiologic examination of the defecation function, has never been reported in Japan, whereas some reports have been published in western countries. However neither the methods nor the criteria for use have been fully established. The author carried out a radiologic study focusing on the maximum lower rectal width and the ano-rectal angle by means of defecography which is considered one of the most efficient methods to examine the morphology and function of defecation. Defecography was carried out in order to study the changes in maximum lower rectal the width and the ano-rectal angle during straining and at rest both with and without the spasmolytic agent, Buscopan. The effects of using different amount of barium sulfate suspension 120 ml and 50 ml were also studied. The maximum rectal width tended to be narrowed and the ano rectal angle to increase during straining as compared to the measurements at rest, while no significant changes, were observed concerning the presence or absence of Buscopan. In comparative studies between pathologic cases such as those with constipation incontinence hemorrhoids and post operative hemorrhoids, and a normal control group, a statistically significant difference was demonstrated only in the cases with hemorrhoids. No difference was demonstrated in any of the cases in association with the use of Buscopan. The length of the anal canal was shortened by straining and was longer in males than in females. Furthermore, by using a catheter with optic fiber, the internal pressure of the anal canal was measured before defecography and it was noted that pressure was lower in older patient and patients with constipation. In conclusion, defecography is one of the most important radiologic examination procedures related to the physio-pathology of defecation.

Adult↗
PubMed2003

Neural control of the internal anal sphincter motility.

Control mechanism of smooth muscle movement of the internal anal sphincter (IAS) by enteric and extrinsic neuvous systems in the dog was investigated. Responses of IAS muscle strips to electrical field stimulation (EFS) and neurotransmitter agents were recorded in vitro. The contraction response to norepinephrine or to EFS was inhibited by phentolamine. The relaxation induced by EFS was not affected by phentolamine, propranolol or atropine. The mechanical activity of smooth muscle in colon and anorectum during spontaneous defecation was recorded using strain gauge force transducers. The colon and anorectum showed the characteristic motility pattern during defecation: 1) The giant migrating contraction of the colon propagated to the rectum, 2) The relaxation of the rectum prior to the contraction, and 3) The IAS muscles continued to relax while the giant contractions of the colon were migrating to the rectum. Sacral nerves were stimulated electrically and the responses of smooth muscles in the rectum and IAS were recorded. The sacral nerve stimulation induced a relaxation followed by contraction of smooth muscle in the rectum and the relaxation in IAS. The mechanical responses of smooth muscle in the IAS were modulated by alpha-adrenergic excitatory and non-adrenergic, non-cholinergic inhibitory nerves. During defecation, the relaxation of IAS smooth muscle was associated with a characteristic motility pattern of the colon and anorectum. The enteric nervous systems may be organizing the motility of these muscles by way of the motor neurones under the control the extrinsic nervous systems.

Anal Canal↗
PubMedDate not supplied

[Biology of Triatoma nitida Usinger, 1939 in laboratory conditions (Hemiptera: Reduviidae)].

Triatoma nitida is a wild species occurring in Mexico and Central America. In order to establish the length of its life cycle and transmission potential, the following parameters were observed: the incubation period, the interval between hatching, or moulting, and the first feeding; the number of blood meals and the time of development. The time-lapse before the bite, the length of feeding and the interval between the end of the blood meal and defecation, as well as the site of defecation were also analyzed. Average length of the egg incubation period was 18.2 days. Time interval between the food source offering and the bite was less than 4 min in 60% of the analyzed cases, except in the fifth instar, where only 38% of the insects began feeding in less than 5 min. The blood-sucking period was long and rising until the fifth instar, decreasing in adults, and ranging from 1 min to 2 and a half hours. Only 26% of the blood meals were followed by defecations within 20 min. The average length of the life cycle was 897.5 days.

Animals↗
PubMed1987

The solitary rectal ulcer syndrome: diagnosis with defecography.

The solitary rectal ulcer syndrome is an uncommon entity consisting of a rectal abnormality caused by straining during defecation and characterized by specific histologic changes. Endoscopy may show single or multiple ulcers or a preulcerative phase consisting of mucosal thickening. Findings on barium enema may be normal or nonspecific, consisting of a thickened valve of Houston, nodularity, and rectal stricture. Pathologic changes consist of replacement of the lamina propria by fibroblasts and smooth muscle fibers with marked hypertrophy of the muscularis mucosae. In five patients with histologically proved solitary rectal ulcer syndrome, defecography was performed to evaluate the accompanying defecation disorder. Two patients showed the spastic pelvic floor syndrome, characterized by failure of relaxation of the pelvic floor musculature during straining. In the remaining three, defecography showed an infolding of the rectal wall toward the rectal lumen increasing gradually to form an intussusception. The results indicate that defecography is useful to show the underlying disorder of defecation in the solitary rectal ulcer syndrome.

Adult↗
PubMed2001

Risk factors for reduced postoperative fecal output in horses: 37 cases (1997-1998).

OBJECTIVE: To determine prevalence and risk factors for development of ileus of the large intestine after surgery in horses, identified by reduced postoperative fecal output (RPFO). DESIGN: Retrospective study. ANIMALS: 37 horses that developed RPFO after undergoing general anesthesia for reasons unrelated to the gastrointestinal tract. PROCEDURE: Fecal output was obtained from medical records as number of defecations per 24-hour period after surgery; RPFO was defined as < or = 3 defecations per 24-hour period after surgery. The reference population included 48 horses that defecated > or = 4 times during the same period. Demographic, clinical, and surgical variables were evaluated for their association with development of RPFO by use of logistic regression analysis. RESULTS: Ten (12%) horses, all of which had RPFO, developed signs of colic after surgery. Horses > or = 5 years old that underwent orthopedic procedures of > 60 minutes' duration and that did not receive phenylbutazone after surgery were at significant risk for developing RPFO. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that after surgery unrelated to the gastrointestinal tract in horses, there is an intermediate clinical phase characterized by reduced fecal output preceding overt signs of colic. Recognition of RPFO may reduce morbidity and mortality of such horses.

Anesthesia↗
PubMed1997

Open field behavior in nucleus basalis magnocellularis-lesioned rats treated with physostigmine and verapamil.

The present study was done to investigate and compare the effect of acetylcholinesterase inhibitor, physostigmine (0.030, 0.045, 0.060 and 0.075 mg/kg sc) and Ca-antagonist, verapamil (1.0, 2.5, 5.0 and 10.0 mg/kg sc) on open field behavior in male Wistar rats with bilateral electrolytic lesions of nucleus basalis magnocellularis (NBM). NBM-lesions produced a significant increase and decrease of ambulation and number of inner squares entered, and defecation, respectively, with no influence on grooming in rats exposed to novel environment. Physostigmine and verapamil in all tested doses, given 30 min before the test did not affect the open field behavior in control animals. In contrast to that, physostigmine (0.045, 0.060 and 0.075 mg/kg) and verapamil (2.5 and 5.0 mg/kg) significantly reduced ambulation and number of inner squares entered in NBM-lesioned rats. Also, physostigmine in a dose of 0.060 mg/kg significantly decreased defecation and in doses of 0.060 and 0.075 mg/kg the grooming, as well. On the other hand, verapamil only in a dose of 2.5 mg/kg significantly increased defecation. It could be concluded that lesions of NBM in rats induced disturbances in the open field behavior, which might be successfully ameliorate by physostigmine and verapamil treatment.

Animals↗