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PubMed1997

Randomized controlled trial of trimebutine (anal sphincter relaxant) for pain after haemorrhoidectomy.

BACKGROUND: Anal sphincter spasm may aggravate pain after haemorrhoidectomy. The aims of this study were to investigate whether a trimebutine suppository (Proctolog) reduced anal resting pressure and, subsequently, to test its efficacy in relieving pain after haemorrhoidectomy. METHODS: Ten patients underwent anal manometry before and 4 h after Proctolog application. A controlled randomized trial was then conducted on 160 consecutive patients. A standard haemorrhoidectomy was performed. Eighty patients were then randomized to receive an application of Proctolog immediately after the procedure (group 1). The remaining 80 did not receive a suppository (controls, group 2). An independent, blinded observer determined the pain scores. RESULTS: Proctolog resulted in a mean 35 per cent reduction in resting anal pressure (P < 0.001). However, there were no differences in the pain score at 4 h after haemorrhoidectomy, maximum pain during the first 24 h, maximum pain during the second postoperative day, ketoprofen requirement or need for intramuscular pethidine injections between groups 1 and 2. CONCLUSION: Although Proctolog reduced mean resting anal pressure at 4 h after application, this did not affect pain after haemorrhoidectomy.

Female↗
PubMed1993

[Magnetic resonance imaging in perianal Crohn's disease].

Magnetic resonance imaging (MRI) was undertaken in a prospective study of 34 consecutive patients (21 women, 13 men; median age 31 [18-53] years) suspected of having active perianal Crohn's disease. The results of the investigation were compared with those obtained by independent observers on proctological and intraoperative examination (n = 31). A total of 58 fistulas and 21 abscesses were noted intraoperatively, 47 fistulas and all 21 abscesses by MRI, and 40 fistulas and 13 abscesses proctologically. The proctological examination proved to be more sensitive in demonstrating short subcutaneous or anovaginal fistulas (three of four subcutaneous and two of five anovaginal fistulas were not shown by MRI). Intersphincteric, ischiorectal and supralevator involvement was shown better by MRI. These results indicate that in perianal Crohn's disease MRI is a useful addition to proctological examination.

Abscess↗
PubMed1999

Prevalence of anal sphincter defects revealed by sonography in 335 incontinent patients and 115 continent patients.

OBJECTIVE: The aim of this study was to compare the prevalence of anal sphincter defects on anal sonography of incontinent and continent patients. SUBJECTS AND METHODS: Four hundred sixty-eight consecutive subjects who underwent anal sonography were studied. The prevalence of anal sphincter defects was calculated in 335 incontinent patients, 115 continent patients, and 18 asymptomatic female volunteers. All subjects answered a questionnaire about childbirth and proctologic surgery. RESULTS: The prevalence of anal sphincter defects revealed on sonography was 65% in the 335 incontinent patients. The prevalence of anal sphincter defects in incontinent patients was 88% in patients with a history of childbirth and proctologic surgery and 62% with childbirth alone. The prevalence of anal sphincter defects revealed on sonography was 43% in continent patients and 22% in asymptomatic volunteers. The prevalence of anal sphincter defects in continent patients with a history of childbirth and proctologic surgery was 92% and was 41% with childbirth alone. We found no difference in the prevalence of sphincter defects according to the age and sex of patients. CONCLUSION: Anal sonography can be used to identify sphincter defects in approximately two thirds of incontinent patients. Prevalence is greater in patients with a history of proctologic surgery. Because of the presence of sphincter defects in continent patients and in asymptomatic volunteers, caution should be used in attributing incontinence to anal sphincter defects alone.

Adolescent↗
PubMed1991

Anal tonometry: a quick method of anal manometry.

Evaluation of anal sphincter tonic activity is important in the proctologic clinic. However, manometric techniques are expensive, complex, and only available in some centers. Because there is often an in-office need for having objective measurements of anal tonic activity, in our clinic we introduced a simple method for measurement of anal pressures. This method is based on the flow of air in an open circuit by using a rubber probe with a side opening at one end. Pressure is assessed by an ordinary manometric gauge for arterial pressure. With this simple instrument, the following parameters are measured: 1) anal resting pressure, 2) squeeze pressure, 3) functional length of the anal canal, and 4) descent of the perineum on staining. After testing the technique in 100 healthy persons, it was applied to 130 patients with several proctologic disorders. Differences in pressures were found between controls and patients with anal fissure (high resting pressures), and patients with anal incontinence (low resting and/or squeeze pressures). A correlation was also found between the descending perineum measured by this method and by defecography. This simple instrument is useful in the office as the first approach to the function of the anal sphincters and the pelvic floor. Nowadays, so-called anal tonometry is part of the proctologic examination in our department, because it is simple, reliable, and takes only a few minutes.

Adolescent↗
PubMed1992

[The active detection of tumors of the large intestine by using automated screening].

A system for automated screening for early detection of proctologic pathologies is described. Questionnaire-based data, formation of high risk groups using a computer and results of examination of 1660 office and professional workers of an industrial enterprise according to a given program are discussed. After filled questionnaires had been processed using a computer, 134 (8%) subjects were selected to group 1, 454 (27%) subjects-to group 2, 383 (23%) subjects-group 3 and 689 (42%) subjects-to group 4. Proctologic pathologies were detected in all persons of group 1, 83% of those in group 2 and in 30% cases of group 3. Asymptomatic proctologic pathology was established in 630 (37.8%) screenees of whom 10 revealed large bowel tumors, 5 early cancers included, whereas 49-large bowel polyps.

Adult↗
PubMed1992

[Endoscopic sonography of the anorectum in inflammatory rectal diseases].

213 patients, classified in 3 groups, were examined in a prospective trial using endorectal ultrasound. 80 patients (group A) had no anorectal disease, the endorectal ultrasound showed normal structures of the anorectum and the perirectal tissue. 80 patients (group B) suffered from Crohn's disease, 30 of them had no clinical signs, the rest of this group (50 patients) felt pain in the anal/perianal region. 83 patients (group C) had perianal abscesses or fistulas, Crohn's disease could be excluded. In all 64 perianal fistulas and 66 perianal abscesses were diagnosed. The results of the rectal-proctological examination were compared with endorectal ultrasound. 100% of the perianal abscesses could be recognized using endosonography. The digital-proctological examination revealed only 57% of perianal abscesses and 48% of perianal fistulas; the supralevatory abscesses couldn't be detected proctologically at all. By endorectal ultrasonography we obtained useful informations about localization and extension of the inflammatory process. From a therapeutic and prognostic view the endorectal ultrasound is a simple, practicable and useful method to investigate perianal and anorectal diseases.

Abscess↗
PubMedDate not supplied

[Disposable isostatic anal retractor: results of a clinical assessment].

In this paper the authors present the technical characteristics and clinical results of a new anal retractor designed and produced by them. This new instrument, made of disposable material, allows the proctologist to operate completely alone thanks to a system of rotating rings which are fixed directly to the patient's legs by means of Velcro bands. Twenty consecutive patients with proctological diseases have been operated on to date with the new device. No complications were registered in our series. The rotation movement and overall stability of the retractor were judged sufficient in 6 cases and good in 14. Opening of the device proved asymmetrical in 20% of the cases without this affecting the surgical technique. Our surgical team considered the prototype ideal, and the operative space available to the surgeon much greater than with previous retractor models. No limitations have been observed in treating any of the proctological diseases. The possibility of performing sutures in the anal canal was judged to be good. In conclusion, our new anal retractor would appear to guarantee greater autonomy in proctological surgery with much better clinical and therapeutic results and lower costs.

Anal Canal↗
PubMed1986

Anogenital syndrome.

The diagnosis "prostatitis" is frequently a makeshift. It not uncommonly occasions long-term antibacterial chemotherapeutic measures which are often ineffective. The symptoms of "prostatitis" may be caused by an anogenital syndrome. This diagnosis can only be made on the basis of meticulous urological and proctological investigations. They frequently obscure the proctological cause of such symptoms (e.g. haemorrhoids).

Anus Diseases↗
PubMed1979

Management of postoperative constipation in anorectal surgery.

Fifty patients who had undergone proctologic operations were given a combination of standardized senna concentrate and dioctyl sodium sulfosuccinate for prevention or treatment of postoperative constipation. Two Senokot S tablets were given on the evening of the first postoperative day. Patients who had bowel movements after receiving this dose and remained in the hospital received two tablets on each of the following two days. Otherwise, dosage was increased gradually to a maximum of four tablets twice daily until defecation occurred or until the four-day treatment period was over. All patients achieved bowel movements, and in no case was it necessary to administer an enema. No hard stools were passed on the day patients were discharged from the hospital. Overall results were excellent or good in 94 per cent of cases; these results were not affected by age. Ninety-two per cent had bowel movements after the first or second dose was administered. On the day of discharge from the hospital, fecal consistency was satisfactory in 88 per cent of cases and loose in 12 per cent. Except for a single instance of diarrhea after administration of one dose, which involved a patient with a history of loose stools, no side effect occurred during the trial. In view of these responses and the virtual absence of side effects in this study group, Senokot S tablets are judged to be of demonstrated value in the postoperative management of patients undergoing proctologic operations.

Adult↗
PubMed1979

Outpatient anorectal surgery.

Over a period of 16 months, three-fourths of the proctologic surgery performed by our clinic was done on an outpatient basis. By doing so, 1,200 patient visits and approximately 300 histories, physicals, and discharge summaries are eliminated, while obviously benefiting patients and reducing health care costs. Thus, we can conclude that hospitalization is not necessary for the majority of proctologic surgery patients.

Ambulatory Surgical Procedures↗
PubMed2000

[Coloproctological diseases of the pelvic floor].

PURPOSE: The aim of this review is to describe the most frequent and important coloproctologic pelvic floor disorders. Relevant diagnostic procedures of the pelvic floor will be presented. MATERIAL AND METHODS: A host of diagnoses and symptoms such as the descending perineum syndrome, rectocele, cystocele, enterocele, uterine and vaginal descensus, anal and rectal prolapse, outlet obstruction, anismus, inertia recti and intussusception are included under the heading "pelvic floor disorders". Although symptoms are often varied, problems concerning urinary and/or faecal continence commonly lead to primary consultation of a physician. RESULTS: Quite often, apparently divergent symptoms such as constipation and incontinence are simultaneously mentioned. A clear gender disposition is observed with female patients inflicted nine-fold in comparison to male patients. The primary consultant may belong to a variety of specialities such as urology, proctology, gynaecology or dermatology, depending upon the predominant symptom. A feeling of trust is essential for the treatment of a disorder involving highly intimate regions of the body. DISCUSSION: An exact medical history and standardized proctologic evaluation consisting of inspection, palpation, rectoscopy and proctoscopy may be augmented by investigations such as anorectal manometry or endosonography. Conventional defecography has been replaced more and more by dynamic MRI of the pelvic floor in specialized institutions, enabling additional gynaecologic and urologic investigations avoiding ionizing radiation.

Colonic Diseases↗
PubMed2004

Local perianal block for anal surgery.

BACKGROUND: We refined a technique for local block of all terminal nerve branches to the anus. METHODS: A total of 30 consecutive patients with proctological disorders consented to ambulatory (n=29) or hospitalised (n=1) operation with local perianal block for skin tags, Milligan- Morgan haemorrhoidectomy, stapled haemorrhoidopexy or anocutaneous fistulae. Patients were operated prone. A total of 40 ml of a 4.75 mg/ml solution of ropivacaine (Narop; Astra, Sweden) was injected in 8 directions (5 ml each) into the ischiorectal fat immediately peripheral to the external sphincter as anaesthetic columns reaching from the skin to the levator. This injection scheme targets the terminal nerve branches of the anus rather than blocking the trunk of major nerves. The relaxation of a pain-free anus was obtained in 2-3 minutes with exposure similar to a general anaesthetic. Postoperative pain was evaluated on a 0 to 10 visual analogue scale (VAS). RESULTS: Patients were pain-free at discharge. However, mean postoperative VAS score at 24 hours was 3.2 following Milligan-Morgan haemorrhoidectomy, 4.8 following stapled haemorrhoidopexy and skin tags or polyps excision, and 2.7 after fistula lay-open. At telephone follow-up 1-2 weeks later, the patients were satisfied with the method of anaesthesia and would willingly accept it for any further anal surgery. CONCLUSIONS: The perianal block is easy to apply and effective as sole method of anaesthesia for proctological operations.

Amides↗
PubMed2006

[Computerized physician order entry of pharmacotherapeutic protocols in a colorectal surgery unit].

INTRODUCTION: Computerized physician order entry was introduced in our hospital. We present the pharmacotherapeutic protocols that we use in patient care. MATERIAL AND METHODS: Six pharmaceutical protocols were designed by consensus in a colorectal surgery unit and were applied over a 2-year period. Patients undergoing ambulatory or urgent surgery were excluded. RESULTS: We treated 772 patients. Two hundred twenty patients (28.5%) were assigned to the preoperative protocol for minor proctologic surgery. After surgery, all 220 patients were included in the postoperative protocol for minor proctologic surgery. The remaining 552 patients (71.5%) were assigned to the protocol for major colorectal surgery. The preoperative protocol for major colorectal surgery was indicated in 542 patients (98.2%) and its variant for patients allergic to beta-lactam antibiotics was used in 10 patients (1.8%). The postoperative pharmacotherapeutic protocol assigned depended on whether a central venous line (317 patients; 57.4%) or only peripheral venous access (235 patients; 42.6%) was used. CONCLUSIONS: Each clinical unit has a duty to carry out and update consensus protocols (always based on the best scientific evidence available) that can be used in the processes managed in that unit. The use of these protocols shows a high degree of acceptance among physicians and nurses, allowing clinical practice to be standardized and healthcare processes to be homogenized.

Colorectal Surgery↗
PubMed2006

Ano-rectal complaints in general practitioner visits: consumer point of view.

AIMS: The perception patients consulting for primary care have of anorectal disorders has never been evaluated. Our aim was to analyze proctological complaints among outpatients consulting general practitioners. PATIENTS AND METHODS: Among 1484 physicians who responded to a nationwide mailing in France, 161 enrolled 437 females and 358 males consulting between October 2004 and December 2005. RESULTS: Females were younger than males (46 +/- 15 vs 51 +/- 13 years) (p<0.0001). Intermediate and upper social-occupational categories were overrepresented as compared with the general population. Symptoms were pain (48%), bleeding (37%), swelling (26%) and pruritus (24%). For 76%, these symptoms persisted for less than one month and 58% mentioned earlier visits or prior treatment. The first manifestation was correlated with a pregnancy in 31% of women. Present symptoms were secondary to acute constipation (52%), stress (33%), ingestion of spices (29%) or alcohol (20%), and diarrhea (8%). Symptoms were considered important in 61% or a cause of anxiety in 33% of patients. Treatment was prescribed for all patients: ointments (90%), phlebotonics (66%) or suppositories (51%), in combination for 75% of prescriptions. Patients preferred oral medicines (41%), ointments (30%) and suppositories (7%). CONCLUSION: Proctological complaints are a reason for repeated visits to the general practitioner and lead to repeated prescriptions. Patients appreciate anti-hemorrhoidal treatments variably.

Anus Diseases↗
PubMed1998

Quality of life in patients with benign anorectal disorders.

BACKGROUND: Benign proctological conditions are very common in Western civilization. However, to date quality of life in these patients has not been evaluated comprehensively. The aim of this study was to investigate whether the Gastrointestinal Quality of Life Index (GIQLI) is a useful instrument for measuring quality of life in these patients, and subsequently to establish baseline values for different anorectal disorders. METHODS: The questionnaire was completed by 325 consecutive patients (182 men; mean age 49 years) seen at the proctology outpatient clinic. For further analysis patients were classified into nine subgroups according to the primary diagnosis: group 1, haemorrhoids (n=96); group 2, anal fissure (n=38); group 3, fistula in ano (n=22); group 4, severe constipation (n=14); group 5, faecal incontinence (n=35); group 6, symptomatic anterior rectocele (n=12); group 7, perianal abscess (n=7); group 8, perianal thrombosis (n=7); and group 9, miscellaneous conditions (e.g. skin tags, anal papillomas, mild constipation, rectal polyps) (n=94). The GIQLI scores were compared between the subgroups. In addition the GIQLI scores of age-matched healthy controls, derived from data in the literature, were compared with the patients' scores. RESULTS: The mean GIQLI score for all patients was 113 (78.5 per cent of the maximum score of 144). Mean scores for the nine diagnostic subgroups were: group 1, 120; group 2, 104; group 3, 119; group 4, 94; group 5, 93; group 6, 112; group 7, 115; group 8, 129; and group 9, 117. Age-matched controls from a series published previously had a significantly higher GIQLI score compared with all patients (P < 0.0001). However, only the subgroups of patients with miscellaneous conditions, fissures, severe constipation and faecal incontinence had a significantly poorer quality of life than age-matched healthy individuals. CONCLUSION: The GIQLI is a valuable instrument for measuring quality of life in patients with benign anorectal disorders. Although certain diseases do not seem to affect quality of life profoundly, certain subgroups of patients, most notably those with incontinence and severe constipation, are extremely compromised. Severely constipated individuals exhibit the same poor quality of life as patients with faecal incontinence.

Adolescent↗
PubMed1975

Factor analy of orality and anality in selected patient groups.

Responses of 150 outpatients, suffering from physical or emotional problems to a 186-item questionnaire concerning their possession of behavioral traits that have been associated with anal and oral personality structures, as well as their practices and concerns about mouth and bowel function, were factor analyzed. Results were comparable with those from an earlier study involvine Army recruits as subjects, in showing some factors that resembled aspects of oral and anal character as described in psychoanalytic theory. These factors were not strong, nor were they clearly related to mouth and bowel behavior. Comparisons among clinical sub-groups showed that on five factors that significantly differentiated the groups, mean factor scores of proctological and ulcer patients resembled each other more than they did those of obsessive-compulsive patients, who were quite similar to passive-dependents. A control group of other types of psychiatric patients mixed with dermatological patients was intermediate between the physical and neurotic groups of patients. As seen in these factors, the somatic patients were relatively easy-going, slipshod, and accepting of change. Proctological and obsessive-compulsive patients, both linked to anal fixations by psychoanalytic theory, were the most dissimilar of all groups.

Anus Diseases↗
PubMed2005

Botulinum toxin in dermatology - beyond wrinkles and sweat.

Botulinum toxin (BTX) types A and B have been used with success in cosmetic dermatology and hyperhidrosis treatment. The present review focuses on other uses of BTX in dermatology. Discussed in particular are the available data on BTX in inflammatory diseases, proctology, and some other indications. From studies in various types of eczema, it seems that BTX-A not only acts as a potent inhibitor of acetylcholine but also as an inhibitor of substance P and of glutamate as well. By those mechanisms, BTX-A may be antipruritic, which may help explain the benefits of BTX-A in lichen simplex and dyshidrotic hand eczema. In Hailey-Hailey disease, facial eccrine hidrocystomas, salivary fistulas, and intrinsic rhinitis, BTX-A blocks the secretion of sweat/saliva/mucus. BTX-A has important applications in proctology where it has become the most powerful nonsurgical therapy for anal fissures. In proctalgia fugax and after hemorrhoidectomy, BTX-A is analgesic. Current treatment applications of BTX-A and its limitations are reviewed in this paper.

Journal Article↗
PubMed1980

Clinical topography of the proctodeum.

Textbooks do not provide sufficient descriptions of the proctodeal anatomy and its clinical significance. For example, operation on anal or anorectal fistulas demands detailed knowledge of the continence organ. Proctologic diseases such as haemorrhoids, abscesses and fistulas clarify the situation as they show the natural spaces and leading structures. We studied the proctodeal region in autopsy specimens and also carried out microscopic work on slices of the continence organ. Clinical (rectoscopic, operative) and autopsy findings were thus combined, and morphology is seen under the aspect of proctologic diseases and their treatment.

Anal Canal↗