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PubMedDate not supplied

A painless treatment for patients undergoing Milligan-Morgan haemorrhoidectomy.

BACKGROUND: Postoperative pain associated with Milligan Morgan haemorrhoidectomy (MMH) remains problematic. Most patients complaint a severe pain on defecation and in the 1st postoperative week because of secondary infection and sphincter spasm. We studied the effect of metronidazole, lactulose and glyceryl-trinitrate on pain after MMH. METHOD: Thirty patients were randomly assigned to two groups. The 1st received a treatment with oral laxative (lactulose 66.7%) metronidazole and a topical glyceryl-trinitrate ointment at 0.2% both pre and postoperative; the 2nd received a placebo at the same dosage. The amount of pain in the 1st week and at the time of two defecation, postoperative analgesic requirement and time to return to normal activities were documented. RESULTS: A significant differences in the score pain on 2nd and 3rd day and on the 1st two defecation were observed among group. Analgesic consumption was highest in the placebo group. CONCLUSION: The treatment with lactulose, metronidazole and topic glyceryl-trinitrate in patients undergoing MMH, seems to reduce secondary pain and increase patients satisfaction and earlier return to work with improvement of cost and benefit.

Administration, Oral↗
PubMed2005

[Usefulness of biofeedback treatment in children with chronic functional constipation].

BACKGROUND: About 2/3 of constipated children present anal-rectal dyssynergy (ARD) with paradoxical contraction of the external anal sphincter (EAS) during defecation. AIM: The aim of our study was to answer the question whether additional treatment with biofeedback training (BF) is more effective than traditional treatment. MATERIALS, METHODS: We assessed chronically constipated children who fulfilled the criteria of ARD: recto-sigmoid transit time in Hinton's test with radio-paque markers at least 28.8 h, paradoxical EAS contraction during defecation trials (anorectal manometry). The study included 22 constipated children (16 boys and 6 girls), aged 5 to 14 years (mean 8.1 +/- SD 2.8). Children were randomly divided in two groups. In group I at the start of the study children had four day-by-day sessions of BF training based on the anorectal manometry and the surface EMG. Children from group II received only traditional treatment. The follow-up was 6 months. Improvement was estimated based on manometric data, number and quality of stools. RESULTS: In the group I after one month, more manometric parameters, significantly improved as compared to the II group. During the observation period the number of stools increased and their quality improved in both groups. There was no statistically significant difference between the groups in terms of the above mentioned symptoms. CONCLUSIONS: Treatment with BF can improve rectal sensation and particularly defecation dynamics, faster than the traditional method. There is no significant effect of additional BF treatment on such objective symptoms as the number and quality of stools.

Adolescent↗
PubMedDate not supplied

[Factors associated with strongyloides stercoralis infection in an endemic area in Peru].

In order to determine the epidemiological factors and clinical symptoms associated with Strongyloides stercoralis infection, we carried out a descriptive study with a control group in the District of Chanchamayo, Province of Chanchamayo, Junin, Peru. Group I (n = 50) represented those individuals with strongyloidosis and group II (n = 50) were those who tested negative for S. stercoralis by parasitological methods. Epidemiological variables significantly associated with group I were: bathing in the river 3-4 times per week, consuming non-drinking water, defecating in the field; and with group II: drinking boiled water, wearing sneakers and living in houses with cement floor. The clinical symptoms of epigastric pain, daily abdominal pain, semi liquid feces, liquid feces, daily defecation frequency, urticaria and nausea were significantly associated with group 1; whereas more solid feces and defecating every other day were significantly associated with group II. Among individuals under the age of 20 there was a higher percentage of malnutrition according to the weight-age index in group I (p = 0.045). We conclude that infection by S. stercoralis should be suspected in persons from tropical areas who are in frequent contact with rivers or streams or live close to watercourses, who have gastroenterological or dermatological symptoms or who are malnourished, especially if they are children or adolescents.

Adolescent↗
PubMed1991

[A new method of treating encopresis].

The treatment program described was designed to establish regular, normal toilet habits in children suffering from disturbances of defecation, including chronic constipation, frequent soiling and refusal to sit on the toilet. 17 children, aged 2.5-6 years were referred during 1988. 1 had a prolapsed rectum while the other 16 had no physiological anomaly but exhibited general negativism in addition to their bowel problems. They were treated with operant conditioning techniques combined with the use of glycerine suppositories. The use of suppositories lasted an average of 1 week (range 1-35 days). The suppositories served as a discriminative stimulus for defecation, ensured daily rectal evacuation under controlled conditions, and allowed the therapist to control timing of bowel movements. Control of timing is necessary so that the therapist can correct dysfunctional defecation directly by shaping and positively reinforcing appropriate toilet behavior, and by eliminating fearful and oppositional responses. Treatment was successful in all and there were no relapses. For most of the children there was also general behavioral improvement.

Behavior Therapy↗
PubMed1989

The natural course of postoperative ileus following abdominal surgery.

Postoperative ileus is a normal, transient condition following surgical procedures of the abdomen. The restoration of gastrointestinal motility was studied in 50 patients who had abdominal surgery. The motility was evaluated by means of physical signs and clinical symptoms. Physical signs, such as bowel sounds, passage of first flatus and defecation, occurred on relatively constant moments in the postoperative period and did not depend on the type of operation. In the patients who had rectopexy, flatus and defecation passed significantly later, probably due to existing defecation problems before the operation. The moment of resumption of a normal diet varied greatly. None of the physical signs had a predictive value with regard to postoperative nausea or vomiting. No relation could be demonstrated between the moment of removal of the nasogastric tube and the volume of gastric aspirate drained by the tube. The period of postoperative drainage of the stomach in comparable patient groups differed strongly from ward to ward. More attention for nasogastric tube management following abdominal surgery seems desirable. Early removal of the tube is possible in most patients and diminishes unnecessary discomfort.

Abdomen↗
PubMed1987

A cyclic somatostatin analog that precipitates withdrawal in morphine-dependent mice.

We evaluated the ability of the mu selective, peptidic, opioid antagonist CTP to precipitate withdrawal in morphine-dependent mice after intracerebroventricular (i.c.v.) and subcutaneous (s.c.) administration. The withdrawal syndrome evoked by i.c.v. CTP was different in some respects from that observed after i.c.v. naloxone. Naloxone, given i.c.v., produced shakes and tremors, defecation, diarrhea, wet dog shakes, jumping and weight loss. In contrast, the prominent signs following i.c.v. CTP were grooming, tremors and shakes, defecation, wet dog shakes and weight loss. CTP treated mice exhibited a greatly reduced incidence of jumping behaviors and diarrhea. While s.c. naloxone evoked similar effects to i.c.v. naloxone, CTP given s.c. stimulated defecation and modest weight loss only. The differences in the profile of withdrawal signs between naloxone and CTP may be related to their differences in receptor selectivity or possibly to their respective alkaloidal and peptidic natures. The relative lack of behavioral effects seen after s.c. CTP probably reflects the inability of CTP to pass through the blood brain barrier, and indicates that although the majority of withdrawal signs are mediated by centrally located opioid receptors, the gastrointestinal tract can be withdrawn independently of the central nervous system.

Animals↗
PubMed1988

Precipitation of spinally mediated withdrawal signs by intrathecal administration of naloxone and the mu-receptor antagonist CTP in morphine-dependent mice.

We evaluated the ability of naloxone and the mu receptor antagonist CTP (D-Phe-Cys-Tyr-D-Trp-Lys-Thr-Pen-Thr-NH2) to precipitate withdrawal in morphine-dependent mice after intrathecal (i.t.) administration. The withdrawal syndromes elicited by naloxone and CTP given i.t. were compared to those of CTP or naloxone injected intracerebroventricularly (i.c.v.). When given i.t. or i.c.v., naloxone produced the classical syndrome of events including jumping, wet dog shakes, urination, defecation followed by diarrhea, and weight loss. There was no significant difference in the potency or efficacy of naloxone when it was given i.t. or i.c.v. The profile of withdrawal effects produced by i.t. CTP resembled that caused by i.c.v. CTP; both were different from that of naloxone. The withdrawal signs seen following both i.t. or i.c.v. CTP included wet dog shakes and defecation. Mice treated with i.t. CTP lost significantly less body weight than those treated with i.c.v. CTP. In addition, i.t. and i.c.v. CTP did not stimulate jumping behaviors or diarrhea. In contrast, while i.c.v. CTP resulted in increased incidence of urination, CTP given i.t. did not. These finding indicate that naloxone given spinally acts on mu receptors to precipitate wet dog shaking and defecation, but acts on other non-mu opioid receptors (i.e. delta and/or kappa) to cause jumping, urination, diarrhea and weight loss. The differential effects of CTP given i.c.v. or i.t. suggest that supraspinal mu receptors are more involved in gastrointestinal and urinary bladder function during dependence/withdrawal than their spinal counterparts.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1985

Modulation of the digestive lysosomal system in Paramecium caudatum. II. Physiological effects of cytochalasin B, colchicine and trifluoperazine.

The heterophagic pathway of the digestive lysosomal system in Paramecium caudatum includes at least four steps: digestive vacuole (DV) formation, acidification-condensation, lysosomal fusion-digestion, and defecation. The second and the third require about 20 min, during which DVs are not egested. Because these steps occur at predictable intervals, the mechanism for each can be explored by exposing labeled DVs to different drugs prior to each step. In this study the effects of cytochalasin B (CB), colchicine and the calmodulin antagonist, trifluoperazine (TFP), were studied. All three drugs inhibited DV formation in a dose-dependent manner when cells were pulsed with latex beads and a drug simultaneously. TFP was cytotoxic above 5 microM. Vacuole formation was completely shut down when cells were pre-exposed to 5 microM TFP for 13 min. At this level, the duration of the acidification step was lengthened, and the rate of defecation decreased with increasing exposure. These results suggest that these inhibitory effects may be more related to TFP's cytotoxicity than to its action on calmodulin-mediated process. Colchicine at 1 mM had no effect on the third or fourth step, but inhibited the acidification step so that DVs were egested later and at a slower rate. Exerting a differential effect on all four steps, CB inhibited DV release from the cytopharynx, egestion of defecation-competent DVs at the cytoproct and lengthened the duration but did not block the lysosomal fusion-digestion step of the acidic DVs; it was most potent in blocking acidification, which prevented both lysosomal fusion with the labeled DVs as well as DV egestion, the latter for more than 50 min.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1982

Neonatal gonadal hormone treatments and adult open-field behavior in female rats.

The present study was conducted to investigate the effect of neonatal gonadal hormone treatments on the rat's emotionality in adult life. Female Sprague-Dawley rats treated subcutaneously on the day of birth with 100 micrograms of 17 beta-estradiol (E) or 1000 micrograms of testosterone propionate [TP] or 1000 micrograms of dihydrotestosterone[DHT] were tested in the open-field apparatus on 5 consecutive days at 6 months of age. All TP-treated rats and 6 out of 11 E-treated rats exhibited the persistent estrus on the vaginal smears, while DHT-treated rats and control rats did not show such changes in estrus cycle. Highly significant difference in either ambulation and defecation scores was found between persistent estrus and normal estrus cycle rats in E-treated group: persistent estrus rats showed higher ambulation and lower defecation than normal estrus cycle rats. As compared with the control level TP-treated persistent estrus rats showed a lower defecation score. These findings indicate that persistent estrus rats induced by E or TP are in the state of low emotionality. A possible relationship between the emotionality and the induction of mammary carcinomas was discussed.

Age Factors↗
PubMed1997

Behavioral similarities and differences among alcohol-preferring and -nonpreferring rats: confirmation by factor analysis and extension to additional groups.

Thirteen behavioral variables from six tasks were measured in alcohol-preferring (AA, FH, and P) and -nonpreferring (ANA, FRL, and NP) rat lines/strains and subjected to Factor Analysis. Four Independent factors accounted for > 90% of the variance. Defecation in the open field and ultrasonic vocalizations after an air puff were negatively correlated with alcohol intake and preference, whereas the increase in daily fluid intake in the presence of saccharin was positively correlated. Other factors could be labeled Activity, Emotionality, and immobility Factors, and each was independent of the Alcohol Factor. When an additional alcohol-preferring rat line (HAD) and two additional nonpreferring groups (LAD and ACI) were tested, they were found to differ on most behaviors that were associated with alcohol intake and preference in the Factor Analysis; vocalizations and saccharin-induced increase in fluid intake, but not defection. A new Factor Analysis was then performed incorporating these three new groups and including five new behavioral measures. The following measures had high loadings on the Alcohol Factor: alcohol intake under choice conditions; alcohol preference; forced alcohol intake; alcohol acceptance (forced alcohol intake/basal water intake x 100); ultrasonic vocalization; saccharin intake; saccharin-induced increase in daily fluid intake; defecation in the open field test; and immobility in a modified forced swim test. These findings indicate that there are indeed certain behavioral characteristics that are common among alcohol-preferring rat lines/strains, but there are also substantial group differences on other behavioral measures. For those behavioral measures reflecting emotionality (defecation and ultrasonic vocalization) that loaded highly on the Alcohol Factor, the alcohol-preferring rats had lower scores.

Alcohol Drinking↗
PubMed1998

Physiological correlates of colonic motility in patients with irritable bowel syndrome.

Irritable bowel syndrome is frequently encountered in clinical practice, and it has been repeatedly suggested that abnormal colonic motor activity is one of the major pathophysiological mechanisms responsible for the origin of symptoms in such disorder. If this statement is true, then high-amplitude propagated colonic contractions (HAPCs), i.e. the mass movements, may play an important role. To test this hypothesis, we conducted an investigation by recording colonic motility for a prolonged (24 h) period in 25 patients with irritable bowel syndrome and in 18 healthy volunteers, to compare the number of mass movements over 24 h in patients (constipation-predominant, alternating bowel habits) and controls. The overall amount of motility was also assessed in twelve patients and 13 controls. We also looked for the possible changes in mass movements and motility which may occur with defecation and after a meal. The results showed that 1) with respect to HAPCs and motility index, neither group was significantly different from controls; 2) HAPCs and the motility index were significantly reduced during sleep in all groups tested; 3) HAPCs were significantly more common before as compared to after defecation and after as compared to before meals; 4) HAPCs are not independent from the segmental contractile activity; 5) the motility index/24 h was lower in the constipation-predominant group of patients with respect to controls. We conclude that in patients with irritable bowel syndrome colonic motility per se may play a pathophysiological role in the genesis of the symptoms, although other mechanisms are likely to concur, or to be responsible for the complaints of these patients. However, colonic prolonged recordings are very useful for studying physiological and pathophysiological correlates of sleep, eating, and defecation.

Adult↗
PubMed1993

Defecatory function in Parkinson's disease: response to apomorphine.

We evaluated the effects of the dopaminergic agent apomorphine on defecation and anorectal function in patients with Parkinson's disease (PD). A gastrointestinal symptom survey, extrapyramidal assessment, defecating proctogram, and anorectal manometric study were performed in 8 subjects with PD. Basal studies showing abnormalities were repeated following apomorphine administration. Prior defecographic abnormalities were normalized following apomorphine injection in 1 of 3 subjects and significant improvements in manometric parameters were observed in all 5 subjects who underwent repeat anorectal manometry. We conclude that apomorphine can correct anorectal dysfunction in PD, and that these abnormalities may be a consequence of dopamine deficiency secondary to the PD process. These findings may also have therapeutic implications.

Aged↗
PubMed1977

Open-field behavior of prenatally irradiated and/or postnatally handled C57BL/6 mice.

Mice (C57BL/6) were prenatally irradiated with 60Co and/or handled on postnatal Days 1-10, and subsequently tested in an open field on Days 21, 42, and 63, and in a shuttle box on Days 30 and 60. Another group of mice was treated and tested similarly, but the shuttle box testing was omitted. All animals were cross-fostered at birth. Handling increased open-field activity and decreased defecation whereas irradiation decreased activity and had inconsistent effects on defecation. A comparison of the data from both groups of mice indicated that the shuttle box experience decreased open-field activity, particularly for the irradiated and unhandled animals. Direct and indirect irradiation effects--revealed by the cross-fostering procedure--were both significant and about equal in magnitude, underlining the importance of attending to irradiation effects on maternal as well as on offspring behavior.

Animals↗
PubMed1999

A study of the effect of distension of the rectosigmoid junction on the rectum and anal canal with evidence of a rectosigmoid-rectal reflex.

PURPOSE: To elucidate the role of the rectosigmoid junction (RSJ) in the mechanism of defecation. METHOD: Fourteen healthy volunteers were enrolled in the study (10 men, 4 women; mean age 38.2 +/- 10.6 years). The pressures in the rectum, anal canal, and RSJ as well as rectal balloon expulsion were recorded in response to balloon distension of the RSJ in increments of 10 ml of carbon dioxide (CO2) to 50 ml. The experiments were repeated after individual anesthetization of the RSJ, rectum, and anal canal. The expulsion of a 50-ml distended balloon located in the anesthetized rectum was tested. RESULTS: RSJ distension with 10 ml of CO2 produced no significant pressure changes in the RSJ, rectum, or anal canal. A 20-ml distension effected a significant pressure rise in the RSJ (P < 0.05) and the rectum (P < 0.01) and a decline in the anal canal (P < 0.05); the rectal balloon was expelled to the exterior. Similar pressure changes (P > 0.05) were recorded with a 30-, 40-, and 50-ml balloon distension. The mean latency for the RSJ response was 12.6 +/- 2.2 ms and for the rectum 15.8 +/- 2.6 ms. The balloon, distended with 50 ml of CO2 and located in the rectum, was not expelled to the exterior. Balloon expulsion occurred only with distension with volumes of above 80 ml. Individual anesthetization of the RSJ, rectum, and anal canal followed by RSJ distension produced no significant pressure changes in RSJ, rectum, and anal canal as well as no rectal balloon expulsion. CONCLUSION: The rectal contraction upon RSJ distension affirms the hypothesis of the possible involvement of a reflex, which we term "rectosigmoid-rectal reflex." This reflex relationship is evidenced by reproducibility and its absence on anesthetization of either the RSJ or the rectum, both presumably representing the two arms of the reflex arc. It is postulated that stools passing from the sigmoid colon to the rectum distend the RSJ and evoke the rectosigmoid-rectal reflex, which produces rectal contraction. The role of the reflex in defecation disorders needs to be studied.

Adolescent↗
PubMed1976

Effects of lithium on open field behavior in "stressed" and "unstressed" rats.

Rats were tested for 3 min per day, for 4 successive days, in an open field apparatus, 20 min after injection of either lithium chloride (2 mEq/kg) or physiological saline. In the first experiment, the open field was illuminated with moderate white light for some rats (stress condition) and dim red light for others (non-stress condition). In the second experiment, some rats received an electric foot shock 5 h before each open field test (stress condition) and others received no foot shock (non-stress condition). In both experiments, lithium significantly reduced rearing behavior in the stressed, but not the unstressed, rats. Lithium also reduced horizontal locomotion, but this effect appeared in both stressed and unstressed rats. In the second experiment, defecation was measured, and it was found that lithium-treated rats defecated less than saline-treated rats in the first session, but not in subsequent sessions, due to habituation which occurred for the saline rats.

Animals↗
PubMed1985

Anismus in chronic constipation.

Among patients complaining of constipation, a group can be defined in which there is slow whole gut transit shown by retention of radiopaque markers but a rectum and colon of normal width judged by measurements of barium enema radiographs compared with control observations. It is not known whether their symptoms are due to an abnormality of colonic motility or to a failure of the defecatory mechanism. Defecation was simulated experimentally in a group of these patients by asking them to expel a water-filled rectal balloon. The constipated patients were not able to expel the balloon, whereas normal subjects could do so. Electromyography of the striated pelvic floor muscles during attempts at expulsion of the balloon in the constipated patients showed failure of the normal inhibition of resting activity. Failure of external and sphincter relaxation on attempted defecation may contribute to the symptoms of some patients who complain of constipation.

Adolescent↗
PubMed1982

Effects of L-aspartic acid, L-asparagine and/or L-asparaginase on forced swimming-induced immobility, analgesia, and decrease in rectal temperature in rats.

The effect of L-aspartic acid, L-asparagine and/or L-asparaginase were compared with those of imipramine on immobility, number of defecations, increase of nociceptive threshold, and hypothermia, induced by forced swimming in rats. L-Aspartic acid was found to be as effective as imipramine in reducing the effects of forced swimming, presumable by normalizing the decreased level of endogenous L-aspartic acid, due to the inhibition of L-asparaginase activity and/or by stimulating the inhibited enzyme. The other treatments antagonized the immobility, but not the increased number of defecations. All compounds abolished the elevation of nociceptive threshold and hypothermia.

Analgesia↗
PubMed1994

Results of ileal J-pouch-anal anastomosis in familial adenomatous polyposis complicated by rectal carcinoma.

PURPOSE: Rectal cancer frequently occurs in patients with familial adenomatous polyposis (FAP) and, in some cases, proctocolectomy and ileal pouch-anal anastomosis (IPAA) can be proposed as an alternative to end ileostomy. This study aimed to assess the results of IPAA for familial adenomatous polyposis complicated by rectal carcinoma. PATIENTS AND METHODS: Postoperative morbidity and bowel function following IPAA were assessed in six patients who had a mesorectal excision for rectal cancer. The functional results were compared with those obtained after IPAA in 134 FAP patients without bowel cancer. RESULTS: Carcinomas were located at a mean of 11 cm from the dentate line. There were no postoperative complications. One patient with synchronous hepatic metastases died 6 months after operation and the 5 others were alive without recurrence after a mean follow-up of 29 months. Mean frequency of defecation was 6.5/day (vs. 4.2/day in patients without carcinoma), 86 percent of patients had nocturnal defecation (vs. 50 percent), day and night continence were normal in 66 percent and 33 percent of patients, respectively, compared with 90 percent and 85 percent for IPAA without cancer. Pouch excision was required in one patient for unsatisfactory functional result. CONCLUSION: IPAA can be safely performed for cancer of the upper rectum complicating FAP, but a poor functional outcome related to mesorectal excision has to be expected.

Adenomatous Polyposis Coli↗