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PubMedDate not supplied

Rectal resection in the dog. A new surgical approach and the evaluation of its effect on fecal continence.

Thirteen healthy mixed breed dogs (6 female and 7 male) underwent rectal transection and resection of 0 to 6 cm using a dorsal approach. Rectoanal sphincter pressure studies were performed preoperatively and 6 weeks after surgery using a double balloon manometer device. Sphincter pressure profiles were altered in the 6 cm resection dogs. Clinical observations of defecation and degree of continence were made over a 10 week period postoperatively. The transection only and 4 cm resection dogs defecated normally. All dogs in the 6 cm resection group involving the peritoneal reflection were incontinent but retained some normal posturing behavior. Surgical complications included minor infection in two dogs, rectocutaneous fecal leakage in four dogs, breakdown of the anastomotic site in four dogs, and incontinence in all of the dogs that underwent 6 cm resections. Barium enemas were performed on the rectums postmortem to ascertain the degree of stricturing induced by the surgery. The index of stenosis measured did not correlate well with the extent of straining in each group. Histopathologic findings on dogs in the transection only and 4 cm resection groups without dehiscence showed mild granulomatous proctitis with normal myenteric plexi seen. Dogs suffering dehiscence had suppurative proctitis, necrosis, and obliteration of the myenteric plexi.

Anastomosis, Surgical↗
PubMed1999

Descending perineum syndrome: audit of clinical and laboratory features and outcome of pelvic floor retraining.

OBJECTIVE: Our aim was to retrospectively analyze the Mayo Clinic experience of descending perineum syndrome from 1987-1997. METHODS: Clinical records were abstracted for demographic features, risk factors, results of anorectal and defecation tests, and a mailed questionnaire evaluated outcome and current symptoms. RESULTS: All results are mean +/- SD. Clinically, 39 patients (38 women, one man), mean age 53+/-14 yr, presented with constipation (97%), incomplete rectal evacuation (92%), excessive straining (97%), digital rectal evacuation (38%), and fecal incontinence (15%). Laboratory tests showed anal sphincter resting pressure was 54+/-26 mm Hg, and squeeze pressure was 96+/-35 mm Hg; expulsion from the rectum of a 50-ml balloon required > 200 g added weight in 27%; perineal descent was 4.4+/-1 cm (normal < 4 cm) by scintigraphy. Scintigraphic evacuation, rectoanal angle change during defecation, and perineal descent were abnormal in 23%, 57%, and 78% of the patients, respectively. Associated features included female gender (96%), multiparity with vaginal delivery (55%), hysterectomy or cystocele/rectocele repair (74%). On follow-up, 64% responded; 17 of these 25 responders underwent pelvic floor retraining. At 2-yr median follow-up (range, 1-6 yr), 12 still experienced constipation or excessive straining; their perineal descent was greater than in patients who responded to retraining (p = 0.005). CONCLUSIONS: Descending perineum syndrome is identifiable by clinical history and examination, and the most prevalent abnormality on testing is perineal descent > 4 cm; rectal balloon expulsion is an insensitive screening test for descending perineum syndrome. Pelvic floor retraining is a suboptimal treatment for this chronic disorder of rectal evacuation; the extent of perineal descent appears to be a useful predictor of response to retraining.

Anal Canal↗
PubMed2002

Anorectal functional testing: review of collective experience.

Anorectal manometry includes a number of specific tests that are helpful in the diagnostic assessment of patients with fecal incontinence and constipation; their purpose is to delineate the pathophysiological mechanism for these symptoms. Some of these tests may also provide helpful information in the assessment of patients with rectal pain or diarrhea, but their sensitivity and specificity are less well established for these symptoms. Tests for which there is consensus regarding their clinical utility include 1) resting anal canal pressure, 2) anal canal squeeze pressure (peak pressure and duration), 3) the rectoanal inhibitory reflex elicited by balloon distension of the rectum, 4) anal canal pressure in response to a cough, 5) anal canal pressure in response to defecatory maneuvers, 6) simulated defecation by means of balloon or radiopaque contrast, 7) compliance of the rectum in response to balloon distension, and 8) sensory thresholds in response to balloon distension. Anal endosonography and pelvic floor electromyography from intra-anal plate electrodes are nonmanometric tests that are also specifically useful in the evaluation of constipation and fecal incontinence. The clinical utility of all anorectal manometric tests is limited by the relative absence of 1) standardization of test protocols and 2) normative data from a large number of healthy individuals. The interpretation of these diagnostic tests is also complicated by the fact that patients are able to compensate for deficits in specific physiological mechanisms maintaining continence and defecation by utilizing other biological and behavioral mechanisms.

Anal Canal↗
PubMed2006

Evidence that stimulation of ghrelin receptors in the spinal cord initiates propulsive activity in the colon of the rat.

Previous studies have failed to reveal an effect of the gastrointestinal peptide hormone ghrelin on colonic motility. In the present work, ghrelin was applied into the lumbo-sacral spinal cord in the region of defecation control centres, and a synthetic ghrelin receptor agonist, CP464709, which crosses the blood-brain barrier, was applied intravenously or into the lumbo-sacral cord. Both ghrelin and CP464709 elicited propulsive contractions and emptying of the colon in anaesthetized rats. In conscious rats, subcutaneous CP464709 caused fecal expulsion. The sites of action and nerve pathways involved in the stimulation of the colon by ghrelin receptor activation were investigated in anaesthetized rats. Intrathecal application of CP464709 at L6-S1, but not application at ponto-medullary levels or to the thoracic spinal cord, elicited propulsive contractions. The stimulation evoked by intravenous CP464709 was prevented if the pelvic nerve outflows were severed, but not if the spinal cord was cut rostral to the defecation centre at L6-S3. The response was also blocked by hexamethonium. When ghrelin, applied intrathecally, was used to desensitize its receptors, the effect of intravenous CP464709 was blocked. CP464709 did not affect small intestine motility or the amplitudes of visceromotor reflexes caused by colorectal distension. It is concluded that activation of ghrelin receptors in the lumbo-sacral spinal cord triggers co-ordinated propulsive contractions that empty the colo-rectum. The pathways through which these responses are generated pass out of the spinal cord via the pelvic nerves and cause propulsive contractions through activation of enteric neurons.

Animals↗
PubMed1966

Open-field behavior in mice: evidence for a major gene effect mediated by the visual system.

In segregating F(2), F(3), and F(4) generations, albino mice had lower activity and higher defecation scores than pigmented animals when tested in a brightly lighted open field. These differences persisted when members of an F(5) generation were tested under white light, but largely disappeared under red light. Thus it was concluded that there is a major gene effect on the quantitative traits of open-field activity and defecation which is mediated by the visual system and that albino mice are more photophobic than pigmented mice under conditions of bright illumination.

Animals↗
PubMed2004

Prognosis of constipation: clinical factors and colonic transit time.

BACKGROUND: Measurement of colonic transit time (CTT) is sometimes used in the evaluation of patients with chronic constipation. AIM: To investigate the relation between symptoms and CTT, and to assess the importance of symptoms and CTT in predicting outcome. METHODS: Between 1995 and 2000, 169 consecutive patients (median age 8.4 years, 65% boys) fulfilling the criteria for constipation were enrolled. During the intervention and follow up period, all kept a diary to record symptoms. CTT was measured at entry to the study. RESULTS: At entry, defecation frequency was lower in girls than in boys, while the frequency of encopresis episodes was higher in boys. CTT values were significantly higher in those with a low defecation frequency (< or =1/week) and a high frequency of encopresis (> or =2/day). However, 50% had CTT values within the normal range. Successful outcome occurred more often in those with a rectal impaction. CTT results <100 hours were not predictive of outcome. However, those with CTT >100 hours were less likely to have had a successful outcome. CONCLUSION: The presence of a rectal impaction at presentation is associated with a better outcome at one year. A CTT >100 hours is associated with a poor outcome at one year.

Child↗
PubMed1985

Bowel behaviour in young black and white children.

Bowel behaviour was investigated in 81 rural black, 117 urban black, and 77 white children aged 1 to 4 years. The study was undertaken principally because intake of dietary fibre by urban blacks is now lower than that of whites: moreover, that of rural blacks has also fallen. Average daily defecation frequencies in rural and urban black children and white children were 1.9, 1.8, and 1.5, respectively. Black children voided smaller stools and more frequently than white children. In both ethnic groups most stools were soft. Median transit times, determined in 55 rural black, 80 urban black, and 45 white children, were approximately 6.5, 7, and 27 hours, respectively. Median transit times increased little with age in black compared with white children. The higher defecation frequency and the much shorter transit time in black children are not explicable in terms of the levels of fibre intake.

Black or African American↗
PubMed1993

Development of bowel habit in preterm infants.

The bowel habits in 844 preterm infants were observed during the first 56 days after birth. Delay in the passage of meconium beyond the second day occurred in 32%, and there was an inverse relation between gestational age and the day of first bowel action. Thereafter the increase in frequency of stools passed each day was related directly to the volume of milk ingested. Unfed infants had a modal defecation rate of one stool each day. For each 50 ml/kg increase in the volume of milk ingested the infants showed a further increase of one stool passed each day. Infants fed with human milk passed a greater number and softer stools than those who received cows' milk formula. In the absence of milk feeds an intrinsic pattern of large bowel motor activity, present as early as 25 weeks' gestation, ensures a defecation rate of one stool each day. The effect of enteral nutrition on this inherent motility is governed by the volume and composition of milk feeds, independently of gestational age.

Age Factors↗
PubMed1987

Twenty four hour manometric recording of colonic motor activity in healthy man.

The motor activity of the transverse, descending, and sigmoid colon was recorded for 24 hours in 14 healthy volunteers with a colonoscope positioned catheter. During the study the patients ate two 1000 kcal mixed meals and one continental breakfast. Colonic motor activity was low before meals and minimal during sleep; the motility index increased significantly after meals and at morning awakening. Most of the motor activity was represented by low amplitude contractions present singly or in bursts, which showed no recognisable pattern. All but two subjects also showed isolated high amplitude (up to 200 mmHg) contractions that propagated peristaltically over long distances at approximately 1 cm/sec. Most of these contractions occurred after morning awakening, and some in the late postprandial period, with a mean of 4.4/subject/24 h. The peristaltic contractions were often felt as an urge to defecate or preceded defecation, and could represent the manometric equivalent of the mass movements.

Adult↗
PubMed1987

Effect of aging on anorectal function.

Measurements of anorectal function were conducted on 37 elderly (66-87 years) and 48 young (19-55 years) normal subjects. Elderly subjects had decreased anal pressures compared with younger subjects, required lower rectal volumes to inhibit anal sphincter tone and had increased rectal pressures upon balloon distension. The rectal volume required to cause the desire to defecate and the maximum tolerated volume were lower in the elderly, but the corresponding rectal pressures were similar, indicating the sensations were mediated by tension, or pressure receptors. Rectal contractions were generated at similar degrees of rectal distension. A lower proportion of elderly, compared with young subjects could defecate a sphere 18 mm in diameter within 20 seconds. The degree of perineal descent was greater in the elderly female subjects compared with the young women, although there was no difference in this measurement between men. The anorectal angle was similar in young and old. The changes in anorectal function in the elderly would tend to make them more susceptible to faecal incontinence.

Adult↗
PubMed1987

Treatment of chronic constipation with cisapride and placebo.

The effect of cisapride (20 mg bid), a new prokinetic drug, on bowel habits and laxative consumption was studied in patients with idiopathic painless constipation and chronic laxative intake. After a four week base line period, spontaneous defection (frequency without laxative intake) and total defecation (total frequency) were measured. Patients with a spontaneous defecation of less than three stools per week entered the treatment period and were randomly assigned to double blind treatment with either cisapride (n = 64) or placebo (n = 62). After eight weeks of treatment, a four week run out phase on single blind placebo medication was conducted. Cisapride and placebo increased spontaneous stool frequency from 1.1 +/- 0.2 SEM to 3.0 +/- 0.2 per week (p less than 0.001) and from 1.2 +/- 0.1 to 1.5 +/- 0.2 (p greater than 0.05), respectively. Laxative consumption was decreased from 3.6 +/- 0.3 to 1.8 +/- 0.2 doses/week by cisapride (p less than 0.001) and from 3.3 +/- 0.3 to 2.8 +/- 0.3 by placebo (p less than 0.05). Both drugs improved constipation as assessed by the patient by means of a visual analogue scale, but cisapride did so to a larger extent than placebo. The effects of cisapride partly outlasted active medication by at least four weeks. It is concluded that cisapride improves bowel habits in patients with idiopathic constipation and reduces laxative consumption.

Cathartics↗
PubMed1989

Defecography in normal volunteers: results and implications.

Forty seven healthy young volunteers underwent defecographic examination to determine the range of normal findings. Normality was shown to encompass radiological features often considered pathological. These features included broad ranges of anorectal angle and pelvic floor descent which overlap with reported pathological states. Furthermore, the formation of rectocoeles during defecation was a very common finding in women. Finally, a subgroup of the volunteers had marginal anorectal function. The marginal anorectal function and certain radiological findings such as rectocoeles or intussusceptions may predispose to later problems, or contribute to clinical problems when combined with other factors such as dietary fibre deficiency. The radiological findings raise a number of questions with respect to different aspects of the functioning of the continence and defecation mechanisms.

Adult↗
PubMed1990

Effect of coffee on distal colon function.

Ninety nine healthy young volunteers (58 men, 34 women, aged 17-27 years) answered a questionnaire concerning their bowel habit with particular reference to the effects of beverages. Twenty nine per cent (63% women) claimed that coffee induced a desire to defecate. The rectosigmoid motor responses to black, unsweetened coffee were then investigated by multiport manometry in 14 healthy-subjects (12 men, two women, eight of whom claimed coffee caused a desire to defecate (responders). Results revealed an increase in motility index within four minutes after ingestion of both regular and decaffeinated coffee (p less than 0.05) in the eight responders, but not in the six non-responders. The increase in rectosigmoid motility induced by coffee lasted at least 30 minutes. There was no increase in the motility index in any subject after a drink of hot water. These results suggest that drinking coffee can stimulate a motor response of the distal colon in some normal people.

Adolescent↗
PubMed1993

Bowel function and irritable bowel symptoms after hysterectomy and cholecystectomy--a population based study.

Because unsubstantiated beliefs link hysterectomy and cholecystectomy with bowel function, this study examined all the women who had had these operations in a defined population (79 and 37 respectively, out of 1058) with respect to bowel habits, irritable bowel syndrome symptoms, and whole gut transit time calculated from records of three defecations. Compared with unoperated controls, women after hysterectomy were more likely to consider themselves constipated; they also strained more and admitted more often to bloating and feelings of incomplete evacuation. Their stools tended to be lumpier and, in women over 50 years, transit time was longer. When women treated by cholecystectomy were compared with women having newly discovered, asymptomatic gall stones, they more often described defecation as urgent but had no other detectable differences. In conclusion symptomatic constipation is frequent in women after hysterectomy; after cholecystectomy, bowel habit is not consistently changed but the rectum seems to be more irritable.

Adult↗
PubMed1994

Relationship of small bowel motility to ileoanal reservoir function.

Some patients with an ileoanal reservoir have a high defecation frequency, despite a good anatomical result and the absence of pouchitis. This study aimed to determine whether variation in function is related to a difference in small bowel motility proximal to the reservoir and if small bowel motility is propagated into the reservoir. Ambulatory small bowel and reservoir motility was studied for 24 hours in five patients with good function (median bowel frequency 4 per day, range 3-6) and seven subjects with poor function (median bowel frequency 12 per day, range 10-20). Five solid state pressure sensors were positioned in the small bowel and one in the reservoir. During the fasting nocturnal period (2300-0800 h), patients with poor function had a median of 10 (range 5-13) migrating motor complexes (MMC), significantly greater (p = 0.03) than the corresponding median number of 3 (range 2-7) in patients with good function. A total of 120 MMCs were observed in the whole series of 12 patients. Of these only two were propagated from the small bowel into the reservoir. Discrete clustered contractions were not propagated into the reservoir, although prolonged propagated contractions did pass into the reservoir in one patient. Patients with poor function had similar 24 hour stool output and radiological reservoir size to those with good function, but the median maximum tolerated volume on reservoir distension was 290 ml (range 160-450) for patients with poor function compared with 475 ml (range 460-550) for patients with good function (p = 0.005). Small bowel motility proximal to the reservoir bears an important relationship to pouch function and defecation frequency. Propagation of coordinated proximal small intestinal motility into the reservoir is rare.

Adult↗
PubMed1999

Effect of cholecystectomy on bowel function: a prospective, controlled study.

BACKGROUND: Published estimates of the prevalence of postcholecystectomy diarrhoea derive from retrospective or uncontrolled data. They ignore functional bowel syndromes and possible changes in diet and drug use. AIMS: To determine prospectively whether and how often cholecystectomy leads to changes in bowel function and bowel symptoms, especially to liquid stools, over and above any non-specific effect of laparoscopic surgery. SUBJECTS PATIENTS: 106 adults undergoing laparoscopic cholecystectomy (85 women, 21 men). CONTROLS: 37 women undergoing laparoscopic sterilisation. METHODS: Before and 2-6 months after surgery patients were administered questionnaires about bowel frequency, bowel symptoms, diet, and drugs, and kept records of five consecutive defecations with assessment of stool form or appearance on a seven point scale. RESULTS: In cholecystectomised women, stated bowel frequency increased, on average by one movement a week, and fewer subjects felt that they became constipated. However, records showed no consistent change in bowel frequency, stool form, or defecatory symptoms. Six women reported diarrhoea after the operation but in only one was it clearly new and in her it was mild. Change in dietary fibre intake did not associate with change in bowel function but stopping constipating drugs did in a minority. In women being sterilised there was no consistent change in bowel function. In men having cholecystectomy no consistent changes were observed. CONCLUSIONS: In women, cholecystectomy leads to the perception of less constipation and slightly more frequent defecations but short term recordings show no consistent change in bowel function. Clinical diarrhoea develops rarely and is not severe.

Adult↗
PubMed2002

Is anorectal endosonography valuable in dyschesia?

AIMS: Dyschesia can be provoked by inappropriate defecation movements. The aim of this prospective study was to demonstrate dysfunction of the anal sphincter and/or the musculus (m.) puborectalis in patients with dyschesia using anorectal endosonography. METHODS: Twenty consecutive patients with a medical history of dyschesia and a control group of 20 healthy subjects underwent linear anorectal endosonography (Toshiba models IUV 5060 and PVL-625 RT). In both groups, the dimensions of the anal sphincter and the m. puborectalis were measured at rest, and during voluntary squeezing and straining. Statistical analysis was performed within and between the two groups. RESULTS: The anal sphincter became paradoxically shorter and/or thicker during straining (versus the resting state) in 85% of patients but in only 35% of control subjects. Changes in sphincter length were statistically significantly different (p<0.01, chi(2) test) in patients compared with control subjects. The m. puborectalis became paradoxically shorter and/or thicker during straining in 80% of patients but in only 30% of controls. Both the changes in length and thickness of the m. puborectalis were significantly different (p<0.01, chi(2) test) in patients versus control subjects. CONCLUSIONS: Linear anorectal endosonography demonstrated incomplete or even absent relaxation of the anal sphincter and the m. puborectalis during a defecation movement in the majority of our patients with dyschesia. This study highlights the value of this elegant ultrasonographic technique in the diagnosis of "pelvic floor dyssynergia" or "anismus".

Adolescent↗
PubMed1988

Solitary rectal ulcer syndrome: findings at barium enema study and defecography.

Sixteen cases of histopathologically proved solitary rectal ulcer syndrome were encountered. Fifteen patients underwent barium enema study; in nine cases the findings--including rectal stricture, granularity of the mucosa, and thickened rectal folds-were nonspecific. In six cases the study was normal. All patients had a long history of defecation disorders, and defecography was performed in all. In seven cases, intussusception of the rectal wall was seen; in another case the intussusception was accompanied by a rectocele. One case showed rectal prolapse. In four cases, failed relaxation of the puborectalis occurred and prevented the passage of the bolus; in another case there was abnormal perineal descent. In two patients studies were normal. In patients with defecation disorders, the possibility of this syndrome should be considered. Defecography is the method of choice for establishing the diagnosis.

Adult↗