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PubMed1988

Comparison of the effects of psyllium and wheat bran on gastrointestinal transit time and stool characteristics.

Gastrointestinal transit time, frequency of defecation, stool weight, and stool consistency were studied in 12 subjects who were each given fiber supplements containing wheat bran, psyllium gum, a combination of wheat bran and psyllium gum, or a low-fiber control for 2 weeks. Gastrointestinal transit time was measured using four different markers: plastic pellets, chromium mordanted bran, cobalt-ethylenediamine-tetraacetic acid, and terbium oxide. The wet weight and dry weight of stools were measured, and a questionnaire accessed subjects' perceptions of the consistency of their stools. Fiber supplementation decreased transit time and increased the daily number of defecations and the wet weight and dry weight of stools. Bran had a greater effect on transit time than psyllium. Psyllium had a greater effect on the amount of water found in the stools and the total stool weight. On the days that stools were passed, 50% of the daily stool ratings were scored as "hard" when subjects received the control supplement. Less than 10% of the ratings were scored as "hard" when subjects received the high-fiber supplements. The type of marker used did not significantly affect the transit time measured.

Adult↗
PubMed1984

[Constipation in the aged. I. Significance, prevalence, causes and treatment].

There is no reason to assume that in old age defecation is different from younger people. Old people who are sound and active often have normal defecation. Their intestinal transit time has been shown to be normal. Nevertheless about fifty percent of the elderly use laxatives. In the very old and in institutions the use is even more frequent. The main cause of this real or supposed constipation is the lack of dietary fibre in the food. In the aged constipation can have dangerous complications, e.g. acute mental confusion, urinary retention, urinary incontinence and fecal impaction. Treatment may include general measurements, the addition of bulk-laxatives to the diet and the prescription of other laxatives. The use of laxatives other than bulk-laxatives may cause many harmful side-effects in the aged. The daily food must contain sufficient dietary fibre. Failing this one can use bran, preparations of psyllium or lactulose syrup.

Aged↗
PubMed1982

Ileoanal anastomosis with proximal ileal reservoir: an experimental study.

Endorectal ileoanal anastomosis with proximal interposition of an ileal reservoir was evaluated experimentally in dogs as an approach to retain sphincteric control of defecation after proctocolectomy. Two months after the operative procedure, eight animals with a reservoir had four to eight semisolid stools per day and were continent. In contrast, six animals with straight ileoanal anastomosis were incontinent with 10 to 14 evacuations per day. Motility studies demonstrated a reduction of propulsive peristalsis within the undistended reservoir, which is considered the responsible factor for increased intestinal transit time and reduced stool frequency. Filling of the reservoir to capacity elicited strong peristaltic contractions, which may assure a more complete evacuation of the reservoir during defecation. Reservoir capacity increased substantially (150% to 200%) within 2 months but only to a minor degree thereafter, indicating that the reservoir does not dilate progressively into an atonic viscus. Motility patterns remained unaltered as the reservoir became more complaint with time. Mucosal alterations (flattening of villi, submucosal inflammation) were detected in the reservoir but did not result in nutritional defects within an observation period of 1 year.

Anal Canal↗
PubMed1978

Genetically selected winner and loser rats: what was selected?

Throughout the 6--12th generation, genetically selected winner and loser rats in the straight runway test, were studied, in relation to weight, open field behavior, behavioral responses to footshock and adrenocortical response following stimulation. The results showed that the Loser Runway Strain (LRS) when compared to the Winner Runway Strain (WRS), were (1) lighter in weight, (2) defecated less, ambulated more and showed higher frequency of rearing-up when submitted to an open field (3) defecated less and jumped more in reaction to footshock and (14) had a higher rise of corticosterone levels following handling or footshock. These differences between WRS--LRS are the same found between male-female rats. This conclusion does not favor the validity of the runway test as a social measure, and suggests that WSR--LRS were selected according to male-female characteristics instead of a winning or losing trait.

Animals↗
PubMed1994

Management of constipation and encopresis in infants and children.

Chronic functional constipation is common in childhood. Basic understanding of the defecation process is essential to formulate a rational diagnostic and therapeutic approach to pediatric patients with chronic constipation, with or without encopresis. Primary care physicians can perform a major preventive function by anticipatory guidance and early dietary intervention. Most patients referred to pediatric gastroenterologists can be effectively treated as outpatients with use of an approach consisting of colonic evacuation, stool softeners, dietary manipulations, bowel training, and behavioral management. Avoidance of painful (laxatives) and invasive (suppositories, enemas) modalities is an important part of successful management. Further evaluation, including manometric tests, are reserved for patients with a history or physical findings suggesting an underlying disorder predisposing the patient to difficulty with defecation. Biofeedback therapy is likely destined to play a role in the subgroup who respond poorly to traditional therapeutic methods.

Barium Sulfate↗
PubMedDate not supplied

[Defecography in internal invagination of the rectum].

Rectal invagination has been considered an important cause of defecation difficulties and blockade (obstructed defecation). In the present study defecographies performed on 15 patients, with previous diagnosis of rectal invagination have been reviewed. Six patients had an intra-rectal (IR) invagination, three had an intra-anal (IA) invagination, while two patients did not show a typical rectal invagination. In the present series there is a suspected radiologic recurrence of the invagination. Three patients show a tendency to rectal stenosis. Anorectal angles at rest and under straining appears higher than the ones in normal subjects, after rectopexy, anorectal angles do not appear to be significantly changed and the pelvic floor is not significantly raising post-operatively. 7 out of 10 women had a rectocele preoperatively and 4 out 9 postoperatively. In 8 patients it was possible to compare a pre to a post-operative defecography. All patients but one displayed a reduction in the ability in emptying the rectum. The fact that rectal emptying is impaired may suggest that some autonomic denervation might occur following rectal mobilization.

Adult↗
PubMedDate not supplied

[Occult rectal prolapse: functional results after rectopexy].

In the present work the Authors have studied 19 patients with occult rectal prolapse evaluating symptoms and functional results after posterior abdominal rectopexy. Symptoms of internal rectal procidentia appear as a definite syndrome. In our patients pain upon defecation, this being often localized to the perineal and sacral region, was observed in 14 on 19 cases, while fecal incontinence was present in 5 cases (29%) and rectal bleeding in 8 (44%). These compliances are relieved by the anatomical correction of the rectal intussusception, but the preexisting functional disorders in the mechanism of defecation appear to be unaffected by rectopexy. (Sensation of obstruction 11 cases (58%) preop. e 9 cases (53%) postop.).

Adult↗
PubMed1994

[The value of defecography for diagnosis of rectocele and rectal prolapse].

The role of defecography with respect to rectoceles and to any grade of rectal prolapses has not been defined so far. Therefore, we studied 42 out of 45 patients that were submitted to a defecography between 1988 and 1992 for defecation disorders of unknown origin. In particular, we compared the diagnosis obtained by anamnestic data and the physical examination with the defecographic results and the definitive diagnosis with regard to the chosen therapies and the results. Rectocele and rectal prolapse were very frequent pathologies with 69% and 33% respectively. Of 23 patients with a clinically palpable rectocele, defecography was false negative in 4 and moreover, it did not provide any information about the functional relevance of the rectocele. Yet, it disproved the clinically diagnosed prolapses in 6 of 15 subjects, but revealed one in 5 of 27 patients that were presumed normal. On the other hand, a previously not diagnosed rectocele was detected in 6 out of 19 patients by means of defecography, but none of them proved to be of any clinical relevance. Of all rectoceles, only 48% were regarded responsible for the patients' symptoms and were therefore operated. Hereby, the indication for a surgical approach based more on anamnestic data and the proctological examination than on radiographic findings. Contrarily, the indication for a rectopexy--even if given only in 4 of those 14 patients with any grade of invagination--mainly based on the dynamics during defecation as documented by defecography.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Videoproctography in the study of rectal intussusception. The authors' own experience].

Videoproctography has proved to be a useful diagnostic technique to investigate anorectal disorders; it can provide morphological and functional information which no other diagnostic method yields. From a series of 898 videoproctographs, the findings of 117 patients with rectal intussusception were retrospectively reviewed. The most common symptoms were an incomplete emptying feeling (93% of cases), obstructed defecation (78%), and a feeling of upright rectal weighting (71%). Of the three known types of rectal intussusception, the most common type was distal intussusception (44%), followed by the rectoanal type (38%) and finally by the proximal type (19%). The three types of intussusception were frequently (42%) associated with other disorders of rectal ampulla and especially with rectocele (15%), mucosal prolapse (8%), and descending perineum syndrome (12%); they had different clinical correlations and proctographic patterns and could be recognized in different defecation phases. In our personal experience, proctography with videorecording was a useful diagnostic tool in the dynamic assessment of this morphofunctional disorder which represents one of its major indications.

Adult↗
PubMed1994

Mothers' hygiene behaviours and their determinants in Suphanburi, Thailand.

The aim of this study was to identify the predisposing and enabling factors affecting mothers' hygiene behaviour in relation to childhood diarrhoeal diseases. Qualitative data were gathered by naturalistic observation of 12 mothers and focus group discussions involving 32 mothers. Mothers with children less than 2 years of age in both urban and rural areas of Suphanburi, a central province of Thailand, were sampled. Twelve local terms describing five different types of diarrhoea were identified. Childhood diarrhoea was classified into two groups depending upon perceived causes: contagious and preventable, and not contagious and unpreventable. To prevent diarrhoea in children, mothers reported that they avoid "taboo" food, avoid breastfeeding with "hot" milk and visit local healers for a herbal paste treatment that is applied to the child's throat. Most mothers did not wash their hands before preparing milk or after disposal of children's faeces. However, they did wash their hands after cleaning the child following the child's defecation, and after their own defecation. Our findings suggest that health education programmes should utilize local terminology and work to counter common misunderstandings regarding childhood diarrhoeal disease and its prevention. Knowledge of the predisposing and enabling factors identified in this study will assist in the development of effective implementation programmes.

Adult↗
PubMedDate not supplied

Paradoxical contraction of pelvic floor muscles: clinical significance.

Paradoxical contraction of pelvic floor muscles during defecation straining has been said to be a cause of constipation and difficulty in passing feces. Nevertheless, controversies about its clinical significance still remained. Twenty patients with constipation and electromyographic evidence of paradoxical contraction of both puborectalis and external anal sphincter were investigated. An anorectal manometry performed in 17 confirmed the paradoxical contraction in 13 (76%). Electromyography revealed neurogenic signs in 11. Defecography demonstrated the paradoxical contraction in 6 only, but, together with barium enema and colon transit time, showed associated anorectal disorders in 9 patients. Twenty control patients were also studied. None had difficulty defecating. Nevertheless, 8 of them (40%) had paradoxical contraction. These observations suggest that paradoxical contraction of pelvic floor muscles may by asymptomatic and that another cause of emptying difficulties has always to be looked for.

Adult↗
PubMed1993

Gastrointestinal problems as a function of carbohydrate supplements and mode of exercise.

The aim of the study was to examine prevalence and duration/seriousness of gastrointestinal (GI) problems as a function of carbohydrate-rich (CHO) supplements and mode of exercise. The relationship between GI problems and a variety of physiological and personal factors (age, exercise experience) was also examined. Thirty-two male tri-athletes performed three experimental trials at 1-wk intervals, each trial on a different supplement: a conventional, semisolid supplement (S; 1.2 g CHO, 0.1 g protein, and 0.02 g fat.kg BW-1 x h-1); an almost isocaloric fluid supplement (F; 1.3 g CHO.kg BW-1 x h-1, no fat, no protein); and a fluid placebo (P). The 3 h of exercise started at 75% VO2max and consisted of alternately cycling (bouts 1 and 3) and running (bouts 2 and 4). GI symptoms were monitored by a questionnaire. Analysis of variance revealed that nausea lasted longer with P as compared with S (P < 0.05). Bloating lasted longer during bout 3 with P as compared with F and S (P < 0.05). Accounting for confounding factors, most GI symptoms occurred more frequently and lasted longer during running than during cycling. Multiple regression analysis revealed significant relationships between nausea and urge to defecate, between an urge to defecate, GI cramps and flatulence, and between belching and side ache. From all other factors energy depletion, CHO malabsorption, exercise intensity, exercise experience, and age were significantly related to GI symptoms during the exercise.

Adult↗
PubMed1994

Evacuation proctography (defecography): an aid to the investigation of pelvic floor disorders.

Patients with pelvic floor disorders frequently have associated anorectal dysfunction, which can be evaluated by a variety of laboratory tests. Evacuation proctography (defecography) documents the process of rectal evacuation and therefore demonstrates disorders of defecation, particularly those of an obstructive nature. It provides objective information about rectocele size and emptying and demonstrates coexistent enteroceles, many of which are missed on physical examination. This radiographic technique is the method of choice for recognizing rectal intussusception, the mechanism by which rectal prolapse occurs. Proctography suggests the diagnosis of spastic pelvic floor (anismus), a disorder amenable to biofeedback therapy. Proctography has limited application in anal incontinence unless there are associated obstructive symptoms. Evaluation of bladder dysfunction is aided by concomitant cystography. Gynecologists managing pelvic floor disorders should assess coexistent anorectal dysfunction, as undiagnosed enteroceles and disorders of defecation are an important cause of persistent or recurrent symptoms following pelvic floor repair. A comprehensive interdisciplinary approach to pelvic floor disorders is recommended.

Anal Canal↗
PubMed1993

The recto-levator reflex: the description of a new reflex and its clinical application. Preliminary report.

This communication embodies the description of a technique of recording a new reflex which I call "recto-levator reflex". The study was performed on 32 normal volunteers. The technique comprises the introduction of a balloon connected with a catheter into the rectum. A concentric needle electrode was introduced into the levator ani. The rectal balloon was distended and the levator myoelectric activity was recorded. In 12 patients, the procedure was repeated after levator infiltration with xylocaine or saline. When the rectal balloon was inflated with air, the levator muscle contracted. Levator contraction increased with increasing rectal distension. Anesthetized muscle did not respond, while saline-infiltrated muscle responded to rectal distension. Latency of the reflex was calculated. The recto-levator reflex seems to play an important role at defecation. On rectal distension with stools, levator contraction opens the rectal neck. Changes in the latency or amplitude of the reflex would indicate a defect in the reflex pathway. The reflex may thus prove of diagnostic significance in defecation disorders.

Adult↗
PubMed1993

Anorectal function of children with neurological problems. II: cerebral palsy.

In response to the frequent complaint of difficulties with defecation experienced by children with cerebral palsy, 34 children (13 girls and 21 boys, mean age 10 years) with cerebral palsy were investigated by questionnaire and anorectal manometry. 24 enuretic children served as controls for the anorectal manometry. Constipation affected 26 of 29, defecation distress eight and faecal incontinence 16 of the index children, but incontinence was mild in most cases. Index children had a low resting pressure in the first centimetre of the anal canal, slow anal rhythmical activity and a pressure increase in the first centimetre during maximum rectal distension. These findings suggest anal sphincter and/or pelvic floor muscle incoordination, but no evidence of abnormal rectal function. The authors conclude that surgical intervention was not indicated for the index children, but that medical treatment could be improved.

Adolescent↗
PubMed1997

The evaluation and treatment of functional constipation.

Constipation and defecation may be considered as the last taboo. The inability to defecate or to achieve this only by digital evacuation has never been a popular topic among patients and doctors. Application of tests from the colorectal laboratory has made it possible to study the function of the different parts of the colon and the mechanism of continence. We consider transit studies, defecography, EMG, and anal manometry, all useful as diagnostic procedures for functional constipation. Several causes of functional constipation can be distinguished in slow transit and difficult evacuation or colonic inertia, spastic pelvic floor syndrome, rectocele and intussusception. This article presents our view of the assessment and management of functional constipation.

Anal Canal↗
PubMed1997

[A clinical study on the effect of kaisailu on alleviating neonatal jaundice].

The effects of kaisailu defecation on alleviating neonatal jaundice were studied. 203 case of newborns fed with total mother breast milk were divided into two groups: experimental group (100 cases) received routine treatment and kaisailu (10 ml per rectum) control group (103 cases) only received routine treatment. The findings were as follows: excretory time of meconium in experimental group was more ahead than that in control group; the excretory meconium volume of the first time was obviously higher in experimental group; time of meconium changed yellow was distinctly shorter and the bilirubin index (measured by transcortical bilirubin method) lowered more rapidly in experimental group than that in control group. The results suggested that kaisailu defecation can alleviate neonatal jaundice.

Defecation↗
PubMedDate not supplied

Randomized comparison of two preoperative methods for preparation of the colon: oral administration of a solution of polyethylene glycol plus electrolytes and total parenteral nutrition.

BACKGROUNDS/AIMS: Two colon preparation methods were compared for their efficacy. The comparison was carried out between whole bowel irrigation using polyethylene glycol-electrolyte lavage solution (PEG-ELS) and total parenteral nutrition (TPN). METHODOLOGY: Twenty-six consecutive patients suffering from colorectal cancer without apparent obstruction were randomly divided into two groups. Twelve patients received 2 litres of PEG-ELS one day before the operation following two tablets of sennoside (24 mg) two days before the operation without restriction of food until PEG-ELS. Fourteen patients received magnesium citrate (34 g) and sennoside (24 mg) on the day before the operation with 7 days' TPN and fasting. RESULTS: The average time of defecation was 9 in the PEG-ELS group and 5 in the TPN group (p < 0.001), with little difference between the necessary times to complete defecation (PEG-ELS: 280 min. vs. TPN: 260 min.). However, although half of the PEG-ELS group complained of side effects of abdominal fullness the overall incidence of side effects in both groups were the same of 50%. There were no significant changes between the data of blood test and routine chemistry before and after the bowel preparation in both groups. The purity of the colorectum judged at operation in both groups were excellent, no residue at all, except in one patient of the TPN group. The total bacterial counts of the rectal samples obtained at operation of PEG-ELS group were fewer than that of TPN group but not statistically significant. CONCLUSION: Colon preparation using PEG-ELS is just as good as the 7-days' TPN treatment and fasting, and exceeds from the standpoint of saving time.

Administration, Oral↗