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PubMed2001

Sensory and biomechanical responses to distension of the normal human rectum and sigmoid colon.

BACKGROUND: Visceral pain is a major clinical problem. The aim of the present study was to compare the pain and biomechanical responses to standardized distension of the human colon. METHODS: The relation between pain intensity and pressure, cross-sectional area (CSA) and tension-strain relations of the rectum and sigmoid colon were studied in 11 normal subjects following standardized distension using impedance planimetry. The bag was inflated stepwise with pressures up to 6 kPa. The subjects, who were blinded for the distension procedure, rated their pain intensity using an aggregate visual analogue score (VAS) combining the intensity of the feeling of air, urge to defecate and pain. RESULTS: The distensions produced an initial rapid increase in CSA followed by a phase of slow increase until a steady state CSA was reached after 0.5-1 min. Several phasic contractions (observed as short-term decreases in the CSA) were recorded in the rectum from the end of the rapid phase to the end of distension at pressures from 1 to 5 kPa. The CSA in the rectum and sigmoid colon was 3,706 +/- 426 mm(2) and 2,305 +/- 426 mm(2) at the maximum bag pressure of 6 kPa (F = 52.4, p < 0.001). The tension-strain relation did not differ between the normal rectum and sigmoid colon. The VAS score for every modality (air, defecation and pain) revealed an increase in intensity as a function of pressure. The VAS score in the rectum and the sigmoid colon as a function of tension and strain did not show any differences. CONCLUSIONS: The biomechanical properties in the sigmoid colon and rectum were alike. For a given wall tension and circumferential strain the sensibility seems equal in the rectum and the sigmoid colon. The observed difference in perception between the two segments was related to the greater CSA in the rectum.

Abdominal Pain↗
PubMed2002

Effect of probiotics on constipation, fecal azoreductase activity and fecal mucin content in the elderly.

BACKGROUND: Constipation is a common problem in elderly subjects, probiotics have been suggested to improve intestinal motility and reduce fecal enzyme activity. METHODS: Elderly subjects (n = 28) were enrolled in an open parallel study. The subjects were divided into 3 groups: 1 control group receiving juice; 1 group receiving juice supplemented with Lactobacillus reuteri, and 1 group receiving juice supplemented with Lactobacillus rhamnosus and Propionibacterium freudenreichii. During the first 3 weeks all subjects consumed unsupplemented juice. In the subsequent 4 weeks, the subjects received their designated juice. During the last 3 weeks, all subjects again received unsupplemented juice. From the subjects, defecation frequency, laxative use, fecal pH, mucin content and azoreductase activity were assessed during the last week of each period. RESULTS: The subjects receiving the L. rhamnosus/P. freudenreichii-supplemented juice exhibited a 24% increase in defecation frequency. However, no reduction in laxative use was observed. The fecal azoreductase activity was also significantly reduced in this group. No changes in fecal pH or mucin excretion were observed. CONCLUSION: Some relief from constipation may be observed with the combination of L. rhamnosus/P. freudenreichii. This probiotic combination also reduced fecal enzyme activity. The tested probiotics did not affect the mucosal barrier.

Aged↗
PubMed2005

Hemorrhoidal ablation and fixation: an alternative procedure for prolapsing hemorrhoids.

BACKGROUND: Many new techniques have been evolved to curb the problem of post-operative pain after hemorrhoidectomy. Stapler hemorrhoidopexy and Doppler-guided hemorrhoidal artery ligation are the two methods gaining popularity amongst proctologists. The author proposes another technique called radiofrequency ablation and fixation of hemorrhoids to add to this list. PATIENTS AND METHODS: The surgical technique and clinical follow-up of 410 patients operated by this technique are presented. An Ellman radiofrequency generator was used for hemorrhoidal ablation at the output power intensity of 80. Post-defecation pain and pain at rest were assessed using a visual analogue scale. Patient satisfaction score was calculated at the mean follow-up of 60 months (range 48-72). The results in terms of mean hospital stay, post-operative pain, post-operative complications, and period of incapacity for work were compared with the published data of results of stapled hemorrhoidopexy and Doppler-guided hemorrhoidal artery ligation. RESULTS: Pain score at first evacuation was 6. The post-defecation pain score in the first week was 4 (range 3-6) and it was 3 (range 2-5) in the second week. The mean pain score at rest in the first week was 2 (range 1-4) and 1 (range 0-2) in the second post-operative week. In the long-term follow-up at a mean of 60 months, this procedure was found in most of the cases to control prolapse, discharge, and bleeding, with no stenosis or incontinence. The recurrence rate was less than 2%. The patient satisfaction score was high. CONCLUSION: The results of this technique of radiofrequency ablation and fixation of hemorrhoids hold positive promises in terms of less post-operative pain, early discharge from the hospital and faster return to work. The results are comparable to stapled hemorrhoidopexy and are better than Doppler-guided hemorrhoidal artery ligation in terms of effectiveness and symptomatic relief on a long-term basis.

Adult↗
PubMed2006

[Treatment of a tetraplegic patient with chronic constipation with the Tibetan remedy Padma Lax--a case report].

BACKGROUND: In spinal cord injuries disturbed defecation, constipation and their concomitant disorders are frequent clinical symptoms. They may severely impair the quality of life of the affected patients. The presented case study and two more case reports, summarized in table form, outline therapeutic difficulties and therapy options in the treatment of constipation in paraplegic patients. CASE REPORT: A 69-year-old male patient with tetraplegia below C4 suffered from disturbed defecation, constipation with recurrent co-prostasis and pronounced meteorism which impeded breathing. Padma Lax was applied for several months, and constipation and the concomitant meteorism were noticeably reduced. CONCLUSION: The herbal preparation based on a formula from Tibetan Medicine may offer new therapeutic options in the care and treatment of patients with severe constipation. This report could also give first indications for controlled clinical studies in tetraplegic patients.

Aged↗
PubMed1989

Genotype-treatment interaction in response of mice to early barbiturate administration.

Results of this investigation show a differential effect of early barbiturate administration on behaviors of mice of two inbred strains in the open field and in the barrier cage. Pups of the inbred strains DBA/l and C57BL/10 were fostered by HS/Ibg dams and were given a daily injection of 50 mg/kg sodium phenobarbital on postnatal days 2-21 (treated groups); control pups received vehicle injections. At 28 and 30 days the animals were tested in an open field and in a barrier cage. The DBA/l mice responded differently from C57BL/10 to early barbiturate treatment. Treated DBA/l mice showed a marked reduction from control levels in open-field locomotion and grooming but not in defecation. In the barrier test, there were reductions in jumping, peeking and grooming and increase in defecation. The differences between controls and treated in the C57BL/10 strain were small except for barrier jumping and peeking. It is suggested that genotype (strain) - environment (drug) interaction exists for the effect of early phenobarbital administration on behavior: DBA/l was sharply affected by the drug, while the behavior of C57BL/10 was little altered by neonatal phenobarbital administration.

Animals↗
PubMedDate not supplied

Chronic constipation in overweight children.

BACKGROUND: Obesity and functional constipation seem to share a common biopsychosocial model of causation. Though chronic constipation can significantly affect the quality of life of an overweight child, this association has not been highlighted in the literature. The purpose of this study was to compare the proportion of overweight children among children with chronic constipation with a control group of children with normal bowel habits. METHODS: Retrospective chart review with a control population. One hundred one consecutive children 5-18 years of age referred to the Subspecialty Clinic for functional constipation were the study group. The control group consisted of 100 consecutive children from the general pediatric practice seen for physicals and minor illnesses. Children with a body mass index (BMI) of >85 percentile from the National Institutes of Health (NIH) 2000 chart were classified as overweight. RESULTS: The control and study groups were statistically comparable in mean age (10.97 +/- 3.83 years and 8.07 +/- 2.56 years, respectively) and gender ratio (58 males in each group). Thirty children in the control group and 44 in the study population were overweight (p < .05). Among children with chronic constipation, the group of overweight children was male predominant (70.45% vs 47.36%, p < .05), had increased incidence of psychological/behavioral problems (45.45% vs 22.8%, p < .05), and was more likely to fail treatment (40.9% vs 21.05%, p < .05). There was no significant difference in the clinical profile of constipation, such as mean duration of constipation before presentation, sex ratio, incidence of painful defecation, and soiling and frequency of defecation between these 2 groups. CONCLUSIONS: There appears to be an association between chronic severe constipation and being overweight. Children with constipation are more likely to be overweight when compared with controls. Among children with chronic constipation, overweight individuals seem to constitute a distinct clinical group. This group is male predominant, has increased incidence of psychological/behavioral disorders, and is more likely to fail treatment.

Adolescent↗
PubMed2004

Intestinal parasites prevalence and related factors in school children, a western city sample--Turkey.

BACKGROUND: Intestinal parasitic infections are amongst the most common infections worldwide. Epidemiological research carried out in different countries has shown that the social and economical situation of the individuals is an important cause in the prevalence of intestinal parasites. Previous studies in Turkey revealed a high prevalence of intestinal parasitic infection. The objectives of the current study were to determine the prevalence of intestinal parasitic infections in Aydin among 7-14 years old school children and to identify associated socio-demographic and environmental factors, behavioral habits and also related complaints. METHODS: Multistage sampling was used in the selection of the study sample. A questionnaire, cellulose adhesive and a stool specimen examination were done. RESULTS: A total of 456 stool specimens were collected. 145 students (31.8%) were infected with one or more intestinal parasites. 29 (6.4%) of the students were infected more than one parasite, 26 (5.7%) with two parasites and 3 (0.7%) with three parasites. The three most common were E. vermicularis, G. intestinalis and E. coli. Intestinal parasite prevalence was higher in rural area, in children with less than primary school educated mother, in children who use hands for washing anal area after defecation, and in children who use toilet paper sometimes or never. The relation between child health and mother education is well known. Children were traditionally taught to wash anal area by hand. Toiler paper usage was not common and might be due to low income or just a behavioral habit also. Most of the complaints of the study population were not significantly related with the intestinal parasitic infection. CONCLUSIONS: Intestinal parasitic infection is an important public health problem in Aydin, Turkey. Rural residence, mother education less than primary school, sometimes or never usage of toilet paper, and washing anal area by hands after defecation were the significant associations. Interventions including health education on personal hygiene to the students and to the parents, especially to mothers are required. The ratio of uneducated women should be declined with specific programs. A multisectoral approach is needed.

Adolescent↗
PubMed2006

Role of the employment status and education of mothers in the prevalence of intestinal parasitic infections in Mexican rural schoolchildren.

BACKGROUND: Intestinal parasitic infections are a public health problem in developing countries such as Mexico. As a result, two governmental programmes have been implemented: a) "National Deworming Campaign" and b) "Opportunities" aimed at maternal care. However, both programmes are developed separately and their impact is still unknown. We independently investigated whether a variety of socio-economic factors, including maternal education and employment levels, were associated with intestinal parasite infection in rural school children. METHODS: This cross-sectional study was conducted in 12 rural communities in two Mexican states. The study sites and populations were selected on the basis of the following traits: a) presence of activities by the national administration of albendazole, b) high rates of intestinal parasitism, c) little access to medical examination, and d) a population having less than 2,500 inhabitants. A total of 507 schoolchildren (mean age 8.2 years) were recruited and 1,521 stool samples collected (3 per child). Socio-economic information was obtained by an oral questionnaire. Regression modelling was used to determine the association of socio-economic indicators and intestinal parasitism. RESULTS: More than half of the schoolchildren showed poliparasitism (52%) and protozoan infections (65%). The prevalence of helminth infections was higher in children from Oaxaca (53%) than in those from Sinaloa (33%) (p < 0.0001). Giardia duodenalis and Hymenolepis nana showed a high prevalence in both states. Ascaris lumbricoides, Trichuris trichiura and Entamoeba hystolitica/dispar showed low prevalence. Children from lower-income families and with unemployed and less educated mothers showed higher risk of intestinal parasitism (odds ratio (OR) 6.0, 95% confidence interval (CI) 1.6-22.6; OR 4.5, 95% CI 2.5-8.2; OR 3.3, 95% CI 1.5-7.4 respectively). Defecation in open areas was also a high risk factor for infection (OR 2.4, 95% CI 2.0-3.0). CONCLUSION: Intestinal parasitism remains an important public health problem in Sinaloa (north-western Mexico) and Oaxaca (south-eastern Mexico). Lower income, defecation in open areas, employment status and a lower education level of mothers were the significant factors related to these infections. We conclude that mothers should be involved in health initiatives to control intestinal parasitism in Mexico.

Analysis of Variance↗
PubMed1992

Effects of sucralfate on acute and late bowel discomfort following radiotherapy of pelvic cancer.

PURPOSE: Radiotherapy, a cornerstone in the management of pelvic cancer, is accompanied by intestinal reactions. Therefore, we investigated the possible effects of sucralfate, an aluminium hydroxide complex of sulfated sucrose used in the treatment of gastric ulcer, in preventing radiation-induced diarrhea and bowel discomfort in patients treated with curative intention for pelvic cancer with external radiotherapy. PATIENTS AND METHODS: The study was double-blind and placebo-controlled and included 70 patients with carcinoma in the prostate or urinary bladder without distant metastases (T1-4No1xMo) and a performance status of greater than or equal to 90% on the Karnofsky scale. Radiotherapy was conventionally delivered with high-energy photons (four-field technique, the total dose 64 Gy, 2 Gy daily, total treatment time 5 to 6 weeks). Dose granules of sucralfate or placebo were dispensed to each patient 2 weeks after radiation started and continued for 6 weeks. All analyses were performed blindly. RESULTS: The frequency of defecation and stool consistency were significantly improved by sucralfate. Fourteen patients in the placebo group and three in the sucralfate group required symptomatic therapy with loperamide. One year later, the patients in the sucralfate group displayed significantly less problems with frequency of defecation, mucus, and blood in the stools compared with the placebo group. There was also a lower intake of loperamide and the weight decrease was less pronounced in the sucralfate group. There was no evidence of adverse effects associated with the use of sucralfate. CONCLUSION: It is suggested that sucralfate can be of beneficial value in diminishing bowel discomfort during treatment and, most importantly, sucralfate also reduces the late bowel disturbances that follow radiotherapeutic treatment of pelvic malignancies. The earlier proposed mechanisms of action (eg, protection of denuded mucosa, cytoprotective properties, binding bile acids) seem adequate to explain the present effects of sucralfate.

Diarrhea↗
PubMed1994

Regulation of feeding behavior in adult Drosophila melanogaster varies with feeding regime and nutritional state.

The regulation of feeding behavior in adult Drosophila melanogaster includes such elements as ingestion responsiveness, volume ingested in a single meal, food storage in the crop and rate of defecation. Our results suggest that feeding behavior varies in a manner dependent on feeding regime (food-deprived or ad-libitum-fed) and nutritional state. Fed flies that are subsequently food-deprived become increasingly more responsive to food stimuli over time and, when offered 1% agar diets containing different concentrations of sucrose, ingest greater amounts of diets that have higher sucrose concentrations. When fed ad libitum for 72 h on these same diets, D. melanogaster maintained much smaller crops on average than food-deprived flies fed a single meal. Additionally, ad-libitum-fed flies are grouped into two categories depending on the concentration of sucrose in the diet. Flies fed for 72 h on 1% agar diets having 50 mmoll-1 sucrose or more are not affected by the concentration of sucrose in the diet, while flies fed on diets of 15 or 25 mmoll-1 sucrose increase ingestion responsiveness, crop size and the rate of defecation with decreasing concentrations of sucrose in the diet. Flies fed on even lower sucrose concentrations (5 or 10 mmoll-1 sucrose) for 27-72 h exhibit both a shift over time to larger crop sizes and increased mortality over those of flies fed 15 mmoll-1 sucrose. These data suggest that flies fed ad libitum are capable of modulating their feeding behavior in response to their nutritional state.

Animals↗
PubMed1996

A case of hypertrophic obstructive cardiomyopathy associated with autonomic nervous dysfunction.

Autonomic nervous dysfunction has recently been considered to be an etiological factor in syncope and sudden death in cases of hypertrophic cardiomyopathy. However, the precise mechanism is still unknown. A 73-year-old woman with obstructive hypertrophic cardiomyopathy was hospitalized with complaints of impaired consciousness; faintness 3 to 4 h after meals, lightheadedness while walking, and syncope during and after defecation and micturition. Faintness was induced by alimentary hypoglycemia related to gastrectomy performed 5 years previously. Lightheadedness and syncope were accounted for by autonomic nervous failure combined with an impairment of alpha 1-adrenoceptor in vasoconstriction and the carotid sinus hypersensitivity which accompanied preceding events such as abdominal pain, defecation and micturition, which could enhance the vagally-mediated baroreceptor reflex.

Aged↗
PubMed2006

[Prevalence of constipation in adolescents enrolled in São José dos Campos, SP, Brazil, school's and in their parents].

BACKGROUND: There is few information concerning constipation in adolescence. AIMS: To evaluate the prevalence of constipation in adolescents enrolled in schools settled down in the city of São José dos Campos, state of São Paulo, Brazil, and in their biological parents. PATIENTS AND METHODS: A transversal study was carried out by analyzing a convenience sample which included adolescents between 9 years and 9 months and 18 years and 7 months old and their parents in five schools situated in São José dos Campos, SP. Data was obtained from an individual and personal questionnaire filled by the father, the mother and the adolescent. Three hundred and seventy two adolescents were studied. Constipation was defined as the elimination of hard stools and the presence of at least one of the following: painful or difficult defecation, soiling or bloody stools. Scybalous feces or dry cracked stools or the defecation frequency equal or minor than two per week were considered criteria for characterization of constipation. Rome II criteria was used for evaluate the prevalence of constipation in the parents. RESULTS: The prevalence of constipation in adolescents was 22.3%, being it more frequent in female (27.4%) than in male (14.9%). Among the fathers, the prevalence of constipation (7.3%; 20/274) was lower than in the mothers. Kappa's coefficient showed a slight concordance in the concomitance of constipation in the adolescent and his/her mother (kappa = 0.12) and in the adolescent and his/her father (kappa = 0.05). CONCLUSIONS: Intestinal constipation is a prevalent disturbance in the studied group of adolescents. However, it was not found relevant concordance between constipation in the adolescents and their parents.

Adolescent↗
PubMed2003

Influence of the blood meal source on the biology of Meccus picturatus Usinger 1939 (Hemiptera: Reduviidae: Triatominae) under laboratory conditions.

Aspects related to hatching, time-lapse between presenting the blood meal and beginning of feeding, feeding time, postfeed defecation delay,life time, mortality and fecundity for each stage of Meccus picturatus, life-cycle were evaluated and compared in two cohorts of M. picturatus fed on hens or rabbits. The hatching rate observed for each of the two studied groups of eggs was 78.1% (n = 2298) on the group fed on hens and 82.1% (n = 2704) on that fed on rabbits, and the average time of hatching was 20 days. Mean time-lapse for beginning feeding was under 3 min in nymphal stages and postfeed defecation delay was under 10 min in all stages, in both cohorts. Mean feeding time was significantly (P < 0.05) shorter in triatomines fed on hens than on rabbits. A similar number of nymphs of each cohort, 69 fed on hens (34.5%) and 68 fed on rabbits (34%), completed the cycle. No significantly (P > 0.05) differences were recorded among the average times from NI to adult in the cohort fed on hens (196.8 15.8 days) and the average time in the cohort fed on rabbits (189.5 22.9). The average span in days for each stage fed on hens was not significantly different to the average span for each stage fed on rabbits. The number of blood meals at each nymphal stage varied from 1 to 6 in both cohorts. The mortality rates were higher on fifth nymphal stage, in both cohorts. No significant (P > 0.05) differences were recorded on mortality rates on most nymphal stages of both cohorts. The average number of eggs laid per female from the cohort fed on hens in a 9-month period was 791.1, whereas the average number of eggs in the cohort fed on rabbits was 928.3.

Animals↗
PubMed2004

[Life cycle of Rhodnius brethesi Matta, 1919 (Hemiptera, Reduviidae, Triatominae), a potential vector of Chagas disease in the Amazon region].

R. brethesi is a sylvatic species from the Amazon region; it has been incriminated as responsible for the transmission of Chagas disease in collectors of piacaba in this region. The aim of present study was to investigate the efficiency of these insects as potential vectors of Trypanosoma cruzi. Aspects related with feeding and defecation patterns, life time, and mortality had been observed in each instar of R. brethesi. We use 5th instar nymphs to get adults virgins, after the moulting 3 groups with 6 females and 2 males each were created to obtain eggs. After hatching, 1st instar nymphs had been weighed and kept in bottles until the next moult. Insects were fed once a week in mice. Results showed that the average period of incubation was 17 days, the number of blood meal was increasing from the 1st to the 5th instar nymph with 7 (average) to become adult, a significative numbers of the defecations occurring immediately after the bloodmeals. The total percentual of mortality was 16%. This results suggests that this species presents a good exploitation of blood meals and a brief nymphal development in laboratory conditions reflecting its behavior in sylvatic environments.

Animals↗
PubMed2004

Development cycle of Panstrongylus rufotuberculatus (Hemiptera: Reduviidae) under laboratory conditions.

Determinant aspects of the development cycle of Panstrongylus rufotuberculatus (Champion, 1899) were evaluated under laboratory conditions. Fertility, duration of life cycle, mortality rate, feeding time, defecation time, thermal reaction time to food source, and volume of blood ingested were studied. From an initial cohort of fifth instars, nine adult pairs were formed, the females of which oviposited 2,338 eggs over 231 d. The eclosion rate was 84.4%; female and male progeny lived 223.56 (14.41) and 180.78 (14.41) d, respectively. The average total life cycle of immature stages (138.82+/-51.42 d) was distributed as egg, 24.22+/-0.42 d; nymph I, 18.94+/-5.15 d; nymph II, 15.80+/-3.29 d; nymph III, 16.55+/-4.36 d; nymph IV, 25.50+/-7.32 d; and nymph V, 36.71+/-2.75 d. Given these values, 2.6 generations per year are possible. Because of its longevity, rapid response to the presence of a host, large volume of blood ingested, and frequent defecation during feeding, this species constitutes a potentially important vector of Chagas' disease in nonendemic rural areas.

Animals↗
PubMed2006

Impaired function of the levator ani muscle in the grand multipara and great grand multipara.

Repeated deliveries might disturb the levator function and increase defecation disorders. In this prospective study, we determined the electric activity of the levator ani muscle (LAM) in nullipara, multipara, grand multipara, and great grand multipara (20 subjects for each group). Multiparity, grand multiparity, and great grand multiparity were defined as women having 2 - 5, 6 - 9, and 10 and over deliveries, respectively. The number of deliveries of multipara, grand multipara and great grand multipara were 4.05 +/- 1.14 (2 - 5), 7.55 +/- 1.23 (6 - 9) and 12.2 +/- 2.16 (10 - 17), respectively. All women were asked whether they had experienced constipation, fecal or urinary incontinence, and/or pelvic pain. All women were also evaluated for pelvic organ prolapse. Electromyography (EMG) of the LAM at rest and on contraction was recorded. EMG is an electrical recording of muscle activity. Constipation, incontinence and pelvic organ prolapse were encountered in multipara, grandmultipara and great grand multipara women. The LAM EMG at rest and on contraction in the nullipara was accepted as control. Both the resting and contractile activities of the LAM were as follows: nullipara > multipara > grand multipara > great grand multipara. These findings indicate that levator dysfunction and defecation disorders are increased with repeated deliveries because of pudendal and/or levator ani nerve injury and traumatic injury to the LAM occurred with the mechanical stresses of vaginal deliveries.

Adult↗
PubMed1984

Mechanism of rectal contraction mediated by sympathetic efferents from rectoanal pelvic afferents in guinea pigs.

In guinea pigs whose pelvic nerves were bilaterally sectioned, afferent stimulation of rectoanal branches of the pelvic nerve (PAS) could produce an intense contraction in the rectum similar to propulsive contractions elicited during defecation. The mechanism of this reflex was analyzed. Rectal contraction by PAS was abolished after transecting the spinal cord at T13 or sectioning the lumbar splanchnic nerves (LSN) or lumbar colonic nerves (LCN), but was unaffected by severing the intermesenteric and hypogastric nerves. Rectal contraction induced by PAS was abolished peripherally by atropine, guanethidine or yohimbine, while propranolol had no affect. Yohimbine antagonized the inhibitory effect of LSN or LCN stimulation on atropine-sensitive rectal contractions. It may, therefore, be concluded that PAS blocks the inhibition, by LCN efferents acting through alpha-adrenoreceptors, of cholinergic neurons in the myenteric plexus, thus facilitating recto-rectal propulsive contractions initiated by the defecation reflex.

Anal Canal↗
PubMed1985

Shaping self-initiated toileting in infants.

We evaluated a method for training infants to cue their mothers on the need to eliminate. The program consisted of three phases: Phase I was directed at establishing a close temporal relationship between body signals (straining) and subsequent defecations on the potty; Phase II was designed to establish a relationship between prompted and unprompted potty reaching/grabbing responses and eliminations (defecations and urinations) on the potty; and Phase III served to establish unprompted potty reaching/grabbing responses as reliable precursors of eliminations. Four babies, between 3.1 and 6.6 months old, all completed the training before age 1 year, with no negative side effects.

Behavior Therapy↗