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PubMed2001

Patient satisfaction after biofeedback for constipation and pelvic floor dyssynergia.

BACKGROUND: Patients referred for chronic constipation frequently report symptoms of straining, feeling of incomplete evacuation, or the need to facilitate defecation digitally (dyschezia). When such patients show manometric evidence of inappropriate contraction or failure to relax the pelvic floor muscles during attempts to defecate, they are diagnosed as having pelvic floor dyssynergia (Rome I). AIMS: To evaluate long-term satisfaction of patients with pelvic floor dyssynergia after biofeedback. PATIENTS: Forty-one consecutive patients referred for chronic constipation at an outpatient gastrointestinal unit and diagnosed as having pelvic floor dyssynergia who completed a full course of biofeedback. METHODS: Data have been collected using a standardised questionnaire. A questionnaire survey of patients' satisfaction rate and requirement of aperients was undertaken. RESULTS: Mean age and symptom duration were respectively 41 and 20 years. Half of patients reported fewer than 3 bowel motions per week. Patients were treated with a mean of 5 biofeedback sessions. At the end of the therapy pelvic floor dyssynergia was alleviated in 85% of patients and 49% were able to stop all aperients. Satisfaction was maintained at follow-up telephone interviews undertaken after a mean period of 2 years, as biofeedback was helpful for 79% of patients and 47% still abstained from intake of aperients. CONCLUSIONS: Satisfaction after biofeedback is high for patients referred for chronic constipation and diagnosed with pelvic floor dyssynergia. Biofeedback improves symptoms related to dyschezia and reduces use of aperients.

Adult↗
PubMed1997

[A temporary reduction of emotional reactivity in postweaning, prejuvenile rats: examination by the Runway Test].

Developmental change of emotional reactivity in Wistar rats was investigated by two experiments using the Runway Test. Rats were tested at 20, 30, 40, 60, and 90 days of age for three successive days. First, a cross-sectional comparison of behavior in the Runway Test showed that 30-day-old rats were faster to enter the runway region, faster to reach the end section, and traversed more sections than other age groups. Rats at 60 and 90 days of age defecated more bolles and urinated more. Second, longitudinal comparisons showed that the ambulation of 30- and 40-day-old rats increased gradually over test days, suggesting lowered emotional reactivity. But 60- and 90-day-old rats showed asymptotic level of ambulation and no increase between days and less defecation. These results suggested that postweaning prejuvenile rats showed a temporary reduction of emotional reactivity in novel environments. Also, their emotional reactivity elevated gradually, and remained stable in each individual level.

Animals↗
PubMed1976

Fetal intestinal disaccharidases in human amniotic fluid.

Based on data from two human fetuses, a correlation exists between amniotic fluid and intestinal disaccharidase activities suggesting that the fetal intestine is the source of these amniotic fluid enzymes. Intestinal disaccharides are apparently released into the amniotic cavity by fetal defecation. As indicated by the drop of disaccharidase activities in amniotic fluid at 22 weeks gestation, defecation stops at this period of gestation.

Amniotic Fluid↗
PubMed1999

[Treatment of anal incontinence and constipation with transanal irrigation].

The Enema Continence Catheter (ECC) consists of a rectal catheter with an inflatable balloon. The balloon keeps the catheter in the rectum, while enemas are administered. Results from 25 adult patients and 12 children treated with the ECC were evaluated by telephone interviews or by information drawn from patient records. The ECC reduced the frequency of incontinence episodes in four of nine (44%) adult patients suffering from faecal incontinence due to spinal cord lesions, myelomeningocele, complicated anal sphincter lesions or anorectal surgery and irradiation therapy. Among 16 adult patients suffering from constipation or obstructed defecation, the ECC reduced symptoms in three (19%). Furthermore, the ECC procedure reduced symptoms in 10 of 11 (91%) children with colorectal dysfunction, mainly due to spina bifida. In conclusion, the ECC can reduce symptoms in most children suffering from faecal incontinence or constipation, and in some adults with faecal incontinence. However, the method is less effective among adults with constipation or obstructed defecation.

Adolescent↗
PubMed1998

Belladonna alkaloids-induced behavioral changes and amnesia on open-field and step-through in 18-, 28-, and 38-day-old mice.

AIM: To study the age-related changes of atropine (Atr), scopolamine (Sco), anisodine (AT3), and anisodamine (Ani) on behaviors and memories. METHODS: The behaviors and memories were measured with open-field test and step-through task. M-cholinergic receptors were determined by [3H] quinuclidinyl benzilate ([3H] QNB). RESULTS: During acquisition session (d 1) the 18-, 28-, and 38-d-old mice pretreated with Atr, Sco, and AT3 (0.02, 0.2, 2, or 20 mg.kg-1, i.p.) in open-field test showed increase in walking counts by 26%-42%, but decrease in rearing, grooming, and defecating counts for 50%-92%, 67%-100%, and 75%-100%, respectively. On recall session (d 2) the walking and rearing behaviors in the 18- and 28-d-old mice receiving Atr, Sco, and AT3 on d 1 were higher than those in the mice receiving saline. But a lower grooming behavior on d 2 was found in the mice receiving the drugs on d 1. On d 1 Ani 20 mg.kg-1 reduced the rearing behavior by 50% in 18-d-old mice and defecation by 33%-36% in 18- and 28-d-old mice. All the 4 belladonna alkaloids increased the number of avoidance-response errors and decreased the retention latencies in step-through task. Bmax of [3H] QNB binding sites in frontal cortex and hippocampus regions in the 38-d-old mice increased 7% and 23% vs in the mice of 18 d of age, respectively. CONCLUSION: 1) The effects of the belladonna alkaloids on behaviors and memories in adult mice were weaker than those in young mice. 2) The belladonna alkaloids-induced amnesia on passive avoidance-response in step-through was more sensitive than behavioral changes and amnesia on open-field. 3) According to the lowest effective doses which insulted the behaviors or memories in young mice, Sco was about 10, 100, and 1000 times more potent than Atr, AT3, and Ani, respectively.

Age Factors↗
PubMed1999

[Our concept of defecography. Methods and reproducibility of results].

Defecography is used in the Czech Republic only exceptionally. Since 1988 the authors made 402 defecographic examinations. They submit a detailed description of hitherto assembled experience and their own modification of the examination. As contrast material they use at present Micropaque susp. thickened by means of wheat bran. They administer it by means of a modified press for dough preparation. The X-rays are taken on a modified ordinary stool made from soft timber. For screening of uncovered places in the visual field they use individually placed copper plates 2 mm thick. For better evaluation of the X-rays the authors place during examination an X-ray contrasting net behind the patient. Pictures are taken at rest, during contraction, during modified Valsalva's manoeuvre and during all stages of defecation. The authors mention the most interesting pathological pictures they encountered so far--internal prolapse, levator hernia, rectocele, sphincter defect, various forms of prolapses and dyskineses of the pelvic floor. In the authors opinion the basic quantifiable parameters are the magnitude of the anorectal angles. They used the assessment method described by Mahieu, as well as the mediorectal angle which in their opinion is a reflection of the patient's somatotype and levator function. More than the absolute values of the angles they emphasize the difference of the two angles and change of the latter during contraction and defecation. In their opinion enlargement of the difference during contraction and diminution to values close to zero is normal. Converse values are according to the authors evidence of dyssynergy of the pelvic floor. Independent assessment of the angles and magnitude of the lift of the pelvic floor by three subjects are subjected to statistical analysis. They provide evidence of complete reproducibility of results of anorectal angles according to the authors' definition. The results of assessment can be used to investigate relations with parameters of anorectal manometry (AM) or transrectal sonographyy (TRS) in subsequent investigations.

Contrast Media↗
PubMedDate not supplied

Defining GERD.

"It is not the death of GERD that I seek, but that it turns from its evil ways and follows the path of righteousness." The reflux world is fully aware of what GERD is and what GERD does. What the world does not know, however, is the answer to the most important yet least asked question surrounding GERD's raison-d'etre: Why is GERD here and why do we have it? What GERD is: abnormal gastric reflux into the esophagus that causes any type of mischief. What GERD does: causes discomfort and/or pain with or without destroying the mucosa; causes stricture or stenosis, preventing food from being swallowed; sets the stage for the development of esophageal adenocarcinoma; invades the surrounding lands to harass the peaceful oropharyngeal, laryngeal and broncho-pulmonary territories; reminds us that we are not only human, but that we are dust and ashes. Why GERD is here: We propose three separate and distinct etiologies of GERD, and we offer the following three hypotheses to explain why, after 1.5 million years of standing erect, we have evolved into a species (specifically Homosapiens sapiens) that is destined to live with the scourge of GERD. Hypothesis 1: congenital. The antireflux barrier, comprising the smooth-muscled lower esophageal sphincter, the skeletal-muscled right crural diaphragm and the phreno-esophageal ligament does not completely develop due to a developmental anomaly or incomplete gestation. Hypothesis 2: acute trauma: The antireflux barrier in adults suffering acute traumatic injury to the abdomen or chest is permanently disrupted by unexpected forces, such as motor vehicle accidents (with steering wheel crush impact), blows to the abdomen (from activities such as boxing, etc.), heavy lifting or moving (e.g., pianos, refrigerators) or stress positions (e.g., hand stands on parallel gym bars). The trauma creates a hiatal hernia that renders the antireflux mechanism useless and incapable of preventing GERD. Hypothesis 3: chronic trauma: The antireflux barrier in children and adults is gradually weakened over time as a result of chronic straining to defecate and straining in an unphysiologic position, both of which stem from our modern day habits of eating a low-fiber diet and living on the high-seated toilet. We suggest that the chronic traumatic hiatal hernia is (a) the cause of more than 90 percent of the GERD that stalks the Western world; (b) is a direct result of abandoning the popular and worldwide practice of squatting to socialize, eat and defecate; and (c) is our just reward for adopting the "civilized" high sitting position on chairs and modern toilets.

Abdominal Injuries↗
PubMed2000

[Social phobia with somatic symptoms including nausea and urgency of micturition].

The common symptoms of the social anxiety response include blushing, trembling, feelings of muscular tension of the face, and fear of eye contact. However, the ICD-10 mentions other less familiar symptoms such as nausea, urgency of micturition or defecation, gastrointestinal discomfort, and diarrhea as symptoms of social phobia. Since some of these somatic symptoms are classified as panic-like symptoms in the DSM-IV, it is sometimes difficult to distinguish between social phobia and agoraphobia when these somatic symptoms appear in situations usually associated with agoraphobia. We investigated whether social phobic patients with familiar symptoms (classical group; N = 24) and those with unfamiliar symptoms such as nausea, urgency of micturition or defecation (N/U group; N = 13) could be distinguished on the basis of several selected demographic and psychological tests. Fear of negative evaluation (FNE), social avoidance and distress (SAD), brief social phobia scale (BSPS), and Rosenberg's self esteem score (Se) were compared among these two groups and 82 controls. We also investigated whether they have "fears of making other people feel uncomfortable" which is believed to be a characteristic symptom for what is known in Japanese as "taijin-kyofu-sho." Both groups had higher scores on FNE, SAD, fear and avoidance scores of BSPS, and lower scores on Se as compared with controls. However, neither group differed in demographic variables or results of psychological tests, except for higher scores on the performance score of BSPS and increased rate of "fears of making other people feel uncomfortable" in the classical group. It is suggested that social phobia patients had common social phobic symptomatology and psychopathology irrespective of their somatic symptoms.

Adult↗
PubMed2000

[Laxigal effectiveness in constipation of various etiology].

The efficiency of laxigal (sodium picosulfate) was evaluated in 66 patients aged 38-73 years with the irritated bowel syndrome (IBS), inert colon, and dolichocolon. Twenty-eight patients had defecations twice a week, 26 once a week or less. Twelve patients had no spontaneous defecations. Laxigal was administered in a dose of 10-24 droplets before sleeping. Good effect was attained in 42 (64%) patients and satisfactory in 24 (36%). Good effect is more often observed in patients with IBS and dolichocolon, while in patients with inert colon the results were usually no better than satisfactory. After long (3 weeks and longer) therapy with laxigal its dose could be reduced by 30-50% without loss of effect. Laxigal induces no diarrhea, abdominal pain, decrease in electrolyte composition or other serum shifts, does not disorder hepatorenal functions.

Adult↗
PubMed2000

in children. Its results were drawn with limited sample size obtained after a short phase of data collection. A further study should be conducted to get more precise and valid results that may be useful for preventing UTI among children.

This hospital-based case-control study was conducted from September 1998 to January 1999 in Metro Manila, Philippines. General objective of the study is to determine the association between selected hygiene behavior and urinary tract infection (UTI) among children aged 6-12 years. Specifically, the study is designed to examine the relationship between UTI and urination, defecation, washing and bathing habits. Twenty-three cases of children with UTI and an equal number of controls were recruited in four tertiary hospitals. The study association was determined by using odds ratio, the chi-square test and the Fisher exact test, where appropriate, in simple analysis. Furthermore, exact logistic regression analysis was applied to overcome the problem of small sample size. The data suggested that bathing habit less than daily, holding of urination during daytime, and washing habit after defecation might have risk effects on UTI. There was not enough evidence of significant association between UTI and other study exposures. Among extraneous variables, age group or school enrollment of children had a borderline significant association with UTI after adjusted simultaneously for selected variables. This study served as a pilot of the Preventive Nephrology Project (Department of Health, Philippines) in determining selected risk factors of

Case-Control Studies↗
PubMed2001

[Fecal incontinence: therapy of congenital sphincter dysplasia in adulthood--a case report].

The dynamic graciloplasty has gained acceptance in the therapy of intractable fecal incontinence. With a success-rate of 60 to 80%, the dynamic graciloplasty is a good alternative towards a permanent colostomy for individual cases. Furthermore, adults suffering from congenital anal atresia may be well treated by this therapy as described in this case. Following surgery, an accurate follow-up is inevitable in these patients, including training of neosphincter control. After 8 to 12 weeks the training-process of the neosphincter-control should be finished. At this point of time the patient will have obtained defecation-control and should be able to execute voluntary defecations.

Adult↗
PubMed1999

[Clinical study on preventive effect of taozhi zhipu mixture on postoperative intestinal adhesion].

OBJECTIVE: To study the clinical effect of Taozhi Zhipu Mixture (TZM) in preventing postoperative intestinal adhesion. METHODS: Three hundred and ninety-six patients who had received abdominal operation were randomly divided into the treated group (188 cases) and the control group (208 cases). Same treatment was given to both groups excepting that the treated group received TZM orally or by nasogastric tube. The time of borborygmus recovering and first passing of flatus-defecation after operation was recorded. Patient's gastro-intestinal motion was observed by isotope tracing with I131 capsule. The frequency and intensity of borborygmus were measured by a tracer. All patients had been followed up for 2-3 years. RESULTS: The recovery of borborygmus, the first passing of flatus-defecation were much earlier, the I131 capsule passed gastro-intestinal tract more quickly, and tracer showed higher frequency and intensity of borborygmus in the treated group than those in the control group. Follow-up study also showed the treated group was better than the control group in the non-adhesion rate and the total effective rate (P < 0.05). CONCLUSION: TZM has good effect on stimulating postoperational gastro-intestinal peristalsis and preventing the occurrence of postoperational intestinal adhesion.

Adolescent↗
PubMed1999

[A study on the symptoms and diagnostic criteria of irritable bowel syndrome in Chinese].

OBJECTIVE: To explore the related symptoms of irritable bowel syndrome (IBS) and its diagnostic criteria in Chinese. METHODS: Symptomatic IBS was diagnosed using Manning criteria in a screening of 2486 subjects in Beijing. A questionnaire study was carried out randomly by clustering samples of residential groups according to a stratified design of city, suburban and rural areas. The sample size of each area studied was in proportion with the population of the area. Symptoms were recorded in detail by trained doctors and medical students and the results underwent computer analysis by comparing their percentages in an IBS (n = 215) group with those in a non-IBS (n = 2271) group. Single factor analysis was done by using Chi square test, those factors of significance were further analyzed by logistic analysis of multifactor. RESULTS: In the single factor analysis, as much as 22 symptoms regarding the whole GI tract and urinary bladder were considered to be significantly related to IBS. After multifactor- analysis, those symptoms of colonic origin remain to be most significant; they were: (1) abdominal pain (> 6 times/a), (2) abdominal pain accompanied by altered bowel habits (both diarrhea and constipation), (3) pain released after defecation, (4) mucus in stool. CONCLUSION: (1) Abdominal pain accompanied by altered bowel habit and pain relieved after defecation are the essential symptoms of IBS. Manning criteria modified by adding constipation with a positive predictive value of 80%, is most suitable in the epidemiologic study as well as in clinical screening of IBS in Chinese; Rome criteria with a positive predictive value of 75% is more reliable in research work and clinical trial. (2) Exclusion of organic disease is important in the diagnosis. (3) There is an overlapping of symptoms between IBS and functional dyspepsia, but those whose colonic symptoms predominate should be diagnosed as IBS, and vise versa. (4) IBS may present extraintestinal symptoms, such as symptoms of the urinary bladder, etc.

Abdominal Pain↗
PubMedDate not supplied

Risk factors of diarrhoea among flood victims: a controlled epidemiological study.

The concept and practice of 'disaster preparedness and response', instead of traditional casualty relief, is relatively new. Vulnerability analysis and health risks assessment of disaster prone communities are important prerequisites of meaningful preparedness and effective response against any calamity. In this community based study, the risk of diarrhoeal disease and its related epidemiological factors were analysed by collecting data from two selected flood prone block of Midnapur district of West Bengal. The information was compared with that of another population living in two non-flood prone blocks of the same district. The study showed that diarrhoeal disease was the commonest morbidity in flood prone population. Some behaviours, like use of pond water for utensil wash and kitchen purpose, hand washing after defecation without soap, improper hand washing before eating, open field defecation, storage of drinking water in wide mouth vessels etc. were found to be associated with high attack rate of diarrhoea, in both study and control population during flood season compared to pre-flood season. Attack rates were also significantly higher in flood prone population than that of population in non-flood prone area during the same season. Necessity of both community education for proper water use behaviour and personal hygiene along with ensuring safe water and sanitation facilities of flood affected communities were emphasized.

Case-Control Studies↗
PubMed2002

When fiber is not enough: current thinking on constipation management.

Constipation is a common disorder and many patients fail to respond to the simple constipation remedies of increased fiber and fluid intake. When secondary to other conditions, medications, or disease processes, the focus of constipation management is correction of causative factors. However, primary constipation - ie, constipation with no identifiable causative factor - is very common. Patients generally present with one of three patterns: constipation-predominant irritable bowel syndrome, slow transit constipation, or pelvic floor dysfunction resulting in dyssynergic defecation. Baseline evaluation for patients with chronic constipation includes a careful history, focused physical examination, and limited laboratory studies. Patients with dyssynergic defecation usually respond best to biofeedback therapy and pelvic muscle re-education. Constipation-predominant irritable bowel syndrome is best managed with dietary monitoring and modifications, fiber therapy, and education regarding self-monitoring and self-care. Patients with slow transit constipation may benefit from fiber therapy and increased activity, but most also will require laxative therapy. Current guidelines for prescribing laxatives suggest bulk agents as first line and osmotic agents as second line therapy. Stimulant laxatives should generally be reserved for PRN use. Current understanding about the etiology, pathology, and classification of different types of constipation are summarized and a stepwise approach to evaluation and management is presented.

Cathartics↗
PubMed2002

[Quality of life in the course of enzyme replacement therapy for chronic pancreatitis].

AIM: The ultimate goal of any treatment in chronic pancreatitis is to maximize the patient's quality of life. The authors evaluated the QoL of patients with chronic pancreatitis prior to and after pancreatic enzyme replacement therapy in a prospective, multicenter, follow-up study. PATIENTS AND METHODS: Two groups of patients were evaluated. Group 1: 31 patients with newly diagnosed chronic pancreatitis who had never been treated with pancreatic enzyme preparations; Group 2: 39 patients whose disease was diagnosed on average 3.4 years before the start of the study. The latter group of patients had undergone pancreatic enzyme replacement therapy, but during the follow-up this proved to be insufficient. The dose of pancreatic enzyme replacement therapy was tailored in accordance with the degree of pancreatic exocrine insufficiency measured by means of exocrine pancreatic function tests. RESULTS: A significant gain in body weight and a significantly reduced defecation rate were found in both groups 1 month after the beginning of the pancreatic enzyme replacement therapy as compared to the pretreatment values. The prevalence of general and disease-specific symptoms, and the intensity of pain were reduced in both groups after 1 month of enzyme substitution therapy. The working ability, the emotional functioning, the financial strain and the overall QoL score were improved significantly in both groups, while the cognitive functioning was found to be significantly improved during the follow-up only in Group 1. The overall increase in the QoL score correlated significantly with the increase in body weight and the decrease in defecation number in both groups. CONCLUSIONS: Individually-tailored enzyme replacement therapy improved the QoL, reduced the extents of steatorrhea and pain, increased the body weight, not only in the untreated chronic pancreatitis patients, but even in the inadequately treated group.

Adult↗
PubMedDate not supplied

[Rapid tolerance to ethanol and high voluntary alcohol consumption in mice selected for brain weight].

Mice of two strains selected for small and large brain weight (SB and LB, respectively) had free access to 10% alcohol and water within three months. At the end of this period, they consumed alcohol in daily dose of 6.9 +/- 0.9 and 7.5 +/- 0.8 g/kg, respectively. After a period of imposed three-day abstinence, the alcohol consumption by the mice of these strains increased by 68.6 and 49.3%, respectively. Exploratory behavior of independent groups of mice from these strains was studied in the closed cross-maze. The animals were injected with ethanol (2.4 g/kg, i.p.) or vehicle twice with a weekly interval. In SB mice, the first ethanol administration increased the total time of maze exploration and the number of stereotyped visits. The second ethanol administration did not increase the time of exploration but increased the number of stereotyped visits even to the greater extent. The latter indicates the development of rapid tolerance and sensitization of these behaviors to the drug, respectively. The ethanol administration inhibited exploratory patrolling behavior and defecations. In LB mice, both the first and second ethanol administrations increased the number of stereotyped visits and decreased the exploration time and the number of defecations. The results do not support the psychomotor stimulant hypothesis of alcohol addiction. It is proposed that SB and LB mice may serve as models for Cloninger's types 1 and 2 alcoholics and may be useful for investigation of neuropharmacological mechanisms of stimulatory and inhibitory effects of ethanol.

Alcohol Drinking↗
PubMed2002

Efficiency of biofeedback therapy for chronic constipation in children.

Chronic constipation is a common disorder in childhood. The underlying mechanisms responsible for chronic constipation remain unknown. Conventional methods of treatment often fail to produce satisfactory results. Favorable effects of biofeedback treatment for constipation have been suggested, however, with variable results reported in the literature. The main aim of the study was to evaluate biofeedback versus conventional therapeutic protocol in the treatment of chronic constipation over a short period of time (3 months). Forty-nine children with chronic idiopathic constipation, 24 allocated to conventional and 25 to biofeedback therapy were included in the study. Thorough history data on bowel function and symptoms, anorectal status and manometric testing were collected before and after treatment. Follow up consisted of a structured interview. Mean age was 94 and 92 months in the children treated by the conventional and biofeedback method, respectively. The initial prevalence of abnormal defecation dynamics was 58% and 56% in the group children allocated to conventional and biofeedback therapy, respectively. The difference was not statistically significant. After the treatment, the values of rectal sensation threshold, critical volume, and recto-anal inhibitory reflex volume were significantly higher, and the prevalence of abnormal defecation dynamics was significantly lower in the group on biofeedback therapy. Biofeedback is an effective method of treatment for chronic constipation in children in short term. Therapeutic results are especially favorable in the recovery of abnormal anorectal dynamics and manometric parameters. There is no clear evidence for long-term benefits of biofeedback therapy.

Biofeedback, Psychology↗