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PubMed1993

Latrine use in rural Sarawak, Malaysia.

A cross-sectional survey covering 976 households in 41 rural villages covered by the Rural Health Improvement Scheme in Sarawak was carried out to determine the type of latrines they have and their usage of pourflush latrines. The survey was carried out by inspection and interview. Fifty-six percent of the households had pourflush latrines and upon inspection 91.3% of them showed signs of recent use. Based on the interview, ninety percent of the women responded that they always use the latrine for defecation. It was also reported that 86.5% of the husbands and 47.6% of the children below five years, always used the latrine for defecation. The most common reason for not using the latrine among adults was the lack of water to flush the latrines as well as not being home when the need arises. The reason for using the latrines were to keep the compound clean, convenience and health reasons. It is recommended that building latrines continue to be a prerequisite for getting water supply under the program and that non health-related reasons be emphasized in health education which aim to motivate people to build and use the latrines.

Child, Preschool↗
PubMed1977

[Etiology and management of habitual constipation (author's transl)].

Habitual constipation is present, if defecation occurs because of prolonged retention of stool in the colon less than three times per week. Motility of the intestine is increased in these cases, not decreased as has been thought for long time. Several factors of modern civilization favor habitual constipation, e.g. nutrition devoided of poorly digestible ingredients, and lack of physical exercise. The diagnosis of habitual constipation should only be made after careful exclusion of all organic causes by means of x-ray and endoscopic examination. Therapy is conservative in most cases. The diet ought to be rich in indigestible ingredients; eating and defecation habits have to be adapted to a regular pattern. Hydrophilic colloid laxatives may be used as well as in a limited extent laxatives effective on an osmotic basis. Laxatives acting more drastically or being effective upon contact with the intestinal mucosa are not suited for long-term therapy of constipation. Surgery is indicated only in a few cases.

Chronic Disease↗
PubMed1993

The constipated serviceman: prevalence among deployed U.S. troops.

The prevalence of constipation in deployed servicemen was determined in a sample of military personnel aboard the USS Iwo Jima LPH 2 during Operation Desert Shield. Results were obtained from a bowel function questionnaire issued to 500 deployed marines and sailors. When constipation is defined as no bowel movement for greater than 3 days, 3.9% of the Marine/sailor personnel are constipated when in their home environment as compared to 6.0% when they are aboard ship and 30.2% while in the field. Alternatively, when constipation is defined as the presence of certain anorectal complaints (hard stools, straining, painful defecation, and bleeding with defecation), the incidence is 7.2% when at home as compared to 10.4% aboard ship and 34.1% in the field. These results confirm that whether constipation is defined as infrequent bowel movements or presence of symptoms of constipation, significantly more servicemen will be constipated when in the field as compared to their home environment. Since approximately one-third of Navy/Marine Corps personnel deployed in a field environment will be constipated, preventive measures ought to be evaluated.

Adolescent↗
PubMed1993

Structured observations of hygiene behaviours in Burkina Faso: validity, variability, and utility.

The use of observation techniques has been promoted for the study of hygiene practices; however, questions still remain about the validity and repeatability of such techniques. In this article we compare data on hygiene behaviours obtained from questionnaires with data obtained using a structured observation approach and examine the repeatability of structured observations of behaviours and spot observations of environmental conditions. Poor agreement between questionnaire responses and observations was found for child defecation and stool disposal practices (kappa statistic: 0.25 and 0.28, respectively). There was evidence of over-reporting of "good" behaviours (P < 0.0001). Repeated observations of child defecation and stool disposal behaviours showed better agreement (kappa statistic: 0.76 and 0.62, respectively) based on small sample sizes. These findings suggest that our questionnaire data are less valid than data obtained by direct observation. However, different approaches to questioning may be less prone to over-reporting of "good" behaviours than our approach. Further research into the validity of different forms of question is warranted. Behaviours and conditions related to hygiene vary. Observations may be useful in determining the frequency of different behaviours/conditions in the community. However, individual practices may be too variable to assign individuals to exposed and non-exposed groups for the purpose of identifying links with health outcomes. Further studies on the variability of behaviours and the repeatability of observations are therefore needed.

Adult↗
PubMed1993

[Colorectal cancer. A study of 133 surgical cases].

The author studied the medical records of 133 patients who underwent surgery for adenocarcinoma of the colon or rectum in the Metropolitan Hospital Complex Arnulfo Arias Madrid from June 1972 to July 1992. In 9 (6.7%) the tumor was staged as Dukes A, in 49 (36.8%) as Dukes B; in 60 (43.1%) as Dukes C and in 10 (16.7%) as Dukes D. The anatomical location of the tumor was the cecum in 9 (6.7%), the ascending colon in 3 (2.3%), the sigmoid colon in 44 (33%) and the rectum in 41 (31.6%). Of the rectal carcinomas 24 (58.5%) were in the inferior one third, 10 (24.3) were in the middle and 7 (17%) in the superior third. It is evident that nearly two thirds of the tumors were within reach of the digital rectal examination of the sigmoidoscopic examination. The parents ranged from 21 to 89 years of age and their median age was 63 years. 73 patients were women and 60 were men. 60.5% of the women and 39.5% of the men had carcinoma of the colon. The sexual prevalence of carcinoma of the rectum was different: 5% were in men and 43% were in women. 2.2% of the tumors were synchronous and 4% were metachronous. The author discusses the number, type and indications for the surgical procedures used. There were no perioperative deaths. The 5 year survival for adenocarcinomas of the colon was 100% for those patients with tumors staged as Dukes A, 78.5% for the Dukes B, 61.1% for the Dukes C and 0% for those staged as Dukes D. For the rectal adenocarcinomas the 5 year survival was 100% for those patients with tumors in Stage Dukes A, 57.1%, for those in Dukes B, 33.3 for those in Dukes C and 0% in those in Dukes D. These results indicate that these patients are seen in an advanced stage and point to the urgent need to make the diagnosis in early, curable stages. The low incidence of tumors in stage Dukes A indicates an indifference of the patients and/or the doctors to the symptoms and signs of this disease. The most frequent symptoms, in descending order were: bleeding on defecation (all types), change in bowel habits (diarrhea or constipation), abdominal pains, tenesmus and anemia (with its different clinical manifestations). Other symptoms were a palapable abdominal mass, feces with bloody mucus and rectal prolapse on defecation.(ABSTRACT TRUNCATED AT 400 WORDS)

Adenocarcinoma↗
PubMed1996

[Anal sphincter electromyography, bulbocavernosus reflex and pudendal somatosensory evoked potentials in diagnosis of neurogenic lumbosacral lesions with disorders of bladder and large intestine emptying and erectile dysfunction].

The diagnostic value of anal sphincter electromyography (EMG), electrical bulbocavernosus reflex (BCR) and pudendal somatosensory evoked potentials (SEP) was studied in 16 male patients with disturbances of bladder function or defecation or with erectile dysfunction (ED) of at least several weeks' duration. All 16 patients had proven neurogenic disorders in the lumbosacral region. Eleven presented with bladder dysfunction, four with defecation problems, and nine with ED (some had more than one symptom). Fifteen patients had a pathological sphincter EMG, 14 patients a pathological BCR, and six patients a pathological pudendal SEP. Thus, the sphincter EMG was the most sensitive technique in the diagnosis of chronic pudendal lesions. However, pure afferent lesions cannot be detected by the sphincter EMG. In this case, the BCR, using unilateral stimulation of the dorsal nerves of the penis, provides the opportunity to distinguish between afferent and efferent lesions of the sacral reflex arc.

Adult↗
PubMed1996

Chronic exercise alters EEG power spectra in an animal model of depression.

The EEG from frontal cortex, EMG and EOG were recorded from rats exposed to only exercise (Treadmill), only stress, exercise + stress and neither (control). In comparison with the control group, the percent of Delta activity in the awake was significantly increased in the depressed group and significantly decreased in the exercised groups, while for Beta-2, the reverse occurred; Theta increased and Beta-2 decreased in the NREM sleep state of the depressed group and the opposite happened for the exercised groups. Delta and Alpha-2 activity significantly increased in the depressed group, and they were significantly decreased in the exercised groups whereas the Beta-2 activity showed contrary changes in the REM sleep state. These findings indicate that exercise has the opposite effect from what stress has on qEEG and concomitant physical exercise reduces the effects of stress. Behavioral tests were done by Open Field (OF) and High Plus Maze (HPM). Slow EEG activity (Delta, Theta, Alpha) was significantly positively correlated with immobilization in the OF and defecation in both OF and HPM and negatively with the food intake, transfer latency in HPM; rearing, grooming and total ambulation in OF Whereas, fast activity (Beta-2) was significantly negatively correlated with immobilization in OF and defecation in OF and HPM, while positively with ambulation in the central squares of OF and time spent at the central cross and number of times arms crossed in the HPM.

Animals↗
PubMed1996

Functional anorectal disorders.

The functional anorectal disorders-functional fecal incontinence, pelvic floor dyssynergia-type constipation, levator ani syndrome, and proctalgia fugax-are common but poorly understood gastrointestinal complaints. Fecal incontinence may occur in constipated patients when a fecal impaction of the rectum reflexly inhibits the internal anal sphincter and allows leakage of soft stool, or it may occur in diarrhea. Constipation-related incontinence can be treated with habit training (use of a routine time to defecate backed up by laxatives) or biofeedback to teach relaxation of the pelvic floor, but diarrhea-related fecal incontinence usually requires antidiarrheal medications. Pelvic floor dyssynergia occurs when the pelvic floor muscles paradoxically contract instead of relaxing when the patient strains to defecate. Biofeedback to teach relaxation of these muscles is effective in two thirds of patients. Levator ani syndrome involves chronic, and proctalgia fugax involves fleeting rectal pain. The cause of these painful conditions is unknown, and no treatment of proven efficacy is available.

Anal Canal↗
PubMed1997

Clinical response to dietary fiber treatment of chronic constipation.

OBJECTIVES: To determine the clinical outcome of dietary fiber therapy in patients with chronic constipation. METHODS: One hundred, forty-nine patients with chronic constipation (age 53 yr, range 18-81 yr, 84% women) at two gastroenterology departments in Munich, Germany, were treated with Plantago ovata seeds, 15-30 g/day, for a period of at least 6 wk. Repeated symptom evaluation, oroanal transit time measurement (radiopaque markers), and functional rectoanal evaluation (proctoscopy, manometry, defecography) were performed. Patients were classified on the basis of the result of dietary fiber treatment: no effect, n = 84; improved, n = 33; and symptom free, n = 32. RESULTS: Eighty percent of patients with slow transit and 63% of patients with a disorder of defecation did not respond to dietary fiber treatment, whereas 85% of patients without a pathological finding improved or became symptom free. CONCLUSION: Slow GI transit and/or a disorder of defecation may explain a poor outcome of dietary fiber therapy in patients with chronic constipation. A dietary fiber trial should be conducted before technical investigations, which are indicated only if the dietary fiber trial fails.

Adolescent↗
PubMedDate not supplied

[Severe chronic constipation: limitations of medical therapy and indications for surgical intervention. II].

Severe chronic constipation is a common problem in children. Most patients have functional constipation, only few (approximately 5%) have an underlying organic disease who requires surgical treatment. Anatomic problems with a painful defecation (anal rhagades, fistulas, hemorrhoids) or with difficult defecation (anal stenosis, tumor) require only a careful physical examination. Other organic problems due to neurogenic and myogenic colonic abnormalities require extensive investigations, including histological and histochemical study, for diagnosis. Ultrashort Hirschprung's disease, neuronal intestinal dysplasia type B and hypoganglionosis represent different levels of a developmental problem of the enteric nervous system. Surgical treatment is recommended in these cases. After surgery is recommended a long period of medical treatment to avoid a functional constipation.

Child↗
PubMed1997

A household survey of dysentery in Burundi: implications for the current pandemic in sub-Saharan Africa.

To characterize the epidemiology of dysentery (defined as bloody diarrhoea) in Burundi, we reviewed national surveillance data and conducted a household cluster survey including two case--control studies: one at the household, the other at the individual level. We estimated that community incidences for dysentery (per 1000 residents) in Kibuye Sector were 15.3 and 27.3, and that dysentery accounted for 6% and 12% of all deaths, in 1991 and 1992, respectively. Factors associated (P < or = 0.05) with contracting dysentery were being female, using a cloth rag after defecation, a history of recent weight loss, and not washing hands before preparing food. The attributable risk, at the household level, of not washing hands before preparing food was 30%. Secondary household transmission accounted for at most 11% of dysentery cases. This study suggests that Shigella dysenteriae type 1 may be one of the leading causes of preventable mortality in Burundi and other African countries where effective antimicrobial agents are no longer affordable. Since hands were the most important mode of transmission of S. dysenteriae in this study, community-based interventions aimed at increasing hand washing with soap and water, particularly after defecation and before food preparation, may be effective for controlling dysentery epidemics caused by S. dysenteriae type 1 in Africa.

Adolescent↗
PubMed1997

Ileocecal interposition--functional outcome.

Surgery of rectal cancer aims at providing satisfactory quality of life early postoperatively. Low postoperative morbidity and good defecation quality early after rectal reconstruction by means of a reservoir construction are essential conditions for a good quality of life. The clinical results show, that the ileocecal interposition is feasible with a low morbidity and that the majority of patients experience good to excellent defecation quality.

Aged↗
PubMed1997

Analysis of social factors and human behavior attributed to family distribution of schistosomiasis japonica cases.

An investigation of family distribution patterns of schistosomiasis japonica was carried out in four pilot villages in Yunnan Province. Family clustering of the disease was present in Bihuayuan Village before and after economic reform (site A); however, such clustering did not occur in Tuanshan and Liantie Villages (sites B and C) in the same periods. Being contrary to the stage prior to economic reform family clustering existed in Zhonghe Village (site D) after the reform. The results obtained from single- and multifactor analysis showed that the main human behavior related to family distribution of schistosomiasis in mountainous regions of Yunnan Province included the frequency of laborer migration, contact with cercariae-infested water in public places or family microenvironments with a high transmission potential, promiscuous defecation and status of cattle grazing. The frequency of laborer migration and human contact with cercariae-infested water in public places in sites B and C without family clustering was higher than that in sites A and D with family clustering. Place for promiscuous defecation and cattle grazing in site A converged compared with that in sites B and C.

Animals↗
PubMed1998

Interobserver agreement in defecography--an international study.

BACKGROUND: Defecography is considered to be an essential investigation in the evaluation of functional anorectal disorders, but the agreement between observers from different clinical centers has never been evaluated. METHODS: 14 defecographic studies were selected aimed to cover the most relevant defecographic findings responsible for disordered defecation. Eight studies were considered unequivocal, but six were thought to be controversial. All were sent to the ten participants in Europe and the US (five proctosurgeons, three radiologists, two gastroenterologists). They evaluated the studies using a previously agreed upon questionnaire. Interobserver agreement was quantified by kappa statistics and by the proportions of positive and negative agreement as compared to chance agreement, respectively. RESULTS: Overall, only the completeness of rectal emptying and the presence of a rectocele achieved acceptable kappa values above 0.4. When restricting the evaluation to the studies considered to be unequivocal, agreement improved considerably and was moderate to good for all items describing the images (kappa 0.43-0.63). However, whether proctosurgery should be performed and whether defecography contributed to the management of the particular patient remained controversial with very low kappa. CONCLUSIONS: It is doubtful whether defecography contributes substantially to the management of patients with disordered defecation.

Anus Diseases↗
PubMed1998

Isolation and characterization of the viscous, high-molecular-mass microbial carbohydrate fraction from faeces of healthy subjects and patients with Crohn's disease and the consequences for a therapeutic approach.

1. An earlier study by our group revealed that the viscosity of faeces from patients with Crohn's disease is significantly lower than that of healthy subjects. This is due to low concentrations of a high-molecular-mass carbohydrate, probably of bacterial origin. The cause of this phenomenon might be the impaired barrier function of the gut mucosa. Low viscosity may allow close contact of intestinal contents (bacterial products and toxins) with the intestinal wall. This could play a role in the maintenance of the disease.2. The first aim of this study was to investigate the high-molecular-mass carbohydrate fraction, responsible for viscosity, in detail. We also tried (in a pilot study) to raise the intestinal viscosity of patients with Crohn's disease with the undegradable food additive hydroxypropylcellulose (E463), in an attempt to alleviate clinical symptoms.3. The high-molecular-mass fraction (>300 kDa) responsible for faecal viscosity was sensitive to lysozyme and contained high levels of muramic acid. It was concluded that this material consisted mainly of peptidoglycan polysaccharides and was consequently of bacterial origin. The muramic acid in material from patients with Crohn's disease was 7.5 (1.5-13.9)%, which was less than in healthy subjects [11.4 (8.5-24.1)%; P=0.0004]. Furthermore, viscosity in material from patients with Crohn's disease was found to be half [14.9 (1.0-33.6) cP] of that found in healthy subjects [35.0 (2.7-90.7) cP; P=0.004].4.A daily dose of 1 g of hydroxypropylcellulose caused an increase in faecal viscosity in patients with Crohn's disease (from 1.4 to 2.3 cP) and in healthy subjects (from 4.9 to 7.5 cP). Faecal consistency improved in patients with Crohn's disease (from watery and loose to formed) and the defecation frequency decreased from 3-4 to about 2 times a day. No changes in defecation patterns were found in healthy subjects.5. These data indicate that the high-molecular-mass fraction that is responsible for faecal viscosity is peptidoglycan. Furthermore, a daily dose of a hydroxypropylcellulose solution to increase the viscosity of the intestinal contents of patients with Crohn's disease might be beneficial. This approach merits further study.

Adult↗
PubMed1989

Anal sphincter dysfunction in Parkinson's disease.

Striated anal sphincter function was studied electrophysiologically and radiologically in six patients with Parkinson's disease and chronic constipation. In five cases, there was paradoxic anal sphincter muscle contraction during simulated defecation straining resembling anismus-type pelvic outlet obstruction. Radiologic studies showed functional improvement of the defecatory mechanism following the administration of the dopamine receptor agonist apomorphine in four patients. Dysfunction of the striated anal sphincter musculature may be a significant cause of constipation in some parkinsonian patients, occurring as part of the generalized extrapyramidal motor disorder.

Anal Canal↗
PubMed2003

Stool toileting refusal: a prospective intervention targeting parental behavior.

OBJECTIVE: To evaluate the effect of an intervention targeting parental behavior on stool toileting refusal. METHODS: This study population comprised 406 children aged 17 through 19 months from a single suburban private practice. Children were randomly assigned to receive 1 of 2 written toilet-training instructions. Both groups were advised to use a child-oriented approach to toilet training. In addition, those in the intervention group were requested to avoid using negative terms for feces and, before training began, to praise the children when they defecated in the diaper. Follow-up telephone calls were made every 2 to 3 months, and 381 children were followed up until they developed stool toileting refusal or completed daytime toilet training. RESULTS: The incidence of stool toileting refusal was 23% in the control group and 26% in the intervention group (P>.10). The mean +/- SD duration was 5.2 +/- 4.9 months in the intervention group vs 7.6 +/- 4.9 in the control group (P =.04). Children with stool toileting refusal in the intervention group trained at 40.0 +/- 6.4 months vs 43.0 +/- 6.5 months in the control group (P =.04). CONCLUSIONS: The intervention did not decrease the incidence of stool toileting refusal but did shorten its duration, leading to earlier completion of toilet training. This should help to ameliorate some of the negative consequences of stool toileting refusal.

Adult↗
PubMed1979

Is there postdefecation bacteremia?

An investigation was done to determine the incidence of postdefecation bacteremia. A study of 82 healthy volunteers was done. Among 164 predefecation cultures, only one (0.6%) from an anaerobic flask was positive for microorganism, which was identified as Staphylococcus epidermidis. In only two of 328 (0.6%) postdefecation cultures did microorganisms grow, which were shown to be Propionibacterium acnes. The results of this study suggest that either bacteremia after defecation does not occur or is a rare event in healthy individuals.

Adolescent↗