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PubMed2000

Voiding pattern in healthy newborns.

A 4-hour observation period has been used in infants to investigate suspected bladder dysfunction. The aim of the present study was to extend the usefulness of this protocol by establishing reference values for voiding frequency, intervals, volumes, and residual urine in healthy newborns. The study included 51 healthy newborns, 26 girls and 25 boys, aged 3 to 14 days. During a 4-hour period, all micturitions and residuals were recorded as well as feeding, sleeping, crying, and defecations. The observation was completed with the child undressed to observe the urinary stream during one void. Different provocation tests were tried to induce urinary leakage. All newborns voided with a stream, about once per hour, with a median volume of 23 mL. For each voiding parameter, there was a large inter- and intra-individual variability. Double voidings were common as well as sizable residual volumes. The diuresis was about six times higher than in healthy school children. The healthy newborns did not leak during provocation tests such as manual compression of the bladder. Neurourol. Urodynam. 19:177-184, 2000.

Defecation↗
PubMed1999

Pelvic floor descent in females: comparative study of colpocystodefecography and dynamic fast MR imaging.

The purpose of this study was to compare fast dynamic magnetic resonance imaging (MRI) with colpocystodefecography (CCD) in the evaluation of pelvic floor descent in women. Thirty-five women with clinical evidence of pelvic floor descent were studied. A fast single-shot MR sequence was performed in the supine position during pelvic floor relaxation and during maximal pelvic strain. On the same day, a dynamic CCD was performed with the patient seated on a stool-chair. The degree of descent of the bladder, vagina, and anorectal junction was evaluated as the vertical distance between the pubococcygeal line and the bladder base, the vaginal vault, and the anorectal junction, respectively. A bulge of more than 3 cm measured as the distance between the extended line of the anterior border of the anal canal and the tip of the rectocele was interpreted as a rectocele. MRI was compared with CCD during maximal pelvic strain (CCD 1) and during voiding and defecation (CCD II). CCD was considered as the gold standard. Compared with clinical examination, CCD I showed a larger number of involved compartments, except for the middle compartment. CCD II was superior to clinical examination in all cases. In comparison with CCD I and especially CCD II, MRI had a lower sensitivity, especially for the anterior and middle compartment. Even four enteroceles seen on CCD II were not detected by MRI. When CCD I and CCD II were compared, a cystocele, a vaginal vault prolapse, an enterocele, and a rectocele were more readily seen on CCD II than with CCD I. When compared with CCD, supine dynamic MRI is unreliable, especially in the anterior and middle compartment. Even in the detection of enteroceles CCD was superior to MRI. In general, the best results with MRI can be expected for evaluation of the rectum.

Adult↗
PubMed1984

Assessment of body elimination attitude.

Constructed a 26-item Likert format Body Elimination Attitude Scale with good internal consistency and temporal stability (N = 60). Factor analysis yielded seven factors labeled Fecal Smell, Personal Hygiene, Sight, Dirty Hair, Animal Feces, Mucous-like Discharge, and Sound. Both the prominence of items that pertained to defecation and the positive association of the Scale with a measure of obsessive personality-anal character were viewed as consistent with psychoanalytic theory. Correlations with psychometric instruments revealed greater body elimination disgust to be associated with psychopathology. Youth, lesser education, having fewer children, being female, and lesser income also were associated with greater disgust.

Adolescent↗
PubMed1991

Straining puborectalis reflex: description and significance of a "new" reflex.

The present communication studies the technique and clinical significance of a new reflex, termed straining puborectalis reflex. Nineteen healthy volunteers with an average age of 38.2 years were studied, including ten males and nine females. The intravesical pressure, representative of intra-abdominal pressure, was measured by means of a balloon-tipped catheter introduced into the urinary bladder and connected to a pressure transducer. The electromyographic (EMG) activity of the puborectalis muscle was recorded using a concentric needle electrode inserted into the muscle. The EMG response of the puborectalis muscle to straining at different pressures was recorded. The response to two types of straining--sudden momentary and slow, sustained--was observed. The procedure was repeated in ten subjects after puborectalis infiltration with xylocaine or saline. Sudden straining evoked puborectalis contraction, whereas slow, sustained straining did not. Puborectalis contraction increased with the increase in straining intensity. These results were reproducible. The anesthetized puborectalis did not respond to straining, whereas the saline-infiltrated muscle did. The latency of the reflex was studied. Besides its role as a voluntary continent sphincter, the puborectalis seems to have a role also in the involuntary continence of the pelvic organs through the straining-puborectalis reflex. The muscle contracts on sudden straining, sealing the rectal and vesical necks and thereby preventing fecal or urinary leak. However, it is only on sudden straining that the puborectalis contracts. Slow, sustained straining as occurs during defecation and micturition does not evoke the reflex action. The straining puborectalis reflex is informative and may be incorporated as an investigative tool in patients with fecal and urinary control disorders.

Adult↗
PubMed1982

The pelvic ileal reservoir: an experimental assessment of its function compared with that of normal rectum.

The function of the 3-loop pelvic ileal reservoir as an alternative to total proctocolectomy and ileostomy is assessed experimentally in dogs and compared with normal rectum under identical conditions. No difference was found between the pelvic ileal reservoir and normal rectum in their ability to maintain continence. The efficiency of evacuation, however, is significantly better in normal rectum (P less than 0.01). Observations made over a prolonged period of time suggest that frequency of defecation, tenesmus and incomplete evacuation are persistent problems with an ileal reservoir. The results of the experiments concur with clinical findings that satisfactory continence may be achieved by using the ileal reservoir but that it does not possess the ability of normal rectum to evacuate completely. Hence the frequent need for self-catheterization.

Animals↗
PubMed2001

Transverse folds of rectum: anatomic study and clinical implications.

There are controversies with respect to the location, number, and function of the transverse folds of the rectum (TFR), probably because their physioanatomic aspects have not been fully investigated. The purpose of this communication was to study the anatomic and histologic structure of the TFR aiming at elucidation of their function in the light of their structure. The TFR were studied morphologically and histologically in 18 cadavers (10 male, 8 female) with a mean age of 36.6 +/- 10.4 (SD) years. Barium enema studies were also performed in 36 volunteers (20 male, 16 female; mean age 38.6 +/- 15.2 [SD] years). The number of TFR varied, the commonest findings being two and three. In a few cases, TFR were absent or exceeded three in number. Most folds extended beyond the middle of the rectal lumen; a few were narrow. They were thick at the base and tapered gradually. Microscopically, the TFR contained circular and longitudinal smooth muscle fibers; they were rarely purely mucosal. TFR varied in location dividing the rectum into compartments; an alternating side-to-side arrangement allows for a wavy movement of the stool in the rectum. The wavy movement, compartmental division, and the shelving action of the TFR are suggested to retard stool movement in the rectum so as to allow time for fecal sampling (stool or gas) and for impulses to reach the conscious level to decide whether or not to defecate. Further studies are needed to investigate the role of the TFR in clinical practice.

Adolescent↗
PubMed1977

Early handling influences on behavioral and physiological responses during active avoidance.

The effects of early handling on behavioral and physiological responses of the rat during active avoidance learning were investigated. Handled and nonhandled males and females were run in a 2-way shuttlebox task with an unconditioned stimulus of either .5 mA or .8 mA. Animals exposed to .8 mA showed a higher corticosterone response, a shorter response latency, and increased defecation. Early handling did not affect performance of the task, however handling did alter the patterns of the plasma corticosterone response over the course of avoidance training. Handled females showed less elevation of plasma corticosterone than nonhandled females, but all females showed a decrease in corticosterone over the course of avoidance learning. All males showed the drop in corticoids if run at .5 mA shock, but only handled males showed this change at .8 mA shock.

Animals↗
PubMed1979

Dissociated effects of inhibition of catecholamine synthesis on motor activity, "emotionality," and aggression in mice.

The inhibitor of catecholamine synthesis at the tyrosine hydroxylase level, alpha-methyltyrosine, administered in daily doses of 250 mg/kg IP, altered motor activity and aggressive behavior of isolated male mice in ten-minute paired encounter tests conducted on nine successive days. Motor activity was determined by an electromagnetic activity meter which measures fine and coarse movements separately. Coarse motor activity correlated significantly with aggressive behavior. Nonaggressive fine motor activity was significantly increased, while all the parameters of aggressive behavior showed a significant decrease in aggression. Increased escape behavior, heterogrooming, squeaking, and two cases of stupor were observed, suggesting possible equivalents of anxiousness. The defecation rate did not differ from that of the control group, victors having had a higher rate than losers. Results are discussed in connection with the "construct of emotionality" and the hypothesis of there being several categories of aggression with corresponding biochemical correlations.

Aggression↗
PubMed2006

Bulk agent Plantago ovata after Milligan-Morgan hemorrhoidectomy with Ligasure.

The aim of this study was to determine usefulness of the bulk agent Plantago ovata in reducing postoperative pain and tenesmus after open hemorrhoidectomy (Milligan-Morgan with Ligasure). Ninety-eight patients were randomized into two groups of 49 patients each. In both groups Milligan-Morgan open hemorrhoidectomy with Ligasure was performed. The first group received postoperatively two sachets daily of 3.26 g of the bulk agent, Plantago ovata, for 20 days. The control group was treated postoperatively with glycerin oil. There was no statistically significant difference in age, gender distribution and hemorrhoid grading, between the two groups. The pain score after first defecation (p < 0.001) and after 10 days (p < 0.01) and the global pain score (p < 0.001) was statistically significantly lower in the group treated with Plantago ovata, while there was no statistically significant difference in the pain level after 20 days (p > 0.05). The hospital stay was statistically significantly shorter in the group receiving Plantago ovata (2.6 +/- 0.6 vs 3.9 +/- 0.7 days, p < 0.001). The incidence of tenesmus was higher in the control group (40.8% vs 10.2%, p < 0.01). Treating patients with Plantago ovata after open hemorrhoidectomy, reduces pain, tenesmus rate and shortens postoperative hospital stay.

Cathartics↗
PubMed2004

The medicinal leech as a convenient tool for water toxicity assessment.

Medicinal leeches previously were used in various toxicological and pharmacological studies because they are sensitive and easy to keep under laboratory conditions. Toxicological studies using leeches became restricted when their natural sources decreased dramatically. We breed medicinal leeches under laboratory conditions and have the possibility of using them for various investigations. The aim of the current study was to investigate changes in behavioral and physiological responses of leeches exposed to a heavy metal model mixture (HMMM). The composition of the HMMM was determined on the basis of the average annual amounts of representative metals (Zn, Mn, Cu, Cr, Ni, Cd, and Pb) in wastewater discharging from the Ignalina Nuclear Power Plant. An annual average was considered a concentration of 1%. Animals were exposed to 0.13%, 0.25%, 0.5%, 1%, and 2% concentrations of the HMMM. The avoidance responses, changes in body weight, feeding behavior, and excretion rates of the leeches were recorded. Avoidance response was observed in animals treated with 1% and 2% concentrations of the HMMM during the first 2 h of exposure. A decrease in body weight was recorded after a 4-week exposure to all tested concentrations. Disturbances in feeding behavior were observed after a 4-week exposure to 0.13%-2% concentrations. An increase in the defecation rate was observed during the 5-week exposure to 0.25%-2% concentrations. The excretion rate via nephridia was decreased during postfeeding period after exposure to 0.25%-2% concentrations. The avoidance response of medicinal leeches can be used as an express method for water quality assessment, whereas physiological responses may be used for the assessment of chronic toxicity of polluted environments.

Animals↗
PubMed1996

Effects of stressful noise on eating and non-eating behavior in rats.

Eating and other behaviors were measured in 36 food-deprived rats on 15 consecutive days during 20 min test sessions. During training sessions 1 to 5 all animals were habituated to the test boxes with white noise of 55 dB intensity. For sessions 6 to 10 noise intensity was increased to 95 dB for the experimental rats and to 60 dB for the control rats. The food intake of experimental rats was lower for stress session 1. The duration of eating behavior was lower, and durations of exploring, grooming and resting behaviors were higher for all stress sessions for rats exposed to 95 dB white noise. Speed of eating behavior was higher for all stress sessions in the experimental group. Defecation rate of the experimental rats was higher for all stress sessions. On post-stress sessions 11 to 15 animals were again tested under the stimulus conditions of the training period (55 dB). No significant effects were observed for this period. The results are discussed with respect to models of "stress-induced" eating and behavioral ecology.

Animals↗
PubMed1997

The effect of dietary fiber on bowel function following radical hysterectomy: a randomized trial.

OBJECTIVE: To assess the effect of high-fiber dietary instruction in relieving chronic constipation, a known and accepted complication of radical hysterectomy (RH). METHODS: Thirty-five women with a diagnosis of cervical cancer who were scheduled for RH were randomized into groups that followed either a high-fiber diet plan or their usual diet. Data were gathered using a validated subjective bowel function questionnaire (SBFQ); a typical day's intake form and food frequency tool; and a diary used to record food, medication, bowel, and exercise information. Patients were evaluated at 1, 4, and 7 months after surgery. RESULTS: Postoperatively, the dietary fiber intake was significantly higher for the treatment (T) group (22.9 g) than the control (C) group (12.4 g) (P = 0.007). With regard to intergroup comparisons, there were few differences at the first follow-up. By the second visit, the T group reported taking medications to achieve regularity less often (P = 0.0269), straining less often (P = 0.0210), having pain with bowel movement (BM) less often (P = 0.0116), and having crampy abdominal pain less often (P = 0.123) than the C group. Four significant positive changes occurred in the T group, whereas only one occurred in the C group. With regard to intragroup comparison, the significant changes in bowel function in the T group were generally positive, whereas all of the C group's significant changes were negative. According to summary questions on the SBFQ, the T group reported a significant change in the frequency of BM (P = 0.0096); however, the C group reported no significant changes. Analysis of bowel function records showed clearer differences. The T group took less time to defecate (P < 0. 001) but had more BMs accompanied by gas (P < 0.001). The C group had significantly more BMs with cramps (P < 0.001), straining (P < 0. 001), and retention (P < 0.001) and significantly more BMs, which were hard (P < 0.001). Two C patients dropped out of the study because of severe bowel dysfunction despite maximum medication. CONCLUSION: Dietary management seems to be an inexpensive effective therapeutic intervention for addressing bowel dysfunction associated with RH.

Constipation↗
PubMed2005

Evacuation of neorectal reservoirs after TME.

Colon pouch reconstruction after deep rectal resection is functionally superior to straight colorectal/anal anastomosis. However, stool evacuation difficulties could jeopardize the functional benefit of neorectal reservoirs. Beside the well proven colon J-pouch, the transverse coloplasty pouch may represent a viable alternative. We examined evacuation and functional outcome after total mesorectal excision and transverse coloplasty pouch reconstruction. Thirty consecutive patients with cancer of the middle and distal third of rectum underwent a total mesorectal excision. In all patients, reconstruction was performed with a transverse coloplasty pouch. Pouch and anastomosis were checked by Gastrografin enema postoperatively. Eight months after surgery, video defecography, anal manometry and pouch volumetry were performed and the patients were interviewed according to a standardized continence questionnaire. Rectal resection and reconstruction with transverse coloplasty pouch anastomosis could be performed in all patients. No insufficiency of the pouch occurred. In the follow-up, no patient had difficulties to evacuate the pouch, none of these patients needed enemas or suppositories to facilitate defecation. All patients were continent for solid stools. Twenty-five of 27 patients had up to three bowel movements per day. Patients with reduced pelvic floor movement in the defecography proved more likely to suffer from urgency, fragmented evacuation and incontinence. Transverse coloplasty pouch reconstruction after total mesorectal excision is not associated with stool evacuation problems. Urgency and incontinence, which are rarely seen after this type of reconstruction, correlate with impaired pelvic floor movement rather than with pouch size or anal sphincter tonus.

Aged↗
PubMed1989

Continence and reflex pressure profile after surgery to correct the imperforate anus.

To clarify the cause of constipation which follows surgery for the supralevator type of disorder associated with the imperforate anus, rectal compliance, percentage maximum static anorectal pressure, and reflex profile were measured by anorectal manometry in 108 normal controls and 42 patients. Patients with constipation had a low percentage anorectal pressure (50%), high rectal compliance, associated with megarectum, and defecation of the staining type with constipation due to a reaction in anorectal motility.

Adolescent↗
PubMedDate not supplied

Defecography: results in 55 patients and impact on clinical management.

We reviewed the medical records and defecograms in 55 consecutive patients to determine the impact of results of defecography on clinical management. Main indication for defecography was constipation, present in 40 (73%) of 55 patients. In the remaining 15 patients, indications included obstructed defecation (5), incontinence (5), and miscellaneous symptoms (5). Defecography evaluated pelvic floor motion by assessing changes in the anorectal angle (ARA) and anorectal junction (ARJ) during various maneuvers, extent of evacuation, and structural abnormalities. Patients were grouped based on results of defecography as being normal (26) or abnormal (29). Comparison of measurements of the ARA and ARJ with various maneuvers showed no significant differences between the two groups. Clinical impact was determined by analyzing therapy done following defecography and subsequent patient response. In the normal group, 15 patients were managed medically, seven surgically, and four lost to follow-up. Clinical improvement occurred in 13 (59%) of 22 patients, with similar results between medical (60%) and surgical (57%) therapy. In the abnormal group, 16 had medical management, seven surgical therapy, and six lost to follow-up. Clinical improvement occurred in 13 (57%) of 23 patients but surgical therapy showed more improvement. In conclusion, most standard measurements of the ARA and ARJ were of no value in determining abnormality. Results of defecography did not alter selection of medical or surgical therapy, and had little impact on patient response to therapy.

Anal Canal↗
PubMed1996

Abdominopreanal proctocolectomy and ileal U-pouch in ulcerative colitis or familial adenomatous polyposis.

In some cases of ulcerative colitis and familial adenomatous polyposis, cancerous changes frequently occur on the distal rectum, in which case a restorative proctocolectomy is not recommended because of the limitations of a radical resection. Even if rectal cancer is not confirmed preoperatively, a strong possibility of cancer in the rectum could afford some support for a radical pelvic dissection during the anus-sparing procedure. The author designed a new operative procedure for resolving this problem. It is an abdominopreanal extrasphincteric proctocolectomy with preileal-pouch positioning of the distal ileal segment including the ileocecal sphincter (ileal U-pouch) for the treatment of ulcerative colitis and familial adenomatous polyposis coli (restorative radical proctocolectomy). The author performed this restorative radical proctocolectomy on seven patients over the past 5 years at the Department of Surgery, Pusan National University Hospital, of which four cases were ulcerative colitis and three were familial adenomatous polyposis. The results obtained were as follows: (a) The most common sequela was nocturnal seepage, which lasted for 6 months in 4 patients after the final operation. (b) The mean frequency of defecation was six times per day at 6 months after the final operation. (c) The average amount of stool was about 460g per day at 6 months after the final operation. Therefore, the ileal U-pouch is considered to be effective in reducing the daily amount of stool. A preanal extrasphincteric approach could be especially useful in the case of a difficult dissection of the anterectal space while also providing an effective dependent drainage of the ileoanal anastomotic space.

Adenomatous Polyposis Coli↗
PubMed1992

Defecatory disorders, anorectal and pelvic floor dysfunction: a polygamy? Radiologic and manometric studies in 41 patients.

A consecutive series of 41 patients with defecatory disorders was prospectively studied by anal manometry and evacuation proctography to determine the relationship between abnormalities and symptoms. The patients (29 female, 12 male, aged 41 +/- 2.3 years) all complained of difficulty in evacuation. All had normal colonoscopy and biochemistry. There was no evidence of megacolon or megarectum, and no symptoms had been previously treated by pelvic floor surgery. All subjects completed detailed questionnaires related to gastrointestinal symptoms with special reference to excessive straining and discomfort, digital manipulations during defecation, a sense of pelvic heaviness and incomplete evacuation. Each patient underwent clinical examination, anal manometry and defecography during a single outpatient visit. Rectocele (16 patients) was significantly associated with vaginal digitation, lower stool frequency, delayed rectal emptying and decreased rectal sensation to distension. Increased anal pressure on straining (14 patients) was also related to a poor rectal emptying in 13 patients. Neither perineal descent (24 patients) nor external rectal prolapse (12 patients) was related to objective obstruction. Nevertheless there was an association with pelvic heaviness and lower anal manometric recordings. Five among 16 patients with rectocele had manometric anismus. Forty percent of patients with intussusception also had a paradoxical sphincter response during defaecation. Furthermore, associated abnormalities were extremely common (34 of 41 patients), accurate interpretation of which was necessary for planning effective therapy.

Adult↗
PubMed1984

delta 1-Tetrahydrocannabinol-induced circling behavior in rats: a possible measure of psychotomimetic activity?

Relatively high dosages of delta 1-tetrahydrocannabinol (delta 1-THC) markedly suppressed almost all normally occurring behavioral elements in rats as observed in both a small and a large open field. This effect persisted following repeated treatment and testing for 3 consecutive days. The psychotropically inert but related compound cannabidiol (CBD) did not suppress behavior, but in contrast had a mild activating effect. Both compounds decreased defecation during the test procedure. In addition, delta 1-THC, but not CBD, induced a bizarre circling and turning response, that was evident over all 3 test days and occurred even when the rats were deeply sedated. It is suggested that an analysis of this phenomenon may be useful in measuring the psychotomimetic action of delta 1-THC and similar compounds in rats.

Animals↗