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PubMed2004

Rectal hyperreactivity to distention in patients with irritable bowel syndrome: role of distention rate.

BACKGROUND AND AIMS: Rectal motor hyperreactivity to distention may be involved in the pathophysiological course of defecatory symptoms in patients with irritable bowel syndrome (IBS), but results of patient studies are conflicting, possibly because of differences in the applied distention rate. Because a fast rate of distention increases the rectal motor response in healthy subjects, it also may show hyperreactivity in patients with IBS. The aim of this study is to compare the effects of 2 distention rates on rectal motor responses and sensations in 16 patients with IBS and 12 healthy subjects. METHODS: Rectal distensibility and the frequency of rectal contractions and sensations were recorded during volume-controlled rectal distentions at 2 distention rates (10 and 100 mL/min). RESULTS: Recta of patients with IBS were significantly less distensible than those of healthy subjects during fast distention (P = 0.0006), but this difference was not statistically significant during slow distention (P = 0.07). The frequency of rectal contractions and sensations, the majority of which were sensations of gas and a desire to defecate, were significantly greater in patients with IBS during both slow and fast distentions (both P < 0.025). CONCLUSIONS: Recta of patients with IBS are hyperreactive to distention, and fast distention magnifies this abnormal motor response. A greater frequency of sensations during a fixed-time distention period may help to characterize the patients.

Adult↗
PubMed2003

Abnormalities of left colonic motility in ambulant nonconstipated patients with irritable bowel syndrome.

Our objective was to evaluate left colonic motility patterns recorded under physiological conditions during 24 hr in fully ambulant nonconstipated IBS patients compared to healthy controls. A 42-hr manometry of the left colon was performed in 11 nonconstipated IBS patients and 10 age- and sex-matched healthy volunteers. On day 1, a 6-channel, 10-cm interval, solid-state catheter was positioned. Frequency, amplitude, and motility index (MI) of segmenting pressure waves in the descending and sigmoid colon were calculated during the 24-hr study period on day 2. High-amplitude propagated contractions (HAPCs) were identified visually and their characteristics were calculated. In IBS patients a higher frequency of segmenting pressure waves was observed in the sigmoid colon compared to the descending colon (P = 0.006). In contrast, no regional differences were observed in controls. Awakening (P = 0.048) as well as having a meal (P = 0.024) was associated with a smaller increase of contraction frequency in the descending colon of IBS patients compared to controls. HAPCs occurred more frequently in IBS patients than in controls (P = 0.035). HAPCs in IBS patients reached a more distal colonic level and occurred more frequently in clusters. Defecation in IBS patients, but not in controls was always preceded by a cluster of HAPCs. In conclusion, left colonic segmenting pressure waves and HAPC characteristics are altered in nonconstipated IBS patients.

Adult↗
PubMed1999

Roughage revisited: the effect on intestinal function of inert plastic particles of different sizes and shape.

The mechanisms by which dietary fiber exerts its laxative action are not fully understood. Finely grinding wheat bran reduces its effect. Inert plastic particles are equipotent to bran if they consist of flakes or sliced tubing. It is not known whether altering the size or shape of inert particles alters their effect on intestinal function. In a randomized crossover study, 18 volunteers swallowed 24 g/day of plastic as branlike flakes or as small granules for 10-12 days with a two-week washout period between interventions. Whole-gut transit time (WGTT), orocecal transit time (OCTT), defecation frequency, stool form, stool water content, stool pH, and dietary intake were assessed. The plastic flakes caused a 24% (P < 0.001) reduction in WGTT and a 19% (P = 0.002) fall in OCTT. Resultant and appropriate changes in stool form, interdefecatory intervals (IDI), and stool weight were seen. The small granules did not cause any significant change in WGTT or OCTT, although IDI did decrease and stool output and stool form score increased. The stimulant effect of solid particles in the intestinal lumen upon transit time is influenced by the morphology of the particles.

Adult↗
PubMed1998

Pilot study of pathophysiology of constipation among community diabetics.

We aimed to compare gastrointestinal transit and defecatory function in a random sample of people with or without diabetes mellitus in a US community who reported constipation or laxative use. In this pilot study we measured: gastric, small bowel, and colonic transit by scintigraphy; vector manometry of anal sphincters at rest and during squeeze; defecatory dynamics by balloon expulsion test; and scintigraphic measurement of anorectal angle at rest and during defecation. Autonomic function tests were performed in diabetics. Diabetics with constipation had a higher prevalence of abnormal evacuation or prolonged colonic transit during the first 24 hr than controls (P = 0.07): three had prolonged 24-hr colonic transit, and three abnormal evacuation. Among constipated controls, only one had anismus. Overall, diabetics had slower colonic transit during the first 24 hr than nondiabetics (P < 0.05). Community diabetics who experience constipation or use laxatives have a greater prevalence of delayed 24-hr colonic transit or evacuatory dysfunction than community controls.

Adult↗
PubMed1998

A comparison of stool characteristics from normal and constipated people.

In people with constipation, it is not known if decreased frequency of defecation is associated with abnormalities in the weight or in the consistency of stools or if the weight or the consistency of stools correlates with the severity of various discomforts associated with bowel movements. In neither normal nor constipated subjects has the consistency of stools been carefully correlated with their relative contents of water and solids. Our aim was to gain insight into these questions. Twenty subjects with idiopathic chronic constipation and 20 age- and sex-matched control subjects were recruited by advertisement. Stools were collected for one week. After each bowel movement, the subject's perception of various discomforts associated with the bowel movement were recorded. The stools were then analyzed. The results and conclusions were as follows: (1) Stool weight per bowel movement was similar in the two groups but stool weight per week was markedly reduced in constipated subjects. (2) Reduced stool weight per week in constipated subjects was due to a nearly proportional reduction in stool water and stool solids output. (3) Using data from both groups, there was a curvilinear correlation between percent insoluble stool solids and stool hardness, as measured by a texture analyzer; hardness increased only slightly as percent insoluble solids increased between 7 and 20%, but hardness increased dramatically when percent insoluble solids exceeded 25%. (4) Only 6% of stools from constipated subjects (2 of 34) had abnormally high values for percent stool solids and physical hardness. (5) In subjects with constipation, the severity of various discomforts associated with bowel movements (such as straining) correlated poorly with the weight or the hardness of stool that was produced by the bowel movement.

Adult↗
PubMed2002

Is squatting a triggering factor for stroke in Indians?

BACKGROUND: Undocumented observations of ours suggested increased occurrence of strokes in the early hours of the morning and in the toilets where most Indians still squat. The present study has been designed to assess the validity of this observation and to identify the likely triggering factor in stroke onset in such situations. MATERIAL AND METHODS: Part A of the study looked into stroke onset data of 100 consecutive CT-confirmed stroke patients specially in relation to time of day, place, posture and activity of the individual. Part B of the study included 67 healthy volunteers (age 24-49 years) whose supine and squatting blood pressure (BP) were measured and the differences noted. Part C of the study consisted of repeating the same procedure in 104 known hypertensives on treatment (age 28-60 years). RESULTS: Part A of the study revealed that most strokes (52%) occurred in the morning and at home (86%) and over a third (36%) while in toilets. Thirty-six per cent of the strokes occurred while the subjects squatted, mostly during the act of defecation. More than half of the haemorrhagic strokes occurred while the subjects were in squatting position. In normal healthy volunteers squatting produced a small (8.09 +/- 7.04 mmHg) but significant rise in systolic blood pressure (SBP) but not in diastolic blood pressure (DBP) (0.9 +/- 7.38 mmHg). In contrast, in treated hypertensives squatting produced a significantly higher rise in both SBP (14.49 +/- 11.63 mmHg) and DBP(9.10 +/- 9.19 mmHg). CONCLUSION: The relationship of the clinical observations regarding stroke onset with the BP changes noted on squatting in healthy as well as hypertensive subjects appears to be more than fortuitous. Squatting induced rise in BP appears to be an important triggering factor for stroke onset in subjects at risk in India.

Adult↗
PubMed2000

A prospective study of the discrete fascial defect rectocele repair.

BACKGROUND: The aim of this study is to describe the results of the discrete fascial defect rectocele repair with special emphasis on dyspareunia after the operation. METHODS: Sixty-seven women underwent rectocele repair from October 1997 to January 1999. Repair was limited to reapproximation of discrete defects in the rectovaginal fascia when possible and a small perineorrhaphy. Each patient was evaluated as to whether or not a discrete defect was present and the location of the fascial defect. Outcome measures were complications, recurrent prolapse after 3 months, changes in defecation problems and dyspareunia after the operation. RESULTS: In 96% (64/67) of the patients a discrete defect was present. Before the operation 40% (27/67) reported problems with evacuation of the rectum and 12% (8/67) dyspareunia or problems with intercourse because of the prolapse. The patients were evaluated 3 months after the operation. Only three patients still complained of evacuation problems and only two patients with prior dyspareunia still had problems, which were cured after a further 3 months. Two patients had de novo dyspareunia but in only one patient was an anatomical defect found. CONCLUSIONS: The discrete defect rectocele repair offers an anatomical correction of the rectocele, which alleviates the symptoms but, most important, does not give the woman dyspareunia. Long term results of the operation are awaited.

Adult↗
PubMed1992

Anourethral reflex. Description of a reflex and its clinical significance: preliminary study.

A new reflex which I call the 'ano-urethral reflex' is described and its clinical significance discussed. It was studied in 16 volunteers with normal vesical and rectal functions. A concentric needle electrode was introduced into the external and sphincter (stimulating), and another one into the external urethral sphincter (recording). The reflex response was recorded by EMG apparatus. The external urethral sphincter basal activity was increased with stimulation of the external anal sphincter. This reflex response was absent when the external and sphincter was anesthetised. The average latency of the reflex was 129.5 ms. Reflex urethral sphincter contraction at defecation guards against involuntary micturition which may result from rectal distension and levator contraction. The anourethral reflex can be a valuable diagnostic tool in routine investigations of patients with urological and proctological complaints.

Adult↗
PubMed2004

Short-term digestive tolerance of different doses of NUTRIOSE FB, a food dextrin, in adult men.

OBJECTIVE: To determine the tolerance of increasing dosages of an incompletely hydrolysed and/or incompletely absorbed food dextrin coming from wheat starch, NUTRIOSE FB, at daily levels of 10 and 15 g up to 60 and 80 g, respectively. DESIGN: A randomized, double-blind, multiple dose, placebo-controlled, combined crossover and parallel trial. SETTING: The metabolic ward of TNO Nutrition and Food Research. SUBJECTS: A total of 20 healthy men (age 31.7 +/- 9.1 y; BMI 24.5 +/- 2.9 kg/m2). INTERVENTION: One group of 10 subjects consumed on top of their diet 10, 30 and 60 g of NUTRIOSE FB or maltodextrin (placebo) daily. The other group of 10 subjects consumed 15, 45 and 80 g daily. Each dose was consumed for 7 days. RESULTS: Compared with placebo, flatulence occurred more frequently over the last 6 days on 30, 60 or 80 g/day of NUTRIOSE FB (P < 0.05). During the last 24 h, that is, days 6-7, of 60 and 80 g/day of NUTRIOSE FB, the frequency of flatulence was even higher (P < 0.05). During the last 24 h on a daily dose of 60 g NUTRIOSE FB, the frequency of defecation decreased (P < 0.05). Bloating occurred more often during the last 24 h on 80 g/day of NUTRIOSE FB (P < 0.05). None of the doses of NUTRIOSE FB resulted in diarrhoea. Compared to baseline levels, breath H2 excretion, which was only measured after a week with 10 and 15 g of NUTRIOSE FB daily, increased (P < 0.05). However, no difference in area under the curve was found. CONCLUSIONS: NUTRIOSE FB is a fermentable carbohydrate and is well tolerated up to a dose of 45 g daily. Higher daily dosages (60 and 80 g) may result in flatulence, but does not result in diarrhoea. SPONSORSHIP: TNO Nutrition and Food Research was assigned by Roquette Frères to perform the study.

Adult↗
PubMed2001

Reproducibility and validity of a questionnaire filled in by spinal cord lesioned individuals before regular follow-up.

OBJECTIVE: To speed up and focus (biennial) check-ups of out-patients with spinal cord lesions by means of a brief mail questionnaire concerning specific impairments as well as general life conditions. METHOD: A trial 69-item questionnaire was filled in twice, at home and on arrival for check-up, and, for a third time, by the physician during the consultation. Out of 115 check-ups, 107 and 105 could be included in a reproducibility and validity assessment respectively. RESULTS: Excellent agreement between the first two completions ('reproducibility') and between the markings made at home and those made by the physician ('validity') was obtained for the majority of the items. Those items not performing satisfactorily, not least those relating to defecation, were scrutinised. CONCLUSION: After revision, the questionnaire can serve the above mentioned purposes in a cost-effective and clinically satisfying manner. Further benefits are envisaged by computerised longitudinal monitoring of the patients' answers. Finally, we have pointed towards weak items/questions in our questionnaire, and we hope this can be of help to others who want to use similar questionnaires in their daily practice.

Activities of Daily Living↗
PubMed2007

TRPM channel function in Caenorhabditis elegans.

The nematode Caenorhabditis elegans contains over 20 genes for TRP (transient receptor potential) channels which include members of all of the subclasses identified in mammalian cells. These proteins include three members of the TRPM (TRP melastatin) family: gon-2 (abnormal gonad development), gtl-1 (gon-2-like 1) and gtl-2. Although studies of these genes are at an early stage, we are beginning to understand their functions in the life of C. elegans. Mutations in gon-2 have defective gonad formation because of failures in the cell division of the somatic gonad precursor cells. gon-2 and gtl-1 are both expressed in the intestine of the animal. Experiments on gon-2,gtl-1 double mutants show that they have a severe growth defect that is ameliorated by the addition of high levels of Mg(2+) to the growth medium. gon-2,gtl-1 double mutants have defective magnesium homoeostasis and also have altered sensitivity to toxic levels of Ni(2+). Furthermore gon-2 mutants have reduced levels of I(ORCa) (outwardly rectifying calcium current) in the intestinal cells. Thus these two channels appear to play an important role in cation homoeostasis in C. elegans. In addition, perturbing the function of gon-2 and gtl-1 disrupts the ultradian defecation rhythm in C. elegans, suggesting that these channels play an important role in regulating this calcium-dependent rhythmic process. The tractability of C. elegans as an experimental animal and its amenability to techniques such as RNAi (RNA interference) and in vivo imaging make it an excellent system for an integrative analysis of TRPM function.

Animals↗
PubMed2002

New method for the determination of fecal consistency and its optimal value in the general population.

BACKGROUND: Although fecal consistency is an important factor, there has been only one study measuring this parameter. We developed a new method to measure fecal consistency and studied the relationship between fecal consistency and other fecal factors, including water content and weight. METHODS: The new method is a modification of the method of Exton-Smith and used an even balance. Subjects in the initial trial were 26 healthy women. Subsequently, fecal consistency was measured in a representative sample of the general Japanese population, in order to evaluate the optimal value to maintain large bowel function. RESULTS: Correlations between fecal consistency and fecal water content and weight were statistically consistent, although not highly correlated with each other. The optimal mean value was around 300 cm2: 'normal' in 'subjective defecatory state', 295.5 cm2 and 305.2 cm2; 'once/day' in 'defecation frequency', 296.1 cm2 and 310.2 cm2; 'soft and plump' in 'fecal characteristics', 293.6 cm2 and 298.3 cm2, in males and females, respectively. The coefficient of variation of this method ranged from 5.2% to 6.3%. CONCLUSIONS: This method is thought to be applicable to large-scale epidemiological surveys. The optimal value of fecal consistency in the general population was evaluated at approximately 300 g/cm2.

Adult↗
PubMed2002

Kiwifruit promotes laxation in the elderly.

Numerous anecdotal reports have suggested that kiwifruit (Actinidia deliciosa) has laxative effects. This could be an acceptable dietary supplement, especially for elderly people who often present with constipation. We wished to obtain objective evidence as to whether or not kiwifruit eaten regularly could promote laxation in elderly people. Thirty-eight healthy adults of age > 60 years consumed their normal diet, with or without one kiwifruit per 30 kg bodyweight for three weeks, followed by a 3-week crossover period. Daily records were taken on frequency of defecation and characteristics of the stools. Kiwifruit significantly enhanced all tested measures of laxation in these adults. The regular use of kiwifruit appeared to lead to a bulkier and softer stool, as well as more frequent stool production. Kiwifruit as a natural remedy appears palatable to most of the population and provides improved laxation for elderly individuals who are otherwise healthy. It is likely that a number of factors in the whole fruit are involved, but the nature of the stools suggest fibre is important. This study provides evidence of the potential for improvement in bowel function, health and well-being through changes in diet.

Actinidia↗
PubMed2001

Alterations in rectal sensitivity and motility in childhood irritable bowel syndrome.

BACKGROUND & AIMS: Children with chronic abdominal pain have a heterogeneous clinical presentation, but no organic cause can be identified in most of them. Some children present with symptoms of irritable bowel syndrome (IBS). We hypothesized that visceral hypersensitivity and motor abnormalities may be underlying mechanisms in these children. METHODS: Rectal sensation and rectal contractile response to a meal were studied in 8 children with IBS and 8 children with functional abdominal pain (FAP) and were compared with those of 9 healthy volunteers (HVs). RESULTS: The threshold for pain, but not that for first sensation and urge to defecate, was significantly decreased in IBS patients (6 +/- 1 mm Hg) compared with FAP patients and HVs (17 +/- 1 and 22 +/- 2 mm Hg, respectively). In HVs and patients with FAP, ingestion of a meal induced a decrease in rectal volume with an early and late component. This motor pattern was absent in children with IBS. In IBS patients, no rapid volume waves were observed during fasting in contrast to FAP patients (2.7 +/- 0.3/10 min) and HVs (1.8 +/- 0.5/10 min). CONCLUSIONS: Children fulfilling the Rome II criteria for IBS have a significantly lowered threshold for pain and a disturbed contractile response to a meal. Comparable to results reported in adults, sensory and motor abnormalities might play a pathophysiologic role in childhood IBS.

Abdominal Pain↗
PubMed2001

Sacral nerve stimulation as a treatment for fecal incontinence.

BACKGROUND & AIMS: Sacral nerve stimulation is a proven therapeutic option for the treatment of some forms of urinary incontinence. Very recently, preliminary reports have given evidence for its efficacy in fecal incontinence (FI) too. METHODS: Since November 1998, 20 patients have been treated for severe FI. The cause of FI was mainly neurologic (n = 15), and was idiopathic in 5 patients. After temporary (subchronic) external stimulation over a period of 10-14 days, patients whose continence status improved underwent implantation of a permanent quadripolar lead and a subcutaneously implanted pulse generator. RESULTS: Acute (needle) testing revealed a positive pelvic floor response in 16 patients who underwent subsequent permanent implantation. The median number of incontinence episodes decreased from 6 episodes (3-15/21 days) to 2 (0-5/21 days). The time period of retention of a volume of saline causing an urge until definitive defecation was 2 minutes (range, 0-5 minutes) preoperatively and increased to 7.5 minutes (2-15 minutes) postoperatively. Results of preoperative and postoperative (3 months) anal manometry showed a statistically significant increase in maximal resting and squeeze pressures. CONCLUSIONS: Sacral nerve stimulation seems to be a new and promising modality for patients with certain types of FI in whom conventional treatment options have failed to achieve an improvement.

Adolescent↗
PubMed2004

Predictive value of the balloon expulsion test for excluding the diagnosis of pelvic floor dyssynergia in constipation.

BACKGROUND AND AIMS: The aim of this study was to establish a simple method to exclude the possibility of pelvic floor dyssynergia (PFD) in constipated patients and thus avoid unnecessary expensive physiologic studies. METHODS: Patients with suspicion of functional constipation (FC) were studied prospectively between 1994 and 2002, excluding those with severe systemic, psychological, or symptomatic anorectal/colonic disorders or taking medications that might modify symptoms or results of studies. Diagnosis of PFD was established retrospectively by manometric plus defecographic findings according to Rome II criteria. Two groups of patients were identified: FC without PFD (FC group) and PFD group. A 30-day symptom diary and balloon expulsion test results were evaluated in all patients. Clinical differences and results of the expulsion test were statistically compared between groups. RESULTS: Of 359 patients evaluated, 130 were included (FC group, 106; PFD group, 24). According to data from the diary, only anal pain was more frequent in the PFD group compared with the FC group (anal pain in >25% of defecations, 70.8% vs. 40.6%; P < 0.05, chi(2) test). The expulsion test was pathologic in 21 of 24 patients with PFD and 12 of 106 without PFD. The specificity and negative predictive value of the test for excluding PFD were 89% and 97%, respectively. CONCLUSIONS: The balloon expulsion test is a simple and useful screening procedure to identify constipated patients who do not have PFD. Symptoms are not enough to differentiate between subtypes of constipation.

Adult↗
PubMed2006

Bowel urgency in patients with irritable bowel syndrome.

BACKGROUND & AIMS: Bowel urgency is the most bothersome symptom in irritable bowel syndrome patients with diarrhea, but its pathophysiology is poorly understood. Our aim was to assess the relationships among reporting the symptom, the reservoir functions of the colon and rectum, and the patients' psychologic profile. METHODS: The study involved 28 consecutive patients with irritable bowel syndrome and 17 healthy subjects. The presence or absence of bowel urgency was verified by means of a questionnaire during the 3 days required for the ingestion of radio-opaque markers. On the fourth day, an abdominal x-ray was taken to assess colonic transit time, and rectal sensory and motor responses were measured during rectal distention. The subjects' psychologic profiles were assessed using a psychologic symptoms checklist. RESULTS: Forty-six percent of the patients reported urgency associated with at least 1 defecation. The multivariate logistic regression analysis showed that colonic transit was the only variable independently associated with reported bowel urgency, but the threshold for the sensation of urgency was not removed from the model since its borderline significance level. Rectal compliance was closely associated with the threshold for the sensation of urgency during rectal distention but was not an independent factor for reporting the sensation. The patients with and without urgency showed altered psychologic profiles. CONCLUSIONS: The symptom of urgency is associated with objective alterations in the colonic and rectal reservoir of patients with irritable bowel syndrome.

Adult↗
PubMed2002

The physiology of continence: idiopathic fecal constipation and soiling.

The anatomic and functional elements contributing to fecal continence and defecation are explored. The high incidence and importance of chronic idiopathic constipation as an entity in itself and a contributing factor to fecal incontinence are emphasized, and its management is discussed. The importance of a proper clinical history and examination is highlighted, and investigative modalities including radiology, transit studies, and anorectal manometry are described and placed in the context of practical clinical management.

Anal Canal↗