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PubMed1981

Fecal characteristics in healthy young adults consuming defined liquid diets or a free-choice diet.

Fat and nitrogen absorption and fecal characteristics were studied in 10 healthy, young adults who ingested a free-choice diet for 12 days and then isocaloric amounts of one of two nutritionally complete liquid defined formula diets during a succeeding 12-day period. Apparent fat absorption was 98 to 99% of intake with both defined formula diets and 95% of intake on the free-choice diet. Nitrogen digestibility was determined during the liquid diet period, and averaged 95 to 98% of intake. There were no statistically significant differences between the liquid diets and the free-choice diets with respect to fecal wet or dry weight, transit time, or stool frequency. Individual stool weights averaged 83 to 96 g on the free-choice or liquid formula diets and were comparable to other values reported in the literature. These results support the theory that a critical volume of feces must accumulate in the colon before defecation occurs, regardless of diet composition.

Absorption↗
PubMed1981

Apparent digestibility of neutral detergent fiber in elderly and young adults.

These experiments assessed the ability of the neutral detergent fiber (NDF) method to remove starch and nitrogen from food NDF residues, and nitrogen and endogenous secretions from fecal NDF residues; and compared indices of bowel function, including apparent NDF digestibility, of nine elderly subjects to those of six young women. Subjects consumed similar, controlled "low fiber" diets containing foods typically eaten in the United States. Nitrogen and starch contents of food composite NDF were determined in NDF obtained by the hog alpha amylase modification of the Van Soest procedure, whereas the nitrogen content of fecal NDF was determined using NDF obtained by the unmodified procedure. The modified Van Soest method adequately removed nitrogen and starch from food NDF, but fecal NDF contained nitrogen. Both groups digested the majority of the NDF, 63 and 70% for the elderly and young subjects, respectively. Apparent fiber digestibility, which was measured several times in each subject, increased to 69 and 75% for the two groups, respectively, when a correction was made for the nitrogen in the fecal NDF. Mean gastrointestinal transit time and frequency of defecation of the two age groups were comparable, whereas mean daily wet and dry stool weights of the elderly were larger than those of the young women. These results suggest that the bowel of the elderly may function as well as that of the young adult.

Adult↗
PubMed1995

Effect of resistant starch on fecal bulk and fermentation-dependent events in humans.

This study investigated the effect of two diets, which differed in resistant starch (RS) concentration, on fecal bulk and fermentation-dependent events in 11 humans. Amounts of RS consumed were 5.0 +/- 0.4 and 39.0 +/- 3.0 g/d (mean +/- SEM) for the low- and high-RS diets, respectively. The two diets were fed for 3 wk each in a randomized crossover design. Fecal collections were made in the third week of each study period. The high-RS diet produced an increase (P < 0.01) in total fecal output (from 138 +/- 22 to 197 +/- 37 g/d) and lowered fecal pH (6.9 +/- 0.1 to 6.3 +/- 0.1). There were significant increases (P < 0.05) in the fecal concentrations and daily excretion of butyrate (+38% and +100%, respectively) and acetate (+26% and +72%, respectively) during the high-RS period. The fecal excretion (g/d) of nonstarch polysaccharides (NSP) also rose by 50% during the high-RS diet, suggesting that the presence of starch in the colon may affect the fermentation of NSP. Subjects reported an increase in flatulence and easier defecation. These results demonstrate that RS has a significant impact on putative markers of colonic health in humans.

Acetates↗
PubMed2000

Studies on the effects of polydextrose intake on physiologic functions in Chinese people.

BACKGROUND: Previous studies showed that polydextrose has physiologic effects similar to those of dietary fiber. OBJECTIVE: Ingestion of 4, 8, and 12 g polydextrose/d was studied to determine the physiologic effects in Chinese subjects. DESIGN: In a placebo-controlled, randomized, double-blind study, we evaluated the effects of polydextrose ingestion on clinical biochemistry indexes, glycated hemoglobin, glucose tolerance, the glycemic index, bowel function, stool weight and pH, short-chain fatty acid production, fecal microflora, and cecal mucosa cell proliferation. RESULTS: Polydextrose had no significant effect on blood biochemistry indexes. Ingestion of 12 g polydextrose plus 50 g glucose resulted in a glycemic index of 89% (compared with a glycemic index of 100% after ingestion of 50 g glucose). Bowel function (frequency and ease of defecation) improved significantly and there were no reports of abdominal distention, abdominal cramps, diarrhea, or hypoglycemia. Fecal weight (wet and dry) increased and fecal pH decreased proportionally to polydextrose intake. Short-chain fatty acid production-notably that of butyrate, isobutyrate, and acetate-increased with polydextrose ingestion. There were substantial changes in fecal anaerobes after polydextrose intake. BACTEROIDES: species (B. fragilis, B. vulgatus, and B. intermedius) decreased, whereas LACTOBACILLUS: and BIFIDOBACTERIUM: species increased. The cecal mucosa whole-crypt labeling index increased, with colonocyte proliferation mainly occurring in base compartments, which provided an indirect confirmation of butyrate production in the colon. CONCLUSION: Polydextrose ingestion had significant dietary fiber-like effects with no laxative problems.

Adult↗
PubMed2001

Effect of peri- and postoperative epidural anaesthesia on pain and gastrointestinal function after abdominal hysterectomy.

In a double blind study we have investigated the effects of epidural local anaesthesia (LA), when added to general anaesthesia (GA) and postoperative paracetamol and NSAID, on postoperative pain and gastrointestinal function in patients undergoing open hysterectomy. Sixty patients were randomized into three study groups: GA, and postoperative paracetamol and NSAID (GA, n=20); GA, paracetamol, NSAID, intraoperative epidural lidocaine and 24-h postoperative epidural saline (Saline, n=20); or GA, paracetamol, NSAID, intraoperative epidural lidocaine and 24-h postoperative epidural bupivacaine (Bupi, n=20). Patients were observed for 72 h postoperatively. Pain at rest, during cough, and mobilization, request for supplementary morphine, and time to first postoperative flatus, was reduced in patients receiving 24-h postoperative epidural anaesthesia, compared with the two other groups. However, these effects of epidural LA, were not sustained beyond the period of infusion, and no differences in PONV, time to first postoperative defecation, mobilization or time to discharge from hospital were observed between groups. A 24 h postoperative epidural infusion with bupivacaine, when added to postoperative paracetamol and NSAID, reduces pain and opioid requirements, but has only limited effects on gastrointestinal function and patient recovery.

Acetaminophen↗
PubMed1983

Colonic function and fermentation in men consuming high fiber diets.

The relationships between fermentation in the gut and colonic function were studied by using data derived from a human metabolic study. Five healthy men were fed diets that were fiber-free or contained cellulose, xylan, pectin or corn bran. Fermentation was assessed by measuring the excretion of flatus gas, volatile fatty acids (VFA) in feces and fecal pH. Colonic function was assessed by measuring transit time, fecal frequency, fecal output and fecal composition. Fibers that were only marginally fermented included cellulose and corn bran, and these fibers caused large fecal output, frequent defecations and prolonged the residence time of digesta in the gut; feces contained high levels of neutral detergent fiber (NDF); neither diet influenced fecal pH nor flatus gas excretion; and only corn bran increased VFA excretion in feces. Fibers that were mostly fermented in the gut included xylan and pectin, and these fibers did not influence fecal frequency or fecal output, but they did decrease transit time; both diets caused high levels of flatus gas to be excreted; pectin caused higher VFA excretion in feces and lower fecal pH. The excretion of VFA in feces was highly correlated with total fecal output, and high levels of VFA were associated with low flatus gas excretion. Mutagenic activity in feces was negligible for all subjects on all diets as measured by the fluctuation test.

Adult↗
PubMed1983

The influence of dietary fiber source on human intestinal transit and stool output.

Wheat bran ground to a coarse and fine particle size, purified cellulose and ethanol-extracted cabbage fiber, fed to 24 adult males during an 80-day metabolic trial, were examined for effects on intestinal transit time, laxation and stool composition. Brilliant blue, plastic pellets, polyethylene glycol (PEG)-4000 and Cr(III) mordanted onto isolated bran fiber were simultaneously administered for transit measurements. Intersubject variability in response to fiber source was highly significant for all transit and stool measurements. Only coarse bran or cellulose addition increased transit speed (decreased transit time) over basal rates. Grinding of bran significantly reduced fecal output because of reduced fecal water. Only subjects consuming cellulose or fine bran reported difficult or uncomfortable defecations. Though cabbage produced the smallest fecal output, stools had a high moisture content comparable to those obtained from coarse bran, which suggests a large microbial output in response to a fermentable substrate. Significant negative correlations were produced when changes in dry matter or cell wall intakes were regressed with Cr (III) transit. These findings suggest that the level of either food or fiber in the diet are variables that influence intestinal transit time and should be controlled in studies measuring it. Increases in fiber intake linearly increased fecal output of water and dry matter. Regression slopes were characteristic of each fiber source.

Adult↗
PubMed1995

A prospective study of rectal methohexital: efficacy and side effects in 648 cases.

Rectal methohexital has been used for nearly 30 yr in pediatric anesthesia. Despite this long and increasingly varied use, no large prospective series has been published detailing safety and efficacy. This study prospectively evaluated the efficacy, safety, and side effects of this medication in a series of 648 cases. On 553 of 648 occasions (85%), the child fell asleep after a single 30-mg/kg dose of 10% methohexital. Sleep was less likely in patients with myelomeningocele or who were receiving oral phenobarbital or phenytoin. When sleep occurred, the average time to onset of sleep was 6 min. Most patients who remained awake 15 min after drug were sedated. Defecation (10%) and hiccups (13%) were common but benign side effects. Partial airway obstruction and/or desaturation to Spo2 < or = 93% occurred in 26 patients (4%), but was resolved with blow-by oxygen and/or jaw-thrust in all but two cases. These two patients (0.3% of total) required aggressive airway intervention by the supervising anesthesiologist. Apnea did not occur in any patient. Methohexital has a high efficacy rate for sleep (85%) or sedation (96%), and has a relatively rapid onset. Significant respiratory side effects occur infrequently, but can be life threatening if not properly managed.

Administration, Rectal↗
PubMed1985

Endorectal ileal pullthrough with isoperistaltic ileal reservoir for colitis and polyposis.

Seventy-eight patients with ulcerative colitis refractory to medical therapy and eight with colonic polypisis have undergone total colectomy mucosal proctectomy, endorectal ileal pull-through with ileoanal anastomosis, and diverting ileostomy at the UCLA Medical Center during the past 7 years. Seventy-seven patients underwent a second stage operation with construction of a lateral isoperistaltic ileal reservoir, 12 to 30 cm long, and closure of the ileostomy. A reservoir 10 to 15 cm long appears optimal for children, and one 20 cm long appears to function best for adults. Major complications were either related to obstruction of the reservoir outlet from leaving a rectal muscle cuff longer than 6 cm, and/or constructing the reservoir too long in the early experience (16 patients), or from cuff abscesses (four patients). Out of the 77 patients, these problems led to reservoir removal in three, temporary ileostomy in eight, and reservoir revision in 16. Persistent cuff abscess was the cause for reservoir removal in two of four patients. Continence was achieved in all patients within 2 weeks. Good to excellent results were obtained in 65 patients. At one year, 78% were completely continent during the day, 18% had minor seepage, and four per cent had occasional soiling. Frequency of defecation in patients without complications, or those surgically corrected, was seven per 24 hours within 3 months. There were no deaths. Six patients were found to have unsuspected cancer at operation. No patient experienced bladder dysfunction or abnormal sexual function. Although a technically difficult operation, the long-term results indicate that the pullthrough operation is a good alternative to proctocolectomy with ileostomy.

Adolescent↗
PubMed1991

Evaluation and surgical treatment of severe chronic constipation.

Patients with chronic constipation may have one of several physiologic disorders, not all of which are amenable to operative therapy. The aim of this study was to test colonic and pelvic floor function preoperatively, to identify patients suitable for surgery based on these studies, and to determine operative outcome over time. Between 1987 and January 1991, 277 patients referred for severe symptoms of chronic intractable constipation underwent colon transit studies, measurement of anal canal pressures and reflexes, and measurements of anorectal angle movements and efficiency of evacuation. Balloon expulsion studies, electromyography of the pelvic floor, and defecating proctograms also were done. Based on these studies, patients were categorized as having: slow transit constipation (STC), 29 patients; pelvic floor dysfunction (PFD), 37 patients; STC + PFD, combined slow transit and pelvic floor dysfunction, 14 patients; and irritable bowel syndrome (IBS), 197 patients. Slow transit constipation patients underwent abdominal colectomy and reanastomosis. Pelvic floor dysfunction patients underwent pelvic floor retraining only. Patients with STC + PFD underwent pelvic floor retraining followed by abdominal colectomy. Irritable bowel syndrome patients were treated symptomatically. Among the 38 patients operated on (STC and STC + PFD), there was no operative mortality. Prolonged ileus developed in 13%, and small bowel obstruction occurred in 11% of patients. On follow-up, a mean of 20 months after ileorectostomy, no patient was constipated, none required a laxative, and none was incontinent. The mean number of stools per day was four. The authors concluded that a prospective evaluation of colonic and pelvic floor function reliably delineated constipated patients with slow transit, suitable for operative management, from those with pure pelvic floor dysfunction or irritable bowel syndrome, who were not. Abdominal colectomy and ileorectostomy in the slow transit patients was safe and effective, resulting in prompt and prolonged relief of constipation.

Adolescent↗
PubMed1992

Treatment of anal incontinence by an implantable prosthetic anal sphincter.

Twelve patients with anal incontinence due to neurologic disease or failure of previous incontinence surgery underwent implantation of an artificial anal sphincter. The system used was a modification of the AMS 800 artificial urinary sphincter. In two patients, infection necessitated removal of the system, and in four patients, eight revisional procedures had to be performed because of mechanical failure. After various modifications of the system, especially reinforcement of the closing mechanism of the cuff, only one case of mechanical failure has occurred. Erosion through the anal canal did not occur. Among 10 patients with the system in function for more than 6 months, the result was considered excellent in 5, with only occasional leakage of flatus, good in 3, who occasionally leaked liquid feces and flatus, and acceptable in 2, in whom the cuff obstructed defecation. It is concluded that implantation of an artificial anal sphincter is a valid alternative to permanant colostomy in patients with anal incontinence due to neurologic disorders and in patients in whom other types of incontinence surgery have failed.

Adult↗
PubMed1991

Defecography as part of the evaluation of anorectal dysfunction.

Defecography is the evaluation of the anus and rectum during the act of defecation. We have devised a very simple method of performing this examination in conjunction with the Radiology Department. The entire procedure takes less than 15 minutes from start to finish. In our hospital, we have performed over 130 of these tests. A high level of patient cooperation has been noted in our experience. For the most part, the entire procedure from bowel preparation to final films is well tolerated.

Barium Sulfate↗
PubMedDate not supplied

Teenage constipation: a case study.

Constipation is a problem of significant magnitude. It can have a devastating impact on a patient's personal life. There are many causes of constipation. Among them are dietary factors such as decreased fiber and low fluid intake, decreased activity, lack of privacy for defecation, pharmacologic agents, physiologic problems such as bowel obstruction or metabolic disorders, and psychosocial distress. A young teenage boy is followed through a series of emergency room visits, office visits, and a hospitalization related to his experiences with constipation. A bowel program was identified and instituted with successful outcomes.

Adolescent↗
PubMed1995

Constipation and incontinence in the elderly.

We summarize the prevalence and causes of constipation and incontinence in an elderly, drawing particular attention to the roles of immobility, dietary fiber, and dehydration. The physiology of fecal impaction is described in detail, and neurological and mechanical causes (rectal prolapse, rectocele, and hemorrhoids) of constipation are discussed. Consideration is also given to constipation associated with diverticular disease and ulcerative colitis. We also discuss the pathogenesis of fecal incontinence in the elderly, paying particular attention to fecal impaction and neurological causes that result in both constipation and incontinence. The importance of previous obstetric trauma and pudendal enuropathy is emphasized. We conclude with detailed guidelines of the clinical assessment and management of an elderly patient with a disorder of defecation.

Aged↗
PubMed1984

Sensitivity of the sigmoid colon and rectum in children treated for chronic constipation.

Sensations in the sigmoid and rectum and the response of the anal canal to balloon distension were measured with a latex balloon and pressure transducer in 15 chronically constipated and 15 healthy control children. The constipated children received milk of magnesia and bowel training. Thirteen constipated children were restudied 7-12 months later and 11 were restudied 3 years later. Although thresholds of transient sensation and of the rectosphincteric reflex were not different in constipated and control children, the threshold of fullness, the critical volume, and the volume for constant relaxation were significantly higher in constipated than in control children (p less than 0.05), and remained higher 1 year and 3 years later, even in the children who recovered. The initial data support the concept of a sigmoid and rectum so enlarged that a normal fecal bolus may not cause a sensation of fullness or a sensory stimulus for defecation. Despite improvement in clinical manifestations and normal rectal size, the abnormalities in sensitivity of the sigmoid and rectum persisted in five of eight recovered children. This may explain why these children are so vulnerable to recurrence of constipation and fecal soiling.

Anal Canal↗
PubMed1997

Use of cisapride in treatment of constipation in children.

BACKGROUND: Chronic constipation is a common problem in children. We observed the effects of cisapride in the management of idiopathic constipation in children. METHODS: Thirty-seven children with a history of constipation (i.e., pain and difficulty or delay in defecation for > 3 months) were recruited and randomly assigned to 8 weeks of treatment with either cisapride, 0.2 mg/kg three times daily, or matching placebo after a 2-week run-in period in a double-blind, parallel-group study design. In phase 1 (2 weeks), patients had plain abdominal radiographs to assess degree of faecal load, and those with impaction were given laxatives. After satisfactory clearance of faeces, total gastrointestinal transit time and orocaecal transit time were measured. In phase 2, after 8 weeks of treatment with either cisapride or placebo (0.2 mg/kg t.d.s.), the transit studies were repeated. RESULTS: Compared with placebo, cisapride did not improve either stool frequency or transit time in this study population. CONCLUSION: This study did not demonstrate a clinical role for the use of cisapride in the treatment of idiopathic constipation in children.

Adolescent↗
PubMed1998

Outcome after ileoanal anastomosis in pediatric patients with ulcerative colitis.

BACKGROUND: To review the outcome after restorative proctocolectomy among children and adolescents with ulcerative colitis at a pediatric inflammatory bowel disease center. METHODS: The records of all patients with ulcerative colitis undergoing colectomy and ileoanal anastomosis at The Hospital for Sick Children, Toronto, Canada, were reviewed. Questionnaires concerning functional results were sent to patients with restored transanal defecation. RESULTS: Seventy three patients (mean age, 13.2 years; range, 2.6-18.8 years) underwent ileoanal anastomosis (19 straight ileoanal anastomosis, 41 J pouch, 13 S pouch) between January 1980 and June 1995 and were observed 5.8+/-3.3 years. The ileoanal anastomosis is nonfunctional in 19 (26%) patients. Excision rates according to type of restorative procedure were J pouch, 7% (3 of 41); S pouch, 32% (4 of 13); and straight ileoanal anastomosis, 32% (6 of 19). Failure was usually attributable to intractable diarrhea among patients with straight ileoanal anastomosis but was caused by anastomotic leak or pelvic-perianal sepsis among patients with pouch procedures. Failure rates did not vary with age at ileoanal anastomosis. Among patients retaining ileoanal continuity, continence problems reported in the questionnaire were frequent and tended to be more extreme among younger patients. Overall, 90% of respondents reported satisfaction with the functional outcome of the restorative operation. CONCLUSIONS: The success rate of the ileoanal anastomosis/J-pouch procedure is comparable to that in adult series. The ileoanal anastomosis/J-pouch procedure is the operation of choice for children and adolescents who want ileoanal continuity restored after colectomy for ulcerative colitis.

Adolescent↗
PubMed2003

Internal anal sphincter achalasia in children: clinical characteristics and treatment with Clostridium botulinum toxin.

OBJECTIVES: To describe the clinical characteristics of children with internal anal sphincter (IAS) achalasia and to evaluate the benefit of intrasphincteric injection of Clostridium botulinum toxin. METHODS: Retrospective review of the medical records of 20 patients (8 male, mean 5.8 +/- 4.2 years) with severe chronic constipation and IAS achalasia. Each patient received four-quadrant, intrasphincteric injections of botulinum toxin at a dose of 15-25U per quadrant. Patients were reassessed 4 weeks-18 months after injection. We compared the clinical characteristics of these patients to 20 consecutive children (14 male, mean age 8.1 + 4.6 y) with functional constipation (control group). RESULTS: The children with IAS achalasia had earlier onset of symptoms, less fecal soiling, and less withholding behavior than the control children. Response to botulinum injection was rated excellent by the parents in 60% and by the physician in 35% of children. There was wide individual variability in the frequency of defecation after therapy. Duration of response ranged from 1 week to 18 months. CONCLUSIONS: Children with IAS achalasia have clinical characteristics differentiating them from children with functional constipation. Intra-anal injection of botulinum toxin is a safe and effective short-term treatment for these children.

Anal Canal↗