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PubMed2000

Pelvic floor study in patients with obstructive defecation: influence of biofeedback.

The aim of this study was to evaluate the pathophysiologic abnormalities in patients with obstructive defecation or dyssynergia and to assess the role of biofeedback treatment. Three groups were studied. Group A had 24 patients with obstructive defecation; B, 25 patients with constipation; and C, 22 healthy volunteers. Rectosigmoid segmental transit time of group A was 28.5 hours (SD +/- 13.4); B, 17.2 hours (SD +/- 11.5); and C, 8.5 hours (SD +/- 6.3) (p < 0.05). There was no statistical difference in resting and squeezing anal pressure among the three groups. Anorectal angle at rest revealed no difference among the three groups. At strain, a statistically significant difference between groups A and C (p < 0.05) and a marginal difference between groups A and B was noted. Rectocele of the anterior rectal wall was present at strain in 17/24 patients of group A and 7/22 patients of group C (p < 0.05). Electromyography during strain revealed abnormal contractions of puborectalis muscle and external anal sphincter, in 13 and 14 patients of group A, respectively, which differed from that observed in groups B and C (p < 0.001). Biofeedback treatment was applied with good results in 7 of 11 patients of group A. At six months, constipation relapsed in only one of treated patients. Patients suffering from obstructive defecation seem to have slower rectosigmoid transit time than the others. Defecography shows smaller anorectal angle at strain and rectocele of the anterior rectal wall more often. Abnormal pelvic floor contraction at strain is often noted in anal electromyography. Some of these patients seem to respond favorably to biofeedback treatment.

Adult↗
PubMedDate not supplied

Privacy for defecation and fecal incontinence in older adults.

INTRODUCTION: Privacy during defecation is important to individuals and society at large and it has not been studied in older people with fecal incontinence. METHODS: One hundred twenty adults aged 65 years and with fecal incontinence who were either living in their own homes or in a nursing home or receiving care in an acute or rehabilitation elderly care ward were surveyed with a questionnaire that included questions on privacy during defecation. RESULTS: Privacy while defecating was often least achieved in the patients with fecal incontinence living in nursing homes (NH) (n=7, 23%) but usually was achieved in those living at home (H) (n=28, 93%) and by some being cared for in rehabilitation wards (R) (n=16, 53%) or in acute wards (AC) (n=15, 50%; P<.001). Very few participants with fecal incontinence were aware of leakage (NH: n=3, 10%; R: n=9, 30%; AC: n=9, 30%; H: n=15, 50%), able to clean themselves (NH: n=0, 0%; R: n=2, 7%; AC: n=5, 17%; H: n=24, 80%) or had access to patient information leaflets about fecal incontinence (NH: n=3, 10%; R: n=4, 13%; AC: n=1, 3%; H: n=16, 53%). CONCLUSION: Older people, especially those who are dependent, lack privacy during bowel movements. They are usually unaware of being incontinent of stool and are unable to clean themselves afterwards. Access to information about fecal incontinence is poor.

Activities of Daily Living↗
PubMed2000

Spatial and temporal organization of pressure patterns throughout the unprepared colon during spontaneous defecation.

OBJECTIVE: The aim of this study was to examine colonic motor events associated with spontaneous defecation in the entire unprepared human colon under physiological conditions. METHODS: In 13 healthy volunteers a perfused, balloon-tipped, 17-lumen catheter (outer diameter, 3.5 mm; intersidehole spacing, 7.5 cm) was passed pernasally and positioned in the distal unprepared colon. RESULTS: In the hour before spontaneous defecation, there was an increase in propagating sequence frequency (p = 0.04) and nonpropagating activity when compared to basal conditions (p < 0.0001). During this hour the spatial and temporal relationships among propagating sequences demonstrated a biphasic pattern. Both the early (proximal) and late (distal) colonic phases involved the whole colon and were characterized by respective antegrade and retrograde migration of site-of-origin of arrays of propagating sequences. There was a negative correlation between propagating sequence amplitude and the time interval from propagating sequence to stool expulsion (p = 0.008). CONCLUSIONS: The colonic motor correlate of defecation is the colonic propagating sequence, the frequency and amplitude of which begin to increase as early as 1 h before stool expulsion. During the preexpulsive phase, the spatial and temporal relationship among the sites of origin of individual propagating sequences demonstrate a stereotypic anal followed by orad migration, which raises the possibility of control by long colocolonic pathways.

Adult↗
PubMed1975

Influences on the defecation and micturition reflexes by the cerebellar fastigial nucleus.

The influence of the cerebellar fastigial nucleus on the defecation and micturition reflexes was investigated in chloralosed cats with recordings of colonic blood flow and motility, intravesical and intraabdominal pressures. Whenever effective, topical fastigial stimulation regularly suppressed both somatomotor and autonomic components of the defecation reflex, to the extent that the straining movements as well as the colnic vasodilatator and motor responses associated with defecation could be completely inhibited. Bladder motility could either be suppressed or enhanced, depending both on prevailing bladder tone and on the fastigial site stimulated. The autonomically conveyed inhibitory responses were in both cases independent of the adrenergic sympathetic pathways, since they were unaffected both by sympathetic nerve sectioning and by adrenergic blocking drugs but eliminated by pelvic nerve section. It is suggested that the mentioned fastigial inhibitory influences are exerted on the spinal parasympathetic reflexes controlling the bladder and colon. Parallels between fastigial control of autonomic somatomotor mechanisms are discussed.

Animals↗
PubMed1994

A prospective study on defecation frequency, stool weight, and consistency.

It has been commonly believed that children in developing countries pass stools that are very different from those of developed countries. A community based study on defecation frequency, stool weight, and consistency was conducted in a cohort of 300 Myanmar (Burmese) children aged 1 to 4 years. Most (80.3%) children opened their bowels daily and none passed more than three stools a day. The mean (SD) defecation frequency was 6.98 (1.94) times a week and total stool weight was 596 (221) g a week. The majority (61%) of children passed soft stools. At all ages, there was no significant difference in the defecation frequency, stool weight, and consistency between boys and girls, those on adult style diet and those partially weaned, and between age groups.

Aging↗
PubMed1992

Defecation frequency and timing, and stool form in the general population: a prospective study.

Because the range of bowel habits and stool types in the community is unknown we questioned 838 men and 1059 women, comprising 72.2% of a random stratified sample of the East Bristol population. Most of them kept records of three consecutive defecations, including stool form on a validated six point scale ranging from hard, round lumps to mushy. Questionnaire responses agreed moderately well with recorded data. Although the most common bowel habit was once daily this was a minority practice in both sexes; a regular 24 hour cycle was apparent in only 40% of men and 33% of women. Another 7% of men and 4% of women seemed to have a regular twice or thrice daily bowel habit. Thus most people had irregular bowels. A third of women defecated less often than daily and 1% once a week or less. Stools at the constipated end of the scale were passed more often by women than men. In women of child bearing age bowel habit and the spectrum of stool types were shifted towards constipation and irregularity compared with older women and three cases of severe slow transit constipation were discovered in young women. Otherwise age had little effect on bowel habit or stool type. Normal stool types, defined as those least likely to evoke symptoms, accounted for only 56% of all stools in women and 61% in men. Most defecations occurred in the early morning and earlier in men than in women. We conclude that conventionally normal bowel function is enjoyed by less than half the population and that, in this aspect of human physiology, younger women are especially disadvantaged.

Adult↗
PubMed1993

Intestinal transit time in the population calculated from self made observations of defecation.

STUDY OBJECTIVES: To assess the feasibility of estimating intestinal transit time in the general population using self recorded data on stool form, frequency of defecation, and the interdefecatory time interval. DESIGN: Prospective measurement of bowel function. SETTING: Bristol, Avon, UK between 1987 and 1989. SUBJECTS: Subjects were drawn from 1897 people who comprised 72.2% of a stratified random sample of all men aged 40-69 years and women aged 25-69 years on the lists of 19 general medical practitioners. Altogether 1561 subjects (59.4%) recorded bowel function and a subsample of 98 (50 women and 48 men) had intestinal transit time measured. MEASUREMENTS AND MAIN RESULTS: The interdefecatory time interval and stool form (on a validated 1-6 scale sensitive to transit time) were recorded prospectively from three consecutive defecations. In the subsample the mean intestinal transit time was measured simultaneously using a four marker, two stool x ray technique. Multiple regression analysis was used to assess the extent to which intestinal transit time could be predicted from the defecatory data. The formulas obtained were then applied to the whole study population. In women, intestinal transit time was best predicted by the formula 103-1.23 (DF)--4.69 (SFS)+0.638 (IDTI), where DF is the stated defecation frequency per week, IDTI is the interdefecatory time interval, and SFS is the sum of the three stool form scores, for which the correlation coefficient r = 0.736. For men the intestinal transit time = 79-1.33 (DF)--1.88 (SFS)+0.329 (IDTI), for which the correlation coefficient r = 0.541. The predicted intestinal transit time was longer in women than men at equivalent ages. Women of childbearing age had longer transit times than older women. CONCLUSIONS: Observations made by untrained subjects can be used to estimate intestinal transit time in epidemiological studies. A gender related difference in transit time exists.

Adult↗
PubMed1994

Child defecation behaviour, stool disposal practices, and childhood diarrhoea in Burkina Faso: results from a case-control study.

OBJECTIVE: To investigate the association between where young children defecate, where stools are disposed of, and the presence of human stools on the ground in the compound and the rate of hospital admission with diarrhoea. DESIGN: This was a case-control study with two control groups. SETTING: The study took place in Bobo-Dioulasso, the second city of Burkina Faso in West Africa. PARTICIPANTS: Three groups of children aged 36 months and under, and living in Bobo-Dioulasso were studied. Cases were 757 children admitted to hospital with symptoms of diarrhoea or dysentery. The first control group comprised 757 neighbourhood control children approximately matched on age and date of recruitment, and the second, 631 children admitted to the same hospital without symptoms of diarrhoea or dysentery. MAIN RESULTS: There was no evidence of any association between where the child was reported to defecate and hospital admission with diarrhoea or dysentery (odds ratio = 1.10; 95% confidence interval (CI) 0.78, 1.57, cases v neighbourhood controls; odds ratio = 0.84; 95% CI 0.60, 1.18, cases v hospital controls). There was evidence of an association between where the mother reported disposing of the child's stools and hospital admission with diarrhoea or dysentery (odds ratio = 1.50; 95% CI 1.09, 2.06, cases v neighbourhood controls; odds ratio = 1.31; 95% CI 0.96, 1.79, cases v hospital controls). Human stools were more frequently observed in the yards of cases than controls (odds ratio = 1.38; 95% CI 0.98, 1.95, cases compared with neighbourhood controls; odds ratio = 1.33; 95% CI 0.96, 1.84, cases compared with hospital controls). CONCLUSIONS: The findings suggest that it is not where the child defecates that matters but how the mother then deals with the child's stools.

Age Distribution↗
PubMed1990

Anorectal function in patients with defecation disorders and asymptomatic subjects: evaluation with defecography.

A controlled radiologic study of anorectal function was performed with the use of defecography in 19 patients with constipation and 13 with incontinence. All patients were age and sex matched to control subjects who were referred for barium enema study and who had no defecation disorder. There were no statistically significant differences between either patient group and the control group in anorectal angle and excursion of the anorectal junction. In the 32 patients and 155 consecutive patients referred for defecography because of a variety of defecation disturbances, approximately twice as many rectal wall abnormalities were seen compared with findings in the control group. These findings included intussusception, rectal prolapse, rectocele, mucosal prolapse, spastic pelvic floor, descending perineum syndrome, and solitary rectal ulcer syndrome. In conclusion, the main role of defecography is to document rectal wall changes during defecation straining as possible causes of evacuation difficulties. Clinical symptoms should also be taken into account when treatment is contemplated.

Anal Canal↗
PubMedDate not supplied

Assessment of the effectiveness of biofeedback in children with dyssynergic defecation and recalcitrant constipation/encopresis: does home biofeedback improve long-term outcomes.

The purpose of this study was to determine whether biofeedback benefits children with dyssynergic defecation and constipation/encopresis, and whether home biofeedback improves long-term outcomes. Thirty-six patients with chronic constipation who had failed at least 6 months of conventional treatment and demonstrated dyssynergic defecation at anorectal manometry were randomized to biofeedback in the laboratory alone (group 1, n=24) or in the laboratory and at home (group 2, n=12) and followed up at 2, 4, and a mean of 44 months. Thirty patients were available for long-term follow-up. Bowel movements increased in all from a mean of 1.4/week to 5.1, 5.8, and 5.1 per week at 2 months, 4 months, and long-term, respectively (p < or = 0.001). Soiling decreased in all from a mean of 5.5/week to 0.6, 0.1, and 1 per week at 2 months, 4 months, and long-term, respectively (p < or = 0.001). Laxative use decreased from a mean of 4.1 days/week to 0.6, 0.3, and 0.7 per week at 2 months, 4 months, and long-term, respectively (p < or = 0.001). Twenty-seven of 30 parents ranked their satisfaction a mean of 2.2 (range 1-excellent to 3-good). There were no significant differences in outcomes between the laboratory alone group and the laboratory plus home group. Biofeedback is beneficial for some children with chronic constipation and dyssynergic defecation. Supplemental home biofeedback does not improve long-term outcomes.

Adolescent↗
PubMed1998

Locomotor activity and defecation of rats observed alone and in pairs in repeated open-field sessions.

Several experiments with independent groups have shown social effects on open-field defecation and locomotor activity in male rats. In this experiment these social effects were studied with a different methodological approach, namely, with repeated measurements. One group of 8 animals was tested always alone in an open field over 10 trials on successive days. The second group of 16 animals was also tested alone on Days 1 to 4 and on Day 9, while they were placed in the open field with a conspecific on Days 5 to 8 and again on Day 10. There was markedly reduced defecation and enhanced locomotion with the conspecific present, while with the absence of the conspecific on Day 9 the scores again reached the level of the rats always tested alone. Therefore, the social effects on defecation and locomotion are very robust phenomena which can also be shown with dependent measurements.

Animals↗
PubMed2005

Sacral anterior root stimulated defecation in spinal cord injuries: an experimental study in canine model.

AIM: To investigate whether there was a dominant sacral root for the motive function of rectum and anal sphincter, and to provide an experimental basis for sacral root electrically stimulated defecation in spinal cord injuries. METHODS: Eleven spinal cord injured mongrel dogs were included in the study. After L4-L7 laminectomy, the bilateral L7-S3 roots were electrostimulated separately and rectal and sphincter pressure were recorded synchronously. Four animals were implanted electrodes on bilateral S2 roots. RESULTS: For rectal motorial innervation, S2 was the most dominant (mean 15.2 kPa, 37.7% of total pressure), S1 (11.3 kPa, 27.6%) and S3 (10.9 kPa, 26.7%) contributed to a smaller part. For external anal sphincter, S3 (mean 17.2 kPa, 33.7%) was the most dominant, S2 (16.2 kPa, 31.6%) and S1 (14.3 kPa, 27.9%) contributed to a lesser but still a significant part. Above 85% L7 roots provided some functional contribution to rectum and anal sphincter. For both rectum and sphincter, the right sacral roots provided more contribution than the left roots. Postoperatively, the 4 dogs had electrically stimulated defecation and micturition under the control of the neuroprosthetic device. CONCLUSION: S2 root is the most dominant contributor to rectal pressure in dogs. Stimulation of bilateral S2 with implanted electrodes contributes to good micturition and defecation in dogs.

Animals↗
PubMed2001

[Feeding and defecation of Rhodnius (hemiptera: Reduviidae) fed human blood].

Feeding and defecation behavior of Rhodnius prolixus Stal, 1859, R. robustus Larrousse, 1927, R. neivai Lent, 1953 and R. pictipes Stal, 1872, artificially fed on human blood, were studied under laboratory conditions. In all species, first instar nymphs did not defecate in the first 30 minutes after feeding. R. pictipes did not accept artificial feeding but fed directly on humans. Nymph and adult R. prolixus had a higher defecation index (DI) than other species; third instar nymphs had the highest DI = 1.62. In all instars, most individuals accepted the food in 3 Pounds minutes and finished feeding in less than 15 minutes.

Animals↗
PubMed2002

Prospective analysis of marlex mesh repair for symptomatic rectocele with obstructive defecation.

OBJECTIVE: Evaluation of perineoplasty with marlex mesh in symptomatic rectocele with obstructive defecation and evaluation of the incidence of postobstetric perineal tear in patients with symptomatic rectocele. DESIGN: Prospective analysis of 11 consecutive patients undergoing elective rectocele repair. Prospective analysis of sphicnter postobstetric tears in patients with rectocele. RESULTS: Incidence of postobstetric perineal tears in 100 per cent of patients. Absence of obstructive defecation symptoms in 100 per cent of patients. Mesh displacement in 5/8 cases. CONCLUSIONS: Endoanal ultrasound secreening in patients with symptomatic rectocele is mandatory. Prosthetic repair eliminates obstructive defecation symptoms in 100 per cent of patients. Mesh is well tolerated although it has to be fixed in the suprasphincteric area and with non reabsorbable stitches.

Adult↗
PubMed1976

A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. III. The longitudinal anal muscle: anatomy and role in anal sphincter mechanism.

A study of the longitudinal anal muscle was performed in 16 cadaveric specimens. The study comprised dissection and microscopic examination. The bundles of the longitudinal were found arranged in three layers: medial, intermediate, and lateral; each has a different origin and is separated from the other by a fascial septum. Four fascial septa related to the longitudinal muscle could be identified. They split and decussate below the lower end of the longitudinal muscle to form the "central tendon." The central tendon lies between the base loop of the external anal sphincter and the longitudinal muscle. It gives rise to multiple small fibrous septa in different directions; those which penetrate the base loop split and decussate to form the corrugator ani cutis. A mechanism of action of the corrugator is presented. The role of the longitudinal muscle in the anal sphincter mechanism and during defecation is discussed. The muscle plays its major role during defecation. The part played by the muscle in anal fixation is considered. It helps to fix the anal canal to the side wall of the pelvis during defecation, thus preventing anal prolapse.

Adult↗
PubMed2004

Colonic transit times and behaviour profiles in children with defecation disorders.

AIMS: To evaluate children referred for defecation disorders using the child behavioural checklist (CBCL). METHODS: A total of 215 patients were divided into three groups: 135 (5-14 years of age) with paediatric constipation (PC), 56 (5-17 years) with functional non-retentive faecal soiling (FNRFS), and 24 (5-16 years) with recurrent abdominal pain (RAP). Behavioural scores were correlated with colonic transit time (CTT) and anorectal function parameters (manometry and EMG). RESULTS: No significant differences in the mean CBCL scores were found among the three patient groups. However, children with PC and FNRFS had significantly more behavioural problems than the Dutch normative sample, while children with RAP had scores within the normal range. No significant differences were found between CTT in the patient groups, with respect to the CBCL. Similarly, no significant difference existed between children able or unable to relax their pelvic floor muscles during defecation attempts and their behaviour profiles. CONCLUSION: There seems to be no relation between colonic/anorectal function and specific behavioural profiles. On the other hand, children with defecation disorders show more behavioural problems than do controls.

Adolescent↗
PubMed2003

The role of the rectal branches of pelvic plexus in defecation and colonic motility in a canine model.

The parasympathetic nerves regulate colonic motility and defecation. The vagal nerve controls the right colon and the pelvic nerve permeates the left colon and rectum via the rectal branches of the pelvic plexus (RBPP). This investigation aimed to measure the functional changes of the colon and rectum after RBPP-transection for over six months. RBPP-transection was performed in 15 dogs. Five dogs each were sacrificed immediately, one month, and six months after RBPP-transection. The stool condition, colorectal transit, defecation reflex, colorectal response to electrical stimulation, and pathological degeneration was investigated prior to, one month after, and six months after RBPP-transection. Four of the 5 dogs observed had loose stool one month after RBPP-transection, and one of the 3 had recovered six months later. Half transit time (HTT) at transverse colon got longer in six of the 8 in one month. Six months later, HTT got shorter in three of the 4 than that of one month. Defecation reflex was not observed one month after RBPP-transection, but noted in two of the 5 six months later. These results may suggest that vagal nerve compensates for the oral site of the left colon after denervation of the pelvic nerve which is originally distributed.

Animals↗
PubMed2006

[Painful defecation and chronic functional constipation in children: Diagnosis and treatment].

AIM: The aim of this study was to report our results on the treatment of chronic constipation associated with pain during defecation. METHODS: From January 1999 to January 2004, 60 patients (25 females, 35 males; age range, 6 months to 12 years) who met the ROMA II diagnostic criteria for chronic functional constipation associated with pain on defecation were enrolled in the study. All subjects underwent anorectal manometry to determine rectosphincter inhibitory reflex function. A retraining program for daily defecation, a diet high in fiber and lactulose, and local administration of prilocaine/lidocaine were instituted. At rectal anal endosonography, 7 drug-treatment-resistant patients presented with increased thickness of the internal anal sphincter and received botulin toxin A injection at the sphincter. Because symptoms persisted in 2 of these patients, they received a sphincterectomy. RESULTS: At the end of treatment, 40 (71.4%) of the 56 patients who completed the study had a daily bowel movement without pain; 9 experienced a relapse; in the 2 surgical patients the alveus returned to normal function at 2 and 6 weeks, respectively. CONCLUSIONS: Our treatment strategy breaks the vicious circle of spasm-pain-spasm with use of prolonged analgesic treatment and feces softener over the course of the day. In treatment-resistant patients with functioning rectosphincter reflexes and thickened internal anal sphincter, administration of botulin toxin A may be a valuable aid in place of standard sphincterectomy.

Anal Canal↗