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Bowel function of the spina bifida was studied by clinical assessment and anorectal manometric studies. Anorectal pressure profiles were well correlated with clinical assessment but not with recto-anal inhibitory reflexes. Early training of the defecation is emphasized to obtain good bowel function.
In evaluating a child with enuresis, an organized approach to the history leads to a working diagnosis and an appropriate treatment plan. Questions are grouped in nine categories: perinatal complications, complications in infancy, toilet training, voiding pattern (assessed with a voiding diary), micturition pattern, urinary infection, defecation pattern, perineal symptoms and food sensitivities. Structural abnormalities must be evaluated cautiously to assure that a functional problem is not overlooked.
Bulk laxatives have been said to have a good effect in normalizing both hard and loose stools in geriatric patients as concluded from some open studies. In a double-blind study Vi-Siblin, Lunelax and placebo were compared in the six weeks treatment of 29 patients (8 patients on Vi-Siblin, 8 patients on Lunelax, 13 patients on placebo). Two weeks prior to the study and the two last weeks of the study defecation frequency, consistency of stools and the use of additional laxatives were registered by the personnel. Results showed no significant differences between groups or between substances. From this controlled double-blind study it is not possible to draw any definite conclusions regarding the efficacy of bulk laxatives on geriatric patients.
The disturbance of defecation in the patient with Hirschsprung's disease and the pathophysiology of constipation in the constipated patient with simple megarectum were investigated. In Hirschsprung's disease, an existence of aganglionosis and the sphincter achalasia are two main factors which cause clinical symptoms such as chronic constipation and megacolon. As a surgical treatment, we have routinely performed our modified Duhamel's operation. Postoperative followup study indicated that the most cases in our series have gained a satisfactory defecatory function 1 to 3 years after operation. In chronically constipated patient with simple megarectum, on the other hand, it was found manometrically that the most of them had significantly high anal canal pressure and incomplete anal relaxation after rectal stimulation. These findings indicate that those patients have hypertonic and achalasic sphincter. Therefore, the authors propose "high anal pressure syndrome (HAPS)" for such constipated patient with simple megarectum. As to the surgical treatment, 6 patients with simple megarectum had a complete posterior internal sphincterotomy and the postoperative results were excellent or good in our series.
In 84 patients treated with Soave-Denda method, informations of their bowel habits were obtained through a questionnaire. These patients were classified into 4 groups (A; less than 3 years, B; 3 to 6 years, C; 7 to 9 years and D; more than 10 years after the operation) and analyzed by comparing their bowel habits with those of normal children in corresponding age group. Some late complications were demonstrated although 80% of patients followed for more than 10 years had a normal bowel habit. Frequent incontinence (more than once a week) was found in 18.2% of group B and 5% of group C. No patients has incontinence in group D. Frequent soiling (more than once a week) was demonstrated in 58.8% of group B, 30% of group C and 23.1% of group D although the incidence of frequent soiling ranged from 0.5 to 2.1% in normal children of these age group. Manometry to detect a rectonal reflex was useful to evaluate anorectal function because patients who showed normal reflex had excellent bowel habits without incontinence. These unexpected high incidence of late complications indicate that postoperative training of defecation is extremely important to give normal bowel habit to the patients with Hirschsprung's disease.
Parent C57BL/10Bg and DBA/1Bg inbred mice were fed 10% ethanol in their drinking solution during mating and pregnancy and/or early post parturition period. The susceptibility to audiogenic seizures and the open field behavior of their offspring were tested at age 29--33 days. Our previous experiments have indicated that continuous exposure to ethanol during pre- and neonatal periods enhanced the susceptibility to audiogenic seizures in both strains and decreased open field activity only in the strain C57. The present study, while confirming previous findings, assessed the relative contribution of the prenatal and the neonatal administration of ethanol to the behavioral changes. Among C57 mice, the neonatal period was most important for the induction of changes in seizures, but prenatal exposure which alone had no effect, enhanced the outcome of neonatal administration. Among DBA mice either period induced seizures, but the contribution of the neonatal period was the most significant. Early ethanol administration affected open field behavior only in C57 mice. There was an additive interaction between the two periods (latency), no effect by any period alone but together they produced a full effect (ambulation), or that either period alone was sufficent to produce a full effect (defecation).
Using the combination of extremely high and low values of two independent behavioural variables (activity and frequency of defecation in open field) four groups of rats were selected with different CNS reactivity corresponding to the types of higher nervous activity described by I.P. Pavlov. These groups of rats revealed significant differences in reactivity to stress and drugs, in social behaviour and biochemical pattern. They may represent a useful tool for the research in experimental psychology, neurophysiology, psychopharmacology and other branches of science.
The specific target behavior of encopresis in individuals with mental retardation and developmental disorders (MR/DD) is not well-defined in the literature on encopresis or in the literature on specific interventions with MR/DD populations. The criteria for establishing a diagnosis of encopresis in individuals with MR/DD are not clear. The literature on encopresis was reviewed for two factors: (1) definitions according to three major definitional criteria of age, defecation patterns and etiology; and (2) the relationship between etiology and intervention in specific, MR/DD, and nonspecific populations. This review yielded no clinical description of encopresis in MR/DD children, no guidelines for differentiating encopresis from generalized developmental delay and no substantive treatment guidelines. Although no definitions or treatment formulations specific to MR/DD were identified, information and definitional guidelines derived from the general literature on encopresis are relevant to identification, definition and treatment issues for MR/DD populations. Interdisciplinary or team approaches are appropriate for individuals with multiple problems or developmental disorders and intractable encopresis. An interdisciplinary approach, neurodevelopmental-behavioral intervention, which was successfully employed with a 5-year-old encopretic child with multiple developmental problems, is described.
The effect of 40 mcg/kg i. p. injections of ACTH4-10 were investigated in C57BL/6J mice. Peptide injections caused a significant (p less than 0,05) decrease in rearing activity frequencies as well as a decrease in defecation and grooming levels. ACTH4-10 accelerated the acquisition of conditioned food-motivated running reaction and also induced significant resistance against extinction of this habit. The ability of mice to solve the task of extrapolating the direction of stimulus movement was nonsignificantly reduced at the first task presentation and in the total experiment. The ACTH4-10 ability to facititate stereotype reactions is one of possible mechanisms of behaviour changes in the present experiments.
Increased- and low-fiber diets composed of common hospital foods were tested for their ability to alter stool weight, frequency of defecation, transit time, and absorption efficiency. The diets were calculated to be isocaloric and similar in protein, fat, and carbohydrate. They were dissimilar in ash and fiber. No stimulants, secretagogues, food concentrates, or extracts were used on either diet. Six normal, healthy, male subjects consumed each constant diet for five to eight days. Diets and stool composites were analyzed for protein, fat, fiber, moisture, and ash. Carbohydrate and calories were calculated. Stool weight during ingestion of the low-fiber diet averaged 51 gm. per day; subjects had an average of one bowel movement every 33 hr.; and the mean transit rate was 48 hr. When subjects consumed the increased-fiber diet, values were 157 gm., 19h., and 12 hr., respectively. Measurements of fecal protein, fat, carbohydrate, and calories from the low-fiber diet were less than half those observed when the increased-fiber diet was consumed. By altering specific components of a normal diet, e.g., fiber, significant differences can be made in bowel habit and absorption efficiency.
Pregnant female Long-Evans hooded rats were exposed to 0, 0.43, 6.67, or 66.67 ppm ethylene dibromide (EDB) via inhalation for four hours/day three days/week from Day 3 to Day 20 of gestation. The 66.67 ppm dose produced an increase in defecation during exposure, decreased gestational weight gain, and enhanced rotorod performance and T-maze brightness discrimination acquisition in the offspring. Similar changes were noted in the dams and offspring exposed to 6.67 ppm, but the magnitude of the effects was reduced. No effects of exposure to 0.43 ppm were detected, nor were litter size, litter composition, nest building, pup retrieval, DRL-20 acquisition, straight alley running speed, or passive avoidance affected by exposure to any dose. We suggest that the behavioral effects of the medium and high doses may be secondary to stress reactions in the dams to exposure to these doses.
The efficacy and tolerability of Ceruletide and Neostigmin were compared in patients with postoperative intestinal atonia after extensive gynecological surgical operations. Patients treated with Ceruletide (n = 30, dosage of Ceruletide 2 ng/kg/min. i.v.) showed earlier defecation than the Neostigmin-group (n = 30, dosage of neostigmin 3 x 0,5 mg/die). The frequency of side effects was comparable in both groups, patients treated with Ceruletide suffered mainly from gastrointestinal symptoms (nausea) whereas patients treated with Neostigmin complained of disorders of circulation. Ceruletide is faster effective than Neostigmin, the tolerability of both drugs is equivalent.
The results from the clinical study on the preparation Imodium, production of the Hungarian firm "Gedeon Richter"--Budapest, are reported. The drug was tried on 53 patients with chronic and acute diarrheal syndrome chronic or acute enterocolitis, ulcerous colitis-- ChUHC, dyskinesia coli, biliary-colic fistula, Crohn's disease, gastric carcinoma with diarrheal syndrome, postresectional syndrome and some other diseases) with a very good result. The feces of the greater part of the patients normalized their consistence after the treatment of half to 10 days with a dose 6-8 mg daily, and their defecations were reduced to 1-2 for 24 h. In II patients an initial constipation occurred that was eliminated with the discontinuation of the preparation. Very good effect was attained in 37 and good in 16 patients. Furthermore, the preparation was very well tolerated and no adverse effects were observed. The good and rapid effect of Imodium developed in the majority of the patients observed, in 21 of the patients (42%) its effect was realized in half to two days, and in 19 of the patients (35%)--to 5 days, and in the rest 23%--from 6 to 10 days.
A survey of 707 participants in the 13th Annual Trail's End Marathon in Seaside, Oregon, showed a high incidence of gastrointestinal disturbances, predominantly of the lower tract, associated with long-distance running. The urge to defecate, both during and immediately after running, occurred in over a third of runners. Bowel movements (35%) and diarrhea (19%) were relatively common after running, and runners occasionally interrupted hard runs or races for bowel movements (18%) or diarrhea (10%). Lower gastrointestinal disturbances were more frequent in women than in men and in younger than in older runners. Awareness of the frequency and nature of gastrointestinal symptoms documented by this survey will assist physicians in evaluating abdominal complaints in runners.
Before 1949, the vomiting center was said to be located in the dorsal vagal nuclei of the medulla, but it was uncertain whether two centers existed separately for the control of direct and reflex actions of emetic agents. Borison and Wang then used a stereotaxic technique with electrical stimulation to localize the vomiting center in the reticular formation at a measurable distance from the dorsal vagal nuclei. They also formulated the concept of a separate emetic chemoreceptor trigger zone (CTZ) so that the vomiting center itself is not sensitive to emetic agents and serves solely to coordinate the reflex process. The CTZ was soon identified with the area postrema (AP), but the question remains unanswered whether the CTZ constitutes part or all of tht circumventricular organ. Furthermore, different chemosensory functions, as for defecation and certain forms of autonomic expression, may be represented regionally within the AP. Species that are unable to vomit, e.g., rodents, show other postrema-mediated effects as radiation-induced gastric stasis and drug-induced conditioned taste aversion. In sheep, digitalis-induced arrest of rumination is prevented by postremectomy. It is suggested that these behavioral end points in nonvomiting species may serve for biological assay of antinauseant drugs. Finally, a tabular summary is given of known causes of vomiting in which the AP has been implicated.
The authors studied the chronic constipation morbidity among the Sofia district population. It was established that 20.6 per cent of the efficient population is affected. The effect of numerous factors upon the defecation rhythm and constipation incidence is statistically studied. The subjective patient's assessment in the disease diagnosis is underlined. The clinical characteristic of the disease and the present state of the treatment are determined on the base of the data obtained by the inquiry carried out among 3509 inhabitants from the district. The necessity of wider health education upon the problem among the population is stressed upon.
This article is a review of the effects that ingested dietary fiber has on gastrointestinal transit time. The various phases of gastrointestinal motility are considered, and the effect of fiber on these various components is explored. Fiber affects each phase of gastrointestinal motility differently; however, the most dramatic effect on decreased transit time and frequency of bowel movements result from the variations it causes in colonic transit time. The mechanisms of defecation in children and the ways in which fiber affects the frequency of bowel movements are emphasized. All types of fiber do not affect gastrointestinal transit in a similar manner, and different preparations of the same fiber either may delay or may increase the time of intestinal transit. In general, fiber is found to increase the frequency of bowel movements and may prove to be of considerable benefit in treating constipation, a common childhood disorder.
BACKGROUND: Biofeedback is the main treatment for dyschezia in patients with anismus, but retraining may fail because of the frequent association of pelvirectal disorders with anismus. We set out to identify indices of biofeedback failure in the treatment of anismus. PATIENTS AND METHODS: From May 1990 to May 1993, 27 patients (20 women and seven men; median age 46 years) with anismus in which dyschezia was not improved by laxative agents were enrolled in a biofeedback retraining programme. All patients underwent proctologic examination, anal manometry and defecography. Anismus was defined as an increase in anal pressure during attempted defecation in conjunction with an impairment of rectal emptying as assessed using an objective test (barium paste expulsion). Associated disorders were encountered frequently. These included abnormal perineal descent (22 cases), large rectocoele (12 cases), high-grade rectal prolapse (six cases), abnormally high anal canal pressures at rest (seven cases) and abnormal rectal response to inflation (20 cases). Anismus was the sole abnormality in 12 patients when perineal descent, low-grade prolapse and abnormal rectal sensations were not taken into account. RESULTS: Biofeedback retraining did not suppress dyschezia in 13 out of 27 patients. Neither associated disorders (rectocoele, rectal prolapse, abnormal perineal descent, anal pressure and abnormalities of rectal sensation) nor a relevant past history (hysterectomy, laxative abuse, use of antidepressive agents) were encountered more frequently in these 13 patients than in the other 14. The duration of symptoms before treatment was significantly longer in the group unresponsive to biofeedback retraining (81 +/- 61 compared with 33 +/- 34 months for the responsive group, P < 0.01), but the total duration of symptoms and the number of retraining sessions attended did not differ significantly between the two groups. CONCLUSIONS: (1) Extensive examination (defecography and manometry) before biofeedback retraining of anismus is not mandatory because the failure of retraining (48%) is not related to the presence of associated pelvirectal disorders. (2) A long past history of dyschezia seems to provide an index of the failure of biofeedback retraining.