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PubMedDate not supplied

[Defecography study of outpouchings of the external wall of the rectum: posterior rectocele and ischio-rectal hernia].

PURPOSE: To report the clinical and defecographic features of posterior rectal wall outpouchings, i.e., posterior rectocele and ischiorectal hernia. MATERIALS AND METHODS: Sixty-six patients with posterior rectal wall outpouching (61 with posterior rectocele and 5 with ischiorectal hernia) were selected among the patients examined in the last two years for defecation disturbance. All patients underwent physical examination, rectoscopy and videodefecography. RESULTS: Posterior rectal wall outpouchings were detected at physical examination in 28 patients and at rectoscopy in 9 patients. Posterior rectocele, more frequent and bigger in men, was usually demonstrated at videodefecography as an outpouching of the lower portion of posterior rectal wall: this finding was visible only in the dynamic phases in 51 patients while it was seen also at rest in 10 patients. In 52 patients, posterior rectocele was associated with other abnormalities--i.e., anterior rectocele (64%), puborectal muscle syndrome (38%), descending perineum (33%), mucosal prolapse (33%) and intussusception (20%). An ischiorectal hernia, defined as a posterolateral ampullar outpouching deeper than 4 cm and already visible at rest, was identified in 5 patients. Descending perineum and anterior rectocele were the most common associated disorders. CONCLUSIONS: We report the clinical and defecographic features of these rectal abnormalities and stress the importance of videodefecography in the real-time study of these morphofunctional disorders.

Adult↗
PubMed1995

Relation between age-related changes in hyper-emotionality and serotonergic neuronal activities in the rat limbic system.

To examine the relationship between higher concentrations of 5-HT and 5-HIAA in the aged rat brain and their hyper-emotionality, behavioral and neurochemical studies were performed. In the behavioral studies, under novel circumstances, the aged rats showed an significant increase in defecation. Furthermore, their locomotor activity was much less than that of young rats, and the numbers of head-dips of aged rats were significantly decreased compared to those of young rats. In the neurochemical studies, the concentrations of 5-HT and 5-HIAA in the limbic system (e.g., hippocampus, amygdala and septal area) of aged rats were much higher than those of young rats (P < 0.001) under normal conditions. The possibility that the hyper-emotionality of aged rats might be related to the hyper-activities of serotonergic neurons in their limbic system were taken into consideration when the results were analyzed.

Aging↗
PubMed1995

Biofeedback therapy for anorectal disorders in children.

The physiological rationale, methodology, and results of biofeedback therapy in the management of anorectal disorders in children are presented. Balloon manometry and surface electromyography (EMG) are current biofeedback methods used to teach improved recognition of rectal distension and coordination of muscle function to either maintain fecal continence or to allow proper defecation. These techniques have permitted a success rate of over 70% in the management of children with functional or organic anorectal disease refractory to conventional medical and behavioral therapy. Biofeedback therapy is recommended to assist in the successful rehabilitation of these patients.

Anus Diseases↗
PubMedDate not supplied

[Surgical treatment of chronic idiopathic constipation].

We review current experience with surgical treatment of severe constipation due to primary inertia of the colon. Over the last 10 years, we have operated 18 patients (14 females and 4 males) with severe constipation. The surgical procedure was either nearly total colonectomy with ascending colon/rectum anastomosis (8 cases) or total colonectomy with ileorectal anastomosis (9 cases). In one patient, coloproctectomy was performed with an ileoanal anastomosi. Indications for surgery were based on results of barium emena and functional evaluation of defecation. Results were satisfactory in all patients. In several patients however, we noted that the motility of other levels of the digestive tract was also impaired. Colonectomy was introduced as a treatment for chronic constipation nearly a century ago and although very few indications have been retained in the recent this procedure has now become an acceptable surgical approach in a limited number of well-though-out cases.

Adult↗
PubMed1994

[Postoperative behavior of gastrectomized rats in an open field after Roux-Y-reconstruction with and without pouch].

In a series of experimental studies on rat behavior following reconstructive surgery after gastrectomy the effects of Roux-Y-Pouch-technique (RY-P) as compared to Roux-Y (RY) alone were observed. 12 rats with RY-P and 13 rats with RY were tested on days 100-105 post surgery using the Open-Field-test paradigm. Feeding behavior and weight were additionally controlled. Data analysis of repeated measurement design (ANOVA) revealed significant group x time-interaction between type of reconstruction and exploratory behaviors (p < .01). Moreover, RY-P rats consumed more food (p < .001), had higher weight gain (p < .01), and tended to more normal defecation. Overall, results favour the more physiological type of reconstruction.

Anastomosis, Roux-en-Y↗
PubMedDate not supplied

[Evaluation of the sphincter function and rectal sensitivity in rectal prolapse associated with fecal incontinence].

It has been suggested that incontinent patients with rectal prolapse develop a relaxation of the internal sphincter at a lower filling volume than those with the same disorder who were continent. A constant relaxation of the internal sphincter during filling before the individual experiences a need to defecate could be a contributory cause of the incontinence in these patients. Aiming to evaluate the former observations we have investigated continent and incontinent patients, with complete and internal rectal prolapse, by mean of the recto-anal manovolumetry. 31 patients were studied, 21 had a complete rectal prolapse and 10 had internal rectal prolapse and 28 sex and age matched controls were selected among volunteers. No difference has been found between the continent and incontinent patients with rectal prolapse, in term of sensory function studied by graded isobaric distention. Moreover, no difference has been found between the rectal volume at which perception of filling and relaxation of the internal sphincter during filling occurs. Therefore, in this respect, the present data are not in agreement with the theory proposed.

Adult↗
PubMed1994

[Chronic constipation--what to do?].

Chronic constipation implicates heterogeneous disturbances of colonic transit and defecation which require both, careful medical evaluation and therapy. While the modes of action and side effects of laxatives are known for years, the understanding of dysfunctions underlying chronic constipation appears to be related to the understanding of subtle and new investigative techniques. This and the former extent of laxative prescriptions may explain why (based on an 'ex cathedra' decision by the governmental and insurance companies) the prescription of laxatives among primary care practitioners (in Germany) is not acknowledged as medical therapy. How to continue? First: two steps back, reestablishing understanding of constipation as a disease, including subtle diagnosis and differential diagnosis; then; two steps ahead, towards specific therapy, being aware that the available drugs are effective and require prescription by an experienced physician.

Cathartics↗
PubMed1994

[The colon-J-pouch anal reconstruction following total rectum resection: functional aspects].

Coloanal reconstruction is a sphincter saving operation following total rectal resection to treat rectal cancer 3 to 11 cm above the dentate line. Total rectal resection in this situation is justified from the oncological and surgical viewpoint because the local recurrence rate and morbidity are not different from the "gold standard", abdominoperineal resection sacrificing the anal sphincter. Although patients undergoing straight coloanal reconstruction preserve continence, they are often disturbed by high stool frequencies and imperative urge. We set out to establish whether construction of a colon-j-pouch could ameliorate the quality of defecation and thus prove useful. In this study the pre- and postoperative results of a pilot study with 4 consecutive patients following colon-j-pouch-anal reconstruction are presented. Perioperatively, 3 of 4 patients suffered from intermittent disturbances of urinary voiding. Sexual function was disturbed in 3 of 4 patients. All patients were completely continent. The preliminary results showed a decreased sphincter pressure at rest of 40 mm Hg (SD: 5) and a normal squeeze pressure. Endoanal ultrasound demonstrated a normal anal sphincter morphology. Pouch compliance yielded 4.7 ml/cm H2O and was better than after straight coloanal reconstruction in the control group (2.8 ml/cm H2O). The stool frequency at 6 months was 3/24 hours without imperative urge. The colon transit time lasted 49 hours and was in the normal range. No pouch evacuation disorders were observed. These results show a minimal morbidity in colon-j-pouch-anal reconstruction with preservation of complete continence in the follow-up time.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Clinical evaluation and treatment of constipation.

Constipation is a symptom but can generally be defined as less than three bowel movements per week. The history and physical examination should be evaluated for stool size, frequency, and straining and discomfort on defecation. The influence of age, gender, and society should also be considered. The etiologies of constipation can be classified as 1. dietary; 2. drug induced; 3. metabolic; 4. neurologic; or 5. anatomic. If hard or small stools are part of the initial evaluation, then a dietary approach of increased dietary fiber intake can be used as a therapeutic trial. If it does not succeed or the history and physical evaluation indicate an etiology other than dietary, then barium-contrast enema, flexible sigmoidoscopy, colonoscopy, transit time, or anorectal manometry can be used selectively in further evaluation. Detailed methods of treatment are described, such as how to increase fiber intake by use of dietary history and recommendation of appropriate fiber, food, or supplement intake. Methods of using behavioral changes such as laxation and toilet-training programs are described. In selected situations pharmacologic therapy and, rarely, surgical intervention, can be useful.

Adult↗
PubMed1993

Radiologic evaluation of constipation and anorectal disorders.

This article has outlined the orderly radiographic approach to evaluating the patient who presents with constipation or other anorectal complaints. Defecography alone provides only a visual record of events taking place during defecation, and it seems likely that further understanding of the pathophysiology will require manometric, electromyographic, and proctographic data in those patients. Defecography is potentially more available than these other techniques because every hospital has a fluoroscopy suite. Studies that relate the proctographic findings with other physiologic studies are underway and necessary. More studies relating pre- and postoperative defecography with clinical results are needed.

Barium Sulfate↗
PubMedDate not supplied

A swimming pool-associated outbreak of Cryptosporidiosis in British Columbia.

An outbreak of Cryptosporidiosis occurred over three months in a British Columbia community, peaking in December 1990. Results of the case-control study and illness surveys support the hypothesis that transmission occurred in a public children's pool at the local recreation centre. Analysis using lab-confirmed cases revealed a matched odds ratio of 4.5 [95% CI 0.97, 20.83], and using clinical cases an unmatched odds ratio of 12.8 [95% CI 3.68, 46.77], associated with swimming in the children's pool within two weeks prior to onset of illness. Other risk factors were not significant. Attack rates in various groups of children's pool users ranged from 8% to 78%. The children's pool was closed for steam cleaning and disinfection. Unusually frequent defecations including liquid stools had occurred before and during the outbreak. Improvements were instituted for removal of feces and superchlorination of pool water.

Adolescent↗
PubMed1993

Naloxone affects gastrointestinal functions and behaviour in horses.

Clinical effects of the opioid antagonist naloxone were investigated in healthy horses. Naloxone caused a transient increase in the frequency of defecations, a softening of the faeces and alterations in the intensity of abdominal borborygmi. Total serum protein concentrations decreased. Behavioural changes like frequent yawning and flehmen occurred, heart rate decreased and respiratory rate tended to increase but no clinical signs of distress or pain were observed. It can be concluded that in healthy animals naloxone had only minor side-effects and could be used to investigate the physiological functions of endogenous opioids in horses.

Animals↗
PubMed1995

Research methodology for developing efficient handwashing options: an example from Bangladesh.

Handwashing has been universally promoted for health interventions, but it is essential that the factors related to behaviour are understood in order to develop appropriate handwashing messages. We found the study of behaviour complex and had to combine several methods: in-depth interviewing, questionnaire; observational and bacteriological. Here we present our experiences in developing efficient handwashing options for rural Bangladesh. The components of handwashing practices after defecation of 90 rural women were studied (phase 1). During phase 1 an in-depth interview was used to design the observational and questionnaire surveys. Behaviour was observed using a semi-structured record form and the effectiveness of the acts was measured by means of bacteriological tests. A questionnaire survey was undertaken on socioeconomic and water sanitation-related variables since they influence behaviour. Then, to develop efficient handwashing options, an experimental phase (phase 2) tested the bacteriological efficacy of the components found appropriate in phase 1. The effectiveness of the handwashing practices is believed to be poor since the bacteriological counts were found to be high (faecal coliform count of the left hand 1995, and of the right hand 1318 colony forming units/hand). The practice comprised several components: use of an agent, handedness, frequency of rubbing, source and volume of rinsing water, and drying of the hands. Seventy-five per cent of the women reported that they could not afford soap. The experimental trials showed that soap, ash and soil give similar results under similar conditions of handwashing (faecal coliform counts of left hands: 195 (soap), 98 (ash), 129 (soil) and of right: 112 (soap), 54 (ash) and 89 (soil) cfu/hand). The use of multi-method techniques in the study helped to understand and develop efficient handwashing options.

Bangladesh↗
PubMed1996

An examination of the reliability of reported stool frequency in the diagnosis of idiopathic constipation.

OBJECTIVES: To investigate the reliability of reported stool frequency in the diagnosis of constipation. METHODS: Our criterion for the diagnosis of idiopathic constipation was < or = 3 stools per week for > or = 6 months. Subjects who believed that they met this criterion were invited to participate. Daily stool frequency was recorded over a 4-wk period, and all stools were weighed during the final week. A colon transit study and anorectal manometry were performed at the beginning and at the end of the study. RESULTS: On review of stool diaries from 45 subjects who described chronic constipation and who completed the 4-wk study, only 22 (49%) actually satisfied our criterion for idiopathic constipation. The remaining 23 (51%) subjects, although describing constipation, had, on average, 6 stools/wk. A history of psychiatric illness was 5 times more frequent among those whose bowel symptoms correlated poorly with objective measures. Measures of difficult defecation were similar in the two groups. Mean colon transit time was significantly longer and correlated closely with stool weight only in subjects who truly were constipated (p < 0.05). Anorectal manometry was not helpful in discriminating between those who satisfied our criterion for constipation and those who did not. CONCLUSIONS: Defining constipation on the basis of a patient's reported stool frequency may prove misleading; the diagnosis of idiopathic constipation should be supported by the use of stool diaries and a colon transit study.

Adult↗
PubMed1996

Can biofeedback therapy improve anorectal function in fecal incontinence?

BACKGROUND: Although biofeedback treatment ameliorates symptoms in patients with fecal incontinence, whether it improves anorectal function is unclear. AIM: To examine prospectively whether biofeedback therapy influences objective and subjective parameters of anorectal function and whether it improves outcome. METHODS: Nineteen consecutive patients (females = 17) with fecal incontinence for over 1 year, underwent a three-phase outpatient treatment program. This program consisted of pelvic muscle strengthening exercises (phase 1), 1-h biofeedback therapy sessions twice a week (phase 2), and reinforcement sessions at 6 wk, 3, 6, and 12 months (phase 3). The number of sessions in phase 2 were customized for each patient. Anorectal manometry, saline continence test, prospective stool diaries, and bowel satisfaction scores were used to assess the changes in bowel function before and 1 year after therapy. RESULTS: After biofeedback therapy, the anal squeeze sphincter pressure (p < 0.05), the duration of squeeze (p < 0.001), and the capacity to retain liquids (p < 0.05) increased. Rectoanal coordination also improved with a reduction (p < 0.001) in rectal pressure and an increase (p < 0.05) in the continence index. Threshold volumes for first perception and desire to defecate decreased (p < 0.05). The number of therapy sessions varied, mean (range) = 7 (4-13). Stool frequency and the number of incontinence episodes decreased (p < 0.001). Bowel satisfaction score improved (p < 0.001). CONCLUSIONS: Biofeedback therapy is effective and improves objective and subjective parameters of anorectal function in patients with fecal incontinence. Customizing the number of sessions and providing periodic reinforcement may improve the success rate.

Anal Canal↗
PubMed1996

Continence and rectoanal sphincteric inhibitory reflex after posterior sagittal anorectoplasty.

Rectoanal sphincteric inhibitory reflex and continence were evaluated in 23 patients with high and intermediate imperforate anus who underwent posterior sagittal anorectoplasty from 1985 to 1993. The postoperative anorectal function was followed both manometrically and clinically at regular intervals. The presence of the reflex was positively related to postoperative continence in patients older than 4 years but not in younger patients. Two patients with a rectoprostate fistula after an internal sphincter saving procedure had unsatisfactory results. Seven of nine patients with a blind rectal pouch, whose distal rectal end (where the internal sphincter lies) was partially excised or trimmed during reconstruction, had fair postoperative defecation. The internal sphincter saving procedure is helpful but it does not seem essential for the development of continence. The fact that patients with a negative reflex turned out to have a positive reflex 7 to 33 months after the initial test suggested that the rectum or perirectal tissue had recovered from surgical trauma. Time and age are important factors in clinical evaluation and interpretation of manometric results.

Anal Canal↗
PubMedDate not supplied

[Role of radiologic diagnosis in rectal mucosal prolapse].

Defecography (DG) is a useful method to detect many morpho-functional deformities of anus and rectum and pelvic floor. We report on a clinical and radiologic study of 165 patients (36 men and 129 women) suffering from defecation disorders and rectal muscosal prolapse (RMP). All the patients had been submitted to clinical examination, endoscopy and double contrast enema to rule out organic colorectal conditions. DG was performed with a dedicated conmode and high-density barium and videorecorded on VHS cassettes to assess the dynamics of evacuation phases and to reduce exposure doses. DG showed single RMP in 28% of cases and multiple RMP in 72% of cases; the condition was isolated in 22% of cases, while in 88% of cases it was associated with other anorectal dysfunctions, such as rectocele (65%), perineal descent syndrome (PDS) (15%), puborectal muscle syndrome (14%) and intussusception (8%). RMP appeared at DG as a wall defect bulging into rectal lumen, which was more evident under straining and during barium evacuation. In 12 patients with multiple RMP, dynamic CT of the pelvis was carried out to study the whole pelvic floor and in 5 cases it showed levator ani diastasis. Fifty-eight patients were submitted to surgery by elastic binding of RMP; DG follow-up showed RMP remission in 47 patients, single RMP relapse in 3 patients and multiple RMP relapse in 3 patients. One patient with PDS and intussusception was submitted to rectopexy and mucosectom.

Adult↗
PubMed1997

Effect of GK-128 [2-[(2-methylimidazol-1-yl)methyl]-benzo[f]thiochromen-1-one monohydrochloride hemihydrate], a selective 5-hydroxytryptamine3 receptor antagonist, on colonic function in rats.

We investigated the effects of various selective 5-hydroxytryptamine (5-HT)3 receptor antagonists, including GK-128 [2-[(2-methylimidazol-1-yl)methyl]benzo[f]thiochromen-1-one monohydrochloride hemihydrate], on colonic function. In conscious rats, 5-HT and a 5-HT3 receptor agonist, 2-methyl-5-HT, dose-dependently increased fecal pellet output, but another 5-HT3 receptor agonist, m-chlorophenylbiguanide, did not affect output. The selective 5-HT3 receptor antagonists GK-128, granisetron, ramosetron, azasetron and ondansetron depressed the increase in fecal pellet output caused by 2-methyl-5-HT and by wrap-restraint stress. However, the rank order of potency of antagonists in the two defecation models was not consistent with that for the von Bezold-Jarisch reflex. Although granisetron and ramosetron dose-dependently reduced the spontaneous excretion of fecal pellets, GK-128 did not affect it. These results suggest that GK-128 may be used for the treatment of stress-induced gastrointestinal dysfunction. Furthermore, the present results suggest that the 5-HT3 receptor involved in colonic motility may be different from the classically defined 5-HT3 receptor and/or that the regulation of colonic motility mediated by 5-HT3 receptors during stress may be different from normal physiological conditions.

Animals↗