Biomedical subjects
Publications and source records attributed to O O Rasmussen.
A patient with rectal cancer and invasion of the urinary bladder without extra-pelvic spread underwent total pelvic exenteration with rectal resection and bladder substitution with the urethro-ileal Kock reservoir. The patient has normal bowel and voiding functions and is without recurrence after two years.
PURPOSE: This study was undertaken to determine the effect of rectal dilation in a patient with urge-type fecal incontinence and frequent bowel movements associated with low rectal compliance and capacity. METHOD: Daily rectal balloon dilation was performed for a period of four weeks. RESULTS: The patient regained complete fecal continence with one to two daily bowel movements. Rectal compliance, capacity, and cross-sectional area increased by 37 to 136 percent. Nine months later the patient was still without symptoms. CONCLUSION: Rectal balloon dilation may be a therapeutic alternative in selected patients.
PURPOSE: The aim of this study was to develop a method for determination of rectal compliance that allows direct measurement of corresponding changes in the rectal cross-sectional area or perimeter and rectal pressure. METHODS: We developed an anal probe for transrectal endosonography. The probe was tested in vitro, and rectal compliance of six healthy patients was determined. RESULTS: In vitro measurements proved the method to be well reproducible. The method allowed calculation of an endosonographic rectal compliance, which correlated well with rectal compliance measured by the standard method. CONCLUSION: Endosonographic determination of rectal compliance is possible, and the endosonographic method may give a more precise and reproducible estimation of rectal compliance.
AIM: To evaluate anal function after childbirth in 94 women in whom sphincter rupture occurred and in 19 control women. The findings of anorectal physiological assessment and history of childbirth were related to the presence of fecal incontinence. METHODS: Anal manometry and electromyography were performed the first days after childbirth and repeated 3 months post partum together with measurement of pudendal nerve terminal motor latency. RESULTS: Eighteen patients (19%) presented with incontinence. None of the controls developed fecal incontinence after delivery. Anal manometry showed that both incontinent and continent patients had decreased resting and squeeze pressures compared to control subjects (p < 0.005). No difference in anal electromyography was found between the three groups. Both anal manometry and electromyography showed a significant increase in pressure and activity respectively 3 months after delivery in patients and controls. Patients with pudendal nerve terminal motor latencies > 2.0 milliseconds had an increased risk of having fecal incontinence compared to patients with pudendal nerve terminal motor latencies < or = 2.0 milliseconds (odds ratio 2.18, p < 0.05). Fecal incontinence could not be related to the weight or head circumference of the infant. The manometric and electromyographic findings, the use of pudendal nerve block, the length of the second stage of labor, the depth of rupture or the use of vacuum extraction could not be related to either fecal incontinence or pudendal nerve function. CONCLUSION: The manometric findings indicated damage to the anal sphincter apparatus in both continent and incontinent patients. Decreased pudendal nerve function characterized incontinent women. Accurate prediction of fecal incontinence in women with obstetric anal sphincter rupture is not possible.
In recent years, several techniques for the treatment of more complex forms of faecal incontinence have emerged. These consist of either transposition of skeletal muscle (gracilis muscle or gluteus maximus muscle) around the anal canal, implantation of an artificial sphincter or implantation of a neuromuscular stimulator having previously transposed gracilis muscle. The latter method seems to hold most promise.
Thirty-eight women with anal sphincter rupture during childbirth were followed for three to 12 months. Fourteen patients presented with continence disturbances, nine to solid or fluid faeces and five to gas. Incontinence was present in nine patients three months after childbirth. Anal manometry and anal electromyography were performed on the patients three to five days after delivery and repeated at three, six and twelve months after childbirth. Manometry and electromyography were performed on 16 control subjects and 24 primiparous control patients who were investigated three to five days and three months after delivery. Anal manometry and anal electromyography showed significant differences between both incontinent and continent patients compared to control subjects and primiparous control patients. Primiparous control patients had decreased squeeze pressure as well as decreased electromyographic activity during the first days after delivery compared to control subjects. After three months no differences were found. Continence disturbances are frequent after sphincter rupture and these patients should be monitored after delivery and those with persisting incontinence offered sphincter repair.
A review in a historic perspective of the present knowledge of anorectal physiology is presented. The techniques used in the anorectal physiology laboratory are discussed. Application of new sophisticated techniques to anorectal physiology research in recent years continue to improve our knowledge of anorectal function. Anal continence and defecation depend on both the anal sphincter and the rectum. The assessment of patients with functional anorectal diseases should include a more complete physiologic evaluation of the anorectum than used previously.
Thirty-eight women with rupture of the anal sphincter occurring during childbirth were followed for 3-12 months. Nineteen had complete rupture of the external anal sphincter, 14 had a lesion involving more than half of the sphincter muscle and five had a superficial rupture. Fourteen patients presented with continence disturbances: nine to solid or liquid faeces and five to flatus. Incontinence was present in nine women 3 months after childbirth. Anal manometry and electromyography were performed in patients 3-5 days after delivery and repeated at 3, 6 and 12 months. Manometry and electromyography were also performed in 16 control subjects who were nulliparous or had given birth more than 2 years previously and 24 primiparous controls, who were investigated at 3-5 days and at 3 months. There were significant differences between both incontinent and continent patients compared with nulliparous and primiparous controls. Primiparous control subjects had decreased anal squeeze pressure as well as decreased electromyographic activity on the first days after delivery compared with nulliparous controls. After 3 months no differences were found. Continence disturbances are frequent after sphincter rupture; these patients should be monitored after delivery and those with persisting incontinence offered sphincter repair.
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Patients with obstructed defecation show no consistent abnormalities when assessed by standard anorectal physiologic methods. With a recently developed technique for dynamic anal manometry, we studied 13 female patients with obstructed defecation and 20 healthy volunteers. Seven parameters of anal function were measured. There were no differences between the median values for the two groups. Seven patients (54 percent; 95 percent confidence limits, 25-81 percent) had anal compliance below the normal range, either during opening or closing of the sphincter at rest (five patients), during squeeze (one patient), or both (one patient). Opening and closing pressures of the sphincter at rest, maximal closing pressure during squeeze, and anal hysteresis were normal. Standard anal manometry did not show any differences between patients and controls. Rectal compliance was lower in patients with obstructed defecation, median difference 5 ml/cm H2O (95 percent confidence limits, 1-9 ml/cm H2O). In conclusion, the more detailed method of dynamic anal manometry shows that some patients with obstructed defecation have a less compliant anal sphincter and a less compliant rectum, but in many patients no abnormal findings can be made.
Follow-up was performed two to six years after anal dilatation for fissure-in-ano in 32 consecutive patients who had not undergone additional anal surgery. All patients were interviewed and asked specifically about impairment of flatus or fecal control and its possible relation to the anal dilatation. Anal dilatation was followed by minor anal incontinence in 12.5 percent of the patients. Anal endosonographic follow-up was accepted by 20 patients, and sphincteric defects were found in 13 (65 percent) of those. Two patients with anal incontinence had internal sphincter defects. Sphincteric defects were also found in 11 of the 18 continent patients who underwent sonography: internal sphincter defects in nine, external sphincter defect in one, and combined defects of both sphincter muscles in one. In conclusion, anal dilatation results in sphincter damage in more than half of patients, but few of them develop anal incontinence.
Anal endosonography, including measurements of anal sphincter size, was performed in 16 patients with obstructed defecation. The findings were compared with those at defecography and anal manometry. Patients with rectocele and intussusception had a normal endosonographic appearance. One patient with puborectalic spasm had normal sonography. There was no correlation between sphincter size and anal manometry. The external sphincter muscle was thicker and the cross-sectional area larger in patients with obstructed defecation than in healthy controls (p < 0.05). Two patients with sphincter spasm and impaired rectal emptying at defecography had clearly thickened internal sphincters which may be the cause of their defecatory disorder. Three patients with previous anal dilatation or hemorrhoidectomy had sphincteric defects. Anal endosonography may be considered in patients with obstructed defecation to identify patients with internal sphincter hypertrophy.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Twenty-four women with primary suture of an obstetric tear of the anal sphincter were examined with anal endosonography a median of 12 (range 3-18) months after delivery. Endosonography was normal in ten patients, of whom one was incontinent. The examination showed a defect in the external anal sphincter in 13 patients; six of these were incontinent, two of whom had normal findings on palpation. An isolated internal sphincter defect was found in a continent patient. Since anal endosonography causes no more discomfort than digital examination, it may be useful to identify patients who would benefit from surgical reconstruction of the anal sphincter.
The volume (V) of air inflated in a latex balloon placed in the rectum and the corresponding pressures (P) were measured in 48 subjects (24 men and 24 women) at three points: (1) earliest defaecation urge; (2) constant defaecation urge; and (3) maximum tolerable volume (MTV). The rectal pressures in all three cases were higher in men than in women. Woman aged over 60 years had higher rectal compliance (delta V/delta P) than men in the same age group, while no difference was found between men and women below the age of 60 years. Day-to-day variation of the measurements was tested in ten subjects. Reproducibility was good only for MTV (95 per cent confidence interval 57-183 per cent). Reproducibility of rectal compliance decreased with increasing values for this parameter. No such trend was found for the other parameters. In conclusion, MTV is a reproducible parameter and suitable for clinical use in evaluation of patients with faecal incontinence or constipation.
The ability to retain viscous fluid in the standing position was tested in 22 patients with fecal incontinence, 11 patients with constipation, and 26 control subjects. Viscous fluid was introduced into the rectum in increments of 50 ml. The examination was stopped when the patient complained of discomfort or the viscous fluid leaked. Eighteen of 22 patients with fecal incontinence leaked fluid, while none of the control subjects and only four of the constipated patients did so. Patients with fecal incontinence retained significantly less viscous fluid than did control subjects, whereas no difference was found between patients with constipation and control subjects. Rectal sensation from distention with air was tested in the patients as well as in the control group. The following volumes and pressures at each sensation were measured: 1) earliest defecation urge (EDU), 2) constant defecation urge (CDU), and 3) maximum tolerable volume (MTV). Patients with fecal incontinence had lower volumes than control subjects at all sensations, while patients with constipation had higher volumes at earliest defecation urge and at constant defecation urge. Rectal compliance was higher in patients with fecal incontinence than in control subjects, whereas patients with constipation did not differ from control subjects. Regression analysis showed a linear relationship between viscous fluid retention and the maximum tolerable volume and also between viscous fluid retention and rectal compliance. No difference in the ability to retain viscous fluid between male and female control subjects was found; regression analysis of viscous fluid retention in relation to age revealed decreasing volumes with increasing age. Day-to-day variation of the ability to retain viscous fluid was tested in eight persons, and reproducibility was found to be good.