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At least 199 records · Page 11Linked to original sources

PubMed1999

Transanal repair of rectocele corrects obstructed defecation if it is not associated with anismus.

PURPOSE: Rectocele is often associated with anorectal symptoms. Various surgical techniques have been described to repair the rectocele. The surgical results are variable. This study evaluated the results of transanal repair of rectocele, with particular emphasis on the impact of concomitant anismus on postoperative functional outcome. METHODS: Fifty-nine consecutive females who underwent transanal repair of rectocele for obstructed defecation were prospectively reviewed. All 59 patients were parous with a median parity of 2 (range, 1-6) and a median age of 58 (range, 46-68) years. The median length of follow-up was 19 (range, 6-40) months. Anismus was detected by anorectal physiology and defecography. The functional outcome was assessed by a standard questionnaire, physical examination, anorectal manometry, neurophysiology, and defecography. The quality-of-life index was obtained using a visual analog scale (from 1-10, with 10 being the best). RESULTS: The functional outcome of transanal repair of rectocele was superior in patients without anismus. Forty (93 percent) of the 43 patients without anismus showed improved evacuation after repair compared with 6 (38 percent) of the 16 patients with anismus (P<0.05). The quality-of-life index improved (9 vs. 4) if anismus was not present (P<0.05). There were minimal complications. Hemorrhage requiring blood transfusion (2 units) occurred in one patient and urinary retention in another. CONCLUSION: Transanal repair of rectocele is safe and, in the absence of anismus, effectively corrects obstructed defecation.

Aged↗

PubMed2000

Rectal akinesia as a new cause of impaired defecation.

PURPOSE: The aim of this prospective study was to point out a new concept of dyschezia using dynamic videoproctography. METHODS: A total of 154 consecutive patients with impaired defecation prospectively underwent dynamic videoproctography from 1996 to 1998. Evacuation of thick barium of standardized consistency was fully videotaped under fluoroscopy in the sitting position. We measured the weight of barium injected into the rectum (Q1 in g), the weight of barium evacuated (Q2 in g) and the time for rectal evacuation (t in seconds). Flow rate and postdefecation residue were given by calculating Q2/t and (Q1 - Q2) X 100/Q1, respectively. We studied all patients whose flow rate and postdefecation residue were less than 5 g/second and more than 30 percent, respectively. These values were arbitrarily chosen, based on rectal evacuation in 25 controls (5 healthy volunteers together with 20 patients without dyschesia). RESULTS: Nine of 154 patients with dyschesia fulfilled the criteria and had none of the usually known causes of dyschezia, such as anismus, megarectum, intussusception, rectal prolapse, rectocele, or enterocele. These nine patients had a normal rectal anatomic appearance and a wide-open short anus but despite exhausting straining efforts were unable to obtain total rectal emptying. Dynamic videoproctography brings strong arguments for an absence of rectal wall contraction, despite normal functioning pelvic floor. CONCLUSIONS: Dynamic videoproctography allows identification of new features in patients with dyschesia: very slow defecation flow rate and high postdefecation residue. This new concept could be called rectal akinesia by analogy with bladder akinesia in some dysuric patients.

Administration, Rectal↗

PubMed1999

Relationship between anatomic and symptomatic long-term results after rectocele repair for impaired defecation.

PURPOSE: The aim of this study was to determine the long-term symptomatic and anatomic results of rectocele repair for impaired defecation. METHODS: All 26 females operated on during a five-year period in one hospital were reviewed in clinic. Follow-up was available on 22 patients after a median of 27 (range, 5-54) months. Interview, anorectal physiological testing, and evacuation proctography were performed preoperatively and postoperatively. Fifteen patients had a transperineal repair and seven patients had a transanal repair. RESULTS: Sixteen (73 percent) patients felt improved. A feeling of incomplete emptying (19 vs. 10, preoperative vs. postoperative; P = 0.02) and the need to use digital assistance vaginally (13 vs. 6; P = 0.07) were both reduced by surgery, the former being improved significantly more often after transperineal repair. The rectocele width and area were reduced by both types of surgery; however, the rectocele diameter was greater than 2 cm in 16 patients preoperatively and 10 patients postoperatively. There was no significant difference between patients who did or did not feel improved by surgery in the percentage reduction in rectocele width (22 vs. 18 percent; P = 0.95), the percentage reduction in rectocele area (65 vs. 62 percent; P = 0.95), or a rectocele width of more than 2 cm (44 vs. 50 percent; P = 0.80), did vs. did not feel improved, respectively. CONCLUSION: Operative repair symptomatically improves a majority of patients with impaired defecation associated with a large rectocele, but the improvement probably relates at least in part to factors other than the dimensions of the rectocele.

Adult↗

PubMed1986

Diagnosis of functional disorders of defecation causing the solitary rectal ulcer syndrome.

The solitary rectal ulcer and colitis cystica profunda are different manifestations of the solitary rectal ulcer syndrome. The cause of solitary rectal ulcer syndrome remains unknown. Since defecation disorders are common among patients with solitary rectal ulcer syndrome, defecography is indicated. Defecography was performed on 19 patients with solitary rectal ulcer syndrome. In five patients, the spastic pelvic floor syndrome had occurred. Twelve patients had internal intussusception of the rectum, and one patient had an anterior rectal wall prolapse. In one patient, no abnormalities could be detected. These abnormalities led to severe straining, which can damage the anterior rectal wall. Findings strongly support the hypothesis that solitary rectal ulcers are traumatic lesions caused by straining. Defecography is a suitable procedure for detecting the causative disorder of defecation and for selecting patients for treatment.

Adult↗

PubMedDate not supplied

A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. VIII. Levator hiatus and tunnel: anatomy and function.

The anatomy of the levator hiatus and tunnel has been studied, aiming at the elucidation of their functional role in mechanisms of defecation, urination, and continence. The material comprised 25 cadavers studied by dissection and serial histologic sections. The levator hiatus occupies the anterior portion of the levator plate which consists of two "crura," that bound the hiatus, and two "lateral masses." Three crural patterns could be identified: classic, crural overlap and crural scissor. The levator tunnel is a muscular tube which surrounds the intrahiatal organs along their way down from the levator hiatius to the perineum. It is double sheathed, with an inner coat of the suspensory sling and an outer of the puborectalis. Both coats are of striped muscle bundles. The inner coat is a tunnel "dilator," whereas the outer is a tunnel "constrictor." The puborectalis not only acts as a "common tunnel" sphincter but provides an "individual" sphincter for each intrahiatal organ. A detailed study of the hiatal ligament which firmly binds the levator plate to the intrahiatal organs is presented. A "tunnel septum" could be identified to line the levator tunnel, and separate it from the intrahiatal organs. Its surgical significance as a landmark for mobilizing the intrahiatal organs from within the tunnel is stressed. The levator plate consists of two functionally separate zones: a lateral "visceral support" zone and medial "dilator" one. The double sphincteric control provided to each intrahiatal organ by the "individual" and "common" sphincters would suggest that unless both sphincters are destroyed, continence could be maintained by either. The role of the "levator complex" which comprises levator crura, tunnel and hiatal ligament in fixation of intrahiatal structures, as well as in mechanisms of defecation, urination, and continence, is discussed. The understanding of the anatomic details of the levator hiatus and tunnel could be of value in mobilizing the intrahiatal structures from within the levator tunnel with preservation of their voluntary sphincteric mechanism.

Defecation↗

PubMed2002

The application of percutaneous endoscopic colostomy to the management of obstructed defecation.

PURPOSE: We describe the case of a 52-year woman with a 17-year history of obstructed defecation in whom all other standard treatments had failed and the patient had refused a colostomy. Her symptoms were controlled by percutaneous endoscopic colostomy with antegrade colonic irrigation. METHOD: A percutaneous endoscopic colostomy tube was placed in the sigmoid colon endoscopically using a colonoscope and the patient irrigated two liters of water through the percutaneous endoscopic colostomy twice each day and was able to successfully evacuate her rectum without excess straining or discomfort. CONCLUSION: Percutaneous endoscopic colostomy is an alternative option to colostomy in the management of obstructed defecation.

Colostomy↗

PubMed2005

Short-pouch and low-anastomosis Duhamel procedure results in better fecal control and normal defecation pattern.

PURPOSE: The purpose of this study was to analyze the long-term outcome of the short-pouch and low-anastomosis Duhamel procedure and to evaluate the quality of life after pull-through. We also tried to answer the questions: Does the modified Duhamel procedure produce fecal continence? Is the quality of life correlated to normal bowel function (1-3 per day) without the use of laxatives? MATERIALS AND METHODS: Between January 1993 and January 2002, 53 patients, 44 (83 percent) males and 9 (17 percent) females, who underwent a Duhamel procedure were assessed retrospectively. Of the 53 children, 36 (67.9 percent) underwent a primary Duhamel procedure at our institute (Group A). Seventeen (32.1 percent) patients had a primary Duhamel pull-through and subsequently a stoma before a redo modified Duhamel procedure (Group B). The technical modification was creation of a short rectal pouch of 35 mm, achieving a low colorectal anastomosis 0.5 cm from or on the dentate line. All 53 patients were assessed prospectively by a disease-specific questionnaire. The total score provided a single index of the quality of life associated with fecal continence. RESULTS: For Group A (n = 36), the mean period of follow-up was 71.4 +/- 29 months. Constipation was seen in four (11.1 percent) patients. In two (5.6 percent) patients there was a mild degree of soiling. Sensation and urge to defecate was intact in 34 (94.4 percent) children who could wait to go to the toilet until it was socially convenient. For Group B (n = 17), the mean period of follow-up was 73.9 +/- 31.2 months. Constipation occurred in 17 (100 percent), encopresis in 14 (82.4 percent), and enterocolitis in 15 (88.2 percent) after the primary Duhamel procedure. In comparison, there was complete absence of constipation (100 percent), encopresis (100 percent), and complete resolution of enterocolitis (100 percent) after the redo modified Duhamel (P = 0.001). Continence to solid stools after primary Duhamel was seen in 5 (29.4 percent) vs. 17 (100 percent) after redo modified Duhamel. After the redo modified Duhamel all 17 (100 percent) patients have retained the sensation and urge to defecate and 15 (88.2 percent) can wait to get to the toilet until it is socially convenient. In all 53 patients, the quality of life was good in 86.8 percent (46/53) and correlated directly with fecal continence (r = 0.977). There was no correlation between age of patient and fecal continence (r = 0.597) and rate of fecal incontinence did not decrease with age. Direct correlation was seen with the presence of constipation and the incidence of late onset enterocolitis (r = 0.942). CONCLUSIONS: Short-pouch, low-anastomosis Duhamel pull-through procedure results in fecal continence and complete emptying. The above procedure has a positive impact on the quality of life in these children.

Anastomosis, Surgical↗

PubMed1988

Forced swimming test in rats: effect of desipramine administration and the period of exposure to the test on struggling behavior, swimming, immobility and defecation rate.

The effect of desipramine administration and the duration of the daily exposure to forced swimming on some variables has been studied in adult male rats. Desipramine administration (15 mg/kg) significantly increased struggling behavior in the first and second 5-min periods of a single exposure to forced swimming. Swimming was reduced in the first 5 min and remained unchanged thereafter. Immobility was decreased in the second and the third 5-min periods. After a pre-exposure to forced swimming for 15 min the day before, the drug was effective in increasing struggling behavior and reducing immobility during a subsequent 5-min test. Swimming was not modified. Daily exposure to forced swimming for 3 days caused a decline in struggling behavior and swimming, while increasing immobility and the defecation rate. The duration of daily exposure to forced swimming did not alter the changes in the variables measured. The present results indicate that a one-day test can be used to discriminate between saline- and desipramine-treated rats, and that struggling behavior could be a reliable measure of the positive action of antidepressants. The finding that behavioral changes over the 3 days were independent of the duration of exposure to swimming argues against the interpretation of the results which suggest that the responses are caused by the appearance of a behavioral despair state, and suggests that these behaviors might be trait-markers in the rat. In addition, the changes in struggling behavior and immobility over the 3 days cannot be attributed to a behavioral adaptation to the test because the defecation rate increased rather than decreased during successive forced swimming tests.

Animals↗

PubMed1993

Neuroleptic-induced defecation in rats as a model for neuroleptic dysphoria.

Two groups of 32 rats were challenged in a well-habituated environment with haloperidol (0.5 mg/kg), haloperidol (0.1 mg/kg), domperidone (0.1 mg/kg), or saline to study the effect of these drugs on defecation--an index of emotionality--and voluntary movements in the 2 hours after the injection. The haloperidol-treated rats in the high-dose condition had significantly more bolus counts in the 2 hours after the injection than were observed in the groups treated with domperidone (a peripheral dopamine D2 receptor antagonist) or placebo. All movements were greatly reduced in the haloperidol-treated rats and, in this group, the ones with more bolus counts did not differ in their activity levels from those with fewer bolus counts. There was a trend for the rats that were less mobile at 10 minutes after the injection to produce more boli in the 2-hour period. Our study, therefore, replicates the findings of Sanberg (1980) and Russell et al. (1987a, 1987b) that haloperidol increases "emotional" defecation in rats in well-habituated environments, but the same model does not replicate the motor component of neuroleptic-induced akathisia seen in human subjects.

Animals↗

PubMed1994

Effect of prolonged treatment with haloperidol on "emotional" defecation and movement in rats in a well-habituated environment.

Sixteen adult male Wistar rats were administered either haloperidol (n = 8), 0.5 mg/kg, or saline (placebo) (n = 8) by subcutaneous injection three times per week for 6 weeks, and were again injected after a 6-week drug-free period. The study was conducted in a well-habituated, distinctive environment to which the rats were introduced 1 hour before the injection on each occasion. The fecal bolus counts 1 hour before and 2 hours after drug injection were obtained, as well as movement counts repeatedly in epochs of 90 seconds upon introduction to the cages and after the injections. Haloperidol produced an overall increase in defecation in the 2 hours after drug injection compared with placebo. The post-drug bolus counts for haloperidol-treated rats were lower in week 2 compared with week 1, but the difference from placebo for this reduction was not significant, and it did not persist beyond week 4. The haloperidol-treated group showed a significant increase in the predrug bolus counts from week 5, suggesting a conditioned response to the cage environment. The haloperidol-treated rats were markedly less mobile than the placebo-treated rats, and with repeated exposure to haloperidol, they tended to develop hypomotility earlier. No tolerance to the movement effect was observed. The defecation and movement effects of haloperidol at 12 weeks were no different from those at week 1. This study supports earlier work indicating that haloperidol produces a dysphoric effect in rats, and it suggests that this effect does not habituate over 6 weeks of repeated administration. It does not replicate the motor aspect of akathisia seen in humans.

Akathisia, Drug-Induced↗

PubMed1995

RP67580, a neurokinin1 receptor antagonist, decreased restraint stress-induced defecation in rat.

We investigated the possibility that substance P would mediate defecation in rats subjected to restraint-stress. The increases in fecal pellet output caused by restraint-stress were inhibited by a neurokinin (NK)1 receptor antagonist, RP67580 with an ED50 (95% confidence limits) value of 0.59 (0.54-0.65) mg/kg i.p. RP68651, the enantiomer of RP67580 devoid of affinity for NK1 receptors, had little effect on it. In contrast, (+/-)SR48968, an NK2 receptor antagonist, was without effect. Furthermore, capsaicin treatment (125 mg/kg i.p.) was inactive in this model. These results suggest that the activation of NK1 receptors and substance P released from intrinsic neurons of the colon would be involved in stress-induced defecation in rats.

Analgesics↗

PubMed2006

Evaluation of the stapled transanal rectal resection technique with two staplers in the treatment of obstructive defecation syndrome.

BACKGROUND: This study was designed to assess the safety and effectiveness of stapled transanal rectal resection (STARR) and to compare the results of two staplers. STUDY DESIGN: From February 2001 to June 2005, 37 patients diagnosed with obstructive defecation syndrome were treated with the STARR technique. We analyzed variables related to the patient, diagnosis based on anorectal exploration, surgical technique used, and clinical and radiologic results. We compared these results in patients with procedure prolapsed hemorrhoids (PPH)33-01 (group 1, n = 17) or PPH33-03 (group 2, n = 20). The patients were followed postoperatively at 1, 3, and 6 months, and annually. RESULTS: Intraoperative hemorrhage at the stapled suture occurred in 13 patients from group 1 and in 6 patients from group 2 (p = 0.03). The degree of postoperative pain was not different between the two groups. During the followup period, radiologic and clinical correction of the rectocele and intussusception was found in 94.6% of the patients, with a recurrence in 1 patient from each group. One patient from group 1 developed stenosis of the anastomosis, which improved with digital dilatations. Six patients from group 1 and none from group 2 (p < 0.05) had granulomas on the staple line at the sites of the reabsorbable reinforcing stitches, which were related to postoperative bleeding and anal discomfort. CONCLUSIONS: STARR is an effective alternative for treatment of obstructive defecation syndrome, with a low morbidity and a shorter hospital stay. The use of PPH33-03 instead of PPH33-01 decreases the risk of hemorrhagic complications and enables more secure implantation as an outpatient procedure.

Adult↗

PubMed2005

Bromelain improves decrease in defecation in postoperative rats: modulation of colonic gene expression of inducible nitric oxide synthase.

Ileus continues to be a common consequence of abdominal surgery, causing significant patient discomfort and often leading to more serious problems. The therapy available is limited, hence, ileus remains an important clinical problem. Activation of inducible nitric oxide synthase (iNOS) directly modulates intestinal dysmotility after bowel manipulation and plays an essential role in initiating intestinal inflammation. Nuclear factor (NF)-kappaB is known to be a critical component of iNOS gene transcriptional activation in response to inflammatory stimuli. Bromelain is a crude extract from the pineapple stem, which is sold as a nutritional supplement to "promote digestive health" and as an anti-inflammatory medication in some developed countries. Here, we have found that oral administration of bromelain improves decrease in defecation in abdominal postoperative rats. Results showed that bromelain increased the wet weight, dry weight, water content and number of fecal pellets in laparotomized plus mechanically manipulated rats, suggesting improvement of postoperative ileus. Furthermore, bromelain treatment inhibited overexpressed iNOS mRNA and restored down-regulated inhibitor kappaBalpha mRNA in the colon of the postoperative rats. From the in vitro experiments, bromelain inhibits lipopolysaccharide (LPS)-induced nitrite overproduction in macrophage cell lines and LPS-induced NF-kappaB luciferase reporter gene expression in RAW264.7 macrophages transfected with NF-kappaB luciferase reporter gene. Thus, our findings suggest that bromelain improves decrease in defecation in postoperative rats, at least in part, by inhibiting colonic iNOS overexpression via NF-kappaB pathway. Our data indicates that bromelain may benefit patients with postoperative ileus.

Animals↗

PubMed2006

Reboxetine induced erectile dysfunction and spontaneous ejaculation during defecation and micturition.

This is a case report of reboxetine induced erectile dysfunction, seminal emission and ejaculation during defecation and micturition. A 44 year old male who had been suffering from depression without any sexual dysfunction was put on venlafaxine XR treatment. Due to delayed ejaculation and occasional episodes of absence of ejaculation he was switched to reboxetine. At the second week of treatment he reported erectile dysfunction and premature ejaculation, and seminal emission and ejaculation during defecation and micturition occurred later at 8th week of treatment. After he was switched to sertraline 50 mg/day, his erectile dysfunction, premature and spontaneous ejaculation symptoms subsided in 2 weeks. Although reboxetine is reported to be free of sexual side effects, individual vulnerabilities to such unwanted effects should be considered, and sexual dysfunction should be assessed thoroughly during the treatment.

Adult↗

PubMed2006

What keeps C. elegans regular: the genetics of defecation.

Caenorhabditis elegans exhibits a repertoire of behaviors that can be studied by genetic, anatomical and pharmacological approaches. Defecation is one of the simpler behaviors, involving a small number of muscles, a couple of neurons and only one neurotransmitter. This simplicity enables the precise characterization of the cells and genes required for executing the behavior and has made the defecation behavior a powerful model for investigating the genetic basis of nervous system function, muscle differentiation, rhythmic behaviors and oscillatory calcium signaling, and the metabolic and environmental regulation of behavior. Our review highlights how the function of a system even this simple results from the integration of many aspects of an organism's biology and involves the action of diverse genes.

Animals↗

PubMed1996

In utero defecation by the normal fetus: a radionuclide study in the rabbit.

An experimental study was performed to investigate the excretion function of the liver, gastrointestinal motility, and in utero defecation by radionuclide techniques in 24 New Zealand white rabbit fetuses at 25 days' gestation (fullterm, 31 to 32 days). 0.1 mL of technetium 99m (99mTc)-HIDA (a derivative of iminodiacetic acid) containing 1 mCi of radioactivity was injected into the gluteus muscle of each fetus which had been exposed through the uterus. After replacing the fetus and uterus into the abdomen, and beginning 1 hour after injection, a live fetus was killed each hour for 24 hours Tissue samples from the lung heart, stomach, kidney, bladder, liver, meconium in the proximal, mid and distal bowel, and amniotic fluid were taken. The radioactivity of each sample was determined by a gamma counter and the percentage uptake per gram of tissue was calculated. The very low radioactivity levels detected in the stomach, kidneys, and bladder indicated the in vivo stability of 99mTc-HIDA 99mTc-HIDA is predominantly trapped by the liver via systemic circulation and is excreted into the gastrointestinal tract through which it passes into the amniotic fluid. Demonstrated passage of excreted 99mTc-HIDA through the fetal liver and into the gastrointestinal tract and amniotic fluid strongly suggests that fetal defecation is a physiological event.

Amniotic Fluid↗

PubMedDate not supplied

A computer-controlled, long-term recording system for studying eating, drinking, and defecation behavior in miniature pigs.

The long-term observation of ingestive and excretory behaviors in freely ambulating and non socially isolated pigs is an important tool in the investigation of the physiological determinants of these behaviors. A computer-controlled laboratory setup for the recording of feeding, drinking, and defecation behavior in minipigs was developed, allowing for the observation of two pigs at a time for weeks. Four minipigs (29-52 kg) were conditioned to operate feeders with a precise food release per response and were then fed ad lib. The animals had up to 50% of their daily energy intake during the night. Meal size and time spent eating was highly correlated, meal size and the preprandial intermeal interval was moderately correlated, whereas meal size and the postprandial intermeal interval was not. Feeding facilitated defecation, supporting the assumption that the gastrocolonic response is present in the pig. The system has been shown to be highly reliable and valid, and thus provides an excellent tool for the investigation of the rhythmicity of ingestive and excretory behaviors in minipigs.

Animals↗

PubMed1995

Post-defecation handwashing in Bangladesh: practice and efficiency perspectives.

Inadequate handwashing after defecation and anal cleaning practices in the Indian subcontinent is an important source of faeco-oral transmission of enteric diseases. To better understand the process as traditionally practised, 90 women in semi-rural Bangladesh were observed washing hands after defecation. Several components of handwashing practices were identified: the cleaning agent, using left or both hands; frequency of rubbing hands, type and amount of water used to wash, and the drying of hands on the wearer's clothes. A subsequent experiment was conducted to assess the effect of currently practised handwashing and drying according to standardised procedure on faecal coliform count of hands. As a rubbing agent, soil was commonly used (40%); soap was used by 19% and was reported unaffordable by about 81% of the non-users. Good handwashing behaviour was positively associated with better social and economic indicators including education of the women observed. Both hands were unacceptably contaminated after traditional handwashing (the geometric mean count of left was 1,995 and right hand was 1,318 faecal coliform units/hand). After standardising the observed components of handwashing procedures the use of any rubbing agent, i.e. soil, ash or soap, produced similar acceptable cleaning. Use of a rubbing agent (e.g. soil, ash or soap), more rubbing (i.e. six times), rinsing with safer water (e.g. 2 litres of tubewell water) and drying with a clean cloth or in the air produced acceptable bacteriological results. Components of traditional handwashing practices were defined through careful observation, and experiments on handwashing with standardised components showed that efficient and affordable options for handwashing can be developed; this knowledge should be helpful in disease control programmes.

Bangladesh↗