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PubMed2006

Colorectal motility and defecation after spinal cord injury in humans.

Following spinal cord injury, colorectal problems are a significant cause of morbidity, and chronic gastrointestinal problems remain common with increasing time after injury. Although many cord-injured patients achieve an adequate bowel frequency with drugs and manual stimulation, the risk and occurrence of fecal incontinence, difficulties with evacuation, and need for assistance remain significant problems. The underlying physiology of colorectal motility and defecation is reviewed, and consequences of spinal cord injury on defecation are reported. A discussion of present management techniques is undertaken and new directions in management and research are suggested. There is need for more intervention in regard to bowel function that could improve quality of life, but there is also a need for more research in this area.

Activities of Daily Living↗

PubMed2001

Effect of levator ani muscle contraction on urethrovesical and anorectal pressures and role of the muscle in urination and defecation.

OBJECTIVES: To investigate the effect of levator ani muscle (LAM) (the main muscle in the pelvic floor) contraction on the anorectal and urethrovesical pressures and elucidate its role in the mechanisms of defecation and urination. METHODS: In 18 healthy volunteers (10 men and 8 women; mean age 38.6 +/- 10.2 years), the LAM was stimulated to contract by a concentric needle electrode, and the anal, rectal, urethral, and vesical pressure responses were recorded. The test was repeated once after LAM anesthetization with Xylocaine injection and again after saline instead of Xylocaine injection into the LAM. RESULTS: On LAM stimulation, the anal and urethral pressures had a significant decline (both P <0.05), and the rectal and vesical pressures exhibited no significant changes (both P >0.05). The anal, rectal, urethral, and vesical pressures did not show significant changes on stimulation of the anesthetized LAM; after saline injection, the pressure response was similar to that before injection (P >0.05). These results were reproducible. CONCLUSIONS: LAM contraction lowers the anal and urethral pressures and appears to assist in the evacuation process. We therefore propose that the LAM is a muscle of evacuation and that LAM dysfunction could lead to defecation and urination disorders.

Adolescent↗

PubMed2001

Dyssynergic defecation.

Dyssynergic defecation is a common clinical problem that affects half of patients with chronic constipation. In many patients, there is a significant overlap with slow transit constipation. The chief underlying pathophysiologic mechanism is a failure of rectoanal coordination. By using a combination of history, prospective stool diaries, detailed clinical evaluation, and anorectal physiologic tests, it is possible to diagnose this problem. Controlled trials are under way to evaluate the efficacy of biofeedback therapy. Meanwhile, it is possible to treat most patients by using neuromuscular conditioning and biofeedback therapy. Further refinements in diagnostic criteria and in rehabilitation therapy programs should facilitate better diagnosis and treatment of patients with dyssynergic defecation.

Abdominal Muscles↗

PubMed2002

Reflex seizures induced by defecation, with an ictal EEG focus in the left frontotemporal region.

We report a 9-year-old boy with seizures induced by defecation. The episodes occurred 1-2 min after passing a bowel action and consisted of initial staring, gagging, and drooling followed by a secondarily generalized tonic-clonic seizure. The interictal EEGs were normal, but an ictal EEG with concurrent video monitoring demonstrated a polyspike wave discharge in the left frontotemporal region. There was no evidence of syncope, and the seizures did not occur while straining to empty his bowels or immediately on standing afterward. His magnetic resonance imaging scan was normal. This is the first reported case in which ictal EEG monitoring has demonstrated reflex seizures induced by defecation.

Child↗

PubMed1999

In-utero defecation: fact or fiction?

An experimental study was performed to investigate the gastrointestinal motility and in-utero defecation by radionuclide techniques. Forty-eight New-Zealand white rabbit fetuses at 25 days' gestation (fullterm, 31 to 32 days) were divided into two groups as A (n: 24) and B (n: 24). 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. This procedure was used for all fetuses and additionally surgical closure of anus by a purse string suture was performed in Group B fetuses. 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 reference organs (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 injected dose (uptake) per gram of tissue is calculated. 99mTc-HIDA was predominantly trapped by the liver via systemic circulation and excreted into the gastrointestinal tract in both groups through which it passed into the amniotic fluid only in Group A. The very low radioactivity levels detected in the amniotic fluid of Group B originated from urinary tract and indicated the in-vivo stability of 99mTc-HIDA, thus reliability of the experimental model. Intestinal transport of a radiopharmaceutical agent in both groups and demonstrated passage into the amniotic fluid only in Group A strongly suggest that fetal defecation is a physiologic event.

Amniotic Fluid↗

PubMed2003

Role of sympathetic innervation in the defecation mechanism: a novel concept of its function.

BACKGROUND/OBJECTIVE: Because the role of sympathetic innervation in the defecation mechanism is still vague and unidentified, this study was performed to investigate this issue. METHODS: The effect of individual administration of alpha- and beta-adrenoceptor blocking agents (3 mg/kg phentolamine mesylate and 1 mg/kg propranolol hydrochloride, respectively) and the effect of thoracolumbar sympathectomy on anal and rectal pressures was studied in 13 mongrel dogs. Pressures were measured by a 2-channel microtip catheter. Bilateral thoracolumbar sympathectomy was performed by excising the sympathetic ganglia from T11 to L2. Incremental rectal filling using a rectal balloon with simultaneous anal and rectal pressure measurements was continued until balloon expulsion was achieved. RESULTS: Rectal balloon distension with 30 to 40 mL of saline affected rectal pressure increase (P < 0.001 ), anal pressure decrease (P < 0.01), and balloon expulsion. Following administration of either phentolamine or propranolol or after thoracolumbar sympathectomy, rectal pressure declined (P < 0.05), but anal pressure showed no change (P > 0.05). At a rectal balloon volume of 50 to 60 mL of saline, rectal pressure increased (P < 0.001), anal pressure decreased (P < 0.01), and the balloon was expelled. CONCLUSION: Sympathetic rectal innervation may have a role during both the filling and evacuation phases of the defecation mechanism. During rectal filling, it most likely maintains rectal compliance. During evacuation in cases of rectal sympathetic block or denervation, a larger volume than usual of rectal distension is needed to induce rectal contraction and evacuation.

Adrenergic alpha-Antagonists↗

PubMed2004

IRI-1, a LIN-15B homologue, interacts with inositol-1,4,5-triphosphate receptors and regulates gonadogenesis, defecation, and pharyngeal pumping in Caenorhabditis elegans.

Inositol-1,4,5-triphosphate receptors (IP(3)Rs) are ligand-gated Ca(2+) channels that control Ca(2+) release from intracellular stores. They are central to a wide range of cellular responses. IP(3)Rs in Caenorhabditis elegans are encoded by a single gene, itr-1, and are widely expressed. Signaling through IP(3) and IP(3)Rs is important in ovulation, control of the defecation cycle, modulation of pharyngeal pumping rate, and embryogenesis. To further elucidate the molecular basis of the diversity of IP(3)R function, we used a yeast two-hybrid screen to search for proteins that interact with ITR-1. We identified an interaction between ITR-1 and IRI-1, a previously uncharacterized protein with homology to LIN-15B. Iri-1 is widely expressed, and its expression overlaps significantly with that of itr-1. In agreement with this observation, iri-1 functions in known itr-1-mediated processes, namely, upregulation of pharyngeal pumping in response to food and control of the defecation cycle. Knockdown of iri-1 in an itr-1 loss-of-function mutant potentiates some of these effects and sheds light on the signaling pathways that control pharyngeal pumping rate. Knockdown of iri-1 expression also results in a sterile, evl phenotype, as a consequence of failures in early Z1/Z4 lineage divisions, such that gonadogenesis is severely disrupted.

Amino Acid Sequence↗

PubMed1988

A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. XXXI. "Strainodynia": an etiopathologic study.

"Strainodynia" is the name I give to the excessive and exhaustive straining that may accompany defecation. Eighty-six patients with strainodynia were studied; the investigations comprised study of the stool character, proctoscopy, colonoscopy, barium enema, intestinal transit rate, EMG, manometry, and rectal biopsy. These patients were classified into 3 groups: band, diet, and levator strainodynia. The first, band strainodynia, more common in men, presented with a normal stool character. However, the rectal neck pressure was elevated, and a fibrous band could be demonstrated by a rectal neck biopsy. Bandotomy relieved the strainodynia. Diet strainodynia, more common in women, presented with stool frequency and weight less than normal. Rectal neck pressure was normal or elevated, and the rectosphincteric reflex was diminished. There was internal sphincter fibrosis. Improvement occurred after dietary management or internal sphincterotomy. Levator strainodynia was due to levator dysfunction syndrome. Stools were repeatedly obstructed at defecation despite normal stool character. Rectal neck pressure was elevated only on straining. There was reduced levator myoelectric activity. Levatorplasty cured the condition.

Adolescent↗

PubMedDate not supplied

Obstructed defecation.

Obstructed defecation is one of the causes of chronic constipation. Clinical tests suggest that patients with obstructed defecation have impaired pelvic floor function. Appropriate management relies on proper identification of the underlying pathophysiology.

Constipation↗

PubMedDate not supplied

An observational longitudinal study to evaluate miction, defecation, and sexual function after radical hysterectomy with pelvic lymphadenectomy for early-stage cervical cancer.

The objective of this study was to evaluate the problems with miction, defecation, and sexuality after a radical hysterectomy with or without adjuvant radiotherapy for the treatment of cervical cancer stage I-IIA. This study included an observational longitudinal study of self-reported bladder, defecation, and sexual problems with a baseline score. Ninety-four women were included in the study. An age-matched control group consisted of 224 women. The patients showed significantly more negative effects on sexual function compared with both the controls and their situation before the treatment throughout 24 months of follow-up. The problems included less lubrication, a narrow and short vagina, senseless areas around the labia, dyspareunia, and sexual dissatisfaction. Up to 12 months after the treatment, the patients complained significantly more of little or no urge to urinate and diarrhea as compared with the controls. Adjuvant radiotherapy did not increase the risk of bladder dysfunction, colorectal motility disorders, and sexual functions. We conclude that a radical hysterectomy for the treatment of early-stage cervical carcinoma is associated with adverse effects mainly on sexual functioning.

Adult↗

PubMed2005

Seizures manifesting as an urge to defecate, with an ictal discharge in the right hemisphere.

We report a 47-year-old right-handed woman with simple partial seizures manifesting in part as an urge to defecate shortly after a visual distortion. On at least one occasion, this was followed by head deviation to the left and a secondarily generalized tonic-clonic seizure. The ictal electroencephalogram lateralized to the right hemisphere, suggesting that the ictal urge to defecate may lateralize to this side.

Cerebral Cortex↗

PubMed1997

Biofeedback therapy for defecation disorders.

Biofeedback therapy is a useful adjunct to conventional treatment for many patients with refractory defecation disorders. This article provides an overview regarding the historical evolution of this treatment together with current perspectives regarding the principles and techniques of performing biofeedback therapy and an assessment of its outcome in adults and pediatric patients with defecation disorders.

Biofeedback, Psychology↗

PubMed1975

Psychosomatic aspects of defecation and its disturbances.

Constipation and diarrhea are usually defined in terms of frequency of defecation and consistency of stool. However, the subjective component in these symptoms is so great that the objective criteria cannot be satisfactory. An important additional aspect is provided by the analysis of sensations and postures in the three phases of the act of defecation (announcing, emptying, subsequent phase). Taking account of the subjective aspects may contribute to a better differentiation and classification not only of constipation and diarrhea but also of such disturbances as organic rectal disease and irritable colon.

Constipation↗

PubMed1983

Unstable angina pectoris--changes in the ST-T segment during daily activities such as bathing, eating, defecating and urinating.

The significance of positive ST-T changes during bathing, eating, defecating and urinating was studied in 103 patients with ischemic heart disease using Holter and 12-lead ECG. The incidence of positive ST-T changes was very high in patients with unstable angina (US) and in those with old myocardial infarction (OMI) associated with unstable angina. However, it was relatively low in angina-free OMI and extremely low in stable angina. Positive ST-T changes during defecation and urination were mostly (70% and 73%, respectively) seen from night to early morning. With regard to showering or eating, the incidence of positive ST-T changes was low during spraying hot water on the body without motion or remaining motionless after eating. It was not until light exertion was added that the incidence increased. However, pressure-rate product after such behavior did not always increase as compared with that before them. Consequently, it is suggested that the mechanism of anginal attack during urination may be similar to that of variant angina. With regard to showering or eating, it is considered that the spraying of hot water or food intake may bring about a change in the cardiac autonomic nerve tone, and that the addition of light exertion can easily induce myocardial ischemia which is not due to an increase in the oxygen demand of the myocardium.

Activities of Daily Living↗

PubMed2001

[Awareness of the health and defecation tendencies among college students by location of domicile].

In order to compare the food habits and defecation tendencies by region, a questionnaire survey was conducted of 1722 college women (18-20 years of age) living in Sapporo (146), Sendai (183), Osaka (1214), and Kumamoto (179). (1) When questioned about food habits, less than 58.5% of the respondents in the four groups considered their food intake to be sufficient to maintain their health. In regard to knowledge about their food intake requirements, the positive response was the highest in Sendai (85.8%), followed by Kumamoto (58.2%) and Osaka (50.9%) with the lowest in Sapporo (41.1%) (p < 0.01, among the four groups). (2) The students in Sendai, Osaka, Kumamoto and Sapporo, 96.2%, 93.5%, 92.9% and 92.5%, respectively, considered that constipation could affect their health (p < 0.05, among four groups). The percentage of those with regular bowel movements every day, tended to decrease in the order of Osaka (22.2%), Sapporo (21.2%) and Sendai (20.8%), with the lowest in Kumamoto (12.3%). Bowel movements of less than three times a week were reported by 24.7% in Sapporo, 24.0% in Sendai, 23.2% in Osaka and 22.3% in Kumamoto (p < 0.01, among the four groups). (3) Of those who defecated every day, in terms of time of day, the percentage was high between waking and after breakfast, with the highest percentage in Kumamoto (72.8%) and the lowest in Sapporo (61.2%) (p < 0.05, among the four groups). For subjects that responded that they should have a bowel movement every day, the highest percentage was in Osaka (91.0%) and the lowest was in Sapporo (83.9%) (p < 0.05, among the four groups).

Adolescent↗

PubMed1996

Defecation induced deep venous thrombosis. A case report.

While the risk of deep venous thrombosis (DVT) during prolonged fights is well recognized, we present the case of a 54-year-old male who suffered a deep venous thrombosis following defecation. Defecation, through a combination of the Valsalva maneuver and squatting, led to a DVT due to venous stasis, most marked in the left leg. Color-duplex scanning not only proved a convenient diagnostic tool but also allowed for monitoring and documentation of popliteal and saphenous vein recanalization. Being non-invasive and complication-free, color-duplex scanning should be considered for any patient in whom DVT is a possibility.

Angiography↗

PubMed2004

Feeding, defecation, and development times of Meccus longipennis Usinger, 1939 (Hemiptera: Reduviidae: Triatominae) under laboratory conditions.

Aspects related to hatching, time-lapse between presenting the blood-meal and beginning of feeding, feeding time, postfeed defecation delay, mortality, and fecundity for each stage of Meccus longipennis life-cycle were evaluated. The bugs were maintained in a dark incubator at 27 1 C and 80 5% rh, were fed weekly and checked daily for ecdysis or death. The hatching rate observed for 300 eggs was 76.7% and the average time of hatching was 19.8 days. Mean time-lapse between presentation of the blood meal and the beginning of feeding was under 5 min in nymphal stages and postfeed defecation delay was under 10 min in most stages, except in fourth and fifth stages. Mean feeding time was longer than 10 min in most stages, except in fourth stage. One hundred thirty-one nymphs (N) (65.5%) completed the cycle and the average time from NI to adult was 192.6 34.8 days. The average span in days for each stage was 18.1 for NI, 21.4 for NII, 29.5 for NIII, 45.5 for NIV and 55.9 for NV. The number of bloodmeals at each nymphal stage varied from 1 to 5. The mortality rate was 3.29 for NI, 6.8 for NII, 2.92 for NIII 3.76 for NIV, and 10.16 for NV nymphs. The average number of eggs laid per female in a 9-month period was 615.6. Based on our results, we conclude that M. longipennis has some biological and behavioral characteristics which influence its capacity of becoming infected and transmitting Trypanosoma cruzi to human populations in those areas of Mexico where it is currently present.

Animals↗

PubMed1996

Is constipation a disorder of defecation or impaired motility?: distinction based on defecography and colonic transit studies.

OBJECTIVE: The purpose of this study was to determine whether constipation is a disorder of defecation or of impaired motility by using defecography and transit studies. MATERIALS AND METHODS: Thirty-five patients (34 women, one man) with severe constipation underwent defecography and colonic transit studies in a 2-month period. Transit studies included the use of orally administered radiopaque markers and plain abdominal radiographs obtained up to 4 days later. Fluoroscopically guided defecography was performed with barium paste introduced into the rectum. RESULTS: Normal colonic transit time was observed in seven (20%) of the 35 patients. Abnormal findings included colonic inertia in six (17%) patients, hindgut dysfunction in 10 (29%) patients, and outlet obstruction in 12 (34%) patients. Rectocele, enterocele, descending perineum syndrome, and dyskinetic puborectalis were found equally in both groups of patients. Rectal prolapse was more commonly found in patients with hindgut dysfunction and outlet obstruction (p < .05). CONCLUSION: Surgical or medical management of severely constipated patients relies on objectively identifying the underlying pathophysiology. Our findings suggest that constipation is often a disorder of defecation rather than an impairment of colonic motility.

Adolescent↗