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PubMed2001

Mecamylamine effects on haloperidol-induced catalepsy and defecation.

Recent clinical experience with Tourette syndrome (TS) patients suggests that the nicotinic receptor antagonist, mecamylamine (Inversine), may be a useful adjunct to neuroleptic therapy for controlling tic symptom. This is consistent with previous preclinical findings demonstrating that mecamylamine can potentiate the cataleptic effects of neuroleptics in rats. However, these earlier preclinical studies employed high doses (1-2.5 mg/kg) of mecamylamine that may not be clinically relevant since human doses of mecamylamine used to treat TS have been much lower (0.03-0.1 mg/kg). In order to test the potential therapeutic properties of mecamylamine preclinically, we conducted catalepsy experiments in rats employing both a low and high dose of mecamylamine in combination with haloperidol. Sixty-four male Sprague Dawley rats were randomized into four treatment groups (n = 16/group). Each rat received an injection of either saline or mecamylamine (0.1 or 3.0 mg/kg s.c.) followed one hour later with a second injection of either saline or haloperidol (0.4 mg/kg s.c.). The bar test was used to measure duration of catalepsy at 3 hrs following the second injection. The results demonstrated that only the mecamylamine treated rats showed statistically significant haloperidol-induced catalepsy when measured at 3 hrs. In addition, haloperidol-induced defecation was not affected by the 0.1 mg/kg mecamylamine dose, but completely abolished by the 3.0 mg/kg dose. These findings suggest that a clinically relevant dose of mecamylamine (0.1 mg/kg) can affect the duration of haloperidol-induced catalepsy without having significant effects on gastrointestinal function.

Animals↗

PubMedDate not supplied

Disorders of defecation and fecal continence.

Although fecal incontinence and disorders of defecation are not uncommon, these disorders are poorly understood by most physicians. Successful management requires an understanding of colorectal function, delineation of the problem and potential contributing factors, careful examination of the anorectal and pelvic floor areas, and psychosocial assessment. Specialized studies to evaluate colorectal function frequently help determine patterns of abnormality and may suggest appropriate therapeutic approaches. Therapeutic options include pharmacologic, behavioral, and surgical approaches, which often ameliorate symptoms and dramatically improve quality of life.

Constipation↗

PubMed1975

A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. The external anal sphincter: a triple-loop system.

Since anal sphincters are used as the continent sphincters in some urologic operations, a study of their anatomic structure and function seems necessary. The anatomy of the external anal sphincter has been studied in 18 cadavers by dissection and serial histologic sections. The muscle has been found to consist of a series of U-shaped loops which are distinguishible as three main "loops": top, intermediate, and base. The puborectalis and the deep portion of the external sphincter have been found to be one muscle which is given the name "top loop." No concentric circular muscle bundles could be detected at any level of the external sphincter except in the base loop. A new concept of the mechanism of action of the external sphincter in anal continence and during defecation is presented. An air-tight occlusion of the anal canal could be achieved by the "triple-loop system" of the external sphincter which compresses opposed alternating anal segments. An incomplete anal occlusion by a single loop contraction is completed and potentiated by the succeeding loop action. The last fecal portion is dispelled from the anal canal by a process of "vermicular contractions" which is the result of the loop arrangement of the muscle bundles. Single-loop continence has been discussed. It is suggested that unless all three of the loops are destroyed, any single loop can act as a sphincter which maintains continence to solid stools but not to fluid ones or flatus.

Adult↗

PubMed2002

[A case-control study of prevention of irinotecan-induced diarrhea: the reducing side effects of irinotecan by oral alkalization combined with control of defecation].

Irinotecan and its active metabolite, SN-38, were reported to have the absorption characteristics of weakly basic drugs. Moreover, stasis of these compounds is thought to induce damage to the intestinal mucous membrane. The purpose of this report was to examine whether oral alkalization (OA) combined with control of defecation (CD) might prevent irinotecan-induced side effects. From day one of irinotecan infusion to day four, OA & CD were practiced using orally administered sodium bicarbonate, magnesium oxide, basic water, and ursodeoxycholic acid. Thirty-two lung cancer patients were treated with irinotecan in combination with cisplatin in the absence of OA & CD (Group A). Thirty-seven patients matched for background characteristics were treated with the same regimen in the presence of OA & CD (Group B). Group B had a reduced incidence of delayed diarrhea (Grade 2 < or = Group A 32.3% vs. Group B 9.4%), nausea, vomiting, and myelotoxicity, especially granulocytopenia compared with Group A. In addition, dose intensification was well-tolerated in Group B. Tumor response rates for non-small cell lung cancer were 59.3% (16/27 patients) in Group B against 38.5% (10/26 patients) in Group A. OA & CD appears to reduce the irinotecan-induced side effects, especially delayed diarrhea. Risk factors statistically associated with delayed diarrhea include advanced age and the use of irinotecan without OA & CD.

Administration, Oral↗

PubMed1979

Effects of vagotomy on feeding and defecation in guinea pigs.

The effect of subdiaphragmatic vagotomy on food intake and defecation was studied in guinea pigs. Weights of food and feces were measured for at least three weeks after vagotomy. The weight of daily food intake and feces evacuated increased about 15 and 30% after vagotomy compared with controls whereas it did not change in sham operated animals. The weight of scybalum decreased after vagotomy although the number increased markedly. It was considered that an increase in food intake after vagotomy may result from blocking of satiety signals mediated by the vagus; moreover, that the increase in feces may depend on the enhancement of scybalum formation in the proximal colon resulting from increasing food intake and transportation of the larger amount of the contents after vagotomy.

Animals↗

PubMed2006

Cinedefecographic findings in patients with obstructed defecation sindrome. A study in 420 cases.

AIM: Obstructed defecation syndrome (ODS) represents a very common clinical problem. The aim of this study was to analyze the cinedefecographic findings in a group of patients with ODS. METHODS: All patients with ODS were prospectively introduced into a database and underwent cinedefecography (CD). The grade of the syndrome was assessed by a new ODS score. The validated Agachan-Wexner Constipation Score System was also used. Four lateral films were taken during resting, squeeze, pushing and postevacuation phases and puborectalis length (PRL), anorectal angle (ARA) and perineal descent were recorded and analysed. The presence of an increased fixed perineal descent (FPD) and dynamic perineal descent (DPD), mucosal rectal prolapse (MRP), recto-rectal intussusception (RRI), recto-anal intussusception (RAI), rectocele (RE), enterocele (ET) and sigmoidocele (SG) were also evaluated. RESULTS: Between February 2002 and March 2005, 420 patients, 404 (96.1%) females and 16 (3.8%) males with a mean age of 49+/-7.7 (range, 21-77) years, underwent CD. In 362 (86.2%) patients CD showed a combination of different cinedefecographic findings. RE, FPD and DPD in association with RAI or RRI were contemporary observed in 118 (26%) patients. MRP, RRI, FPD, RAI and RE were observed as singular finding in 21 (5%), 19 (4.5%), 12 (2.8%), 3 (0.7%) and 3 (0.7%) patients, respectively. In 6 (1.4%) patients a paradoxical contraction of the puborectalis muscle was observed. CONCLUSIONS: CD shows that ODS is largely caused by multiple patterns of different abnormalities of the rectum and pelvic floor. Any treatment in symptomatic patients could be designed to treat multiple combinations of different abnormalities.

Adult↗

PubMed1990

[Defecometry: determination of objective parameters of defecation].

A method is presented for the identification and analysis of constipation due to difficult evacuation of rectal content. This condition--which has not been elucidated by former techniques--was identified in 5 out of the 19 constipated patients by this new method. Disturbed defecation was characterized by prolonged evacuation of the simulated stool and the greater work performed during this process. The cause of this phenomenon was the paradox movement of the pelvic floor, i.e. contraction instead of relaxation. The results' highlight: the excessive straining can induce a neuromuscular damage to the pelvic floor. The clinical importance of this method lies in the clarification of the principle, that the therapy of this condition must be initiated as early as possible.

Constipation↗

PubMed1980

Anorectal manometry for evaluating defecation disorders.

Anorectal manometry is a valuable tool in the differential diagnosis of disorders of defecation. While especially useful in differentiating between functional constipation and Hirschsprung's disease and thus reducing in many children the need for barium enema and rectal biopsy, anorectal manometry can be a practical adjunct in the diagnosis and management of patients of all ages with constipation and/or fecal soiling due to a wide range of congenital and acquired disease.

Adolescent↗

PubMedDate not supplied

Defecographic evaluation of patients with defecation difficulties.

Defecographic studies were carried out in 36 females and 19 males with specific complaints of straining with defecation, incomplete rectal emptying and perineal descent. Of these, 91% had abnormal defecographic findings. Abnormalities were more common in females than in males. The female patients mean anorectal angles were 111.3 degrees (resting), 102.2 degrees (squeezing) and 124.7 degrees (straining). Their mean anterior rectocele size was 1.8 cm and the mean difference between the pelvic floor and the anorectal junction at rest and during maximal straining, the mean Ds-R, was also 1.8 cm. Ninety-one percent of the females had anterior rectoceles, 33% had internal rectal intussusception, 25% had hypertonic puborectalis slings and 22% had a Ds-R > 3 cm. The mean anorectal angles of the males were 116.3 degrees (resting), 102.0 degrees (squeezing) and 132.9 degrees (straining) and the mean Ds-R was 2.0 cm. Sixty-eight percent of the males had hypertonic puborectalis slings, 58% had internal rectal intussusception, and 42% had a Ds-R > 3 cm. All patients with hypertonic puborectalis slings had smaller, more acute straining angles. Males with abnormal perineal descent had a greater Ds-R than patients without perineal descent.

Adult↗

PubMed1993

[The defecation habits in a normal working population].

We have studied the bowel habits of a theoretically normal working population to know the range defecation patterns, characteristics and main factors that may influence it. We have designed a questionnaire composed of 80 questions and distributed to 837 people. Answers, were evaluated in 414 cases (187 men and 227 women), with a median age of 33 years (range 20-64 years). The average number of stools was 7.1 +/- 3.3 per week and in 62.4% of subjects they were between the range of 5 and 8. Bowel movements were less frequent in women than in men, and the same finding was seen about self-reported constipation; nevertheless there were no differences in regard to age. Laxatives were used regularly by 11.3%, and 36% referred straining at stool at least 25% of the time and 8.3% referred straining for loose stools. Alternating bowel function presented in 19.4% and functional abdominal pain in 28% with a female predominance. Faecal incontinence occurred in 6.8% of population; an important prevalence. We also analyse variables such as diet influence, physical activity, obstetrical, gynaecological and psychosocial factors. Although this survey has revealed that a normal bowel function is very variable, only a 7.5% of the subjects, consulted a doctor for bowel complaints.

Adult↗

PubMed1995

[What is the role of the pubococcygeal and puborectal muscles in patients with obstructive defecation disorders? An electromyography study].

BACKGROUND: We believe that the M. levator ani plays little or no role in obstructed defaecation, and that the concept of "paradoxical" puborectalis muscle activity is misleading. The main aim of the study was to investigate the function of the pubococcygeal muscle during simulated defaecation and to compare this with the electromyographic activity of the puborectal muscle. METHODS AND RESULTS: In a prospective electromyographic study of 18 women (average age 53 years) with obstructive defecation disorder the activity of the pubococcygeal muscle and the puborectal muscle was investigated at rest, during contraction and straining. The control group consisted of 18 healthy women with an average age of 54 years. The function of the pubococcygeal muscle and the puborectal muscle was largely the same in both, study and control group. No statistically significant differences in the amplitude were found between the two groups at rest during contraction and maximum strain. CONCLUSION: We therefore conclude that the increase in activity of the voluntary muscle of the pelvic floor observed on electromyography during defaecation does not indicate automatically a pathologic condition but is a possible functional state at this moment.

Adult↗

PubMed1997

Manometric evaluation of defecation disorders: Part II. Fecal incontinence.

Fecal incontinence is a silent affliction that often leads to self-imposed ostracism. For many years, a lack of understanding regarding its pathophysiology and a lack of empathy among many physicians has bedeviled this problem. However, during the last two decades, remarkable strides have been made, both in the evaluation and in the treatment of incontinence. These advances stem from the ability to perform a detailed and comprehensive assessment of anorectal physiology. Anorectal manometry has spearheaded this renaissance. Manometry is not a single test but consists of a series of measurements that include an assessment of anal sphincter function, rectal sensation, rectoanal reflexes, and rectal compliance. Electrophysiological assessments such as pudendal nerve terminal latency can provide additional information regarding neuromuscular integrity. Newer techniques such as vectography, saline continence test, impedance planimetry, and prolonged ambulatory anorectal manometry have added a new dimension to the overall assessment. Radiological tests such as defecography and anal endosonography can provide complimentary information. These tests of anorectal function have advanced immensely our understanding of the pathophysiological mechanisms that are responsible for fecal incontinence. Equipped with sound objective information, today, it is possible to treat most incontinent patients with novel treatments that include medical, biofeedback, or surgical therapies. This is the second article in a two-part evaluation of defecation disorders that discusses the manometric evaluation of fecal incontinence.

Adult↗

PubMed2006

Projections from bed nuclei of the stria terminalis, magnocellular nucleus: implications for cerebral hemisphere regulation of micturition, defecation, and penile erection.

The basic structural organization of axonal projections from the small but distinct magnocellular and ventral nuclei (of the bed nuclei of the stria terminalis) was analyzed with the Phaseolus vulgaris leucoagglutinin anterograde tract tracing method in adult male rats. The former's overall projection pattern is complex, with over 80 distinct terminal fields ipsilateral to injection sites. Innervated regions in the cerebral hemisphere and brainstem fall into nine general functional categories: cerebral nuclei, behavior control column, orofacial motor-related, humorosensory/thirst-related, brainstem autonomic control network, neuroendocrine, hypothalamic visceromotor pattern-generator network, thalamocortical feedback loops, and behavioral state control. The most novel findings indicate that the magnocellular nucleus projects to virtually all known major parts of the brain network that controls pelvic functions, including micturition, defecation, and penile erection, as well as to brain networks controlling nutrient and body water homeostasis. This and other evidence suggests that the magnocellular nucleus is part of a corticostriatopallidal differentiation modulating and coordinating pelvic functions with the maintenance of nutrient and body water homeostasis. Projections of the ventral nucleus are a subset of those generated by the magnocellular nucleus, with the obvious difference that the ventral nucleus does not project detectably to Barrington's nucleus, the subfornical organ, the median preoptic and parastrial nuclei, the neuroendocrine system, and midbrain orofacial motor-related regions.

Animals↗

PubMed1981

A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. XII. Anorectal mobilization: a new surgical access to rectal lesions. Preliminary report.

A new technique for the removal of inaccessible benign intrarectal lesions and malignant lower third rectal tumors with sphincter preservation is presented. The procedure was performed in eight patients, four with huge bilharzial papillomas and four with malignant lower third rectal tumors. The essential feature of the operation is preservation of the levator tunnel, which is responsible for maintaining normal, voluntary continence and defecation. The results were satisfactory. The technique provides easy access to the interior of the rectum, and it extends the indications for sphincter-saving operations to include malignant lower third rectal tumors. It is hoped that this procedure will eliminate the use of abdominoperineal excision in the treatment of rectal cancer.

Adult↗

PubMed2005

Radiographic findings of post-operative double stapled trans anal rectal resection (STARR) in patient with obstructed defecation syndrome (ODS).

Longo's procedure of double stapled trans anal rectal resection (STARR) has been evocated as surgical treatment of the obstructed defecation syndrome (ODS) in patients with rectal mucosal prolapse. The aim of this study was to investigate the post-interventional findings of this technique, to help radiologist in knowledge of the changed morphology of the rectal lumen, also in attempt to recognize some potential related complications.

Adult↗

PubMed1986

Disturbed defecation after colectomy for aganglionosis investigated with monoclonal antineurofilament antibody.

Experience with 108 neonates treated for aganglionosis at the Sophia Children's Hospital, Rotterdam, between 1975 and 1983 has been reviewed. Twenty two of them suffered from disturbed defecation postoperatively, involving 16 cases of classical Hirschsprung's, 4 long-segment aganglionosis, 1 case of aganglionosis up to the cecum, and 1 total aganglionosis. The monoclonal antineurofilament antibody NF2F11 was used to investigate ganglionated as well as aganglionic bowel specimens of these patients as well as 17 patients from the remainder without postoperative constipation serving as controls. The original diagnosis was confirmed in all cases. Proximal ganglionated bowel of all 17 controls appeared normal, while the antibody revealed normal bowel in only 4 out of the 22 patients with postoperative constipation. In 18 cases this new staining technique revealed the picture of pseudo-obstruction. Early recognition of pseudo-obstruction in proximal ganglionated bowel would provide early warning of postoperative complications.

Antibodies, Monoclonal↗

PubMed1996

Treatment of defecation disorders by colonic enemas in children with spina bifida.

Faecal incontinence and constipation are well known problems in children with spina bifida. Effective treatment can be difficult and this gave the condition a low priority despite the obvious physical and psychological sequelae. Positive experience with colonic enemas (CE) in the paediatric post-operative care have led us to adopt this method as the treatment of choice for defecation disorders in children with spina bifida. In 41 spina bifida children (mean age 8.4 years, range 7 months to 22 years), retrograde CEs with hand-warm tap water were given at home from once a day to twice per week. Satisfaction with the procedure was evaluated with a questionnaire sent out after a mean follow-up period of 33 months (range 6 to 55 months). The indications to start CEs were faecal incontinence (27%), constipation (27%) or both. 34% of 41 children also had other gastrointestinal complaints, 7% had headaches, 29% had poor appetite and 15% felt generally unwell. Before the start of CE 22% of the children had been on a diet, 37% on oral laxatives, 31% on a rectal laxative and 44% had to have manual evacuations. 90% used diapers on a daily basis. At the end of the follow-up period 27% of the children were still on a diet and 17% still used oral laxatives but rectal laxatives were no longer used nor were manual evacuations necessary. 66% of the 41 children were completely faecally continent and constipation occurred only occasionally, no child had faecal retention or impaction. At follow-up 39% still used diapers regularly and 20% used a panty-line and complaints of abdominal pain, headache and poor appetite were rare. Satisfaction with the procedure was rated highly by 63% of parents and children and good by 37% but 15% of the children found regular CEs painful. It is concluded from the study that CEs are therapeutically effective in the treatment of both faecal incontinence and constipation in children with spina bifida. The procedure is well tolerated even by very young children. Long-term histopathological effects of daily CEs on the lower gastrointestinal tract needs to be evaluated by future research.

Adolescent↗

PubMed1979

Disorders of defecation in children: evaluation and management.

In a series of 123 children with disorders of defecation, constipation was the main problem in 89 and fecal incontinence in 34. All but three of the latter also had constipation. The principal physical findings were abdominal protuberance with palpable stool in the bowel and the presence of a fecal mass in the rectal ampulla. Laboratory and radiologic findings were nonspecific except in two of the three patients found to have congenital megacolon (Hirschsprung's disease). Rectal suction biopsy, performed in 69 patients, was diagnostic in all three with Hirschsprung's disease. Anorectal manometry, done in 11 patients, was of limited value. In general, treatment consists of patience and understanding on the part of physician and family, a regimen of orally administered (noncathartic) laxatives with dose gradually reduced over weeks to months, frequent telephone communication between physician and parents, and occasional office visits. Patients with nonretentive fecal incontinence require an intensive psychologic approach. A patient, empathetic, and available physician is one of the most important ingredients in the treatment regimen.

Adolescent↗