SEARCH · PubMed Health

Results for “DEFECATION”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 37 records · Page 2Linked to original sources

PubMed2001

Electromyography of the pelvic floor musculature in the assessment of obstructed defecation symptoms.

PURPOSE: The purpose of this study was to use electromyography to examine the behavior of the external sphincter, puborectalis muscle, and pubococcygeus muscle during attempted defecation in patients with symptoms of obstructed defecation and in normal subjects to highlight differences of clinical significance. METHODS: A total of 35 patients (31 females) aged 20 to 80 (mean, 53.7 +/- 13.3) years with unprepared bowel who had normal colon transit time and obstructed defecation symptoms and 12 voluntary control subjects (7 females) aged 23 to 68 (mean, 48 +/- 11.5) years underwent an electromyography evaluation of the activity of the external sphincter, puborectalis muscle, and pubococcygeus muscle during attempted defecation. The patients were also examined in separate sessions with defecography and anal manometry. RESULTS: During attempted defecation, puborectalis muscle and external sphincter always reacted in the same manner. When evaluated with pubococcygeus muscle, three main patterns of activity were observed either in patients or in controls: 1) coordinated activation pattern; 2) coordinated inhibition pattern; and 3) uncoordinated or equivocal pattern: activation of pubococcygeus muscle with inhibition of puborectalis muscle/external sphincter, activation followed by inhibition of the three muscles, and activation followed by inhibition of pubococcygeus muscle and no change in the others. We never observed activation of puborectalis muscle/external sphincter concomitant with inhibition of pubococcygeus muscle. The inhibitory coordinated pattern occurred significantly (P = 0.01) more frequently in controls than in patients. These subjects also presented a significantly (P = 0.01) lower frequency of pubococcygeus muscle inhibition. CONCLUSIONS: Either activation or inhibition appears as a physiological behavior, possibly adopted in different circumstances, of the pelvic floor muscles during attempted defecation. The higher prevalence of coordinated inhibitory patterns in normal subjects and the lower frequency of pubococcygeus muscle inhibition in patients with symptoms of obstructed defecation, however, suggests that a loss of inhibition capacity progressing from pubococcygeus muscle to puborectalis muscle/external sphincter muscles could determine the insurgence of obstructed defecation symptoms in some subjects, who should therefore benefit from biofeedback retraining aimed at reacquisition of the inhibition capacity of all muscles of the pelvic floor during defecation.

Adult↗

PubMed2001

Electrical impedance, a sensory system for detection of rectal filling after anorectal reconstruction: experimental study of rectal impedance measurements and defecation in dogs.

BACKGROUND: Total anorectal reconstruction with dynamic graciloplasty is an alternative to a permanent colostomy; however, perfect continence cannot be achieved because of loss of sensitivity. This study was designed in dogs to determine whether monitoring of rectal electric impedance can give information about fullness or motility of the rectum. METHODS: Four adult female beagle dogs underwent rectal electric impedance measurements using a bipolar electrode implanted on the rectal wall. An alternating current of 1 microA at a frequency of 4 kHz was applied between the two wires. Variations of impedance (called impedance waves), defecations, and weight of stools were recorded and analyzed. RESULTS: The basal rectal impedance was 682+/-19 omega. During the period of observation (n = 4), 84 impedance waves (amplitude, 72+/-2 omega; duration, 58+/-11 minutes) were observed and 33 defecations (weight of stools, 74+/-6 g) occurred. Four types of impedance waves were identified and classified into two groups: low-amplitude or short-duration waves (Types I, II, and III), and high-amplitude and long-duration waves (Type IV). Frequency of defecation was associated with the amplitude of the waves. The weight of stools was correlated with the duration of the waves (r = 0.574, n = 27, P = 0.002). Types I, II, and III waves were correlated with eventual partial defecations, whereas Type IV waves were correlated with complete defecations. After defecation, no spontaneous new defecation occurred before recovering at least 80 percent of the basal impedance. CONCLUSIONS: Rectal impedance variations are correlated with defecation in a canine model, and single bipolar measurements provide a suitable evaluation of rectum fullness. This suggests the possible use of impedance signals to control electrostimulated graciloplasty after anorectal reconstruction.

Anal Canal↗

PubMed1993

Eating lowers defecation threshold in pigs through cholinergic pathways.

The effect of atropine on defecation threshold was compared to placebo pre- and postprandially in four 20- to 30-kg pigs. Stepwise balloon distention was performed 10 cm from the anal verge with a 5-cm latex balloon. Volume was increased in steps of 10 ml up to 200 ml of air or until the balloon was defecated (defecation threshold). Dependent measures were balloon volume, rectal pressure, rectal compliance, and an index of distention-induced contractile activity. Under placebo conditions, the volume and pressure to elicit defecation were significantly lower after feeding (p < 0.05). The distention-induced contractile activity significantly increased near the defecation threshold, but pre- and postprandial conditions were not different. No differences were seen between pre- and postprandial rectal compliance curves. Atropine abolished the postprandial decrease in defecation threshold, but did not affect rectal compliance. The increase in contractile activity at defecation threshold seen with placebo was abolished by atropine. These results show that eating lowers the defecation threshold in terms of distention volume and rectal pressure, and demonstrate that these changes are mediated through cholinergic pathways.

Animals↗

PubMed2001

Phenotypic and suppressor analysis of defecation in clk-1 mutants reveals that reaction to changes in temperature is an active process in Caenorhabditis elegans.

Mutations in the Caenorhabditis elegans maternal-effect gene clk-1 affect cellular, developmental, and behavioral timing. They result in a slowing of the cell cycle, embryonic and postembryonic development, reproduction, and aging, as well as of the defecation, swimming, and pharyngeal pumping cycles. Here, we analyze the defecation behavior in clk-1 mutants, phenotypically and genetically. When wild-type worms are grown at 20 degrees and shifted to a new temperature, the defecation cycle length is significantly affected by that new temperature. In contrast, we find that when clk-1 mutants are shifted, the defecation cycle length is unaffected by that new temperature. We carried out a screen for mutations that suppress the slow defecation phenotype at 20 degrees and identified two distinct classes of genes, which we call dsc for defecation suppressor of clk-1. Mutations in one class also restore the ability to react normally to changes in temperature, while mutations in the other class do not. Together, these results suggest that clk-1 is necessary for readjusting the defecation cycle length in response to changes in temperature. On the other hand, in the absence of clk-1 activity, we observe temperature compensation, a mechanism that maintains a constant defecation period in the face of changes in temperature.

Animals↗

PubMed1987

Defecation dynamics and behavior profiles in encopretic children.

The social competence and behavioral profiles of 38 encopretic children were evaluated, and the social competence and behavioral ratings were correlated with physiologic abnormalities found during anorectal manometric and EMG evaluation and with treatment outcome. When defecation was studied, 66% of encopretic children were not able to defecate rectal balloons and 63% were not able to relax the external anal sphincter during defecation attempts. Total social competence and behavior problem scores were not different for boys able and unable to defecate balloons. Total social competence scores were significantly lower in girls unable to defecate balloons than in those able to (P less than .006), whereas behavior problem scores were similar in girls able to and unable to defecate. We found that persistence of encopresis at 6-month and 12-month follow-up was not related to the social competence (P greater than .2) or behavioral scores (P greater than .2) but was significantly related to the inability to defecate (P less than .01) and to the inability to relax the external sphincter during defecation attempts (P less than .03).

Anal Canal↗

PubMed1986

Defecation syncope. A symptom with multiple etiologies.

To our knowledge, there is no previous clinical description in the literature of patients with defecation syncope. We evaluated 20 patients with this disorder who were a subgroup of a larger, prospective study of syncope, 13 women and seven men, with a mean age of 59 years. Eleven patients had had one episode and nine had experienced multiple episodes. Fourteen patients were recumbent before the urge to defecate, nine of these asleep. The diagnostic evaluation disclosed that two patients had gastrointestinal tract problems, three had cardiac diseases, and one had transient ischemic attacks. Three additional patients had marked orthostatic hypotension. No identifiable cause for defecation syncope was found in 11 patients, but new medical problems were noted in four of those patients. In follow-up at two years, syncope had recurred in ten patients, but the majority of recurrences were unassociated with defecation. Seven patients died during the follow-up period of underlying chronic diseases. We conclude that defecation syncope is not a single distinct clinical entity. Multiple pathologic abnormalities in association with physiologic changes during sleep and defecation may contribute to syncope. Patients with defecation syncope should undergo a careful evaluation for diagnosis of underlying illness causing syncope.

Adult↗

PubMed1987

Haloperidol-induced emotional defecation: a possible model for neuroleptic anxiety syndrome.

The neuroleptic haloperidol was found to produce increased defecation in laboratory rats when tested in well habituated environments. It is well known that haloperidol induces catalepsy through antagonism of striatal dopaminergic receptor mechanisms. When another cataleptic agent, morphine, was tested, no significant increases in defectation were detected. Another study focused on the possible role of peripheral dopamine receptor sites within the gastrointestinal tract on neuroleptic-induced defecation. When the peripheral dopamine receptor antagonist domperidone was tested, no significant differences in fecal elimination were recorded. Thus, it appeared that the cataleptic state per se, or the peripheral effects of haloperidol did not seem to be responsible for the increased defecation. Defection is often used as an index of emotionality. The fact that this measure increased following administration of a major tranquilizer suggested the need to study more directly the relationship of this phenomenon of defecation with the affective state of the animal. In a control study it was found that the antianxiety agent benzodiazepam did not by itself influence defecation. However, those animals which were pre-injected with diazepam followed by haloperidol did not show increased defecation. Thus under certain circumstances, normal rats given haloperidol show "emotional defecation" which seems to reflect increased anxiety. This finding may serve as a basis for the development of an animal model for some of the atypical side effects of major tranquilizers, such as akathisia, dysphoria, and neuroleptic anxiety syndrome.

Animals↗

PubMed2001

Rectal sensory perception in females with obstructed defecation.

PURPOSE: Parasympathetic afferent nerves are thought to mediate rectal filling sensations. The role of sympathetic afferent nerves in the mediation of these sensations is unclear. Sympathetic nerves have been reported to mediate nonspecific sensations in the pelvis or lower abdomen in patients with blocked parasympathetic afferent supply. It has been reported that the parasympathetic afferent nerves are stimulated by both slow ramp (cumulative) and fast phasic (intermittent) distention of the rectum, whereas the sympathetic afferent nerves are only stimulated by fast phasic distention. Therefore, it might be useful to use the two distention protocols to differentiate between a parasympathetic and sympathetic afferent deficit. METHODS: Sixty control subjects (9 males; median age, 48 (range, 20-70) years) and 100 female patients (median age, 50 (range, 18-75) years) with obstructed defecation entered the study. Rectal sensory perception was assessed with an "infinitely" compliant polyethylene bag and a computer-controlled air-injection system. This bag was inserted into the rectum and inflated with air to selected pressure levels according to two different distention protocols (fast phasic and slow ramp). The distending pressures needed to evoke rectal filling sensations, first sensation of content in the rectum, and earliest urge to defecate were noted, as was the maximum tolerable volume. RESULTS: In all control subjects, rectal filling sensations could be evoked. Twenty-one patients (21 percent) experienced no sensation at all in the pressure range between 0 and 65 mmHg during either slow ramp or fast phasic distention. The pressure thresholds for first sensation, earliest urge to defecate, and maximum tolerable volume were significantly higher in patients with obstructed defecation (P < 0.001). In each subject, the pressure thresholds for first sensation, earliest urge to defecate, and maximum tolerable volume were always the same, regardless of the type of distention. CONCLUSION: Rectal sensory perception is blunted or absent in the majority of patients with obstructed defecation. The observation that this abnormality can be detected by both distention protocols suggests that the parasympathetic afferent nerves are deficient. Because none of the patients experienced a nonspecific sensation in the pelvis or lower abdomen during fast phasic distention, it might be suggested that the sympathetic afferents are also deficient. This finding implies that it is not worthwhile to use different distention protocols in patients with obstructed defecation.

Adult↗

PubMed2001

The gastrorectal reflex in women with obstructed defecation.

This study evaluated the tonic response of the rectum to a meal in women with obstructed defecation. Fifteen control subjects and 60 women with obstructed defecation were studied. Total colonic transit time was normal in 30 patients (group I) and prolonged in the other 30 (group II). After over-night fasting an "infinitely compliant" polyethylene bag was inserted into the rectum. Rectal tone was assessed by measuring variations in bag volume with a computerized electromechanical air injection system. After an adaptation period of 30 min all subjects consumed a 450-kcal liquid meal. Postprandial recordings were continued for 3 h. In a second recording session we investigated the tonic response of the rectum to an evoked urge to defecate. In a third session rectal sensory perception was assessed. Following the meal all controls showed an increase in rectal tone (mean 74.8 +/- 17%). Patients in whom colonic transit time was normal showed a similar tonic response. In group II the increase in rectal tone was significantly lower (mean 27.8 +/- 10%; P < 0.001). Three patients of this group showed no response to a meal at all. All controls showed an increase in rectal tone during an evoked urge to defecate (mean 39.2 +/- 9%). In both groups this tonic response was absent or significantly blunted (mean 15.3 +/- 6% and 16.4 +/- 5%, respectively; P < 0.001). In both groups rectal sensory perception was significantly impaired. In conclusion, patients with obstructed defecation in whom colonic transit time is normal have an intact gastrorectal reflex. The increase in rectal tone after a meal is absent or blunted in patients with obstructed defecation in whom transit time is prolonged. The tonic response of the rectum to an evoked urge to defecate as well as rectal sensory perception are significantly impaired both in patients with a normal and in those with a prolonged transit time.

Adolescent↗

PubMed2002

Relationship between lifestyle factors and defecation in a Japanese population.

BACKGROUND: There is a paucity of accurate data regarding any association in the general population between defecation and lifestyle factors such as diet, exercise, physique, and childbirth. AIMS OF THE STUDY: To evaluate the effects of such lifestyle factors on defecation among regional residents of Japan. METHODS: Residents (n = 1,699) of northern Japan, aged over 40 years, were surveyed in 1995 using a questionnaire to assess their lifestyle factors (diet, beverage consumption, exercise, physique, and childbirth), and examining their defecation status. We evaluated the relationship between these lifestyle factors and defecation using logistic regression analysis. The authors used four measures (defecation frequency, subjective defecation state, subjective fecal properties, and fecal consistency) and assigned the subjects to a group defined by their defecatory status: constipation, diarrhea, or normal, depending on the responses of the subjects to all four criteria. RESULTS: The tendency for constipation correlated positively with age in males ( p = 0.130), although this trend was not observed in females ( p = 0.641). Of the dietary factors examined, only rice, which accounts for the largest proportion of daily dietary fiber intake in Japan, demonstrated a preventive effect on constipation in both sexes ( p = 0.050 in males and 0.003 in females). Walking was a preventive factor for constipation among males ( p = 0.049), and alcohol also inhibited constipation among males ( p = 0.007). CONCLUSIONS: These results suggest that exercise, such as walking, and a high intake of dietary fiber, such as rice, were useful in the maintenance of defecation.

Adult↗

PubMed1991

Presynaptic dopaminergic neurotransmission mediates amphetamine-induced unconditioned but not amphetamine-conditioned locomotion and defecation in the rat.

A series of experiments were conducted to investigate the role of presynaptic dopamine (DA) and noradrenaline (NA) neurotransmission in stimulant-unconditioned and conditioned locomotion and defecation. (+)-Amphetamine (AMP, 1.5 mg/kg, s.c.) increased both locomotion and defecation in rats, and both of these effects were conditioned to environmental stimuli. Some groups of rats were treated with DSP4 (50 mg/kg, i.p.), a selective, long-lasting NA neurotoxin, given 7 days prior to conditioning with AMP. This treatment depleted forebrain NA to between 1% and 54% of control levels, depending on the brain region, but did not attenuate either AMP-unconditioned or conditioned locomotion. These results indicate that NA does not mediate either AMP unconditioned or conditioned locomotion. alpha-Methyl-para-tyrosine methyl ester (alpha MPT, 25-50 mg/kg, s.c.), a selective inhibitor of catecholamine synthesis given during conditioning with AMP, attenuated unconditioned AMP-induced locomotion and defecation but did not influence AMP-conditioned locomotion and defecation. Thus, alpha MPT blocked AMP-induced unconditioned locomotion, supporting the hypothesis that the locomotor and defecation stimulant effects of AMP are mediated by DA release. In spite of the attenuation of the direct effects of AMP, alpha MPT did not attenuate AMP-conditioned locomotion or defecation. It is concluded that AMP-induced release of dopamine is responsible for the unconditioned behavioral effects of amphetamine but not for the conditioning of amphetamine-induced locomotion and defecation.

3,4-Dihydroxyphenylacetic Acid↗

PubMed1987

Giant migrating contractions during defecation in the dog colon.

The colonic motor correlates of defecation were studied in 5 conscious dogs. A set of six strain-gauge transducers were implanted on the colon of each dog. An implanted cannula gave access to the terminal ileum. During a total control recording period of 230 h we observed 12 large-amplitude contractions that occurred spontaneously in the proximal colon and migrated caudad. We called them giant migrating contractions. The mean amplitude of these contractions was 2.8 times larger than the mean peak amplitude of phasic contractions during colonic motor complexes. The following stimuli were applied to induce defecation: 2 mg/kg guanethidine (i.v.), 30 micrograms/kg neostigmine (i.v.), 1-4 ml/kg castor oil (p.o.), 200 ml of 25% glucose (into ileum), and rectal distention by a balloon (120 ml). In 85% of experiments with guanethidine, neostigmine, glucose, and castor oil, giant migrating contractions occurred before defecation. The giant migrating contractions migrated over the entire colon or a part of its length. The migration velocity varied from 0.2 to 3.2 cm/s (mean +/- SE, 0.82 +/- 0.1 cm/s). In 11% of the experiments, giant contractions occurred almost simultaneously at different recording sites at the time of defecation. In 4% of the experiments giant contractions occurred only at a single site. Balloon expulsion was only rarely accompanied by giant contractions in the colon, and then occurred only at a distal site and did not migrate. We conclude that the colon has spontaneous but infrequent large-amplitude caudad-migrating contractions. These contractions may be the motor equivalent of mass movements. Defecation is usually preceded by colonic giant migrating contractions. The giant migrating contractions may provide a major force for defecation and be partially responsible for the evacuation of the colon during defecation. However, evacuation of contents such as a balloon seems to be possible without giant migrating contractions.

Animals↗

PubMed2004

Abnormal predefecatory colonic motor patterns define constipation in obstructed defecation.

BACKGROUND & AIMS: The pathophysiology of constipation in the syndrome of obstructed defecation is unknown. Using 24-hour pancolonic manometric recordings of the unprepared colon to record basal pressures and spontaneous defecation episodes, we tested the hypothesis that the frequency, timing, or spatial distribution of propagating colonic pressure waves is abnormal in patients with obstructed defecation. METHODS: In 11 patients with obstructed defecation and 16 healthy controls, pressures were recorded using a nasocolonic catheter that was positioned such that 16 recording sites spanned the unprepared colon at 7.5-cm intervals. RESULTS: The overall frequency of propagating sequences (PS) in the colon did not differ between patients and controls. When compared with controls, patients had a significant increase in the frequency of retrograde and antegrade PS (P < 0.05) in the left colon and a significant reduction in the amplitude of propagating pressure waves throughout the entire colon (P < 0.03). Defecation occurred in 6 of 11 patients and 9 of 16 controls. In the 15 minutes before defecation, controls showed a highly significant increase in frequency (P = 0.001) and amplitude (P = 0.01) of PS. In contrast, patients did not demonstrate this or the typical spatiotemporal organization of PS normally observed before expulsion of stool. CONCLUSIONS: Patients with obstructed defecation lack the normal predefecatory augmentation in frequency and amplitude of propagating pressure waves and lack the normal stereotypic spatiotemporal patterning of colonic pressure waves that would normally culminate in effective expulsion of stool.

Adult↗

PubMed1998

Involvement of the 5-HT3 receptor in CRH-induce defecation in rats.

We evaluated the possibility that serotonin (5-HT) mediates defecation induced by corticotropin-releasing hormone (CRH) exogenously administered or released from the central nervous system by stress via the 5-HT3 receptor in rats. Intracerebroventricular (i.c.v.) injection of CRH (1, 3, and 10 micrograms/rat) dose dependently increased the number of stools excreted in rats, whereas intravenous (i.v.) injection of up to 100 micrograms/kg CRH did not affect defecation. alpha-Helical CRH-(9-41) and 5-HT3 receptor antagonists ramosetron and azasetron inhibited CRH (10 micrograms i.c.v.)-induced defecation in a dose-dependent manner with ED50 values of 4.3 micrograms/kg i.v., 3.8 micrograms/kg p.o., and 70.4 micrograms/kg p.o., respectively. alpha-Helical CRH-(9-41) also inhibited CRH-induced defecation by i.c.v. injection with an ED50 value of 0.078 microgram/rat. In contrast, ramosetron and azasetron injected i.c.v. had no effect on CRH-induced defecation. alpha-Helical CRH-(9-41), ramosetron, and azasetron reduced defecation caused by restraint stress with ED50 values of 0.32, 3.6, and 19.7 micrograms/kg i.v., respectively. These results indicate that CRH exogenously administered or released from the central nervous system by stress peripherally promotes the release of 5-HT, which in turn stimulates defecation through the 5-HT3 receptor.

Animals↗

PubMed1992

[Activity of the respiratory muscles during natural defecation: a study on experimental animals].

Activity of the respiratory muscles during natural defecation was studied in two anesthetized and two decerebrate dogs. In anesthetized dogs, excitation of the abdominal muscles and an increase in gastric pressure were observed during defecation. However, pleural pressure was little influenced by such increase in abdominal pressure, maintaining the same rhythmic changes as observed during spontaneous respiration. The rhythmic changes in pleural pressure were associated with rhythmic activity of the diaphragm. When gastric pressure increased during defecation, the diaphragmatic activity also increased during both the inspiratory and expiratory phases. In a decerebrate dog, airflow and airway pressure changed similarly to during defecation. The diaphragm was continuously active, with superimposed rhythmic augmentation. In a paralyzed and artificially ventilated dog with open-chest, the phrenic nerve similarly developed discharges. We conclude that the non-respiratory activity and rhythmic augmentation of phrenic nerve discharge during defecation is pre-programmed in the command for defecation. The activity of phrenic motoneurons may be further modulated by changes in thoracic and abdominal pressure. These mechanisms may act together to coordinate respiration and defecation.

Anesthesia↗

PubMed1992

Painful defecation and fecal soiling in children.

Fecal soiling is a common complaint among school-age children. The fecal soiling is often accompanied by chronic constipation and so-called "idiopathic," "functional," or "psychogenic" megacolon, the cause of which is undetermined. The records of all children presenting to a pediatric gastroenterology clinic between 1981 and 1990 with difficult defecation were reviewed to determine the incidence of painful defecation and its relationship to chronic impaction and fecal soiling. There were 227 children; 74 were younger than 36 months of age and 153 were older than 36 months. Of the younger children, 86% presented with pain, 71% with impaction, and 97% with severe withholding. The younger children had painful defecation for a mean of 14 +/- 9 (SD) months before presentation. Of the older children, 85% presented with fecal soiling, 57% with pain, and 73% with fecal impaction, and 96% exhibited withholding; the older children had difficult defecation for a mean of 56 +/- 42 months before presentation. Sixty-three percent of the children presenting with fecal soiling had a history of painful defecation beginning before 36 months of age. Painful defecation frequently precedes chronic fecal impaction and fecal soiling in American children. Early, effective treatment of painful defecation in infancy might reduce the incidence of chronic fecal impaction and fecal soiling in school-age children.

Adolescent↗

PubMed2006

Defecation disorders: a French population survey.

PURPOSE: Despite frequent occurrence, functional defecation disorders and related conditions have been infrequently reported in population studies. This study was designed to assess symptoms, lifestyle-behavioral changes, and medical care seeking related to functional defecation disorders in a large household community survey. METHODS: A large household community survey was conducted in 10,000 individuals aged 15 years or older. A mailed questionnaire was used to assess ten common anorectal complaints; frequency, association, impact on quality of life, and medical care seeking were quantified. RESULTS: Evaluation was obtained in 7,196 patients (3,455 males). During the previous 12-month period, 2,097 patients (29.1 percent) experienced functional defecation disorders: outlet constipation and fecal incontinence were reported in 22.4 and 16.8 percent respectively. Compared with patients with no anorectal complaint, patients with functional defecation disorders had a different gender status (females, 63.3 vs. 47.6 percent; P<0.01). Based on symptom severity, functional defecation disorders were perceived as the main anorectal complaint in 1,192 patients. In this group, emptying difficulties, unsatisfied defecation, gas, and fecal incontinence occurred at least once per month in 71.6, 56.1, 77.9, and 49 percent respectively: 66.6 percent with outlet constipation and 85.6 percent with incontinence revealed impairment in quality of life. Incontinent patients more frequently avoided medical care than those complaining of outlet constipation (67.4 vs. 46.4 percent; P<0.01). CONCLUSIONS: Functional defecation disorders concerns at least one of four French individuals. Outlet constipation and fecal incontinence frequently occur in association. Despite a low rate of patients seeking care, symptoms often are severe and related to quality of life impairment.

Adult↗

PubMed2004

Midline rectovaginal fascial plication for repair of rectocele and obstructed defecation.

OBJECTIVE: To estimate the efficacy of midline fascial plication of the posterior vaginal wall in women with rectoceles and obstructed defecation. METHODS: Prospective evaluation of 38 consecutive women with symptomatic rectoceles (stage II or greater) and obstructed defecation included pre- and postoperative standardized pelvic floor questions, pelvic organ prolapse quantification measurements, validated bowel function questionnaires, defecating proctogram, and patient satisfaction. Reviews were conducted by nonsurgical coauthors. RESULTS: The median follow-up was 12.5 months (range 2.5-26 months). The subjective success rates were 97% (95% confidence interval [CI] 0.83-1.00%) at 12 months and 89% (95% CI 0.55-0.98%) at 24 months. The objective success rates were 87% (95% CI 0.64-0.96%) at 12 months and 79% (95% CI 0.51-0.92%) at 24 months. The average points, Ap and Bp, were significantly reduced from -0.1 (range -2 to 3) and 1.1 (range -1 to 8), preoperatively, to -2.6 (range -3 to -1) and -2.5 (range -3 to 0), postoperatively, respectively (P <.001). Depth of rectocele also reduced postoperatively on defecating fluoroscopy (P <.001). The correction of the anatomical defect was associated with improved functional outcome, with 33 women (87%) no longer experiencing obstructed defecation, and there was a significant reduction in postoperative straining to defecate, hard stools, and dyspareunia (P =.001). The improved anatomical and functional outcomes were reflected in the fact that 97% of the women reported very high patient satisfaction. CONCLUSION: Midline fascial plication is effective in correcting anatomical and functional outcomes associated with symptomatic rectoceles and obstructed defecation. LEVEL OF EVIDENCE: III

Adult↗