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At least 145 records · Page 8Linked to original sources

PubMed2000

Treatment of impaired defecation associated with rectocele by behavorial retraining (biofeedback).

PURPOSE: Large rectoceles have been associated with symptoms of impaired rectal evacuation, often leading to rectocele repair. However, these symptoms, or the anatomic abnormality, may be caused, at least in part, by a primary disturbance of rectoanal coordination. This study aimed to determine the efficacy of biofeedback therapy in such patients. METHODS: Thirty-two female patients (median age, 52 years) complaining of impaired rectal evacuation and with a rectocele greater than 2 cm at proctography were evaluated by structured questionnaire before, immediately after treatment, and at follow-up. Physiologic and proctographic findings were related to outcome. RESULTS: Immediate results were available in 32 patients and medium-term follow-up (median, 10; range, 2-30 months) in 25 patients. At follow-up 14 (56 percent) patients felt a little and 4 (16 percent) patients felt major improvement in symptoms, including 3 (12 percent) with complete symptom relief. Immediately after biofeedback there was a modest reduction in need to strain (from 72 to 50 percent), feeling of incomplete evacuation (from 78 to 59 percent), need to assist defecation digitally (from 84 to 63 percent), and need to use an evacuant (from 47 to 28 percent), and this was maintained at follow-up. Bowel frequency was significantly normalized at follow-up (P = 0.02). Pretreatment presence of symptoms of digitally assisting defecation, pelvic floor incoordination, and proctographic rectocele size and contrast trapping, did not predict outcome. CONCLUSIONS: Behavioral therapy, including biofeedback, leads to major symptom relief in a minority, and partial symptom relief in a majority, of patients with a feeling of impaired defecation and the presence of a large rectocele. Residual symptoms are common. Biofeedback may be a reasonable first-line treatment for such patients.

Adult↗

PubMed2000

Defecation problems in children with Hirschsprung's disease: a biopsychosocial approach.

Although most patients with operated Hirschsprung's disease (HD) have good continence in adulthood, a majority have postoperative defection problems during school age. Persistence of chronic constipation and/or incontinence may have considerable consequences for psychosocial development, parent-child interactions, quality of life, and the child's general condition. Considering these consequences, it is important to treat these problems as early as possible. From a biopsychosocial view, we developed a multidisciplinary treatment aimed at resolving defecation problems by teaching the child bowel self-control, primarily by training optimal defecation skills and subsequently toilet behavior. This treatment, carried out by a child psychologist, a pediatric physiotherapist, and a pediatric surgeon, consists of five steps: explanation; extinction of fear and avoidance behavior; learning new defecation behavior; learning an adequate straining technique; and generalization toward daily life. The effect of the treatment was investigated retrospectively in 16 boys with operated HD. The children improved significantly in all aspects during treatment, suggesting that multidisciplinary treatment can significantly reduce the postoperative chronic bowel problems of most children with operated HD. The treatment was as effective in young children (2-5 years) as in older children (5-14 years).

Adolescent↗

PubMed1995

Schedule-induced defecation: a demonstration in pigeons exposed to fixed-time schedules of food delivery.

Previous studies have found that defecation increases in rats exposed to intermittent schedules of food delivery. In the present study, food-deprived pigeons were exposed to fixed-time 30-, 60-, 120-, and 240-s schedules of food delivery. For the subjects as a group, significantly more defecation (indexed by fecal weight) occurred under the fixed-time 60-s schedule than during massed-food control sessions in which an equivalent amount of food was presented. Thus, the present findings suggest that schedule-induced defecation occurs in pigeons.

Animals↗

PubMed2002

[Anal sphincter-CT and dorsal sphincteropexy - a new approach in therapy of obstructive defecation disorder].

The dysplasia of anal sphincter represents an obstructive defecation disorder. The disease is known as "anterior displaced anus" in pediatric surgery. An anorectal malformation with missing dorsal osseous fixation of the sphincter complex is the underlying cause. Beyond clinical symptoms and examination result (anterior displaced anus with palpable dorsal gap) the defect can be visualized by computered tomography. A surgical correction is possible by the simple intervention of dorsal sphincteropexy. In our trial with 48 patients (male n = 12, female n = 36, mean age 51 +/- 17 years, follow-up in 39 patients) a significant improvement of defecation could be achieved in 46 % of the patients. In correlation to a good clinical outcome a significant reduction in the defecation score was observed. 10 % of the patients had only small changes in symptoms. However, the proportion of dissatisfied patients was relatively high with 44 %. In this group patients with long-standing chronic constipation and laxative abusus were found more often and the rate of previous anal or abdominal surgery was quite higher. Dissatisfied patients showed a higher variation in symptoms of pelvic floor disorders (e. g. anal pain syndrome) besides the rectal evacuation disorder. In addition to the heterogenity of symptoms chronic alterations of pelvic floor structures might create worse results in patients with chronic constipation. In spite of a lot of publications dealing with the functional anatomy of the pelvic floor only a few investigations on the dorsal sphincter dysplasia in patients with rectal evacuation disorder are found in the literature. Further investigations on this disorder are necessary.

Adolescent↗

PubMedDate not supplied

[Defecation disorders. Characteristics of manometric studies and rehabilitation].

The authors review the literature and their personal experience about the systematic exploration of defecation disorders by anorectal manometry and colpocystodefecography. They stress the importance of combining functional and morphological evaluation, in order to avoid inappropriate surgery. Concerning anorectal manometry, the determination of the smallest volume of rectal distention inducing a complete relaxation of the internal anal sphincter was found more useful than the maximal tolerable volume in the exploration of defecation disorders. Finally, the authors report the results of biofeedback conditioning prescribed in 30 patients (27 women, 3 men, mean age: 55 years) with defecation disorders (terminal constipation in 21, fecal incontinence in 9 patients). Several characteristics of anorectal manometry and of defecography were significantly improved after biofeedback conditioning.

Adult↗

PubMed1989

Management of defecation in spina bifida.

The main presenting complaint in defecational disorders in spina bifida is constipation. The principal cause of this complaint is hypofunction or paralysis of muscles in the pelvic floor as a result of the spinal cord injuries. To evaluate the present status of defecation, anorectal manometry with special reference to the anorectal pressure profile has been useful. The possibility of using anorectal manometry for the research of anorectal movement and participation of spinal cord was discussed.

Anal Canal↗

PubMed1995

The use of an ileostomy connector to diminish the frequency of defecation prior to ileostomy closure in patients with a pelvic pouch.

A new method for allowing stool passage into the pelvic pouch before ileostomy closure to verify the defecation state and diminish stool frequency is reported herein. This was accomplished by fitting an ileostomy connector connecting the proximal and distal openings of the diverting loop stoma. The ileostomy connector was initially in place for 6 h a day, the length of time being gradually increased until it was able to be left in for 24 h a day over a 3-month period. The calculated daily frequency of stools decreased from 24 to 6 or 7 times, and the mean daily frequency immediately after ileostomy closure was 6.5 times. Physiological study also showed an improvement, with squeeze pressure increasing from 35 cmH2O to 116 cmH2O and the maximum tolerated volume increasing from 35 ml before, to 90 ml 3 months following the use of an ileostomy connector. Thus, we conclude that an ileostomy connector may be useful to predict postoperative functional outcome and its complications, and to diminish the frequency of defecation before ileostomy closure in patients with a covering loop stoma.

Adult↗

PubMed1984

Treatment of solitary rectal ulcer syndrome with high-fiber diet and abstention of straining at defecation.

Twenty-one patients with a solitary ulcer of the rectum were treated with instructions for a high-fiber diet and abstention of straining at defecation, since there is evidence that the solitary ulcer syndrome is caused by chronic mechanical and ischemic trauma, by hard stools, and intussusception of the mucosa. In 15 patients disappearance of symptoms and complete ulcer healing was obtained in an average period of 10.5 months (range 2.5-21 months). In the other six patients the lesions remained unchanged. The results demonstrate that softening of stools and normalization of defecation habits should be the mainstay in the treatment of this otherwise chronic disorder with poor healing tendency.

Adolescent↗

PubMed1990

Streamlining the management of defecation disorders.

Obstinate constipation is a frequent but elusive gastrointestinal symptom. Increased understanding of defecation physiology and recent availability of simple, ready-to-use tools have increased specificity of both diagnosis and treatment. This patient series includes over 700 severely constipated patients with over 70 percent overall therapeutic success. Cinedefecography, pelvic floor electromyography, and determination of rectoanal inhibitory reflex were performed with simple and readily available equipment to document outlet anatomy and dynamics. Colonic transit time was examined in patients whose defecography and electromyography results were nondiagnostic and/or whose response to medical management was suboptimal, using a commercially available marker capsule, followed by abdominal x-rays. Retention of markers throughout the colon suggested colonic hypomotility or "inertia"; rectosigmoid retention confirmed functional outlet obstruction. With careful history, physical examination, and exclusion of organic causes, orderly application of readily available techniques can afford rapid, objective, and anatomically specific evidence upon which treatment of disordered defecation may be based.

Cineradiography↗

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↗

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↗