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Journal of Paediatrics and Child Health Apr 2019
Review
Topics: Bathroom Equipment; Cultural Evolution; Defecation; Disgust; Female; Global Health; Humans; Hygiene; Male; Needs Assessment; Poverty; Sanitation
PubMed: 30957335
DOI: 10.1111/jpc.14296 -
Diseases of the Colon and Rectum Feb 2019
Topics: Defecation; Fissure in Ano; Hemorrhoids; Humans; Patient Reported Outcome Measures
PubMed: 30640840
DOI: 10.1097/DCR.0000000000001284 -
Techniques in Coloproctology Jan 2020
Topics: Anal Canal; Anus Diseases; Constipation; Defecation; Humans
PubMed: 31784854
DOI: 10.1007/s10151-019-02106-7 -
Zentralblatt Fur Chirurgie Aug 2019After successful implementation of sacral nerve stimulation in the treatment of fecal incontinence, the first cohort studies showed promising results for sacral... (Review)
Review
After successful implementation of sacral nerve stimulation in the treatment of fecal incontinence, the first cohort studies showed promising results for sacral neuromodulation in the treatment of conservative refractory chronic constipation and obstructed defecation. However, these results have not been confirmed with long-term data or with studies of the highest level of evidence. Randomised trials failed to show any difference between patients with and without sacral nerve stimulation. In the long term, many patients suffer from loss of efficacy or adverse events, leading to high explantation rates. On the basis of existing clinical trials, it cannot be concluded that sacral neuromodulation should be included in the treatment algorithm of chronic constipation and obstructed defecation. So far it is unclear whether and which patient cohort may benefit from sacral nerve stimulation. Therefore further trials are needed to identify possible selection criteria for sacral nerve stimulation in the treatment of chronic constipation and obstructed defecation. The aim of this narrative review is to give an overview of the existing literature on sacral nerve stimulation in chronic constipation and the subgroup of obstructed defecation.
Topics: Constipation; Defecation; Electric Stimulation Therapy; Fecal Incontinence; Humans; Lumbosacral Plexus; Treatment Outcome
PubMed: 31412417
DOI: 10.1055/a-0961-8054 -
Physiological Measurement Jun 2021Biomechatronics (bionics) is an applied science that is interdisciplinary between biology and engineering (mechanical, electrical and electronics engineering).... (Review)
Review
Biomechatronics (bionics) is an applied science that is interdisciplinary between biology and engineering (mechanical, electrical and electronics engineering). Biomechatronics covers a wide area and is probably best known in development of prosthetic limbs, vision aids, robotics and neuroscience. Although the gastrointestinal tract is difficult to study, it is particularly suited for a bionics approach as demonstrated by recent developments. Ingestible capsules that travel the tract and record physiological variables have been used in the clinic. Other examples include sacral nerve stimulators that seek to restore normal anorectal function. Recently, we developed a simulated stool termed fecobionics. It has the shape of normal stool and records a variety of parameters including pressures, bending (anorectal angle) and shape changes during colonic transit and defecation, i.e. it integrates several current tests. Fecobionics has been used to study defecation patterns in large animals as well as in humans (normal subjects and patient groups including patients with symptoms of obstructed defecation and fecal incontinence). Recently, it was applied in a canine colon model where it revealed patterns consistent with shallow waves originating from slow waves generated by the interstitial cells of Cajal. Furthermore, novel analysis such as the rear-front pressure (preload-afterload) diagram and quantification of defecation indices have been developed that enable mechanistic insight. This paper reviews the fecobionics technology and outlines perspectives for future applications.
Topics: Anal Canal; Animals; Bionics; Colon; Defecation; Dogs; Gastroenterology; Humans; Manometry; Rectum
PubMed: 34190049
DOI: 10.1088/1361-6579/ac023c -
Journal of Visceral Surgery Mar 2022Functional defecation disorders (FDDs) and fecal incontinence (FI) are common anorectal disorders often distressing and significantly add to the healthcare burden. They... (Review)
Review
Functional defecation disorders (FDDs) and fecal incontinence (FI) are common anorectal disorders often distressing and significantly add to the healthcare burden. They present with multiple, overlapping symptoms that can often obscure the underlying pathophysiology and can pose significant management dilemmas. A detailed history, stool diaries and visual scales of stool form, a careful digital rectal examination are needed to guide anorectal physiology tests. With high-resolution (3-D) anorectal manometry, anal ultrasonography, (magnetic resonance) defecography and imaging, and neurophysiological tests, it is possible to define and characterize the underlying structural and functional abnormalities more accurately. In this review, we present a succinct update on the latest knowledge with regards to the pathophysiology, diagnosis and management of FDDS, fecal incontinence and abnormalities of rectal capacity (i.e., megarectum, microrectum).
Topics: Anal Canal; Constipation; Defecation; Fecal Incontinence; Humans; Manometry; Rectum
PubMed: 35123906
DOI: 10.1016/j.jviscsurg.2021.12.004 -
Gut and Liver Jul 2018Anorectal disorders are common and present with overlapping symptoms. They include several disorders with both structural and functional dysfunction(s). Because symptoms... (Review)
Review
Anorectal disorders are common and present with overlapping symptoms. They include several disorders with both structural and functional dysfunction(s). Because symptoms alone are poor predictors of the underlying pathophysiology, a diagnosis should only be made after evaluating symptoms and physiologic and structural abnormalities. A detailed history, a thorough physical and digital rectal examination and a systematic evaluation with high resolution and/or high definition three-dimensional (3D) anorectal manometry, 3D anal ultrasonography, magnetic resonance defecography and neurophysiology tests are essential to correctly identify these conditions. These physiological and imaging tests play a key role in facilitating a precise diagnosis and in providing a better understanding of the pathophysiology and functional anatomy. In turn, this leads to better and more comprehensive management using medical, behavioral and surgical approaches. For example, patients presenting with difficult defecation may demonstrate dyssynergic defecation and will benefit from biofeedback therapy before considering surgical treatment of coexisting anomalies such as rectoceles or intussusception. Similarly, patients with significant rectal prolapse and pelvic floor dysfunction or patients with complex enteroceles and pelvic organ prolapse may benefit from combined behavioral and surgical approaches, including an open, laparoscopic, transabdominal or transanal, and/or robotic-assisted surgery. Here, we provide an update on the pathophysiology, diagnosis, and management of selected common anorectal disorders.
Topics: Anal Canal; Defecation; Defecography; Digital Rectal Examination; Disease Management; Humans; Rectal Diseases
PubMed: 29050194
DOI: 10.5009/gnl17172 -
The Permanente Journal 2017Atypical defecation habits are common and distressing for children and families and can have a major impact on quality of life. Often, no underlying factor can be... (Review)
Review
CONTEXT
Atypical defecation habits are common and distressing for children and families and can have a major impact on quality of life. Often, no underlying factor can be identified, and the defecation disorder is considered functional. Current interventions are not successful for up to 50% of children. We suggest this high failure rate may be caused by lack of consistency in descriptors of behavioral indicators for functional defecation problems. Most investigations and descriptors focus on general behavior. There are fewer reports concerning defecation-specific behaviors.
OBJECTIVE
To develop a thorough inventory of defecation-specific behaviors, providing a more informed foundation for assessment and intervention.
DESIGN
A systematic review of six common databases was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Reference lists of retained articles were screened for additional studies.
MAIN OUTCOME MEASURES
Content analysis was used to classify defecation-specific behaviors into 17 categories.
RESULTS
Our search yielded 2677 articles; 98 peer-reviewed publications were retained for full-text review, and 67 articles were included in the final qualitative synthesis. Although there is inconsistency in reported diagnostic criteria, stool withholding and manifesting pain on defecation are the most commonly reported defecation-specific behaviors. In the studies that included children with autism or attention-deficit/hyperactivity disorder, the defecation-specific behaviors were not unique to the diagnostic group.
CONCLUSION
Consistent use of established diagnostic criteria, along with use of behaviors identified through this review, lay a foundation for more effective interventions.
Topics: Adolescent; Child; Child Behavior; Child, Preschool; Constipation; Defecation; Encopresis; Fecal Incontinence; Female; Humans; Infant; Infant, Newborn; Male; Toilet Training
PubMed: 29035187
DOI: 10.7812/TPP/17-047 -
Digestive Diseases and Sciences Apr 2022
Topics: Anal Canal; Biofeedback, Psychology; Constipation; Defecation; Humans; Treatment Outcome
PubMed: 34129126
DOI: 10.1007/s10620-021-07097-w -
The American Journal of Emergency... May 2021
Topics: Aged, 80 and over; Defecation; Electrocardiography; Enema; Fecal Impaction; Female; Humans; Male; Non-ST Elevated Myocardial Infarction
PubMed: 33036857
DOI: 10.1016/j.ajem.2020.09.070