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Neurogastroenterology and Motility Dec 2022Functional defecatory disorders (FDD) are common among women. Despite the extensive research on peripheral mechanisms involved in FDD, the central-neural contribution to...
BACKGROUND
Functional defecatory disorders (FDD) are common among women. Despite the extensive research on peripheral mechanisms involved in FDD, the central-neural contribution to its pathophysiology remains poorly understood. We aimed to delineate specific supra-spinal regions involved in defecation and examine whether their activity, as measured by blood-oxygen-level-dependent (BOLD) signals, is different in FDD.
METHODS
We performed functional MRI (fMRI) with concurrent rectal manometry in 15 controls and 18 females with ROME III diagnosis of FDD. A block design was used and brain activation maps based on BOLD effect employing the generalized linear model were calculated for each subject. Statistical significance between groups was assessed by a Student t-test with cluster-based multiple comparisons correction (corrected p < 0.01).
KEY RESULTS
Simulated defecation was associated with activation of regions of primary and supplementary motor (SMA) and somatosensory cortices, homeostatic afferent (thalamus, mid-cingulate cortex, and insula), and emotional arousal networks (hippocampus and prefrontal cortex), occipital and cerebellum along with deactivation of right anterior cingulate cortex (ACC) in controls. Women with FDD had fewer regions engaged in defecation and BOLD activation was much decreased is areas related to executive-cognitive function (insula, parietal, and prefrontal cortices). Patients unlike controls showed activation in right ACC and otherwise had similar brain activation patterns during anal squeeze.
CONCLUSIONS & INFERENCES
Our results provide evidence that distinct differences exist in supra-spinal control of defecation in key regions of motivational-affective regulation and executive-cognitive function, in patients with FDD as compared to controls.
Topics: Humans; Female; Defecation; Magnetic Resonance Imaging; Manometry; Brain; Rectum
PubMed: 35478218
DOI: 10.1111/nmo.14389 -
Scandinavian Journal of Gastroenterology Feb 2021The aim of this study was to compare the effects of colonic electrical stimulation (CES) and prucalopride on gastrointestinal transit and defecation and to verify the...
OBJECTIVE
The aim of this study was to compare the effects of colonic electrical stimulation (CES) and prucalopride on gastrointestinal transit and defecation and to verify the safety of CES in a canine model of constipation.
METHODS
Eight beagles received CES implantation and induction drugs for slow transit constipation (STC). In the STC model, the gastrointestinal transit time (GITT), colonic transit time (CTT), stool frequency and stool consistency were assessed to compare the effects of CES and prucalopride on gastrointestinal transit and defecation. The histocompatibility of the implantable device was evaluated.
RESULTS
The individualized parameters for CES varied greatly among the animals, and the GITTs were not significantly shortened by CES or prucalopride; however, both the CES and prucalopride treatment significantly accelerated CTT and improved stool consistency compared with sham stimulation. CES treatment also resulted in significantly higher stool frequency than prucalopride treatment, which did not significantly change the stool frequency. No severe inflammation response was detected in the gross and microscopic appearance around the implants.
CONCLUSION
CES and prucalopride treatment may yield similar short-term effects for improving gastrointestinal transit and stool consistency, and CES outperformed prucalopride treatment in terms of defecation inducement in the short term. There were ideal levels of endurance and histocompatibility for the animals that underwent CES.
Topics: Animals; Benzofurans; Colon; Constipation; Defecation; Dogs; Electric Stimulation; Gastrointestinal Transit
PubMed: 33307879
DOI: 10.1080/00365521.2020.1856919 -
The American Journal of Occupational... 2019We examined the literature to identify reports of sensory integration concerns in children with functional defecation issues and to explore whether difficulty processing... (Review)
Review
OBJECTIVE
We examined the literature to identify reports of sensory integration concerns in children with functional defecation issues and to explore whether difficulty processing sensation may be related to their challenging bowel management behaviors.
METHOD
A scoping review was used to address the research question. We sourced articles from six databases in three languages, searched reference lists of all included articles, and identified additional articles through discussion with experts in the field.
RESULTS
Twelve articles were included in the final synthesis, identifying 15 challenging behaviors potentially related to sensory integration concerns.
CONCLUSION
We summarize research documenting sensory integration concerns in children with functional defecation issues, providing researchers and clinicians with an overview of the current state of understanding.
Topics: Child; Defecation; Humans; Perception; Research; Sensation
PubMed: 31120835
DOI: 10.5014/ajot.2019.030387 -
Proceedings of the Institution of... Apr 2019Constipation is an important issue that has impact on quality of life and health expenses of the elderly. It may lead to many other gastrointestinal disorders like colon... (Review)
Review
Constipation is an important issue that has impact on quality of life and health expenses of the elderly. It may lead to many other gastrointestinal disorders like colon cancer, haemorrhoids, anal fissures and so on. Squatting is considered to be the natural, traditional and most widely followed posture for defecation and hence, it is one of the practical solutions for avoiding constipation. Musculoskeletal issues due to ageing and changes in lifestyle make it difficult for the elder population to follow squatting or semi-squatting posture for defecation. Developing assistive devices to overcome older people's difficulty to attain squatting or semi-squatting posture is one of the research areas which need to be explored further. This review covers various designs of such devices which will enable a user to attain 'semi-squatting' posture to defecate and also addresses various challenges and limitations to overcome.
Topics: Aged; Constipation; Defecation; Equipment Design; Humans; Lower Extremity; Posture; Self-Help Devices
PubMed: 30898031
DOI: 10.1177/0954411919838644 -
Neurogastroenterology and Motility Jan 2022Self-efficacy in defecation plays an important role on behavioral therapy for functional constipation (FC). There is an unmet need for valid child self-report measures... (Observational Study)
Observational Study
Measuring self-efficacy in defecation: Validation and utilization of a Chinese version of the self-efficacy for functional constipation questionnaire (SEFCQ) in a pediatric population.
BACKGROUND
Self-efficacy in defecation plays an important role on behavioral therapy for functional constipation (FC). There is an unmet need for valid child self-report measures of task-specific self-efficacy for pediatric FC. Our aim was to cross-culturally validate the Self-Efficacy for Functional Constipation Questionnaire (SEFCQ) and to explore the salient factor(s) of self-efficacy in defecation that correlate with anxiety and constipation symptom severity among Chinese children.
METHODS
The SEFCQ was adapted to Chinese version following the Rome Foundation guidelines for the translation of questionnaires. Two hundred and three children with FC were involved in psychometric testing. Confirmatory factor analysis was conducted to determine the structure of the SEFCQ. Construct validity was evaluated by testing the relationship between the SEFCQ and both anxiety and the Patient Assessment of Constipation Symptoms (PAC-SYM). Test-retest reliability, internal consistency, and interfactor correlation were used to evaluate reliability. Hierarchical multiple regression was used to identify salient self-efficacy for FC that correlates with anxiety and constipation symptom severity.
KEY RESULTS
Confirmatory factor analysis supports the two-factor structure of the SEFCQ. Adequate test-retest reliability (r = 0.973, p<0.001) and internal consistency (Cronbach's α = 0.871) were obtained. Both self-efficacy factors were significantly associated with anxiety (r = -0.227 to -0.350, p<0.001) and PAC-SYM (r = -0.495 to -0.602, p<0.001), with emotional self-efficacy being the most salient factor for predicting the symptom severity of constipation after controlling for sex, age, quality of parents' marriage, and family history.
CONCLUSION AND INFERENCES
The SEFCQ showed satisfactory psychometric properties. Low self-efficacy in defecation correlates with anxiety and may contribute to poor adherence to behavior change, which exacerbates the symptoms of constipation. Further study is needed to apply social cognitive intervention to increase children's self-efficacy in defecation and assess its effect on treatment outcomes.
Topics: Anxiety; Child; Child, Preschool; China; Constipation; Defecation; Female; Humans; Male; Psychometrics; Reproducibility of Results; Self Efficacy; Surveys and Questionnaires
PubMed: 34494345
DOI: 10.1111/nmo.14255 -
Sensors (Basel, Switzerland) Sep 2022(1) Background: Incontinence and its complications pose great difficulties in the care of the disabled. Currently, invasive incontinence monitoring methods are too...
(1) Background: Incontinence and its complications pose great difficulties in the care of the disabled. Currently, invasive incontinence monitoring methods are too invasive, expensive, and bulky to be widely used. Compared with previous methods, bowel sound monitoring is the most commonly used non-invasive monitoring method for intestinal diseases and may even provide clinical support for doctors. (2) Methods: This paper proposes a method based on the features of bowel sound signals, which uses a BP classification neural network to predict bowel defecation and realizes a non-invasive collection of physiological signals. Firstly, according to the physiological function of human defecation, bowel sound signals were selected for monitoring and analysis before defecation, and a portable non-invasive bowel sound collection system was built. Then, the detector algorithm based on iterative kurtosis and the signal processing method based on Kalman filter was used to process the signal to remove the aliasing noise in the bowel sound signal, and feature extraction was carried out in the time domain, frequency domain, and time-frequency domain. Finally, BP neural network was selected to build a classification training method for the features of bowel sound signals. (3) Results: Experimental results based on real data sets show that the proposed method can converge to a stable state and achieve a prediction accuracy of 88.71% in 232 records, which is better than other classification methods. (4) Conclusions: The result indicates that the proposed method could provide a high-precision defecation prediction result for patients with fecal incontinence, so as to prepare for defecation in advance.
Topics: Algorithms; Defecation; Humans; Neural Networks, Computer; Signal Processing, Computer-Assisted; Sound
PubMed: 36146430
DOI: 10.3390/s22187084 -
Clinical and Translational... May 2021Defecatory disorders including obstructed defecation (OD) are currently diagnosed using specialized investigations including anorectal manometry and the balloon...
INTRODUCTION
Defecatory disorders including obstructed defecation (OD) are currently diagnosed using specialized investigations including anorectal manometry and the balloon expulsion test. Recently, we developed a simulated stool named Fecobionics that provides a novel type of pressure measurements and analysis. The aim was to study OD phenotypes compared with slow transit constipation (STC) patients and normal subjects (NS).
METHODS
Fecobionics expulsion parameters were assessed in an interventional study design. The Fecobionics device contained pressure sensors at the front, rear, and inside a bag. All constipation patients had colon transit study, defecography, anorectal manometry, and balloon expulsion test performed. The Fecobionics bag was distended in the rectum until desire-to-defecate in 26 OD compared with 8 STC patients and 10 NS. Rear-front pressures (preload-afterload parameters) and defecation indices (DIs) were compared between groups.
RESULTS
The Wexner constipation scoring system score was 13.8 ± 0.9 and 14.6 ± 1.5 in the OD and STC patients (P > 0.5). The median desire-to-defecate volume was 80 (quartiles 56-80), 60 (54-80), and 45 (23-60) mL in OD, STC, and NS, respectively (P < 0.01). The median expulsion duration was 37 (quartiles 15-120), 6 (3-11), and 11 (8-11) seconds for the 3 groups (P < 0.03). Fecobionics rear-front pressure diagrams demonstrated clockwise loops with distinct phenotype differences between OD and the other groups. Most DIs differed between OD and the other groups, especially those based on the anal afterload reflecting the nature of OD constipation. Several OD subtypes were identified.
DISCUSSION
Fecobionics obtained novel pressure phenotypes in OD patients. DIs showed pronounced differences between groups. Larger studies are needed on OD subtyping.
Topics: Anal Canal; Bionics; Constipation; Defecation; Feces; Female; Gastrointestinal Transit; Humans; Male; Manometry; Middle Aged; Pressure; Rectum
PubMed: 33949343
DOI: 10.14309/ctg.0000000000000354 -
The American Journal of Tropical... Jun 2024South Asian children are among the most severely malnourished worldwide. One prominent hypothesis is that open defecation in the local area exposes children to human...
South Asian children are among the most severely malnourished worldwide. One prominent hypothesis is that open defecation in the local area exposes children to human fecal pathogens that can cause diarrhea and malnutrition. Much of the existing research uses district-level measures of open defecation, which could mask important local-area variation. A second hypothesis is that animal fecal matter is a major source of exposure. This analysis tested these dual hypotheses using census data collected from 949 villages in Tamil Nadu, India, and a survey conducted in a random sample of 5,000 households in the same area. The final analytic sample consisted of 2,561 children aged 0-10 years. We estimated the association between the measures of village- and household-level open defecation, household livestock ownership, and child height-for-age Z-scores in a regression framework, controlling for potential confounders. Results revealed that village- and household-level open defecations are negatively associated with child height. There was an estimated difference of approximately 0.5 height-for-age Z-score between children living in villages with no open defecation and children in villages where all households practiced open defecation (P = 0.001) and a 0.2 Z-score difference between children living in households that practiced open defecation and those living in households that did not (P = 0.001). Livestock ownership was not associated with child height. Overall, the findings provide evidence on the centrality of open defecation in explaining persistent child malnutrition in India and the higher risk of exposure to human fecal pathogens compared with animal feces in the south Indian context.
Topics: Humans; India; Animals; Child, Preschool; Livestock; Infant; Male; Female; Nutritional Status; Defecation; Child; Ownership; Feces; Infant, Newborn; Family Characteristics; Diarrhea; Body Height
PubMed: 38688272
DOI: 10.4269/ajtmh.23-0405 -
Medical Humanities Mar 2021This essay focuses on sensory aspects of care in situations surrounding defecation in hospitals and other care institutions. Sensory activity does not merely encompass...
This essay focuses on sensory aspects of care in situations surrounding defecation in hospitals and other care institutions. Sensory activity does not merely encompass pleasant experiences that enhance healing and well-being. Anthropologists-and other disciplines as well-have paid little attention to unpleasant and disgusting experiences that our senses meet and that may rather increase pain and suffering in the context of care. Our essay therefore reflects on a common but highly uncomfortable aspect of being a-sometimes bedridden-patient: defecation. The sensory effects of human defecation are well known. They affect at least four of the five traditional senses. But equally repulsive are the social and emotional effects that defecation in a hospital context has on both patients and professional and other care providers. The essay is based on anthropological observations and the authors' personal experiences in Bangladesh, Ghana and the Netherlands and covers a wide variety of cultural and politicoeconomic conditions. It further draws on (scarce) scientific publications as well as on fictional sources. Extensive quotations from these various sources are presented to convey the lived sensorial experience of disgust and overcoming disgust more directly to the reader.
Topics: Defecation; Emotions; Hospitals; Humans; Netherlands; Sensation
PubMed: 32606069
DOI: 10.1136/medhum-2019-011766 -
European Spine Journal : Official... Dec 2016Sacrectomy is a highly demanding surgery representing the main treatment for primary tumors arising in the sacrum and pelvis. Unfortunately, it is correlated with loss... (Review)
Review
PURPOSE
Sacrectomy is a highly demanding surgery representing the main treatment for primary tumors arising in the sacrum and pelvis. Unfortunately, it is correlated with loss of important function depending on the resection level and nerve roots sacrificed. The current literature regarding residual function after sacral resection comes from several small case series. The goal of this review is to appraise residual motor function and gait, sensitivity, bladder, bowel, and sexual function after sacrectomies, with consideration to the specific roots sacrificed.
METHODS
An exhaustive literature search was conducted. All manuscripts published before May 2015 regarding residual function after sacrectomy were considered; if a clear correlation between root level and functioning was not present, the paper was excluded. The review identified 15 retrospective case series, totaling 244 patients; 42 patients underwent sacrectomies sparing L4/L4, L4/L5 and L5/L5; 45 sparing both L5 and one or both S1 roots; 8 sparing both S1 and one S2; 48 sparing both S2; 11 sparing both S2 and one S3, 54 sparing both S3, 9 sparing both S3 and one or both S4, and 27 underwent unilateral variable resection.
RESULTS
Patients who underwent a sacrectomy maintained functionally normal ambulation in 56.2 % of cases when both S2 roots were spared, 94.1 % when both S3 were spared, and in 100 % of more distal resections. Normal bladder and bowel function were not present when both S2 were cut. When one S2 root was spared, normal bladder function was present in 25 % of cases; when both S2 were spared, 39.9 %; when one S3 was spared, 72.7 %; and when both S3 were spared, 83.3 %. Abnormal bowel function was present in 12.5 % of cases when both S1 and one S2 were spared; in 50.0 % of cases when both S2 were spared; and in 70 % of cases when one S3 was spared; if both S3 were spared, bowel function was normal in 94 % of cases. When even one S4 root was spared, normal bladder and bowel function were present in 100 % of cases. Unilateral sacral nerve root resection preserved normal bladder function in 75 % of cases and normal bowel function in 82.6 % of cases. Motor function depended on S1 root involvement.
CONCLUSION
Total sacrectomy is associated with compromising important motor, bladder, bowel, sensitivity, and sexual function. Residual motor function is dependent on sparing L5 and S1 nerve roots. Bladder and bowel function is consistently compromised in higher sacrectomies; nevertheless, the probability of maintaining sufficient function increases progressively with the roots spared, especially when S3 nerve roots are spared. Unilateral resection is usually associated with more normal function. To the best of our knowledge, this is the first comprehensive literature review to analyze published reports of residual sacral nerve root function after sacrectomy.
Topics: Defecation; Humans; Neurosurgical Procedures; Sacrum; Spinal Nerve Roots; Urinary Bladder
PubMed: 26914097
DOI: 10.1007/s00586-016-4450-3