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Techniques in Coloproctology Jan 2018
Topics: Constipation; Defecation; Humans; Rectum; Surgical Staplers; Treatment Outcome
PubMed: 29353428
DOI: 10.1007/s10151-017-1743-4 -
PloS One 2022Autonomic dysfunction is a factor in irritable bowel syndrome (IBS). However, there are no reports of autonomic nervous system (ANS) activity during natural defecation...
BACKGROUND
Autonomic dysfunction is a factor in irritable bowel syndrome (IBS). However, there are no reports of autonomic nervous system (ANS) activity during natural defecation in patients with IBS. We aimed to clarify the relationship between ANS activity and life events, such as defecation and abdominal symptoms, using real-time recording.
METHODS
Six patients with IBS and 14 healthy controls were enrolled in this prospective multicenter study. ANS activity was recorded for 24 h using a T-shirt wearable device, and life events were recorded simultaneously in real time using a smartphone application software. Low frequency/high frequency (LF/HF) and HF calculated by power spectrum analysis were defined as activity indicators of the sympathetic and parasympathetic nerves, respectively.
RESULTS
The means of LF/HF and HF in the period with positive symptoms were comparable between the groups; however, the sum of LF/HF, sum of ΔLF/HF, and the maximum variation in ΔLF/HF were significantly higher in the IBS group. In the IBS group, the sum of ΔLF/HF and LF/HF increased significantly from 2 min before defecation, and the sum of LF/HF remained significantly higher until 9 min after defecation. The sum of ΔLF/HF at 2 min before defecation was significantly positively correlated with the intensity of abdominal pain and diarrhea and constipation scores. In contrast, it was significantly negatively correlated with defecation satisfaction and health-related quality of life.
CONCLUSIONS
In patients with IBS, sympathetic nerve activity was activated 2 min before defecation, which was correlated with abdominal symptoms and lower QOL.
Topics: Humans; Irritable Bowel Syndrome; Quality of Life; Prospective Studies; Constipation; Wearable Electronic Devices; Defecation
PubMed: 36490298
DOI: 10.1371/journal.pone.0278922 -
Acta Paediatrica (Oslo, Norway : 1992) Nov 2016Early full enteral feeding in preterm infants decreases morbidity and mortality. Our systematic review covered the effectiveness of rectal stimulation, suppositories and... (Review)
Review
UNLABELLED
Early full enteral feeding in preterm infants decreases morbidity and mortality. Our systematic review covered the effectiveness of rectal stimulation, suppositories and enemas on stooling patterns and feeding tolerance in low-birthweight infants born at up to 32 weeks. It comprised seven studies published between 2007 and 2014 and covered 495 infants.
CONCLUSION
Suppositories were ineffective in shortening the time to reach full enteral feeding, and the evidence on enemas was contradictory. Enemas and rectal stimulation did not shorten the time until complete meconium evacuation was reached. Further research into safe, effective interventions to accelerate meconium excretion is needed.
Topics: Defecation; Enema; Enteral Nutrition; Humans; Infant, Extremely Premature; Infant, Newborn; Infant, Very Low Birth Weight; Intensive Care Units, Neonatal; Meconium; Physical Stimulation; Suppositories; Time Factors
PubMed: 27506482
DOI: 10.1111/apa.13540 -
Digestive and Liver Disease : Official... Mar 2024Defecation Disorders (DD) are a frequent cause of refractory chronic constipation. DD diagnosis requires anorectal physiology testing. Our aim was to evaluate the...
BACKGROUND AND AIMS
Defecation Disorders (DD) are a frequent cause of refractory chronic constipation. DD diagnosis requires anorectal physiology testing. Our aim was to evaluate the accuracy and Odds Ratio (OR) of a straining question (SQ) and a digital rectal examination (DRE) augmented by abdomen palpation on predicting a DD diagnosis in refractory CC patients.
METHODS
Two hundred and thirty-eight constipated patients were enrolled. Patients underwent SQ, augmented DRE and balloon evacuation test before entering the study and after a 30-day fiber/laxative trial. All patients underwent anorectal manometry. OR and accuracy were calculated for SQ and augmented DRE for both dyssynergic defecation and inadequate propulsion.
RESULTS
"Anal Muscles" response was associated to both dyssynergic defecation and inadequate propulsion, with an OR of 13.6 and 5.85 and an accuracy of 78.5% and 66.4%, respectively. "Failed anal relaxation" on augmented DRE was associated with dyssynergic defecation, with an OR of 21.4 and an accuracy of 73.1%. "Failed abdominal contraction" on augmented DRE was associated with inadequate propulsion with an OR >100 and an accuracy of 97.1%.
CONCLUSIONS
Our data support screening constipated patients for DD by SQ and augmented DRE to improve management and appropriateness of referral to biofeedback.
Topics: Humans; Defecation; Manometry; Constipation; Anal Canal; Biofeedback, Psychology; Ataxia; Diagnostic Tests, Routine
PubMed: 37394370
DOI: 10.1016/j.dld.2023.06.004 -
Digestive Diseases and Sciences Jun 2023
Topics: Humans; Reproducibility of Results; Rectum; Defecation
PubMed: 36879179
DOI: 10.1007/s10620-023-07891-8 -
Lancet (London, England) Mar 2019
Topics: Defecation; Humans; Hygiene; India; Sustainable Development; Water; Water Supply
PubMed: 30910289
DOI: 10.1016/S0140-6736(19)30731-7 -
Updates in Surgery Feb 2022Obstructed Defecation Syndrome (ODS) is a rather complex entity concerning mainly females and causing primarily constipation. Surgical treatment in the form of Ventral... (Meta-Analysis)
Meta-Analysis Review
Obstructed Defecation Syndrome (ODS) is a rather complex entity concerning mainly females and causing primarily constipation. Surgical treatment in the form of Ventral Prosthesis Rectopexy (VPR) has been proposed and seems to have the best outcomes. However, the selection criteria of patients to undergo this kind of operation are not clear and the reported outcomes are mainly short-term and data on long-term outcomes is scarce. This study assesses new evidence on the efficacy of VPR for the treatment of ODS, specifically focusing on inclusion criteria for surgery and the long-term outcomes. A search was performed of MEDLINE, EMBASE, Ovid and Cochrane databases on all studies reporting on VPR for ODS from 2000 to March 2020. No language restrictions were made. All studies on VPR were reviewed systematically. The main outcomes were intra-operative complications, conversion, procedure duration, short-term mortality and morbidity, length of stay, faecal incontinence and constipation, quality of life (QoL) score and patient satisfaction. Quality assessment and data extraction were performed independently by three observers. Fourteen studies including 963 patients were eligible for analysis. The immediate postoperative morbidity rate was 8.9%. A significant improvement in constipation symptoms was observed in the 12-month postoperative period for ODS (p < 0.0001). Current evidence shows that VPR offers symptomatic relief to the majority of patients with ODS, improving both constipation-like symptoms and faecal incontinence for at least 1-2 years postoperatively. Some studies report on functional results after longer follow-up, showing sustainable improvement, although in a lesser extent.
Topics: Defecation; Digestive System Surgical Procedures; Female; Humans; Prostheses and Implants; Quality of Life; Treatment Outcome
PubMed: 34665411
DOI: 10.1007/s13304-021-01177-2 -
The American Journal of Gastroenterology Oct 2014There are conflicting data regarding the association between bowel movement frequency, constipation, and colorectal cancer (CRC). In this issue, Citronberg et al....
There are conflicting data regarding the association between bowel movement frequency, constipation, and colorectal cancer (CRC). In this issue, Citronberg et al. present data from a large prospective study that was designed to examine this issue. In addition to examining bowel habits, these authors included information about the participants' laxative use, distinguishing between fiber and non-fiber-based laxatives. The investigators also collected data with respect to CRC risk factors including demographics, family history, lower endoscopy exposure, smoking, medication use, and detailed dietary information. The results demonstrated no relationship between bowel movement frequency or constipation and CRC. The authors also observed an increased CRC risk in patients who were in either the low or high non-fiber laxative use groups as compared with individuals who never used these agents (low risk: hazard ratio (HR)=1.49; and high risk: HR=1.43; Ptrend=0.05). Conversely, there was a statistically significant lower risk for those patients who reported a high use of fiber laxatives (HR=0.44, 95% confidence interval: 0.21-0.95) as compared with the nonuse group. These data have implications for physicians who treat patients with constipation.
Topics: Colorectal Neoplasms; Constipation; Defecation; Female; Humans; Laxatives; Male
PubMed: 25287089
DOI: 10.1038/ajg.2014.292 -
ELife Jun 2022Biological clocks are fundamental to an organism's health, controlling periodicity of behaviour and metabolism. Here, we identify two acid-sensing ion channels, with...
Biological clocks are fundamental to an organism's health, controlling periodicity of behaviour and metabolism. Here, we identify two acid-sensing ion channels, with very different proton sensing properties, and describe their role in an ultradian clock, the defecation motor program (DMP) of the nematode . An ACD-5-containing channel, on the apical membrane of the intestinal epithelium, is essential for maintenance of luminal acidity, and thus the rhythmic oscillations in lumen pH. In contrast, the second channel, composed of FLR-1, ACD-3 and/or DEL-5, located on the basolateral membrane, controls the intracellular Ca wave and forms a core component of the master oscillator that controls the timing and rhythmicity of the DMP. and mutants show severe developmental and metabolic defects. We thus directly link the proton-sensing properties of these channels to their physiological roles in pH regulation and Ca signalling, the generation of an ultradian oscillator, and its metabolic consequences.
Topics: Acid Sensing Ion Channels; Animals; Caenorhabditis elegans; Caenorhabditis elegans Proteins; Defecation; Protons
PubMed: 35666106
DOI: 10.7554/eLife.75837 -
Biomechanics and Modeling in... Oct 2022Fecobionics is an integrated device that has shown promise for assessment of anorectal function. We used a wireless Fecobionics prototype to visualize defecatory...
Fecobionics is an integrated device that has shown promise for assessment of anorectal function. We used a wireless Fecobionics prototype to visualize defecatory patterns and to compute volume-pressure, contraction work, and flow. Twelve normal subjects were studied. The probe was 10 cm-long and contained pressure sensors and electrodes for impedance planimetry. Pressures, diameters, and volume data during defecation were analyzed. The bag was distended inside rectum to the urge-to-defecate level where after the subjects were asked to evacuate. The contraction work and defecatory flow were computed from the volume changes during expulsion. The minimum anal diameter during the evacuation was 17.6 ± 1.5 mm. The middle diameter recording was 10-20% lower than the front diameter channels and 10-20% bigger than the rear channels. The bag volume at urge correlated with the minimum diameter (r = 0.63). The diameter-pressure and volume-pressure loops were counterclockwise with phases of bag filling, isometric contraction, ejection and anal passage. The defecatory contraction work was 3520 ± 480 mL × cmHO. The maximum flow during defecation was 302 ± 33 mL/s. The flow was associated with the anal diameter (r = 0.84) but not with the rectoanal pressure gradient (r = 0.14). Volume-pressure loops have a tremendous impact on the understanding of cardiopulmonary pathophysiology. Future studies will shed light on potential clinical impact in defecatory pathophysiology.
Topics: Humans; Defecation; Manometry; Anal Canal; Rectum; Isometric Contraction
PubMed: 35908095
DOI: 10.1007/s10237-022-01610-4