-
Advances in Clinical and Experimental... Jun 2018Crohn's disease (CD) and ulcerative colitis (UC) typically clinically manifest with symptoms like chronic diarrhea, cramps, abdominal pain, and rectal bleeding. However,...
BACKGROUND
Crohn's disease (CD) and ulcerative colitis (UC) typically clinically manifest with symptoms like chronic diarrhea, cramps, abdominal pain, and rectal bleeding. However, symptoms of abnormal anorectal function seem to be of equal importance, regardless of the presence or absence of perianal disease.
OBJECTIVES
The aim of this study was to assess stool patterns and the prevalence of symptoms of disordered anorectal function, particularly urgency and fecal incontinence, and their severity in patients with inflammatory bowel diseases (IBDs).
MATERIAL AND METHODS
Thirty-three patients with CD and 38 patients with UC completed a questionnaire. A push/strain maneuver was performed on all patients and 20 controls.
RESULTS
Thirty-three patients had more than 3 bowel movements a day; 44 had loose/watery stools. Two patients had fewer than 3 bowel movements a week, 8 had hard/lumpy stools, and 3 used laxatives. Excessive straining and incomplete evacuation were reported by 17 and 38 patients, respectively. Fifty-two patients complained of urgency and 32 of tenesmus. Significantly, more UC patients than CD patients had urgency at least once a day (p < 0.04). The following symptoms were reported by patients in the following numbers: fecal incontinence (31), passive (20) and urge incontinence (16), incontinence to gas (24), as well as liquid (33) and solid stool (7). Stool/gas discrimination was defective in 28 patients. Eleven patients had to wear pads. Everyday functioning was worsened because of urgency/tenesmus in 39 patients and because of fecal incontinence in 28 patients. The push/strain maneuver was abnormal in 12 patients with CD, 15 patients with UC and 1 control subject. The differences between the 2 study groups and the controls were significant (p < 0.03 and p < 0.01).
CONCLUSIONS
A majority of patients with IBD complain of urgency. Fecal incontinence is reported by over 50% of patients. Both worsen patients' everyday functioning. A relevant proportion of patients have symptoms consistent with constipation, which is in connection with an abnormal push/strain maneuver in more than 1/3 of them.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Constipation; Defecation; Fecal Incontinence; Feces; Female; Humans; Inflammatory Bowel Diseases; Male; Middle Aged; Prevalence; Young Adult
PubMed: 29893516
DOI: 10.17219/acem/68986 -
Gastroenterology & Hepatology Mar 2015Ulcerative colitis (UC) is a chronic inflammatory condition associated with rectal bleeding and urgency, tenesmus, and diarrhea. Several medical therapies can be used in...
Ulcerative colitis (UC) is a chronic inflammatory condition associated with rectal bleeding and urgency, tenesmus, and diarrhea. Several medical therapies can be used in the treatment of UC. Aminosalicylates are widely used based on their efficacy in the induction and maintenance of remission. Although corticosteroids are effective in patients with more severe disease, systemic use is associated with significant safety concerns. The newer corticosteroid budesonide has lower systemic bioavailability and, consequently, a more favorable safety profile. A budesonide extended-release formulation allows once-daily dosing and delivers the agent locally throughout the colon. Biologic agents used for the treatment of moderate to severe UC include the tumor necrosis factor inhibitors infliximab, adalimumab, and golimumab, and the integrin inhibitor vedolizumab. Rectally administered therapy can also be useful in the treatment of UC. In October 2014, the US Food and Drug Administration approved a budesonide foam formulation for inducing remission in patients with active mild to moderate distal UC extending up to 40 cm from the anal verge. Budesonide foam rapidly distributes to the sigmoid colon and the rectum and avoids some of the drawbacks of suppositories and enemas.
PubMed: 26491415
DOI: No ID Found -
Journal of Investigative Medicine High... 2022Rectal infection with the L1, L2, and L3 serovars of can cause lymphogranuloma venereum (LGV) proctocolitis, particularly among men who have sex with men (MSM)....
Rectal infection with the L1, L2, and L3 serovars of can cause lymphogranuloma venereum (LGV) proctocolitis, particularly among men who have sex with men (MSM). Symptoms of this sexually transmitted infection include anal pain, rectal bleeding and discharge, tenesmus, constipation, and fever. Clinicians should consider LGV when there is a history of receptive anal intercourse and symptoms of proctocolitis. A positive nucleic acid amplification test (NAAT) on a rectal sample is diagnostic. This report describes a man with HIV and chronic proctocolitis in whom the diagnosis of LGV was delayed because the clinical picture mimicked inflammatory bowel disease.
Topics: Chronic Disease; Homosexuality, Male; Humans; Inflammatory Bowel Diseases; Lymphogranuloma Venereum; Male; Proctocolitis; Sexual and Gender Minorities
PubMed: 35762449
DOI: 10.1177/23247096221107233 -
Journal of Ayurveda and Integrative... 2015The medical management of hemorrhoids should include an integrated approach. This integrated approach can be achieved by polyherbal formulations containing...
BACKGROUND
The medical management of hemorrhoids should include an integrated approach. This integrated approach can be achieved by polyherbal formulations containing anti-inflammatory, styptics, analgesics, and laxative effect which reduce inflammation, pain, and bleeding, and increase gastro-intestinal motility and soften stools. One such polyherbal kit is "Arshkeyt™, a 7 day kit," which consists of oral tablets and powder along with topical cream.
OBJECTIVE
Efficacy and safety of Arshkeyt™, a 7 day kit, a marketed polyherbal formulation was evaluated in comparison with conventional therapy practiced in surgery outpatient departments.
MATERIALS AND METHODS
Patients (n = 90) with hemorrhoids were randomly allocated to receive either Arshkeyt™ or standard therapy (combination of oral Isabgul powder and 2% lidocaine gel) for 14 days. Assessment on the basis of rectal symptoms and proctoscopic examination was done on day 0, 7, and 14 to derive a "composite score" which ranged from 0 to 25 by a blinded evaluator. The primary endpoint was number of patients achieving composite score 0 at the end of therapy (day 14). Inter-group analysis was done using Chi-square test.
RESULTS
On day 14, the composite score of 0 was achieved in 15 patients of Arshkeyt™ group versus 6 patients receiving standard therapy. The symptoms and signs which showed significant improvement in Arshkeyt™ group compared to standard treatment group were the tenesmus (visual analog score) score (P = 0.047), anal sphincter spasm (P = 0.0495) and a decrease in the grade of hemorrhoids (P = 0.0205) on day 14. Arshkeyt™ was also more beneficial in case of bleeding hemorrhoids as compared to nonbleeding hemorrhoids (P < 0.05). The incidence of adverse drug reactions in both groups was comparable and no patient required any treatment for the same.
CONCLUSION
"Arshkeyt™, a 7 day kit," was effective in the treatment of hemorrhoids and had a good safety profile.
PubMed: 26834421
DOI: 10.4103/0975-9476.172382 -
Cureus Nov 2021This prospective study aimed to determine the outcomes and postoperative complications of hemorrhoid disease (HD) treated by hemorrhoidal laser procedure (HeLP).
AIM
This prospective study aimed to determine the outcomes and postoperative complications of hemorrhoid disease (HD) treated by hemorrhoidal laser procedure (HeLP).
BACKGROUND
We, herein report the results of 18 months of methodical use of mini-invasive laser procedures in 100 patients with grades 2 and 3 hemorrhoids and minimum to a mild degree of rectal prolapse. The surgical technique is called HeLP.
METHODS
Data were collected on the duration of the procedure, intraoperative complications, postoperative pain, the declivity of hemorrhoids, persistency or complete resolution, and recurrence of hemorrhoids were collected prospectively.
RESULTS
No evidence of intraoperative complications occurred. The median follow-up was nine months. Postoperative pain was not significant or null in most patients. There was no rectal tenesmus or alteration of defecation habits. Plateau of hemorrhoid symptoms and downgrading of hemorrhoid size reached approximately three to seven months post-procedure. The frequency of pain, bleeding, pruritus ani, and acute hemorrhoidal syndrome decreased by 75-80%. There was a significant reduction in hemorrhoids with the rate of recurrence being 7% over 12 months of follow-up.
CONCLUSION
Our study evaluated and demonstrated that HeLP is an effective, safe, and non-painful procedure for the management of patients with the symptomatic second or third degree of hemorrhoid with mild to the minimum degree of rectal mucosal prolapse. It is a suitable ambulatory treatment.
PubMed: 34804743
DOI: 10.7759/cureus.19497 -
Journal of Gastrointestinal and Liver... Aug 2021A 49-years-old woman with a recent history of tenesmus, constipation, abdominal and rectal pain referred to our Unit. There was no previous history of rectal bleeding or...
A 49-years-old woman with a recent history of tenesmus, constipation, abdominal and rectal pain referred to our Unit. There was no previous history of rectal bleeding or a family history of gastrointestinal diseases. Laboratory tests showed haemoglobin 10.9 g/dl, MCV 72fl, ferritin 18 U/l. Physical examination was normal. The patient underwent a colonoscopy which identified a single ulcer of 2.5 cm of diameter without bleeding signs in the distal rectum, 4 cm from the anal margin. Histopathological examination revealed shallow ulceration with fibrosis in lamina propria. We decided to treat the ulcer with one application of Purastat. Four weeks later, a follow-up colonoscopy revealed a complete mucosal healing with only mild residual mucosal erythema. Solitary Rectal Ulcer Syndrome (SRUS) is an uncommon benign proctologic disease usually affecting young adults with a prevalence of 1:100.000 per year, equally affecting women and men with a slight predominance in young women. SRUS is characterized by chronic rectal pain and bleeding, constipation, incomplete evacuation, tenesmus and mucous discharge impairing the patients' quality of life. In past years several topical agents have been used reporting clinical improvements, also if none of them has been evaluated in prospective controlled trials. Purastat (3D-Matrix Europe SAS, France) is a novel self-assembling peptide developed as a haemostatic agent for endoscopic and surgical procedures. In addition to the known haemostatic effect, it has been hypothesized that the activated Purastat nanostructure favors the cell and tissue proliferative process since the similarity of the activated Purastat 3-D nanostructure with the natural extracellular matrix (ECM-SM) scaffold material would result in an adequate adherence of cells and regenerative tissues, achieving more effective healing of the mucosa. Based on this hypothetical re-epithelizing property of Purastat, we decided to use it in this patient, achieving mucosal healing and symptoms improvement.
PubMed: 34375377
DOI: 10.15403/jgld-3680 -
World Journal of Gastrointestinal... Nov 2015In the last few decades radiotherapy was established as one of the best and most widely used treatment modalities for certain tumours. Unfortunately that came with a...
In the last few decades radiotherapy was established as one of the best and most widely used treatment modalities for certain tumours. Unfortunately that came with a price. As more people with cancer survive longer an ever increasing number of patients are living with the complications of radiotherapy and have become, in certain cases, difficult to manage. Pelvic radiation disease (PRD) can result from ionising radiation-induced damage to surrounding non-cancerous tissues resulting in disruption of normal physiological functions and symptoms such as diarrhoea, tenesmus, incontinence and rectal bleeding. The burden of PRD-related symptoms, which impact on a patient's quality of life, has been under appreciated and sub-optimally managed. This article serves to promote awareness of PRD and the vast potential there is to improve current service provision and research activities.
PubMed: 26649150
DOI: 10.4240/wjgs.v7.i11.279 -
Journal of Gastrointestinal Surgery :... Aug 2014Splenosis is a rare condition defined as seeding and autotransplantation of splenic tissue, typically after blunt abdominal trauma (e.g. from road traffic collision)....
Splenosis is a rare condition defined as seeding and autotransplantation of splenic tissue, typically after blunt abdominal trauma (e.g. from road traffic collision). Sites of splenosis ranging from intrathoracic to intrapelvic have been reported, and symptoms vary greatly depending on the site and size of lesions. We present the use of Tc-99m sulphur colloid SPECT/CT in diagnosing a case of multiple abdominopelvic splenosis as the cause of new-onset tenesmus and constipation, which was initially thought to be due to colorectal malignancy, 47 years following the initial abdominal trauma.
Topics: Constipation; Humans; Male; Middle Aged; Radiopharmaceuticals; Rectal Diseases; Splenosis; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed, Single-Photon
PubMed: 24871083
DOI: 10.1007/s11605-014-2548-7 -
Medical Science Monitor : International... Feb 2017BACKGROUND The aim of this study was to evaluate the curative effect of transvaginal mesh repair (TVMR) and stapled transanal rectal resection (STARR) in treating outlet... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND The aim of this study was to evaluate the curative effect of transvaginal mesh repair (TVMR) and stapled transanal rectal resection (STARR) in treating outlet obstruction constipation caused by rectocele. MATERIAL AND METHODS Patients who had outlet obstruction constipation caused by rectocele were retrospectively analyzed and 39 patients were enrolled the study. Patients were assigned to either the TVMR or STARR group. Postoperative factors such as complications, pain, recurrence rate, and operative time were compared between the 2 groups. RESULTS Total effective rate was 100% in both groups. No long-term chronic pain occurred and discomfort rate of tenesmus was higher in the STARR group than in the TVMR group. Postoperative defecography showed that the rectocele depth was significantly reduced, and the prolapse of the rectal mucosa and the lower rectal capacity was also decreased. Four cases had mesh exposure in the TVMR group and 2 cases in the STARR group had anastomotic bleeding after the surgery. CONCLUSIONS For outlet obstruction constipation caused by rectocele, TVMR and STARR both obtained satisfactory results. Although TVMR is complex with longer operative time and hospitalization period, its long-term effect is better than that of STARR.
Topics: Aged; Anal Canal; Constipation; Defecography; Digestive System Surgical Procedures; Female; Humans; Intestinal Obstruction; Middle Aged; Operative Time; Postoperative Complications; Prospective Studies; Rectocele; Rectum; Surgical Mesh; Treatment Outcome
PubMed: 28146137
DOI: 10.12659/msm.898790