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Scientific Reports Jun 2022Defecatory disorders including fecal incontinence (FI) are diagnosed on the symptom pattern supplemented by anorectal manometry (ARM), the balloon expulsion test (BET),...
Defecatory disorders including fecal incontinence (FI) are diagnosed on the symptom pattern supplemented by anorectal manometry (ARM), the balloon expulsion test (BET), and endo-anal ultrasonography. In this study, we used a simulated stool named Fecobionics to study distinct defecation patterns in FI patients using preload-afterload diagrams and to provide comparative data on defecation indices (DIs) between passive and urge incontinent patients. All subjects had Fecobionics, endo-anal ultrasonography and ARM-BET done. The Fecobionics bag was distended in rectum until urge in 37 female patients (64.1 ± 1.5 yrs) and a group of normal subjects (NS, 12F, age 64.8 ± 2.8 yrs). Rear-front pressure (preload-afterload) diagrams and DIs were compared between groups. The FISI score in the patients was 8.6 ± 0.6. The NS did not report FI-related symptoms. All patients and NS defecated Fecobionics and ARM-BET within 2 min. The urge volume was 46.1 ± 3.6 and 35.3 ± 5.9 mL in the FI and normal groups (P > 0.1). The expulsion duration was 14.8 ± 2.4 and 19.8 ± 5.1 s for the two groups (P > 0.1). The preload-afterload diagrams demonstrated clockwise loops that clearly differed between the FI subtypes and NS. The DIs showed profound difference between patients and NS. Fecobionics data showed higher correlation with symptoms in FI patients than ARM-BET. Fecobionics obtained novel pressure signatures in subtypes of FI patients and NS. Fecobionics provides DI data that cannot be obtained with ARM-BET.
Topics: Aged; Anal Canal; Defecation; Fecal Incontinence; Female; Humans; Manometry; Middle Aged; Rectum
PubMed: 35732729
DOI: 10.1038/s41598-022-14919-y -
Psychiatria Polska Apr 2023Anodyspareunia (anal dyspareunia) is a phenomenon related to the passive side's feeling of pain or discomfort in anal sex when attempting or completely penetrating the... (Review)
Review
Anodyspareunia (anal dyspareunia) is a phenomenon related to the passive side's feeling of pain or discomfort in anal sex when attempting or completely penetrating the anus. This dysfunction was first described in 1998 by Rosser's team investigating its biopsychosocial correlates in a sample of men who had sex with men. The work is theoretical in nature and is an attempt to integrate the current knowledge on the phenomenon of anodyspareunia. It presents attempts to define the phenomenon and data on its prevalence, possible reasons for its occurrence and further research directions. The analyzed studies show that although the occurrence of anodyspareunia is influenced by both physiological factors (e.g., lack of lubrication, oral or manual stimulation of the anus prior to penetration) and psychological factors, the latter seem to play a decisive role in the experience of pain. Not all people who practice anal sex report pain associated with it, which may lead to the perception of anal dyspareunia.
Topics: Male; Female; Humans; Dyspareunia; Anal Canal; Sexual Behavior; Pelvic Pain; Emotions
PubMed: 36370441
DOI: 10.12740/PP/OnlineFirst/145891 -
Ultrasound in Obstetrics & Gynecology :... Aug 2021The aim of this study was to explore the risk of levator ani muscle (LAM) avulsion and enlargement of the levator hiatus following vaginal birth after Cesarean section...
OBJECTIVE
The aim of this study was to explore the risk of levator ani muscle (LAM) avulsion and enlargement of the levator hiatus following vaginal birth after Cesarean section (VBAC) in comparison with vaginal delivery in primiparous women.
METHODS
In this two-center observational case-control study, we identified all women who had a term VBAC for their second delivery at the Departments of Obstetrics and Gynecology at the Faculty of Medicine in Pilsen and the 1 Faculty of Medicine in Prague, Charles University, Czech Republic, between 2012 and 2016. Women with a repeat VBAC, preterm birth or stillbirth were excluded from the study. As a control group, we enrolled a cohort of primiparous women who delivered vaginally during the study period. To increase our control sample, we also invited all primiparous women who delivered vaginally in both participating units between May and June 2019 to participate. All participants were invited for a four-dimensional pelvic floor ultrasound scan to assess LAM trauma. LAM avulsion and the area of the levator hiatus were assessed offline from the stored pelvic floor volumes obtained at rest, during maximum contraction and during Valsalva maneuver. The laterality of the avulsion was also noted. The cohorts were then compared using the χ test and Wilcoxon's two-sample test according to the normality of the distribution. P < 0.05 was considered statistically significant. Multivariate regression analysis, controlling for age and body mass index (BMI), was also performed.
RESULTS
A total of 356 women had a VBAC for their second delivery during the study period. Of these, 152 (42.7%) attended the ultrasound examination and full data were available for statistical analysis for 141 women. The control group comprised 113 primiparous women. A significant difference was observed between the VBAC group and the control group in age (32.7 vs 30.1 years; P < 0.05), BMI (28.4 vs 27.4 kg/m ; P < 0.05) and duration of the first and second stages of labor (293.1 vs 345.9 min; P < 0.05 and 27.6 vs 35.3 min; P < 0.05, respectively) at the time of the index birth. The LAM avulsion rate was significantly higher in the VBAC compared with the control group (32.6% vs 18.6%; P = 0.01). The difference between the groups was observed predominantly in the rate of unilateral avulsion and remained significant after controlling for age and BMI (adjusted odds ratio 2.061 (95% CI, 1.103-3.852)). There was no statistically significant difference in the area of the levator hiatus at rest (12.0 vs 12.6 cm ; P = 0.28) or on maximum Valsalva maneuver (18.6 vs 18.7 cm ; P = 0.55) between the VBAC and control groups. The incidence of levator hiatal ballooning was comparable between the groups (17.7% and 18.6%; P = 0.86).
CONCLUSIONS
VBAC is associated with a significantly higher rate of LAM avulsion than is vaginal birth in nulliparous women. The difference was significant even after controlling for age and BMI. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Adult; Anal Canal; Case-Control Studies; Female; Humans; Obstetric Labor Complications; Pregnancy; Soft Tissue Injuries; Ultrasonography, Prenatal; Vaginal Birth after Cesarean
PubMed: 33724564
DOI: 10.1002/uog.23629 -
Techniques in Coloproctology Jun 2023Fecal incontinence (FI) is common, but its etiology is complex with large knowledge gaps. Several phenotypes of FI are known, but the phenotype is often not decisive in...
PURPOSE
Fecal incontinence (FI) is common, but its etiology is complex with large knowledge gaps. Several phenotypes of FI are known, but the phenotype is often not decisive in the chosen therapy. In this study we aimed to assess the association of the clinical characteristics of patients with FI and the various phenotypes, in order to establish a targeted clinical treatment decision tree.
METHODS
We retrospectively studied the charts of patients with FI, who visited our institute from January 2018 until December 2020. Patients were divided into the following groups: passive fecal loss, urge incontinence, combined fecal incontinence with predominantly passive fecal loss, and combined fecal incontinence with predominantly urge incontinence. We compared the characteristics between the passive and urge incontinence groups, the passive and combined mainly passive groups, and the urge and combined mainly urge groups.
RESULTS
Patients with passive incintinence were older, more often had a flaccid anus with presence of a mucosal prolapse, and had a lower resting pressure on anorectal manometry. Patients with urge incontinence were younger and more often had a history of birth trauma. The combined groups showed characteristics of both of the main types of FI.
CONCLUSION
Differentiating into phenotypes of FI can be clinically meaningful. The patient history and clinical judgement of the consulting specialist, rather than the physical characteristics, seem to be decisive in the categorization. Additional diagnostic testing can be helpful in complicated cases, but should not be used routinely.
Topics: Humans; Fecal Incontinence; Retrospective Studies; Manometry; Urinary Incontinence, Urge; Anal Canal
PubMed: 36967451
DOI: 10.1007/s10151-023-02778-2 -
Frontiers in Endocrinology 2021Evidence from animal studies has indicated that neonatal thyroid function is vital for the reproductive development. Anogenital distance (AGD), a sensitive biomarker of...
BACKGROUND
Evidence from animal studies has indicated that neonatal thyroid function is vital for the reproductive development. Anogenital distance (AGD), a sensitive biomarker of the fetal hormonal milieu, can be used to predict adult reproductive disorders. However, few human studies have examined the association between neonatal thyroid function and AGD. We aimed to explore their associations in a birth cohort study.
METHODS
Concentrations of thyroid stimulating hormone (TSH) and thyroid hormones (THs), including total triiodothyronine (TT), total thyroxine (TT), free triiodothyronine (FT), and free thyroxine (FT) were measured in cord plasma in the Shanghai-Minhang Birth Cohort. The offspring AGD (AGD [anus-penis] and AGD [anus-scrotum] for boys and AGD [anus-clitoris] and AGD [anus-fourchette] for girls), body weight and anogenital index (AGI = AGD/weight [mm/kg]) were obtained at each follow-up visit. In total, 344 children (194 boys and 150 girls) with cord plasma concentrations of THs and TSH and at least one AGD measurement at birth and at 6, 12, and 48 months of age were included. Multiple linear regression and generalized estimating equation (GEE) models were used to examine the associations of cord plasma concentrations of THs and TSH with AGI.
RESULTS
Multiple linear regression models showed inverse associations of TT, FT, and FT with female AGI, although statistical significance was only reached at birth, 6 and 48 months of age. These associations were also found in GEE models: higher TT and FT concentrations were associated with lower AGI (TT: β = -0.27, 95% CI: -0.50, -0.03 for middle . lowest tertile; FT: β = -0.38, 95% CI: -0.61, -0.16 for middle and β = -0.30, 95% CI: -0.55, -0.04 for highest . lowest tertile). Besides, girls with the highest tertile of FT concentrations had lower AGI than those with the lowest tertile (the highest . lowest tertile: β = -0.22, 95% CI: -0.36, -0.08). Positive associations between TSH and AGI at birth and at 12 months of age were observed in boys.
CONCLUSIONS
This study provides further evidence on the effects of neonatal thyroid function on reproductive development at an early life stage.
Topics: Anal Canal; Anthropometry; Child, Preschool; Female; Genitalia; Humans; Infant; Infant, Newborn; Male; Thyroid Function Tests; Thyroid Gland; Thyrotropin; Thyroxine; Triiodothyronine
PubMed: 34566898
DOI: 10.3389/fendo.2021.736505 -
Reproductive Sciences (Thousand Oaks,... Dec 2022AGD is the distance measured from the anus to the genital tubercle. Recent evidence suggests that a shorter AGD, a sensitive biomarker of the prenatal hormonal...
AGD is the distance measured from the anus to the genital tubercle. Recent evidence suggests that a shorter AGD, a sensitive biomarker of the prenatal hormonal environment, could be associated with higher endometriosis risk. However, studies investigating AGD in affected women are scanty. We have set up a case-control study recruiting nulliparous women (aged 18-40 years) with endometriosis between 2017 and 2018. Cases were 90 women with a surgical or with a current nonsurgical diagnosis of endometriosis (n = 45 deep infiltrating endometriosis (DIE), and n = 45 ovarian endometrioma (OMA)). Controls were 45 asymptomatic women referring for periodical gynaecological care and without a previous diagnosis of endometriosis. They were matched to cases for age and BMI. For each woman, two measures were obtained using a digital calliper: AGD, from the clitoral surface to the upper verge of the anus, and AGD, from the posterior fourchette to the upper verge of the anus. Each distance was derived from the mean of six measurements acquired from two different gynaecologists. The mean ± SD AGD in women with DIE, OMA and without a diagnosis of endometriosis was 76.0 ± 12.1, 76.1 ± 11.1 and 77.8 ± 11.4 mm, respectively (p = 0.55). The mean ± SD AGD in women with DIE, OMA and without a diagnosis of endometriosis was 22.8 ± 5.0, 21.7 ± 9.0 and 23.7 ± 7.8 mm, respectively (p = 0.38). Our study failed to find an association between AGD and the presence of endometriosis. AGD does not seem to represent a reliable indicator of the presence of endometriosis to be used in clinical practice.
Topics: Pregnancy; Female; Humans; Case-Control Studies; Genitalia, Female; Endometriosis; Anal Canal; Biomarkers
PubMed: 35817951
DOI: 10.1007/s43032-022-01009-7 -
Gastroenterology Jun 2022Epithelial wound healing is compromised and represents an unleveraged therapeutic target in inflammatory bowel disease (IBD). Intestinal epithelial cells exhibit...
BACKGROUND & AIMS
Epithelial wound healing is compromised and represents an unleveraged therapeutic target in inflammatory bowel disease (IBD). Intestinal epithelial cells exhibit plasticity that facilitates dedifferentiation and repair during the response to injury. However, it is not known whether epithelial cells of a neighboring organ can be activated to mediate re-epithelialization in acute colitis. Histological findings of a permanent squamous tissue structure in the distal colon in human IBD could suggest diverse cellular origins of repair-associated epithelium. Here, we tested whether skin-like cells from the anus mediate colonic re-epithelialization in murine colitis.
METHODS
We studied dextran sulfate sodium-induced colitis and interleukin 10-deficient colitis in transgenic mice. We performed lineage tracing, 3-dimensional (3D) imaging, single-cell transcriptomics, and biophysical modeling to map squamous cell fates and to identify squamous cell types involved in colonic repair.
RESULTS
In acute and chronic colitis, we found a large squamous epithelium, called squamous neo-epithelium of the colon (SNEC), near the anorectal junction. Neighboring squamous cells of the anus rapidly migrate into the ulcerated colon and establish this permanent epithelium of crypt-like morphology. These squamous cells derive from a small unique transition zone, distal to the border of colonic and anal epithelium, that resists colitic injury. The cells of this zone have a pre-loaded program of colonic differentiation and further upregulate key aspects of colonic epithelium during repair.
CONCLUSION
Transitional anal cells represent unique reserve cells capable of rebuilding epithelial structures in the colon after colitis. Further study of these cells could reveal novel approaches to direct mucosal healing in inflammation and disease.
Topics: Anal Canal; Animals; Carcinoma, Squamous Cell; Colitis; Colon; Dextran Sulfate; Disease Models, Animal; Epithelial Cells; Humans; Inflammatory Bowel Diseases; Intestinal Mucosa; Mice; Mice, Inbred C57BL; Re-Epithelialization
PubMed: 35227778
DOI: 10.1053/j.gastro.2022.02.031 -
Archives of Gynecology and Obstetrics Jun 2020The present study aimed to assess the risk of obstetric anal sphincter injuries (OASIS) of a subsequent delivery after the previous OASIS in countries with low (Finland)...
PURPOSE
The present study aimed to assess the risk of obstetric anal sphincter injuries (OASIS) of a subsequent delivery after the previous OASIS in countries with low (Finland) and high rates (Norway and Sweden) of OASIS.
METHODS
This population-based case-control study included women who experienced OASIS 1997-2002. 26,598 women with OASIS were included from countries with low (Finland) and high (Norway and Sweden) OASIS incidences. Each case was matched with one background-adjusted control without OASIS. A follow-up data, including all subsequent deliveries between 1998 and 2011 were then collected. Statistics significances were calculated using chi-square test, test for relative proportions and Students t test, where appropriate.
RESULTS
OASIS in the first birth was associated with increased recurrences in subsequent births, 6.9% vs. 1.7% in Norway (p < 0.001); 4.5% vs. 0.7 (p < 0.001) in Sweden; and 2.1% vs. 0.8% in Finland (p = 0.038). In Norway, more than two deliveries occurred in 4.8% of cases and 6.2% of controls (p = 0.001), 4.2% vs. 5.1% in Sweden (p < 0.001), and 5.7% vs. 6.3% in Finland (p = 0.572). For women with OASIS in a previous delivery, the rates of cesarean deliveries in subsequent pregnancies were 16.4% (7.9% for controls) in Norway, and 16.3% (6.0% for controls) in Sweden, and 50.2% (14.2% for controls) in Finland. In all countries, the differences between cases and controls were significant (p < 0.001).
CONCLUSION
Next deliveries after OASIS are associated with increased frequency of new OASIS, more cesarean deliveries, and less subsequent deliveries in the high-risk population than women without previous OASIS.
Topics: Adult; Anal Canal; Case-Control Studies; Cesarean Section; Female; Humans; Incidence; Obstetric Labor Complications; Pregnancy; Risk Factors
PubMed: 32328710
DOI: 10.1007/s00404-020-05550-1 -
Andrology Mar 2020Many diseases have been associated with anogenital distance, as an indicator of intrauterine androgen exposure.
BACKGROUND
Many diseases have been associated with anogenital distance, as an indicator of intrauterine androgen exposure.
OBJECTIVES
The aim of this study was to investigate the association between lifelong premature ejaculation and anogenital distance.
MATERIALS AND METHODS
The study included 140 participants: 70 with lifelong premature ejaculation (group 1) and 70 without any ejaculatory complaints (group 2). Premature Ejaculation Diagnostic Tool and stopwatch intravaginal ejaculatory latency time were recorded from all participants in order to evaluate ejaculatory function. Two variants of anogenital distance were measured: anogenital distance (from anus to the posterior base of the scrotum) from anus to the posterior base of the scrotum and anogenital distance (from anus to the cephalad insertion of the penis) to the cephalad insertion of the penis. We compared differences between groups and correlations between anogenital distance variants and patients' characteristics.
RESULTS
The groups were similar in terms of age, BMI, and total testosterone levels. The mean anogenital distance (from anus to the posterior base of the scrotum) scores were 59.45 ± 10.76 vs. 55.02 ± 10.13 (p = 0.01), and anogenital distance (from anus to the cephalad insertion of the penis) scores were 128.37 ± 22.2 vs. 126.78 ± 16.21 (p = 0.63) in groups 1 and 2, respectively. Significant correlation was observed between anogenital distance (from anus to the posterior base of the scrotum) and Premature Ejaculation Diagnostic Tool scores (r = 0.199, p = 0.019) and intravaginal ejaculatory latency time (r = -0.185, p = 0.028). There were no statistically significant differences between anogenital distance (from anus to the posterior base of the scrotum) scores and total testosterone levels and between anogenital distance (from anus to the cephalad insertion of the penis) and Premature Ejaculation Diagnostic Tool scores or intravaginal ejaculatory latency time.
CONCLUSIONS
These results suggest that longer anogenital distance is associated with higher possibility of lifelong premature ejaculation. However, further studies are needed to confirm our results.
Topics: Adult; Anal Canal; Body Weights and Measures; Humans; Male; Penis; Premature Ejaculation
PubMed: 31536679
DOI: 10.1111/andr.12709 -
American Journal of Obstetrics and... May 2024Several 2-dimensional and 3-dimensional measurements have been used to assess changes in pelvic floor structures and shape. These include assessment of urogenital and... (Review)
Review
Several 2-dimensional and 3-dimensional measurements have been used to assess changes in pelvic floor structures and shape. These include assessment of urogenital and levator hiatus dimensions, levator injury grade, levator bowl volume, and levator plate shape. We argue that each assessment reflects underlying changes in an individual aspect of the overall changes in muscle and fascial structures. Vaginal delivery, aging, and interindividual variations in anatomy combine to affect pelvic floor structures and their connections in different ways. To date, there is no unifying conceptual model that permits the evaluation of how these many measures relate to one another or that reflects overall pelvic floor structure and function. Therefore, this study aimed to describe a unified pelvic floor conceptual model to better understand how the aforementioned changes to the pelvic floor structures and their biomechanical interactions affect pelvic organ support with vaginal birth, prolapse, and age. In this model, the pelvic floor is composed of 5 key anatomic structures: the (1) pubovisceral, (2) puborectal, and (3) iliococcygeal muscles with their superficial and inferior fascia; (4) the perineal membrane or body; and (5) the anal sphincter complex. Schematically, these structures are considered to originate from pelvic sidewall structures and meet medially at important connection points that include the anal sphincter complex, perineal body, and anococcygeal raphe. The pubovisceral muscle contributes primarily to urogenital hiatus closure, whereas the puborectal muscle is mainly related to levator hiatus closure, although each muscle contributes to the other. Dorsally and laterally, the iliococcygeal muscle forms a shelflike structure in women with normal support that spans the remaining area between these medial muscles and attachments to the pelvic sidewall. Other features include the levator plate, bowl volume, and anorectal angle. The pelvic floor conceptual model integrates existing observations and points out evident knowledge gaps in how parturition, injury, disease, and aging can contribute to changes associated with pelvic floor function caused by the detachment of one or more important connection points or pubovisceral muscle failure.
Topics: Humans; Female; Pelvic Floor; Parity; Pelvic Organ Prolapse; Pregnancy; Aging; Anal Canal; Age Factors; Delivery, Obstetric; Perineum
PubMed: 38036167
DOI: 10.1016/j.ajog.2023.11.1247