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Frontiers in Nutrition 2021, a traditional Japanese herbal medicine (Kampo), has been used to treat abdominal distention of the middle yang stage pattern. The use of has not been thoroughly...
, a traditional Japanese herbal medicine (Kampo), has been used to treat abdominal distention of the middle yang stage pattern. The use of has not been thoroughly investigated in critical care. To investigate a new Kampo approach to defecation control in critically ill patients, our study aimed to assess the effects of on fecal management. We analyzed 30 consecutive patients treated with in the intensive care unit (ICU) between March 2017 and February 2021. The eligibility criteria were patients who were newly prescribed in the ICU during the study period. Exclusion criteria were patients who were started on other laxatives within one day of beginning . The study's primary outcome was defecation volume three days before and three days after starting . We recorded the most dominant stool quality within three days after the start of . Twenty-one patients were included in the analysis. The median age was 69.0 years, and the median sequential organ failure assessment score on admission to the ICU was 6.0. Major diseases included trauma, pancreatitis, and burns. Administration of resulted in defecation in 17 of twenty-one patients (81.0%). Comparison of defecation volume between 3 days before administration and three days, including the day of administration, showed that defecation volume increased significantly after administration, with a median of 0 to 360 g ( < ). At the three-day follow-up, six of 17 (35.3%) patients defecated on the day of administration, and nine (52.9%) defecated on the day after administration. One patient was judged to have excessive defecation, and administration was discontinued. Stool quality was normal in one (5.9%) of the 17 patients, soft-formed in two (11.8%), loose-unformed in 11 (64.7%), and liquid in three (17.6%). administration in critically ill patients caused defecation in 81% of the patients and significantly increased stool volume. The novelty of this study is that it sheds light on the Kampo treatment of defecation control in critically ill patients. In addition to the present report, further studies are warranted to quantify the therapeutic efficacy and safety of .
PubMed: 34708065
DOI: 10.3389/fnut.2021.749570 -
Journal of Feline Medicine and Surgery Feb 2022Changes in bowel movements (BMs) are an important clinical sign in many diseases, including chronic kidney disease (CKD), and the purpose of this study was to collect...
OBJECTIVES
Changes in bowel movements (BMs) are an important clinical sign in many diseases, including chronic kidney disease (CKD), and the purpose of this study was to collect information on BMs and fecal scores in both apparently healthy and CKD cats. A secondary aim was to assess owner awareness of BM frequency.
METHODS
Owners were asked to complete an initial online questionnaire about their cat's health and litter box habits (including predicted BM frequency and fecal scores) and were then asked to clean the box daily for 7 days and report results (observed frequency of BMs and fecal scores) daily. Differences in BM frequency and fecal scores between apparently normal and CKD cats were compared using the Mann-Whitney test, and predicted vs observed data were compared using the Wilcoxon signed rank test. Difference in percentage of cats defecating more or less than once daily were assessed with Fisher's exact test.
RESULTS
Survey data from 124 owners of apparently healthy cats and 43 owners of CKD cats who submitted two or more days of daily observations (in addition to the initial questionnaire) were analyzed. Eighty-five percent of apparently healthy cats were observed to defecate one or more times per day and 15% defecated less than once per day. Fifty-eight percent of CKD cats defecated one or more times per day and 42% defecated less than once per day. A significantly higher percentage of CKD cats defecated less than once per day in comparison with apparently healthy cats ( <0.0001). Observed BM frequency was significantly less in CKD cats compared with healthy cats ( = 0.02). Observed fecal scores were not significantly different between healthy and CKD cats.
CONCLUSIONS AND RELEVANCE
The observed BM frequency of cats with CKD was less than apparently healthy cats and represents a clinically important variation from normal.
Topics: Animals; Behavior, Animal; Cat Diseases; Cats; Defecation; Feces; Renal Insufficiency, Chronic; Surveys and Questionnaires
PubMed: 34013812
DOI: 10.1177/1098612X211012684 -
Journal of Pediatric Gastroenterology... Jun 2022The present study aimed to assess long-term functional outcomes of children with anorectal malformations (ARMs) across a network of expert centers in France.
OBJECTIVES
The present study aimed to assess long-term functional outcomes of children with anorectal malformations (ARMs) across a network of expert centers in France.
METHODS
Retrospective cross-sectional study of patients ages 6-30 years that had been surgically treated for ARM. Patient and ARM characteristics (eg, level, surgical approach) and functional outcomes were assessed in the different age groups.
RESULTS
Among 367 patients, there were 155 females (42.2%) and 212 males (57.8%), 188 (51.2%) cases with, and 179 (48.8%) higher forms without, perineal fistula. Univariate and multivariate statistical analyses with logistic regression showed correlation between the level of the rectal blind pouch and voluntary bowel movements (odds ratio [OR] = 1.84 [1.31-2.57], P < 0.001), or soiling (OR = 1.72 [1.31-2.25], P < 0.001), which was also associated with the inability to discriminate between stool and gas (OR = 2.45 [1.28-4.67], P = 0.007) and the presence of constipation (OR = 2.97 [1.74-5.08], P < 0.001). Risk factors for constipation were sacral abnormalities [OR = 2.26 [1.23-4.25], P = 0.01) and surgical procedures without an abdominal approach (OR = 2.98 [1.29-6.87], P = 0.01). Only the holding of voluntary bowel movements and soiling rates improved with age.
CONCLUSION
This cross-sectional study confirms a strong association between anatomical status and functional outcomes in patients surgically treated for ARM. It specifically highlights the need for long-term follow-up of all patients to help them with supportive care.
Topics: Adolescent; Adult; Anal Canal; Anorectal Malformations; Child; Constipation; Cross-Sectional Studies; Defecation; Female; Humans; Male; Rectum; Retrospective Studies; Young Adult
PubMed: 35849503
DOI: 10.1097/MPG.0000000000003447 -
PLoS Pathogens Oct 2021
Review
Topics: Animals; Behavior, Animal; Defecation; Feces; Insecta; Social Behavior
PubMed: 34710195
DOI: 10.1371/journal.ppat.1009964 -
Pediatric Surgery International Dec 2023To investigate the correlation between postoperative feeding intolerance and defecation, with a view to carrying out prognostic assessment and timely intervention for...
PURPOSE
To investigate the correlation between postoperative feeding intolerance and defecation, with a view to carrying out prognostic assessment and timely intervention for the recovery of postoperative gastrointestinal function.
METHODS
The 114 neonates with congenital intestinal atresia who underwent primary anastomosis admitted to Shenzhen Children's Hospital from January 2014 to December 2022 were studied, and the patients' basic information, intraoperative conditions, postoperative feeding and defecation, and hospitalization time were retrospectively analyzed.
RESULTS
The risk factors for feeding intolerance after primary anastomosis for intestinal atresia are the gestational days, the time of the first postoperative defecations, the number of defecations on the previous day and the average number of defecations before feeding.
CONCLUSION
The incidence of postoperative feeding intolerance is higher in preterm infants, and pediatricians can decide the timing of breastfeeding on the basis of the patients' defecation. The focus on accurate defecation may be more meaningful in determining and predicting postoperative feeding intolerance in the infants.
Topics: Infant; Child; Female; Infant, Newborn; Humans; Infant, Premature; Defecation; Intestinal Atresia; Retrospective Studies; Infant, Newborn, Diseases; Anastomosis, Surgical
PubMed: 38133659
DOI: 10.1007/s00383-023-05603-x -
The Cochrane Database of Systematic... Aug 2020Postpartum constipation, with symptoms, such as pain or discomfort, straining, and hard stool, is a common condition affecting mothers. Haemorrhoids, pain at the...
BACKGROUND
Postpartum constipation, with symptoms, such as pain or discomfort, straining, and hard stool, is a common condition affecting mothers. Haemorrhoids, pain at the episiotomy site, effects of pregnancy hormones, and haematinics used in pregnancy can increase the risk of postpartum constipation. Eating a high-fibre diet and increasing fluid intake are usually encouraged. Although laxatives are commonly used in relieving constipation, the effectiveness and safety of available interventions for preventing postpartum constipation should be ascertained. This is an update of a review first published in 2015.
OBJECTIVES
To evaluate the effectiveness and safety of interventions for preventing postpartum constipation.
SEARCH METHODS
We searched Cochrane Pregnancy and Childbirth's Trials Register, and two trials registers ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (7 October 2019), and screened reference lists of retrieved trials.
SELECTION CRITERIA
We considered all randomised controlled trials (RCTs) comparing any intervention for preventing postpartum constipation versus another intervention, placebo, or no intervention in postpartum women. Interventions could include pharmacological (e.g. laxatives) and non-pharmacological interventions (e.g. acupuncture, educational and behavioural interventions). Quasi-randomised trials and cluster-RCTs were eligible for inclusion; none were identified. Trials using a cross-over design were not eligible.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened the results of the search to select potentially relevant trials, extracted data, assessed risk of bias, and the certainty of the evidence, using the GRADE approach. We did not pool results in a meta-analysis, but reported them per study.
MAIN RESULTS
We included five trials (1208 postpartum mothers); three RCTs and two quasi-RCTs. Four trials compared a laxative with placebo; one compared a laxative plus a bulking agent versus the same laxative alone, in women who underwent surgical repair of third degree perineal tears. Trials were poorly reported, and four of the five trials were published over 40 years ago. We judged the risk of bias to be unclear for most domains. Overall, we found a high risk of selection and attrition bias. Laxative versus placebo We included four trials in this comparison. Two of the trials examined the effects of laxatives that are no longer used; one has been found to have carcinogenic properties (Danthron), and the other is not recommended for lactating women (Bisoxatin acetate); therefore, we did not include their results in our main findings. None of the trials included in this comparison assessed our primary outcomes: pain or straining on defecation, incidence of postpartum constipation, or quality of life; or many of our secondary outcomes. A laxative (senna) may increase the number of women having their first bowel movement within 24 hours after delivery (risk ratio (RR) 2.90, 95% confidence interval (CI) 2.24 to 3.75; 1 trial, 471 women; low-certainty evidence); may have little or no effect on the number of women having their first bowel movement on day one after delivery (RR 0.94, 95% CI 0.72 to 1.22; 1 trial, 471 women; very low-certainty evidence); may reduce the number of women having their first bowel movement on day two (RR 0.23, 95% CI 0.11 to 0.45; 1 trial, 471 women; low-certainty evidence); and day three (RR 0.05, 95% CI 0.00 to 0.89; 1 trial, 471 women; low-certainty evidence); and may have little or no effect on the number of women having their first bowel movement on day four after delivery (RR 0.22, 95% CI 0.03 to 1.87; 1 trial, 471 women; very low-certainty evidence), but some of the evidence is very uncertain. Adverse effects were poorly reported. Low-certainty evidence suggests that the laxative (senna) may increase the number of women experiencing abdominal cramps (RR 4.23, 95% CI 1.75 to 10.19; 1 trial, 471 women). Very low-certainty evidence suggests that laxatives taken by the mother may have little or no effect on loose stools in the baby (RR 0.62, 95% CI 0.16 to 2.41; 1 trial, 281 babies); or diarrhoea (RR 2.46, 95% CI 0.23 to 26.82; 1 trial, 281 babies). Laxative plus bulking agent versus laxative only Very low-certainty evidence from one trial (147 women) suggests no evidence of a difference between these two groups of women who underwent surgical repair of third degree perineal tears; only median and range data were reported. The trial also reported no evidence of a difference in the incidence of postpartum constipation (data not reported), but did not report on quality of life. Time to first bowel movement was reported as a median (range); very low-certainty evidence suggests little or no difference between the two groups. A laxative plus bulking agent may increase the number of women having any episode of faecal incontinence during the first 10 days postpartum (RR 1.81, 95% CI 1.01 to 3.23; 1 trial, 147 women; very low-certainty evidence). The trial did not report on adverse effects of the intervention on babies, or many of our secondary outcomes.
AUTHORS' CONCLUSIONS
There is insufficient evidence to make general conclusions about the effectiveness and safety of laxatives for preventing postpartum constipation. The evidence in this review was assessed as low to very low-certainty evidence, with downgrading decisions based on limitations in study design, indirectness and imprecision. We did not identify any trials assessing educational or behavioural interventions. We identified four trials that examined laxatives versus placebo, and one that examined laxatives versus laxatives plus stool bulking agents. Further, rigorous trials are needed to assess the effectiveness and safety of laxatives during the postpartum period for preventing constipation. Trials should assess educational and behavioural interventions, and positions that enhance defecation. They should report on the primary outcomes from this review: pain or straining on defecation, incidence of postpartum constipation, quality of life, time to first bowel movement after delivery, and adverse effects caused by the intervention, such as: nausea or vomiting, pain, and flatus.
Topics: Adult; Constipation; Defecation; Dietary Fiber; Female; Humans; Laxatives; Perineum; Postpartum Period; Puerperal Disorders; Randomized Controlled Trials as Topic; Time Factors
PubMed: 32761813
DOI: 10.1002/14651858.CD011625.pub3 -
Digestive Diseases (Basel, Switzerland) 2021The COVID-19 disease, which was declared epidemic by the WHO, is a global emergency public health problem. Patients with extrapulmonary symptoms are the group of...
BACKGROUND/AIMS
The COVID-19 disease, which was declared epidemic by the WHO, is a global emergency public health problem. Patients with extrapulmonary symptoms are the group of patients who should be considered for person-to-person transmission in the community. In our study, it was aimed to investigate the characteristics of patients with COVID-19-related diarrhea symptoms.
MATERIALS AND METHODS
The study was conducted retrospectively in CO-VID-19 rtRT-PCR-positive patients in 5 medical centers. Three or more loose/liquid stools per day or increased number of defecations compared to normal defecation were defined as diarrhea. The patients were analyzed in 2 groups as those with and without diarrhea.
RESULTS
One thousand eighty-six patients were included in the study. Seventy-eight (7.2%) of the patients had diarrhea. Diarrhea was watery in 54 (69.2%) patients while with blood and mucus in 18 (23.1%) patients. Diarrhea continued for an average of 5.2 ± 1.6 (2-11) days. The clinical and laboratory findings of patients with diarrhea were more serious than those without diarrhea. Diarrhea is more common in the elderly and people with comorbid disease, and patients with diarrhea had higher CMI score and CRP and higher complaints of fever, cough, shortness of breath, myalgia, and fatigue.
CONCLUSIONS
The presence of diarrhea should indicate a suspected COVID-19 infection and suggest testing for early diagnosis of the disease. It should be kept in mind that the course of the disease may be more severe in these patients, and precautions should also be taken in terms of fecal transmission during discharge.
Topics: Aged; COVID-19; Diarrhea; Feces; Humans; Retrospective Studies; SARS-CoV-2
PubMed: 33647911
DOI: 10.1159/000515521 -
PloS One 2022Open defecation is the disposal of human faeces in the fields, forests, bushes, and open bodies of water. It is practiced more in sub-Saharan African countries and is...
BACKGROUND
Open defecation is the disposal of human faeces in the fields, forests, bushes, and open bodies of water. It is practiced more in sub-Saharan African countries and is considered a sign of underdevelopment. Open defecation facilitates the transmission of pathogens that cause diarrheal diseases which is the second leading contributor to the global burden of disease. In Ethiopia, it kills half a million under-five children annually. Even though open defecation practice is a major cause of childhood mortality and morbidity in Ethiopia, there is minimal evidence on the trend, spatiotemporal distribution, wealth-related inequalities, and other determinates of open defecation practice.
OBJECTIVES
Therefore, this study aimed to investigate the trend, spatiotemporal distribution, and determinants of open defecation among households in Ethiopia.
METHODS
Cross-sectionally collected secondary data analysis was conducted based on 2016 Ethiopian Demographic and Health Survey (EDHS). A total weighted sample of 16,554 households was included. We assessed the 16 years (2000-2016) trend of open defecation with 95% confidence intervals. Data were weighted, recoded, cleaned, and analyzed using STATA version 14.2 software. A mixed-effect analysis was employed to identify factors contributing to open defecation practice in Ethiopia. In the final multivariable analysis, the associations between dependent and independent variables were presented using adjusted odds ratios and 95% confidence intervals with a p-value of <0.05. The concentration index was used to assess wealth-related inequalities, while spatial analysis was used to explore the spatial distribution and significant windows of open defecation practice.
RESULTS
The trend of open defecation practice in Ethiopia was significantly decreased from 81.96% (95% CI: 81.08, 82.8) in 2000 EDHS, to 32.23% (95% CI: 31.16, 33.31) in 2016 EDHS. Individual-level factors such as; age, educational attainment, marital status, media exposure, wealth status, and source of drinking water, as well as community-level factors such as residence, region, community-level poverty, and community level media usage, had a significant association. Open defecation practice was significantly and disproportionately concentrated on the poor households [C = -0.669; 95% CI: -0.716, -0.622]. A non-random open defecation practice was observed in Ethiopia. Among the 11 regions, primary clusters were identified in only 3 regions (Afar, Somali, and Eastern Amhara).
CONCLUSION
Open defecation practice remains a public health problem irrespective of the significant decrease seen in Ethiopia for the past 16 years. Individual and community-level factors had a significant association with this problem. Since it is a leading cause of under-five children mortality and morbidity, the Ethiopian ministry of health should plan and work on basic sanitation programs that focus on the poorest communities, rural societies, and small peripheral regions. These programs should include regional planning for sanitation, and translation of materials into local languages to prevent under-five mortality and morbidity due to diarrheal diseases caused by open defecation.
Topics: Child; Defecation; Diarrhea; Ethiopia; Family Characteristics; Humans; Spatial Analysis
PubMed: 35588139
DOI: 10.1371/journal.pone.0268342 -
Journal of Neurogastroenterology and... Jul 2022High-resolution anorectal manometry (HRAM) measures anal sphincter function and anorectal co-ordination. This study aims to provide normal data for HRAM and evaluate the...
BACKGROUND/AIMS
High-resolution anorectal manometry (HRAM) measures anal sphincter function and anorectal co-ordination. This study aims to provide normal data for HRAM and evaluate the effect of gender, age, and body mass index (BMI) on anorectal functions in healthy Indian subjects.
METHODS
HRAM was performed on 93 healthy volunteers using a 20-channel, water-perfused catheter. We evaluated anorectal pressures, rectal sensation, and balloon expulsion time. Measurements were recorded during rest, squeeze, and simulated defecation (push).
RESULTS
Median anal resting pressure (88 mmHg vs 94 mmHg, = NS), anal squeeze pressure (165 mmHg vs 147 mmHg, = NS) were not significantly different between males and females. Rectal pressure (70 mmHg vs 54 mmHg, = 0.024) and anal pressure (82 mmHg vs 63 mmHg, = 0.008) during simulated evacuation without rectal distention, were higher in males. The threshold for the first sensation was lower in females (40 mL vs 30 mL, = 0.021) but desire to defecate (105 mL vs 90 mL, = NS) and maximum tolerable volume (160 mL vs 140 mL, = NS) were not significantly different in males and females. Anal residual pressure (median mmHg 83 vs 71 mmHg, = 0.025) was higher in subjects < 40 years of age. Maximum anal squeeze pressure (185 mmHg vs 165 mmHg, = 0.024) and maximum rectal pressure (75 mmHg vs 62 mmHg, = 0.032) during push higher in BMI < 23 kg/m.
CONCLUSIONS
The present study provides normal data for the Indian population that can be used for comparison and further work. Age, gender, and BMI affect anorectal parameters in HRAM and should be considered while reporting.
PubMed: 35799233
DOI: 10.5056/jnm21107 -
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