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An approach to the diagnosis and management of Rome IV functional disorders of chronic constipation.Expert Review of Gastroenterology &... Jan 2020: Chronic constipation is highly prevalent, affecting between 10% and 15% of the population. The Rome IV criteria categorizes disorders of chronic constipation into four... (Review)
Review
: Chronic constipation is highly prevalent, affecting between 10% and 15% of the population. The Rome IV criteria categorizes disorders of chronic constipation into four subtypes: (a) functional constipation, (b) irritable bowel syndrome with constipation, (c) opioid-induced constipation, and (d) functional defecation disorders, including inadequate defecatory propulsion and dyssynergic defecation. The initial management approach for these disorders is similar, focusing on diet, lifestyle and the use of standard over-the-counter laxatives. If unsuccessful, further therapy is tailored according to subtype.: This review covers the definition, epidemiology, diagnostic criteria, investigations and management of the Rome IV disorders of chronic constipation.: By adopting a logical step-wise approach toward the diagnosis of chronic constipation and its individual subtypes, clinicians have the opportunity to tailor therapy accordingly and improve symptoms, quality of life, and patient satisfaction.
Topics: Chronic Disease; Constipation; Defecation; Dietary Fiber; Exercise; Fluid Therapy; Humans; Laxatives
PubMed: 31893959
DOI: 10.1080/17474124.2020.1708718 -
Journal of the International Society of... Dec 2023Rectal distension increases regulatory burden to autonomic nervous system in the brain.
BACKGROUND
Rectal distension increases regulatory burden to autonomic nervous system in the brain.
PURPOSE
To determine the effect of rectal defecation on endurance performance and blood supply to the prefrontal brain and sub-navel regions of elite triathletes.
METHODS
Thirteen elite triathletes completed a cycling time trial (80% VO) under defecated and non-defecated conditions, using a counterbalanced crossover design. Oxygenation and blood distribution in prefrontal brain and sub-navel regions were monitored by near-infrared spectroscopy (NIRS) during cycling.
RESULTS
Defecation moderately decreased systolic blood pressure (-4 mmHg, < 0.05, d = 0.71), suggesting an alleviation of autonomic nervous activity. During the exercise trials, fatigue (cycling time to exhaustion) occurred when cerebral oxygenation decreased to ~ 5 % below baseline regardless of treatment conditions, suggesting a critical deoxygenation point for sustaining voluntary exertions. Cerebral blood (estimated by total hemoglobin) increased progressively throughout the entire exercise period. Defecation decreased sub-navel oxygenation levels below the non-defecated level, suggesting an increased sub-navel oxygen consumption. Exercise also decreased sub-navel blood distribution, with minimal difference between non-defecated and defecated conditions. Defecation improved blood pooling in the prefrontal brain during exercise ( < 0.05) and enhanced cycling performance in triathletes (Non-defecated: 1624 ± 138 s vs. defecated: 1902 ± 163 s, d = 0.51, < 0.05).
CONCLUSION
Our results suggest that improved exercise performance after defecation is associated with greater blood availability to compensate deoxygenation in the prefrontal brain region during exercise. Further investigation is needed to examine the role of increasing sub-navel oxygen consumption in the performance improvement after defecation.
Topics: Humans; Defecation; Exercise; Oxygen Consumption; Fatigue; Cerebrovascular Circulation
PubMed: 37102434
DOI: 10.1080/15502783.2023.2206380 -
PLoS Pathogens Oct 2021
Review
Topics: Animals; Behavior, Animal; Defecation; Feces; Insecta; Social Behavior
PubMed: 34710195
DOI: 10.1371/journal.ppat.1009964 -
Journal of Insect Physiology Jan 2019Feces provides information about the donor and potentially attracts both conspecifics and predators and also parasites. The excretory system must be coordinated with...
Feces provides information about the donor and potentially attracts both conspecifics and predators and also parasites. The excretory system must be coordinated with other behaviors in insects. We found that crickets started walking forward following defecation. Most intact crickets walked around the experimental arena, stopped at a particular site and raised their bodies up with a slight backward drift to defecate. After the feces dropped to the floor, a cricket started walking with a non-coordinated gait pattern away from the defecation site, and then changed to a tripod gait. To demonstrate that walking is a reflex response to defecation we analyzed the behavior of headless crickets and found that they also showed walking following defecation. In more than half of defecation events, headless crickets walked backwards before defecation. The posture adopted during defecation was similar to that of intact crickets, and forward walking after defecation was also observed. The frequency of forward walking after defecation in headless crickets was greater than in intact crickets. The gait pattern during forward walking was not coordinated and never transitioned to a tripod gait in headless crickets. In animals whose abdominal nerve cords were cut, in any position, pre- or post-defecation walking was not shown in either intact or headless crickets, although they defecated. These results indicated that the terminal abdominal ganglion receives information regarding hind gut condition. It also indicated that ascending signals from the terminal abdominal ganglion initiated leg movement through the neuronal circuits within the thoracic ganglia, and that descending signals from the brain must regulate the leg motor circuit to express the appropriate walking gait.
Topics: Animals; Defecation; Gryllidae; Walking
PubMed: 30468738
DOI: 10.1016/j.jinsphys.2018.11.004 -
Soft Matter Jul 2017Animals discharge feces within a range of sizes and shapes. Such variation has long been used to track animals as well as to diagnose illnesses in both humans and...
Animals discharge feces within a range of sizes and shapes. Such variation has long been used to track animals as well as to diagnose illnesses in both humans and animals. However, the physics by which feces are discharged remain poorly understood. In this combined experimental and theoretical study, we investigate the defecation of mammals from cats to elephants using the dimensions of large intestines and feces, videography at Zoo Atlanta, cone-on-plate rheological measurements of feces and mucus, and a mathematical model of defecation. The diameter of feces is comparable to that of the rectum, but the length is double that of the rectum, indicating that not only the rectum but also the colon is a storage facility for feces. Despite the length of rectum ranging from 4 to 40 cm, mammals from cats to elephants defecate within a nearly constant duration of 12 ± 7 seconds (N = 23). We rationalize this surprising trend by our mathematical model, which shows that feces slide along the large intestine by a layer of mucus, similar to a sled sliding down a chute. Larger animals have not only more feces but also thicker mucus layers, which facilitate their ejection. Our model accounts for the shorter and longer defecation times associated with diarrhea and constipation, respectively. This study may support clinicians use of non-invasive procedures such as defecation time in the diagnoses of ailments of the digestive system.
Topics: Animals; Cats; Constipation; Defecation; Diarrhea; Feces; Hydrodynamics; Models, Biological; Mucus; Pressure; Viscosity
PubMed: 28470247
DOI: 10.1039/c6sm02795d -
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 -
World Journal of Gastroenterology Nov 2006Dyssynergic defecation is one of the most common forms of functional constipation both in children and adults; it is defined by incomplete evacuation of fecal material... (Review)
Review
Dyssynergic defecation is one of the most common forms of functional constipation both in children and adults; it is defined by incomplete evacuation of fecal material from the rectum due to paradoxical contraction or failure to relax pelvic floor muscles when straining to defecate. This is believed to be a behavioral disorder because there are no associated morphological or neurological abnormalities, and consequently biofeedback training has been recommended for treatment. Biofeedback involves the use of pressure measurements or averaged electromyographic activity within the anal canal to teach patients how to relax pelvic floor muscles when straining to defecate. This is often combined with teaching the patient more appropriate techniques for straining (increasing intra-abdominal pressure) and having the patient practice defecating a water filled balloon. In adults, randomized controlled trials show that this form of biofeedback is more effective than laxatives, general muscle relaxation exercises (described as sham biofeedback), and drugs to relax skeletal muscles. Moreover, its effectiveness is specific to patients who have dyssynergic defecation and not slow transit constipation. However, in children, no clear superiority for biofeedback compared to laxatives has been demonstrated. Based on three randomized controlled studies in the last two years, biofeedback appears to be the preferred treatment for dyssynergic defecation in adults.
Topics: Adult; Ataxia; Biofeedback, Psychology; Child; Constipation; Defecation; Humans; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 17131466
DOI: 10.3748/wjg.v12.i44.7069 -
Annals of Medicine Dec 1990Defecation may be considered as "the last taboo". The inability to defecate, or to achieve it only by digital evacuation, has never been a popular topic among patients... (Review)
Review
Defecation may be considered as "the last taboo". The inability to defecate, or to achieve it only by digital evacuation, has never been a popular topic among patients and doctors. The extensive development of tests in laboratories studying colorectal disorders during recent years, however, has made it possible to study the different parts of the mechanism for maintaining continence. Since constipation is a disorder of this mechanism, namely a disorder of rectal evacuation, application of these tests on constipated patients is logical. Certainly surgery, either colectomy or sphincter division, is not the solution, nor is the injection of muscle weakening solutions. Biofeedback, however, seems to be a logical treatment. Development of new functional tests and strategies is needed to enable a better understanding of the problem. Collaboration between surgeon and psychologist has proved valuable and is recommended.
Topics: Constipation; Defecation; Humans; Muscles; Rectum
PubMed: 2076272
DOI: 10.3109/07853899009147279 -
Journal of the Experimental Analysis of... Jul 1982Excessive defecation, typically considered to be a concomitant of stress, was experimentally induced or eliminated under specific schedules of positive reinforcement of...
Excessive defecation, typically considered to be a concomitant of stress, was experimentally induced or eliminated under specific schedules of positive reinforcement of lever pressing by rats. The schedules were, by and large, those under which polydipsia is typically induced. In the first of three experiments, rats under fixed-interval 32-second schedules and variable interval 32-second schedules for food and water reinforcers defecated profusely, but not under fixed-interval one-second schedules or other small interval schedules. Somewhat higher rates of defecation were observed on variable interval 32-second schedules than on fixed-interval 32-second schedules. In a second experiment, fixed-ratio schedules were used, some of which resulted in responding such that reinforcement densities were similar to those on the interval schedules that induced defecation. Defecation was not systematically induced by these ratio schedules. In a third experiment, fixed-time schedules of food presentations were utilized. High rates of defecation were induced comparable to those induced by interval schedules of the same time parameter. No other behavior commonly termed "emotional" was observed in any of these experiments.
Topics: Animals; Conditioning, Operant; Defecation; Drinking Behavior; Feeding Behavior; Female; Humans; Male; Rats; Reinforcement Schedule; Reinforcement, Psychology; Stress, Psychological
PubMed: 7202038
DOI: 10.1901/jeab.1982.38-19 -
Trends in Genetics : TIG Oct 2006Caenorhabditis elegans exhibits a repertoire of behaviors that can be studied by genetic, anatomical and pharmacological approaches. Defecation is one of the simpler... (Review)
Review
Caenorhabditis elegans exhibits a repertoire of behaviors that can be studied by genetic, anatomical and pharmacological approaches. Defecation is one of the simpler behaviors, involving a small number of muscles, a couple of neurons and only one neurotransmitter. This simplicity enables the precise characterization of the cells and genes required for executing the behavior and has made the defecation behavior a powerful model for investigating the genetic basis of nervous system function, muscle differentiation, rhythmic behaviors and oscillatory calcium signaling, and the metabolic and environmental regulation of behavior. Our review highlights how the function of a system even this simple results from the integration of many aspects of an organism's biology and involves the action of diverse genes.
Topics: Animals; Caenorhabditis elegans; Calcium Signaling; Defecation; Nervous System Physiological Phenomena; Periodicity; Signal Transduction
PubMed: 16911844
DOI: 10.1016/j.tig.2006.08.006