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The Journal of Pediatrics Mar 1996To evaluate whether the ability to defecate a rectal balloon might predict 12-month recovery in children with functional constipation and encopresis. (Comparative Study)
Comparative Study
OBJECTIVE
To evaluate whether the ability to defecate a rectal balloon might predict 12-month recovery in children with functional constipation and encopresis.
METHODS
We evaluated the ability to defecate within 5 minutes a 100 ml waterfilled rectal balloon by 20 healthy children and 139 children with functional constipation and encopresis.
RESULTS
All healthy children and only 47% of the patients were able to defecate the balloon. Twelve months after the start of treatment, 51% of patients able to and 34% of patients unable to defecate the balloon had recovered (p < 0.03). Logistic regression revealed that the ability to defecate the balloon and a history of secondary encopresis were related to recovery (p < 0.04). Patients who were unable to defecate the balloon or who did not recover had significantly more impairment in anorectal functions than those who were able to defecate the balloon or who did recover. The ability of the balloon defecation test to predict recovery had a sensitivity of 57%, a specificity of 60%, a positive predictive value of 0.51, and a negative predictive value of 0.66.
CONCLUSION
Children with functional constipation and encopresis who were able to defecate the rectal balloon were twice as likely to recover. Even though there was a clinically significant difference in the recovery rates between patients who could and those who could not defecate the balloon, calculation of predictive values showed that the balloon defecation test could not reliably predict recovery.
Topics: Anal Canal; Case-Control Studies; Child; Constipation; Defecation; Encopresis; Female; Follow-Up Studies; Humans; Logistic Models; Male; Manometry; Predictive Value of Tests; Pressure; Sensitivity and Specificity; Time Factors; Treatment Outcome
PubMed: 8774500
DOI: 10.1016/s0022-3476(96)70277-9 -
Therapeutische Umschau. Revue... May 2003The ano-rectal organ derives from two different structures, the proctodaeum and the hindgut. The uro-rectal septum splits off the hindgut from the anterior part of the...
The ano-rectal organ derives from two different structures, the proctodaeum and the hindgut. The uro-rectal septum splits off the hindgut from the anterior part of the cloaca. This means that the anorectum has the same origin of nerves and blood vessels as the anterior part of the cloaca, which derives from the uro-genital sinus. In order to understand continence and defaecation, exact knowledge of the anatomy and physiology is compulsory. Studies in embryology are essential to the understanding of the anatomic and topographic structures.
Topics: Anal Canal; Defecation; Fecal Incontinence; Humans; Pelvic Floor; Rectum
PubMed: 12806793
DOI: 10.1024/0040-5930.60.5.243 -
Digestive Diseases and Sciences Jul 2003The aim of the study was to compare the straining forces applied when sitting or squatting during defecation. Twenty-eight apparently healthy volunteers (ages 17-66... (Comparative Study)
Comparative Study
The aim of the study was to compare the straining forces applied when sitting or squatting during defecation. Twenty-eight apparently healthy volunteers (ages 17-66 years) with normal bowel function were asked to use a digital timer to record the net time needed for sensation of satisfactory emptying while defecating in three alternative positions: sitting on a standard-sized toilet seat (41-42 cm high), sitting on a lower toilet seat (31-32 cm high), and squatting. They were also asked to note their subjective impression of the intensity of the defecation effort. Six consecutive bowel movements were recorded in each position. Both the time needed for sensation of satisfactory bowel emptying and the degree of subjectively assessed straining in the squatting position were reduced sharply in all volunteers compared with both sitting positions (P < 0.0001). In conclusion, the present study confirmed that sensation of satisfactory bowel emptying in sitting defecation posture necessitates excessive expulsive effort compared to the squatting posture.
Topics: Adolescent; Adult; Aged; Defecation; Female; Gastrointestinal Transit; Humans; Male; Middle Aged; Posture; Pressure; Sensory Thresholds; Toilet Facilities
PubMed: 12870773
DOI: 10.1023/a:1024180319005 -
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 -
Proceedings. Biological Sciences Nov 2010The iron-limited Southern Ocean plays an important role in regulating atmospheric CO(2) levels. Marine mammal respiration has been proposed to decrease the efficiency of...
The iron-limited Southern Ocean plays an important role in regulating atmospheric CO(2) levels. Marine mammal respiration has been proposed to decrease the efficiency of the Southern Ocean biological pump by returning photosynthetically fixed carbon to the atmosphere. Here, we show that by consuming prey at depth and defecating iron-rich liquid faeces into the photic zone, sperm whales (Physeter macrocephalus) instead stimulate new primary production and carbon export to the deep ocean. We estimate that Southern Ocean sperm whales defecate 50 tonnes of iron into the photic zone each year. Molar ratios of C(export):Fe(added) determined during natural ocean fertilization events are used to estimate the amount of carbon exported to the deep ocean in response to the iron defecated by sperm whales. We find that Southern Ocean sperm whales stimulate the export of 4 × 10(5) tonnes of carbon per year to the deep ocean and respire only 2 × 10(5) tonnes of carbon per year. By enhancing new primary production, the populations of 12 000 sperm whales in the Southern Ocean act as a carbon sink, removing 2 × 10(5) tonnes more carbon from the atmosphere than they add during respiration. The ability of the Southern Ocean to act as a carbon sink may have been diminished by large-scale removal of sperm whales during industrial whaling.
Topics: Animals; Carbon; Carbon Dioxide; Defecation; Feces; Iron; Oceans and Seas; Oxygen Consumption; Population Dynamics; Sperm Whale
PubMed: 20554546
DOI: 10.1098/rspb.2010.0863 -
Expert Opinion on Pharmacotherapy Jan 2013Childhood constipation is a common problem, varying from mild and short-lived to severe and chronic. In the majority of children, no organic cause can be identified and... (Review)
Review
INTRODUCTION
Childhood constipation is a common problem, varying from mild and short-lived to severe and chronic. In the majority of children, no organic cause can be identified and complaints are, thus, referred to as functional constipation. Infrequent painful defecation in combination with fecal incontinence has a significant impact on a child's quality of life. Pharmacological treatment often consists of fecal disimpaction and maintenance therapy. With current treatment options, results are often disappointing.
AREAS COVERED
The aim of this review is to provide an overview of current and future pharmacological therapies for functional constipation in childhood.
EXPERT OPINION
Despite the widespread use of laxatives, there is a paucity of evidence to support this practice. No strong conclusions can be drawn on which laxative to prefer over the other. However, polyethylene glycol appears to be a reasonable first choice for maintenance therapy. Due to advances in our understanding of intestinal (patho)physiology, new classes of drugs have been developed. Data from adult studies are promising; however, pediatric data are lacking. Ongoing and future studies have to determine the efficacy and safety of these new drugs in the treatment of functional constipation in children.
Topics: Adolescent; Child; Child, Preschool; Constipation; Defecation; Humans; Infant; Laxatives; Polyethylene Glycols; Quality of Life; Surface-Active Agents
PubMed: 23216375
DOI: 10.1517/14656566.2013.752816 -
Clinics in Orthopedic Surgery Aug 2023This prospective randomized controlled study aimed to determine the effects of abdominal massage on constipation management in elderly patients with hip fractures. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
This prospective randomized controlled study aimed to determine the effects of abdominal massage on constipation management in elderly patients with hip fractures.
METHODS
From August 2017 to December 2018, patients aged above 65 years with hip fractures (n = 88) were randomly assigned to a massage group that received a bowel massage (n = 48) or a control group that did not receive a bowel massage (n = 40). Patients in the bowel massage group received a bowel massage from a trained caregiver after breakfast at approximately 9:00 AM for an hour. On admission, 5 days after surgery, and on the day of discharge, the patient's normal and actual defecation pattern, stool consistency, and any problems with defecation were assessed through a structured interview. The questionnaire comprising the Bristol Stool Scale, patient assessment of constipation, time to defecation, medication for defecations, failure to defecate, cause of admission, admission period, and date of surgery were recorded. Statistical analyses were performed 5 days after surgery and on the day of discharge.
RESULTS
The mean age of the study cohort was 81.4 years (range, 65-99 years). The number of constipation remedies was significantly lower in the massage group than in the control group on postoperative day (POD) 5 and at discharge (9 vs. 15, = 0.049 and 6 vs. 11, = 0.039, respectively). The number of defecation failures was significantly lower in the massage group than in the control group (10 vs. 17, = 0.028) on POD 5. However, the number of defecation failures at discharge was not significantly different between the two groups ( = 0.131). The development of postoperative ileus ( = 0.271) and length of hospital stay ( = 0.576) were not different between the groups.
CONCLUSIONS
The number of constipation remedies was significantly lower in the massage group than in the control group on POD 5 and discharge, and the number of defecation failures was significantly lower in the massage group than in the control group on POD 5. Therefore, abdominal massage may be considered as an independent nursing initiative for constipation management.
Topics: Aged; Humans; Aged, 80 and over; Defecation; Prospective Studies; Constipation; Massage; Hip Fractures
PubMed: 37529190
DOI: 10.4055/cios22091 -
Expert Review of Gastroenterology &... Feb 2013
Randomized Controlled Trial
Topics: Caffeine; Central Nervous System Stimulants; Coffee; Colectomy; Defecation; Gastrointestinal Motility; Humans; Ileus; Postoperative Complications; Postoperative Period
PubMed: 23363257
DOI: 10.1586/egh.12.78 -
Scandinavian Journal of Gastroenterology Nov 1985The dietary habits and defecation patterns of 12 patients were examined 8-34 months after total colectomy with mucosal proctectomy and the construction of an ileal...
The dietary habits and defecation patterns of 12 patients were examined 8-34 months after total colectomy with mucosal proctectomy and the construction of an ileal reservoir attached to an anal anastomosis. The reservoir was provided with a long efferent leg (12 cm) through the anal canal. The patients were divided into two groups in accordance with the frequency of defecation--one with fewer than six defecations per 24 h and another with more than six defecations per 24 h. The fecal output, however, was not significantly different in the two groups. The fecal content of sodium and potassium was the same as in feces from conventional ileostomies. The dietary intake was insufficient in energy content, vitamins, minerals, and trace elements. Dietary supplement was recommended.
Topics: Adult; Anal Canal; Colectomy; Defecation; Feces; Feeding Behavior; Female; Humans; Ileum; Male; Rectum
PubMed: 4089516
DOI: 10.3109/00365528509088871 -
Journal of Paediatrics and Child Health Sep 2015To study whether diurnal variations and time in relation to defecation has to be taken into account when measurements of rectal diameter are used to determine faecal...
AIM
To study whether diurnal variations and time in relation to defecation has to be taken into account when measurements of rectal diameter are used to determine faecal impaction in constipated children.
METHODS
Repeated ultrasound measures of rectal diameter were performed in 28 children (14 constipated/14 healthy, aged between 4 and 12 years) every third hour during 24 h. After defecation, three additional scans were performed at 1-h intervals.
RESULTS
No diurnal variation in rectal diameter was found in the healthy group. In the constipated group, mean rectal diameter was significantly larger at 2 pm (P = 0.038) and 5 pm (P = 0.006). There were significant differences between rectal diameter in the healthy group and the constipated group at 2 pm (P = 0.016) and 5 pm (P = 0.027). When we omitted the rectal diameter of five constipated children who had their first bowel movement after 5 pm, there were no difference between groups (2 pm (P = 0.103)/5 pm (P = 0.644) ). Only in the constipated group, rectal diameter exceeded 3 cm without the patients feeling the urge to defecate.
CONCLUSION
We found no independent daily variation in either group without relation to defecation. There was a relation between defecation and changes in rectal diameter in both healthy children and constipated children during maintenance treatment.Asking for defecation signals before scanning should be considered a routine question, and a positive answer should cause postponement of the scan.
Topics: Abdomen; Child; Child, Preschool; Constipation; Defecation; Fecal Impaction; Female; Humans; Male; Rectum; Ultrasonography
PubMed: 25872799
DOI: 10.1111/jpc.12881