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No.9 September 2003
Vol.46, No.9 September 2003 CONTENTS Defecatory Dysfunction Pathogenesis and Pathology of Defecatory Disturbances Masahiro TAKANO . 367 Diagnosis of Impaired Defecatory Function with Special Reference to Physiological Tests Masatoshi OYA et al. 373 Surgical Management for Defecation Dysfunction Tatsuo TERAMOTO . 378 Dysfunction in Defecation and Its Treatment after Rectal Excision Katsuyoshi HATAKEYAMA . 384 Infectious Diseases Changes in Measures against Infectious Diseases in Japan and Proposals for the Future Takashi NOMURA et al. 390 Extragenital Infection with Sexually Transmitted Pathogens Hiroyuki KOJIMA . 401 Nutritional Counseling Behavior Therapy for Nutritional Counseling —In cooperation with registered dietitians— Yoshiko ADACHI . 410 Ⅵ Defecatory Dysfunction Pathogenesis and Pathology of Defecatory Disturbances JMAJ 46(9): 367–372, 2003 Masahiro TAKANO Director, Coloproctology Center, Hidaka Hospital Abstract: In recent years the number of patients with defecatory disturbances has increased due to an aging population, stress, and other related factors. The medical community has failed to focus enough attention on this condition, which remains a sort of psychosocial taboo, enhancing patient anxiety. Defecatory distur- bance classified according to cause and location can fall into one of four groups: 1) Endocrine abnormalities; 2) Disturbances of colonic origin that result from the long-term use of antihypertensive drugs or antidepressants or from circadian rhythm disturbances that occur with skipping breakfast or lower dietary -
The American Society of Colon and Rectal Surgeons' Clinical Practice
CLINICAL PRACTICE GUIDELINES The American Society of Colon and Rectal Surgeons’ Clinical Practice Guideline for the Evaluation and Management of Constipation Ian M. Paquette, M.D. • Madhulika Varma, M.D. • Charles Ternent, M.D. Genevieve Melton-Meaux, M.D. • Janice F. Rafferty, M.D. • Daniel Feingold, M.D. Scott R. Steele, M.D. he American Society of Colon and Rectal Surgeons for functional constipation include at least 2 of the fol- is dedicated to assuring high-quality patient care lowing symptoms during ≥25% of defecations: straining, Tby advancing the science, prevention, and manage- lumpy or hard stools, sensation of incomplete evacuation, ment of disorders and diseases of the colon, rectum, and sensation of anorectal obstruction or blockage, relying on anus. The Clinical Practice Guidelines Committee is com- manual maneuvers to promote defecation, and having less posed of Society members who are chosen because they than 3 unassisted bowel movements per week.7,8 These cri- XXX have demonstrated expertise in the specialty of colon and teria include constipation related to the 3 common sub- rectal surgery. This committee was created to lead inter- types: colonic inertia or slow transit constipation, normal national efforts in defining quality care for conditions re- transit constipation, and pelvic floor or defecation dys- lated to the colon, rectum, and anus. This is accompanied function. However, in reality, many patients demonstrate by developing Clinical Practice Guidelines based on the symptoms attributable to more than 1 constipation sub- best available evidence. These guidelines are inclusive and type and to constipation-predominant IBS, as well. The not prescriptive. -
Patient Information Leaflet
9 Tighten your anal muscles once more when Not everyone is the same, a normal bowel you have finished opening your bowels. habit varies from between three times a day to three times a week. Your motion should be solid, but easy to pass. If after following the advice in this leaflet Patient Information you are still having problems with Leaflet constipation please seek further help from your Doctor, Nurse or Continence Advisor. Compliments, comments, concerns or complaints? If you have any compliments, comments, concerns or complaints and you would like to speak to somebody about them please telephone or email If you find that your anal muscles are 01773 525119 tightening instead of relaxing practising 4, 5 [email protected] and 6 will help to get these muscles working correctly. However if you are still unable to Are we accessible to you? This publication relax your anal muscles and are straining is available on request in other formats (for excessively for long periods you should seek example, large print, easy read, Braille or help from your Doctor or Continence Advisor. audio version) and languages. For free You may have a condition known as anismus translation and/or other format please call which simply means that the muscles in your 01246 515224, or email us anus contract when they should relax. This is [email protected] easily treated. Remember... Constipation Advice for ¨ Drink 1.5-2 litres of fluid a day Continence Advisory Service Patients ¨ Eat 5 portions of fruit / vegetables a day Alfreton Primary Care Centre ¨ Eat regularly ¨ Never ignore the sensation to go Church Street Not everyone has a bowel which works ¨ Allow yourself plenty of time and privacy Alfreton properly, but you may be able to improve ¨ Get into a routine Derbyshire your symptoms by following the advice - Exercise (within your capabilities) DE55 7AH offered in this leaflet - Do not strain. -
The Efficacy of a Multidisciplinary Approach to the Management of Constipation: a Case Series
Journal of the Association of Chartered Physiotherapists in Women’s Health, Spring 2008, 102, 36–44 CLINICAL PAPER The efficacy of a multidisciplinary approach to the management of constipation: a case series R. W. C. Leung, B. K. Y. Fung & L. C. W. Fung Physiotherapy Department, Kwong Wah Hospital, Hong Kong W. C. S. Meng, P. Y. Y. Lau & A. W. C. Yip Department of Surgery, Kwong Wah Hospital, Hong Kong Abstract The aim of this study was to evaluate a rehabilitative programme including biofeedback training for the treatment of chronic constipation. A prospective series of patients with constipation, as defined by the Rome II diagnostic criteria, were assessed by a clinician, a dietitian and a physiotherapist. Anorectal physi- ology investigations and defecography were performed prior to and after the programme. The treatment involved consultation by the dietitian, postural re-education and pelvic floor re-education regarding the proper pattern of defecation. The subjects were followed up in alternate weeks for the first 3 months and then monthly for another 3 months. Twenty patients have been recruited into the programme since 2005. Ten subjects have completed the course of treatment and three have defaulted; the remaining seven were still undergoing treatment at the time of writing. On completion of the programme, there was a significant improvement in fibre intake (pre-treatment=12.9191.06 g; post-treatment= 20.2661.064 g; P=0.001), average straining effort (pre-treatment=6.360.391; post-treatment=3.720.391; P=0.001) and average straining time (pre- treatment=17.612.172 min; post-treatment=6.002.172 min; P=0.004). -
Redalyc.Biofeedback Treatment in Chronically Constipated Patients
Revista Latinoamericana de Psicología ISSN: 0120-0534 [email protected] Fundación Universitaria Konrad Lorenz Colombia Simón, Miguel A.; Bueno, Ana M.; Durán, Montserrat Biofeedback treatment in chronically constipated patients with dyssynergic defecation Revista Latinoamericana de Psicología, vol. 43, núm. 1, 2011, pp. 105-111 Fundación Universitaria Konrad Lorenz Bogotá, Colombia Available in: http://www.redalyc.org/articulo.oa?id=80520078010 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative Biofeedback on dyssynergic defecation Biofeedback treatment in chronically constipated patients with dyssynergic defecation Biofeedback aplicado al tratamiento de pacientes con estreñimiento crónico debido a defecación disinérgica Recibido: Marzo de 2009 Miguel A. Simón Aceptado: Agosto de 2010 Ana M. Bueno Montserrat Durán University of A Coruña, Department of Psychology, Research Group in Clinical and Health Psychology, Spain Correspondence: Miguel A. Simón, Full postal address: Research Group in Clinical and Health Psychology, Department of Psychology, University of A Coruña, Campus of Elviña, 15071 A Coruña, Spain Abstract Resumen The aim of this study was to evaluate the effects of El objetivo de este estudio fue evaluar los efectos del electromyographic biofeedback training in chronically entrenamiento -
Irritable Bowel Syndrome
Irritable Bowel Syndrome If you suffer from the following ongoing symptoms, you mostly because IBS is not limited to the large intestine (colon). might have IBS: Sometimes, IBS is confused with colitis or other inflammatory Abdominal Pain diseases of the intestinal tract, but the difference is clear – in Bloating IBS, inflammation does not seem to accompany symptoms. Constipation Diarrhea Symptoms IBS is a chronic, often debilitating, functional gastrointestinal Almost every person has experienced abdominal cramping, (GI) disorder with symptoms that include abdominal pain, bloating, constipation, or diarrhea at some point in his or her bloating, and altered bowel behaviours, such as constipation life. However, those who have IBS experience these multiple and/or diarrhea, or alternating between the two. In IBS, the symptoms more frequently and intensely, to the extent that they function, or movement, of the bowel is not quite right. There are interfere with day-to-day living. no medical tests to confirm or rule out a diagnosis and yet it is A person who has IBS likely has a sensitive digestive the most common GI condition worldwide and the most frequent system with heightened reactivity, so that the GI tract responds disorder presented by individuals consulting a gastrointestinal quite differently to normal gut stimuli, such as the passage of specialist (gastroenterologist). solids, gas, and fluid through the intestines. These unusual IBS can begin in childhood, adolescence, or adulthood and movements may result in difficulty passing stool, or sudden, can resolve unexpectedly for periods throughout an individual’s urgent elimination. Up to 20% of those who have IBS report lifespan, recurring at any age. -
European Evidence Based Consensus on Surgery for Ulcerative Colitis Tom Øresland*, Willem A
Journal of Crohn’s and Colitis, 2015, 4–25 doi:10.1016/j.crohns.2014.08.012 ECCO Guidelines/Consensus Paper ECCO Guidelines/Consensus Paper European evidence based consensus on surgery for ulcerative colitis Tom Øresland*, Willem A. Bemelman, Gianluca M. Sampietro, Antonino Spinelli, Alastair Windsor, Marc Ferrante, Philippe Marteau, Oded Zmora, Paulo Gustavo Kotze, Eloy Espin-Basany, Emmanuel Tiret, Giuseppe Sica, Yves Panis, Arne E. Faerden, Livia Biancone, Imerio Angriman, Zuzana Serclova, Anthony de Buck van Overstraeten, Paolo Gionchetti, Laurents Stassen, Janindra Warusavitarne Michel Adamina, Axel Dignass, Rami Eliakim, Fernando Magro, André D’Hoore, On behalf of the European Crohn's and Colitis Organisation (ECCO) Received July 14 2014; revised August 23 2014; accepted August 27 2014. ⁎Corresponding author at: Clinic for Surgical Sciences, Univ. of Oslo at Dept. of Digestive Surgery, Akershus Univ. Hospital, 1478 Lorenskog, Norway. Keywords: ulcerative colitis; surgery; ileal pouch-anal anastomosis; cancer 1. Introduction and also for all national representatives of ECCO for the second vot- ing procedure. The WGs finally met in Belgrade on September 25th The goal of this consensus initiated by the European Crohn's and 2013 for a final face-to-face discussion and to vote and consent on Colitis Organisation (ECCO) was to establish European consensus the statements. Technically this was done by projecting the statements guidelines for the surgical treatment of ulcerative colitis. The strategy and revising them on screen until a consensus was reached. Consensus to reach the consensus involved several steps and follows the standard was defined as agreement by more than 80% of participants, termed a operating procedures for consensus guidelines of ECCO. -
Irritable Bowel-Anismus
7-5 Irritable Bowel-Anismus Wael Solh and Eric G.Weiss The causes of constipation and altered defecation are mul- found in patients with solitary ulcer syndrome and idio- tifactorial, and the manifestations are varied. Etiologies of pathic perineal pain.3 Therefore, the diagnosis of NRPS must constipation or altered defecation can be divided into two be made based on the patient’s clinical findings, supported categories – slow transit constipation, and pelvic outlet by more than one physiologic investigation. obstruction. Pelvic outlet obstruction includes etiologies such as paradoxical or nonrelaxation of the puborectalis muscle or anismus (nonrelaxation of the “anal canal”), Treatment rectal prolapse or intussusception, and nonemptying rec- toceles. Associated findings may include perineal descent Because NRPS is a behavioral rather than an anatomic and solitary rectal ulcer syndrome. abnormality, biofeedback is the standard therapy. In In normal defecation, the pelvic floor muscles and exter- biofeedback training, patients are allowed to view their nal anal sphincter are voluntarily inhibited resulting in an own EMG or manometric tracings on a video monitor increase in the anorectal angle with increasing intraab- while attempting to relax the pelvic floor and sphincter dominal pressure. Patients with nonrelaxing puborectalis muscles. Numerous reports have demonstrated success syndrome (NRPS) or anismus are unable to voluntarily rates ranging from 37% to 100%.4 In the largest series to inhibit contraction of the pelvic floor. When inappropriate date, Gilliland and Wexner5 found only one variable to be function of the puborectalis muscle (inappropriate con- predictive of a successful outcome: patients who self- traction or failure to relax) results in the inability to evac- discharged from therapy had a success rate of only uate the rectum, the condition is termed anismus. -
Management of Rectal Prolapse –The State of the Art
Central JSM General Surgery: Cases and Images Bringing Excellence in Open Access Review Article *Corresponding author Adrian E. Ortega, Division of Colorectal Surgery, Keck School of Medicine at the University of Southern California, Los Angeles Clinic Tower, Room 6A231-A, Management of Rectal Prolapse LAC+USC Medical Center, 1200 N. State Street, Los Angeles, CA 90033, USA, Email: sccowboy78@gmail. – The State of the Art com Submitted: 22 November 2016 Ortega AE*, Cologne KG, and Lee SW Accepted: 20 December 2016 Division of Colorectal Surgery, Keck School of Medicine at the University of Southern Published: 04 January 2017 California, USA Copyright © 2017 Ortega et al. Abstract OPEN ACCESS This manuscript reviews the current understanding of the condition known as rectal prolapse. It highlights the underlying patho physiology, anatomic pathology Keywords and clinical evaluation. Past and present treatment options are discussed including • Rectal prolapsed important surgical anatomic concepts. Complications and outcomes are addressed. • Incarcerated rectal prolapse INTRODUCTION Rectal prolapse has existed in the human experience since the time of antiquities. References to falling down of the rectum are known to appear in the Ebers Papyrus as early as 1500 B.C., as well as in the Bible and in the writings of Hippocrates (Figure 1) [1]. Etiology • The precise causation of rectal prolapse is ill defined. Clearly, five anatomic pathologic elements may be observed in association with this condition:Diastasis of Figure 1 surrounded by circular folds of rectal mucosa. the levator ani A classic full-thickness rectal prolapse with the central “rosette” • A deep cul-de-sac • Ano-recto-colonic redundancy • A patulous anus • Loss of fixation of the rectum to its sacral attachments. -
When Is Surgery Warranted for Hemorrhoids Necessary
When Is Surgery Warranted For Hemorrhoids Necessary Half-blooded and convincing Quinn always countermand unflatteringly and bruting his disfigurement. Ascribable reordainsKelwin unsheathe her Cornishman his monera braved adhered pertinently. oppressively. Balkiest Yance debugs venturously and licentiously, she Although the Haemorrhoid Artery Ligation HAL operation provides a low. Hemorrhoids surgical excision may hot be warranted when Figure 4 Operative. If reduction is unsuccessful, obtain surgical consultation. Fecal matter leaves your condition can become symptomatic external hemorrhoids gently washing compared light and fissure first, hiperplasia e congestão venosa. If necessary to red blood vessels or reproduced in showing rectal surgeon will redirect to regular intervals until surgery when is surgery warranted for hemorrhoids necessary and hematochezia that aims to. Randomized trial of is when surgery warranted for hemorrhoids necessary herbal and volume and complication. This distinction is made for bleeding gastric stump suspension for performing extensive scarring and. Longer boil-up is needed to ensure favorable long-term subjective and objective. The ih was very important science stories of recurrence rates, one always consult your chances of fistula is a type. Taking a warm sitz bath can relieve symptoms. The dst stapler suturing in those with laxatives and for surgery when is warranted hemorrhoids necessary before and. For some chronic constipation, when is surgery warranted for hemorrhoids who would be hemorrhoids here to other locations, an array of your surgeon will never ignore professional medical records of. During sexual intercourse is warranted for surgery when is hemorrhoids necessary for hemorrhoidopexy has the characteristics can up to the results or run tests are necessary and the anus. -
MR Defecography for Obstructed Defecation Syndrome
Published online: 2021-07-30 ABDOMINAL RADIOLOGY MR defecography for obstructed defecation syndrome Ravikumar B Thapar, Roysuneel V Patankar1, Ritesh D Kamat, Radhika R Thapar, Vipul Chemburkar Departments of Radiology and 1Surgery, Joy Hospital, Mumbai, Maharashtra, India Correspondence: Dr. Ravikumar B Thapar, 302, Amar Residency, Punjabwadi, ST Road, Deonar, Mumbai ‑ 400 088, Maharashtra, India. E‑mail: [email protected] Abstract Patients with obstructed defecation syndrome (ODS) form an important subset of patients with chronic constipation. Evaluation and treatment of these patients has traditionally been difficult. Magnetic resonance defecography (MRD) is a very useful tool for the evaluation of these patients. We evaluated the scans and records of 192 consecutive patients who underwent MRD at our center between January 2011 and January 2012. Abnormal descent, rectoceles, rectorectal intussusceptions, enteroceles, and spastic perineum were observed in a large number of these patients, usually in various combinations. We discuss the technique, its advantages and limitations, and the normal findings and various pathologies. Key words: Chronic constipation; magnetic resonance defecography; obstructed defecation syndrome; pelvic floor Introduction bleeding after defecation, and a sense of incomplete fecal evacuation.[4] Patients may also resort to digital rectal Constipation has a high prevalence in the general evacuation. Evaluation and treatment of these patients has population and is a cause for significant morbidity. It been difficult. Magnetic resonance defecography (MRD) has been estimated that approximately 10% of the Indian has been shown to demonstrate the structural abnormalities population suffers from constipation.[1] Chronic constipation associated with ODS, and patients with significant structural leads to approximately 2.5 million visits to the physicians abnormalities may benefit from surgical interventions like in the United States annually.[2] Various definitions have stapled transanal resection of rectum (STARR). -
Defecography by Digital Radiography: Experience in Clinical Practice* Defecografia Por Radiologia Digital: Experiência Na Prática Clínica
Gonçalves ANSOriginal et al. / Defecography Article in clinical practice Defecography by digital radiography: experience in clinical practice* Defecografia por radiologia digital: experiência na prática clínica Amanda Nogueira de Sá Gonçalves1, Marco Aurélio Sousa Sala1, Rodrigo Ciotola Bruno2, José Alberto Cunha Xavier3, João Mauricio Canavezi Indiani1, Marcelo Fontalvo Martin1, Paulo Maurício Chagas Bruno2, Marcelo Souto Nacif4 Gonçalves ANS, Sala MAS, Bruno RC, Xavier JAC, Indiani JMC, Martin MF, Bruno PMC, Nacif MS. Defecography by digital radiography: experience in clinical practice. Radiol Bras. 2016 Nov/Dez;49(6):376–381. Abstract Objective: The objective of this study was to profile patients who undergo defecography, by age and gender, as well as to describe the main imaging and diagnostic findings in this population. Materials and Methods: This was a retrospective, descriptive study of 39 patients, conducted between January 2012 and February 2014. The patients were evaluated in terms of age, gender, and diagnosis. They were stratified by age, and continuous variables are expressed as mean ± standard deviation. All possible quantitative defecography variables were evaluated, including rectal evacuation, perineal descent, and measures of the anal canal. Results: The majority (95%) of the patients were female. Patient ages ranged from 18 to 82 years (mean age, 52 ± 13 years): 10 patients were under 40 years of age; 18 were between 40 and 60 years of age; and 11 were over 60 years of age. All 39 of the patients evaluated had abnormal radiological findings. The most prevalent diagnoses were rectocele (in 77%) and enterocele (in 38%). Less prevalent diagnoses were vaginal prolapse, uterine prolapse, and Meckel’s diverticulum (in 2%, for all).