Digital rectal examination(DRE)is essential for diagnosing anorectal diseases,yet its widespread adoption remains suboptimal among practitioners.While modalities such as anorectal manometry,rectal balloon expulsion te...Digital rectal examination(DRE)is essential for diagnosing anorectal diseases,yet its widespread adoption remains suboptimal among practitioners.While modalities such as anorectal manometry,rectal balloon expulsion tests,pelvic floor electromyography,and dynamic imaging(defecography/pelvic floor magnetic resonance imaging)enable comprehensive assessment of anorectal function,many healthcare facilities lack advanced diagnostic tools and specialized personnel.DRE has notable diagnostic value in the primary evaluation of functional defecation disorders(FDDs),particularly for detecting dyssynergic defecation and structural pelvic floor defects.Its cost efficiency and universal accessibility render it indispensable in resource-limited environments where high-resolution diagnostic technologies(e.g.,high-resolution manometry)are unavailable.This review delineates standardized DRE protocols for assessing FDDs and highlights characteristic imaging features of FDDs with the aim of improving the understanding of DRE.This review will hopefully encourage clinicians to perform DREs in diverse clinical settings.展开更多
Digestive health is important for overall well-being,but gut health problems are common in the Chinese population.The objective of this study was to investigate the effects of oatβ-glucan-based prebiotic blended form...Digestive health is important for overall well-being,but gut health problems are common in the Chinese population.The objective of this study was to investigate the effects of oatβ-glucan-based prebiotic blended formulas in humans on digestive health by assessing defecation frequency,defecation symptoms,stool quality,self-reported digestive feelings,defecation satisfaction,and gut bacteria.A parallel,randomized,double-blind,controlled trial was conducted in 168 eligible adults randomized to 3 groups for 14 days:Intervention groups A and B received 2 different doses of oatβ-glucan-based prebiotic blended formulas and a Control group received oatβ-glucan mixed with hydroxypropylmethyl-cellulose and microcrystalline cellulose.Participants completed a defecation diary and Bristol stool chart daily and digestive system questionnaires weekly.Fecal samples were collected on day 0 and day 14 to evaluate gut bacteria using 16S rDNA analysis.Both formulas improved defecation frequency,stool quality,defecation symptoms,defecation satisfaction,and on digestive health of human,compared with baseline(P<0.05).Both formulas led to increased quantities of Bifidobacterium and Akkermansia bacteria,compared to control,on day 14.This study therefore demonstrated the beneficial effects of oatβ-glucan-based prebiotic blended formulas on gut health in generally healthy Chinese adults.These formulas are a feasible nutritional strategy for digestive health.展开更多
Obstructed defecation syndrome(ODS)represents an important cause of constipation,primarily arising from dysfunctions within the pelvic floor.Characterized by an inability to complete defecation or effectively evacuate...Obstructed defecation syndrome(ODS)represents an important cause of constipation,primarily arising from dysfunctions within the pelvic floor.Characterized by an inability to complete defecation or effectively evacuate fecal material despite the urge to defecate,ODS results in a persistent sensation of incomplete evacuation and often requires excessive straining during defecation.Conventional clinical examinations fail to adequately assess the complex dynamic dysfunctions of the pelvic floor and anorectal region.Magnetic resonance defecography(MRD),a sophisticated form of dynamic pelvic floor imaging,provides a comprehensive,non-invasive means of visualizing and quantifying various anorectal and pelvic floor abnormalities.By allowing detailed assessment of structural and functional deficits during the defecation process,MRD plays a crucial role in the diagnostic workup of ODS,enabling colorectal surgeons to formulate more precise and individualized treatment strategies.This manuscript highlights the important anatomical and functional disorders of pelvic floor that are associated with ODS.展开更多
BACKGROUND Obstructed defecation syndrome(ODS)is a subtype of constipation that is consi-dered one of the major pelvic floor dysfunctions affecting the aging population,particularly women over 50 seeking medical care....BACKGROUND Obstructed defecation syndrome(ODS)is a subtype of constipation that is consi-dered one of the major pelvic floor dysfunctions affecting the aging population,particularly women over 50 seeking medical care.The condition is characterized by the urge to defecate but an impaired ability to expel the fecal bolus.ODS is associated with various anorectal abnormalities,which are not always apparent during a standard physical examination,requiring specialized imaging techniques for proper diagnosis.AIM To study the distribution of causes of ODS in patients with chronic constipation by magnetic resonance defecography(MRD).METHODS This observational study evaluated the causes of ODS in 57 patients with chronic constipation who presented to Bangabandhu Sheikh Mujib Medical University between July 2020 and June 2021.After obtaining institutional review board approval and informed consent,patients underwent history taking,physical exams,and relevant investigations.ODS was diagnosed using Rome III criteria,with colonoscopy ruling out organic causes.Standard MRD was performed in different phases,and images were analyzed by expert radiologists and reported in a stan-dardized format.RESULTS Pelvic floor descent and anorectal junction descent were the most frequent findings,each present in 94.7%of cases.Rectocele was observed in 78.9%of patients,while vaginal or uterine prolapse was seen in 59.4%of females.Less common abnormalities included paradoxical contraction(7%),and there were no cases of sigmoidocele.Functional measurements showed significant differences in pelvic floor dynamics between rest and defecation,particularly in the H-line,M-line,and descent of pelvic organs(P<0.05).CONCLUSION Pelvic floor descent and anorectal descent were the most common findings in patients suffering from ODS,fo-llowed by rectocele.Younger females(<30 years)were most affected.展开更多
BACKGROUND Non-operative spinal infections(NOSI)are caused by tuberculosis,brucella,and other specific bacteria.The etiology of the disease is insidious,the onset is slow and the diagnosis and treatment are difficult....BACKGROUND Non-operative spinal infections(NOSI)are caused by tuberculosis,brucella,and other specific bacteria.The etiology of the disease is insidious,the onset is slow and the diagnosis and treatment are difficult.Identifying the factors associated with spinal infection and early intervention can reduce the occurrence of the disease.At present,the research mainly focuses on the accurate diagnosis and treatment of spinal infection,and there are few studies on the prevention of spinal infection.The concept of"preventive treatment of diseases"in traditional Chinese medicine may help identify the causes and reduce the occurrence of NOSI.AIM To determine the association of age,bowel movements,and sleep patterns with NOSI.METHODS Data of 69 NOSI patients and 84 healthy controls in a tertiary hospital from January 2019 to June 2024 were collected.Patients with NOSI had imaging evidence(magnetic resonance imaging)of spinal infections(including infections caused by tuberculosis,brucopathy,and other pathogens)and had no history of spinal surgery in the last 1 year were included in the analysis.Patients with spinalinfection due to spinal surgery are excluded in the study.Data including age,sex,place of residence,sleeping status,and bowel movements were collected.SPSS22.0 was used for correlation analysis of all data.RESULTS The mean age of the NOSI group and the control group was 63.55±14.635 years and 59.18±17.111 years,respectively,without statistical difference(P=0.096).There was also no statistically significant difference in gender between the two groups.In the NOSI group,45(65.22%)were over 60 years old,and 44(63.77%)were rural residents.Compared with the control group,the NOSI group had more patients with sleep disorder and defecation disorder,accounting for 69.57%and 68.12%,respectively,with significant statistical difference(both P<0.001).Regression analysis showed that defecation and sleep disorders were closely related to NOSI(both P<0.001).CONCLUSION Most patients with NOSI are older and have sleep disorders and abnormal defecation.展开更多
BACKGROUND Obstructed defecation syndrome(ODS)represents the most prevalent form of chronic constipation,affecting a diverse patient population,leading to numerous complications,and imposing a significant burden on he...BACKGROUND Obstructed defecation syndrome(ODS)represents the most prevalent form of chronic constipation,affecting a diverse patient population,leading to numerous complications,and imposing a significant burden on healthcare resources.Most ODS patients have insufficient rectal propulsion,but the exact mechanism underlying the pathogenesis of ODS remains unclear.AIM To explore the molecular mechanism underlying the pathogenesis of ODS.METHODS A total of 30 pairs of rectal samples were collected from patients with ODS(ODS group)or grade IV prolapsed hemorrhoids without constipation(control group)for quantitative proteomic and bioinformatic analysis.Subsequently,50 pairs of paraffin-embedded rectal specimens were selected for immunohistochemistry and immunofluorescence studies to validate the analysis results.Human intestinal smooth cell contractile function experiments and electrophysiological experiments were conducted to verify the physiological functions of target proteins.Cellular ultrastructure was detected using transmission electron microscopy.RESULTS In comparison to the control group,the expression level of dystrophin(DMD)in rectal specimens from ODS patients was markedly reduced.This finding was corroborated using immunohistochemistry and immunofluorescence techniques.The diminished expression of DMD compromised the contractile function of intestinal smooth muscle cells.At the molecular level,nucleoporin protein 153 and L-type voltage-gated calcium channel were found to be overexpressed in intestinal smooth muscle cells exhibiting downregulated DMD expression.Electrophysiological experiments confirmed an excessive influx of calcium ions into these cells.Moreover,vacuolar-like structures which may be associated with excessive calcium influx were observed in the cells by transmission electron microscopy.CONCLUSION Decreased DMD expression in intestinal smooth muscle may upregulate L-type voltage-gated calcium channel expression,leading to excessive calcium influx which may cause a decrease in rectal propulsion,thereby contributing to the pathogenesis of ODS.展开更多
Physicochemical parameters of surface water sources in the study of local government areas (LGAs) were assessed using standard procedures. The mean physicochemical parameters for pH (5.49), NO2 (0.23 mg/L), SO4 (0.77 ...Physicochemical parameters of surface water sources in the study of local government areas (LGAs) were assessed using standard procedures. The mean physicochemical parameters for pH (5.49), NO2 (0.23 mg/L), SO4 (0.77 mg/L), Na (28.72 mg/L), Ca (28.94 mg/L), Mg (17.50 mg/L), Cl (11.65 mg/L), TSS (6.27 mg/L), TDS (104.23 mg/L), BOD (2.83 mg/L) and F (0.87 mg/L) were below WHO standards irrespective of their defecation status. The values for electrical conductivity (EC) (2770.50 µs/cm, turbidity (481.24 NTU), dissolved oxygen (DO) (5.32 mg/L), chemical oxygen demand (COD) (445.50 mg/L), K (125.06 mg/L), PO4 (0.78 mg/L) and Fe (0.57 mg/L) were above the WHO limits for safe water. Higher EC and COD values obtained in the study is evidence of pollution of the water sources by organic matter.展开更多
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...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. Tn 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.展开更多
Chronic constipation is a common and extremely troublesome disorder that significantly reduces the quality of life,and this fact is consistent with the high rate at which health care is sought for this condition.The a...Chronic constipation is a common and extremely troublesome disorder that significantly reduces the quality of life,and this fact is consistent with the high rate at which health care is sought for this condition.The aim of this project was to develop a consensus for the diagnosis and treatment of chronic constipation and obstructed defecation.The commission presents its results in a "Question-Answer" format,including a set of graded recommendations based on a systematic review of the literature and evidence-based medicine.This section represents the consensus for the diagnosis.The history includes information relating to the onset and duration of symptoms and may reveal secondary causes of constipation.The presence of alarm symptoms and risk factors requires investigation.The physical examination should assess the presence of lesions in the anal and perianal region.The evidence does not support the routine use of blood testing and colonoscopy or barium enema for constipation.Various scoring systems are available to quantify the severity of constipation;the Constipation Severity Instrument for constipation and the obstructed defecation syndrome score for obstructed defecation are the most reliable.The Constipation-Related Quality of Life is an excellent tool for evaluating the patient's quality of life.No single test provides a pathophysiological basis for constipation.Colonic transit and anorectal manometry define the pathophysiologic subtypes.Balloon expulsion is a simple screening test for defecatory disorders,but it does not define the mechanisms.Defecography detects structural abnormalities and assesses functional parameters.Magnetic resonance imaging and/or pelvic floor sonography can further complement defecography by providing information on the movement of the pelvic floor and the organs that it supports.All these investigations are indicated to differentiate between slow transit constipation and obstructed defecation because the treatments differ between these conditions.展开更多
The management of obstructed defecation syndrome(ODS) is mainly conservative and mainly consists of fiber diet, bulking laxatives, rectal irrigation or hydrocolontherapy, biofeedback, transanal electrostimulation, yog...The management of obstructed defecation syndrome(ODS) is mainly conservative and mainly consists of fiber diet, bulking laxatives, rectal irrigation or hydrocolontherapy, biofeedback, transanal electrostimulation, yoga and psychotherapy. According to our experience, nearly 20% of the patients need surgical treatment. If we consider ODS an "iceberg syndrome", with "emerging rocks", rectocele and rectal internal mucosal prolapse, that may benefit from surgery, at least two out of ten patients also has "underwater rocks" or occult disorders, such as anismus, rectal hyposensation and anxiety/depression, which mostly require conservative treatment. Rectal prolapse excision or obliterative suture, rectoceleand/or enterocele repair, retrograde Malone's enema and partial myotomy of the puborectalis muscle are effective in selected cases. Laparoscopic ventral sacral colporectopexy may be an effective surgical option. Stapled transanal rectal resection may lead to severe complications. The Transtar procedure seems to be safer, when dealing with recto-rectal intussusception. A multidisciplinary approach to ODS provides the best results.展开更多
AIM:To evaluate the safety and efficacy of stapled transanal rectal resection(STARR),and to analyze the outcome of the patients 12-mo after the operation.METHODS:From May 2007 to October 2008,50 female patients with r...AIM:To evaluate the safety and efficacy of stapled transanal rectal resection(STARR),and to analyze the outcome of the patients 12-mo after the operation.METHODS:From May 2007 to October 2008,50 female patients with rectocele and/or rectal intussusception underwent STARR.The preoperative status,perioperative and postoperative complications at baseline,3,6 and 12-mo were assessed.Data were collected prospectively from standardized questionnaires for the assessment of constipation[constipation scoring system,Longo’s obstructed defecation syndrome(ODS)score system,symptom severity score],patient satisfaction (visual analogue scale),and quality of life(Patient Assessment of Constipation-Quality of Life Questionnaire).RESULTS:At a 12-mo follow-up,significant improvement in the constipation scoring system,ODS score system,symptom severity score,visual analog scale and quality of life(P<0.0001)was observed.The symptoms of constipation improved in 90%of patients at 12 mo after surgery.The self-reported definitive outcome was excellent in 15(30%)patients,fairly good in 8(16%),good in 22(44%),and poor in 5(10%).CONCLUSION:STARR can be performed safely without major morbidity.Moreover,the procedure seems to be effective for patients with obstructed defecation associated with symptomatic rectocele and rectal intussusception.展开更多
Obstructed defecation （OD） and fecal incontinence （FI） are challenging clinical problems, which are commonly encountered in the practice of colorectal surgeons and gastroenterologists. These disorders sodally and ...Obstructed defecation （OD） and fecal incontinence （FI） are challenging clinical problems, which are commonly encountered in the practice of colorectal surgeons and gastroenterologists. These disorders sodally and psychologically distress patients and greatly impair their quality of life. The underlying anatomical and pathophysiological changes are complex, often incompletely understood and cannot always be determined. As a consequence, many medical, surgical, and behavioral approaches have been described, with no panacea. Over the past decade, advances in an understanding of these disorders together with rational and similar methods of evaluation in anorectal physiology laboratories （ARP）, radiology studies, and new surgical techniques have led to promising results. In this brief review, we discuss treatment strategies and recent updates on clinical and therapeutic aspects of obstructed defecation and fecal incontinence.展开更多
AIM: To compare biofeedback-guided pelvic floor exercise therapy (BFT) with the use of oral polyethylene glycol (PEG) for the treatment of obstructive defecation.
Obstructed defecation syndrome(ODS) is a functional disorder commonly encountered by colorectal surgeons and gastroenterologists, and greatly affects the quality of life of patients from both societal and psychologica...Obstructed defecation syndrome(ODS) is a functional disorder commonly encountered by colorectal surgeons and gastroenterologists, and greatly affects the quality of life of patients from both societal and psychological aspects. The underlying anatomical and pathophysiological changes of ODS are complex. However, intra-rectal intussusception and rectocele are frequently found in patients with ODS and both are thought to play an important role in the pathogenesis of ODS. With the development of evaluation methods in anorectal physiology laboratories and radiology studies, a great variety of new operative procedures, especially transanal procedures, have been invented to treat ODS. However, no procedure has been proved to be superior to others at present. Each operation has its own merits and defects. Thus, choosing appropriate transanal surgical procedures for the treatment of ODS remains a challenge for all surgeons. This review provides an introduction of the current problems and options for treatment of ODS and a detailed summary of the essential assessments needed for patient evaluation before carrying out transanal surgery. Besides, an overview of the benefits and problems of current transanal surgical procedures for treatment of ODS is summarized in this review. A report of clinical experience of some transanal surgical techniques used in the authors' center is also presented.展开更多
Obstructive defecation syndrome(ODS) is a common disorder with a considerable impact on the quality of life of affected patients.Surgery for ODS remains a challenging topic.There exists a great variety of operative te...Obstructive defecation syndrome(ODS) is a common disorder with a considerable impact on the quality of life of affected patients.Surgery for ODS remains a challenging topic.There exists a great variety of operative techniques to treat patients with ODS.According to the surgeon's preference the approach can be transanal,transvaginal,transperineal or transabdominal.All techniques have its advantages and disadvantages.Notably,high evidence based studies are significantly lacking in literature,thus making accurate assessments difficult.Careful patient's selection is crucial to achieveoptimal functional results.It is mandatory to assess not only defecation disorders but also evaluate overall pelvic floor symptoms,such as fecal incontinence and urinary disorders for choosing an appropriate and tailored strategy.Radiological investigation is essential but may not explain complaints of every patient.展开更多
AIM:To investigate the effects of the probiotic Bifidobacterium longum BB536 on the health management of elderly patients receiving enteral feeding.METHODS:Two double-blind,placebo-controlled trials were performed wit...AIM:To investigate the effects of the probiotic Bifidobacterium longum BB536 on the health management of elderly patients receiving enteral feeding.METHODS:Two double-blind,placebo-controlled trials were performed with long-term inpatients receiving enteral tube feeding at Kitakyushu Hospital Group,Fukuoka,Japan.BB536 was administered as BB536-L and BB536-H powders that contained approximately 2.5 × 10 10 and 5 × 10 10 cfu of BB536,respectively.In the first trial,83 patients(age range:67-101 years) were randomized into 2 groups that received placebo(placebo group) or BB536-H(BB536 group) powders.In the second trial,123 patients(age range:65-102years) were randomized into 3 groups,and each group received placebo(placebo group),BB536-L(BB536-L group),or BB536-H(BB536-H group) powders.Each patient received the study medication for 16 wk after 1 wk of pre-observation.Fecal samples were collected from each patient prior to and after the intervention during Trial 2.Clinical observations included body temperature,occurrence of infection,frequency of defecation,and fecal microbiota.RESULTS:No significant changes were observed in the frequency of defecation for either treatment in Trial 1.However,a significant change was noted in the BB536-L group(P = 0.0439) in Trial 2 but not in the placebo or BB536-H groups.Subgroup analyses based on the frequency of defecation for each patient during the pre-observation period for both trials revealed significant increases in bowel movements in patients with a low frequency of defecation and significant decreases in the bowel movements of patients with a high frequency of defecation during the intervention period in the BB536 groups.The combination of Trials 1 and 2 data revealed a modulatory effect of BB536 ingestion on the changes in bowel movements.Significantly increased bowel movements were observed in patients in the low frequency subgroup with significant intergroup differences(P < 0.01).Significantly decreased bowel movements were observed in patients in the high subgroup,but no significant intergroup differences were observed compared with the placebo group.BB536 ingestion increased the prevalence of normally formed stools.BB536 intake also significantly(P < 0.01) increased the cell numbers of bifidobacteria in fecal microbiota,and significant intergroup differences were observed at week 16.No adverse events were reported in any group.CONCLUSION:Our results suggest that BB536 ingestion modulated the intestinal environment and may have improved the health care of elderly patients receiving enteral feeding.展开更多
BACKGROUND Although total or subtotal colectomy for slow-transit constipation(STC)has been proven to be a definite treatment,the associated defecation function and quality of life(QOL)are rarely studied.AIM To evaluat...BACKGROUND Although total or subtotal colectomy for slow-transit constipation(STC)has been proven to be a definite treatment,the associated defecation function and quality of life(QOL)are rarely studied.AIM To evaluate the effectiveness of surgery for STC regarding defecation function and QOL.METHODS From March 2013 to September 2017,30 patients undergoing surgery for STC in our department were analyzed.Preoperative,intra-operative,and postoperative 3-mo,6-mo,1-year,and 2-year follow-up details were recorded.Defecation function was assessed by bowel movements,abdominal pain,bloating,straining,laxative,enema use,diarrhea,and the Wexner constipation and incontinence scales.QOL was evaluated using the gastrointestinal QOL index and the 36-item short form survey.RESULTS The majority of patients(93.1%,27/29)stated that they benefited from the operation at the 2-year follow-up.At each time point of the follow-up,the number of bowel movements per week significantly increased compared with that of the preoperative conditions(P<0.05).Similarly,compared with the preoperative values,a marked decline was observed in bloating,straining,laxative,and enema use at each time point of the follow-up(P<0.05).Postoperative diarrhea could be controlled effectively and notably improved at the 2-year follow-up.The Wexner incontinence scores at 6-mo,1-year,and 2-year were notably lower than those at the 3-mo follow-up(P<0.05).Compared with those of the preoperative findings,the Wexner constipation scores significantly decreased following surgery(P<0.05).Thus,it was reasonable to find that the gastrointestinal QOL index scores clearly increase(P<0.05)and that the 36-item short form survey results displayed considerable improvements in six spheres(role physical,role emotional,physical pain,vitality,mental health,and general health)following surgery.CONCLUSION Total or subtotal colectomy for STC is not only effective in alleviating constipation-related symptoms but also in enhancing patients’QOL.展开更多
AIM:To prospectively assess the eff icacy and safety of stapled trans-anal rectal resection(STARR) compared to standard conservative treatment,and whether preoperative symptoms and findings at defecography and anorect...AIM:To prospectively assess the eff icacy and safety of stapled trans-anal rectal resection(STARR) compared to standard conservative treatment,and whether preoperative symptoms and findings at defecography and anorectal manometry can predict the outcome of STARR.METHODS:Thirty patients(Female,28;age:51 ± 9 years) with rectocele or rectal intussusception,a defecation disorder,and functional constipation were submitted for STARR.Thirty comparable patients(Female,30;age 53 ± 13 years),who presented with symptoms of rectocele or rectal intussusception and were treated with macrogol,were assessed.Patients were interviewed with a standardized questionnaire at study enrollment and 38 ± 18 mo after the STARR procedure or during macrogol treatment.A responder was def ined as an absence of the Rome Ⅲ diagnostic criteria for functional constipation.Defecography and rectoanal manometry were performed before and after the STARR procedure in 16 and 12 patients,respectively.RESULTS:After STARR,53% of patients were responders;during conservative treatment,75% were responders.After STARR,30% of the patients reported the use of laxatives,17% had intermittent anal pain,13% had anal leakage,13% required digital facilitation,6% experienced defecatory urgency,6% experienced fecal incontinence,and 6% required re-intervention.During macrogol therapy,23% of the patients complained of abdominal bloating and 13% of borborygmi,and 3% required digital facilitation.No preoperative symptom,defecographic,or manometric finding predicted the outcome of STARR.Post-operative defecography showed a statistically significant reduction(P < 0.05) of the rectal diameter and rectocele.The postoperative anorectal manometry showed that anal pressure and rectal sensitivity were not significantly modified,and that rectal compliance was reduced(P = 0.01).CONCLUSION:STARR is not better and is less safe than macrogol in the treatment of defecation disorders.It could be considered as an alternative therapy in patients unresponsive to macrogol.展开更多
AIM To investigate compliance with transanal irrigation(TAI) one year after a training session and to identify predictive factors for compliance.METHODS The compliance of one hundred eight patients [87 women and 21 me...AIM To investigate compliance with transanal irrigation(TAI) one year after a training session and to identify predictive factors for compliance.METHODS The compliance of one hundred eight patients [87 women and 21 men; median age 55 years(range 18-83)] suffering from constipation or fecal incontinence(FI) was retrospectively assessed. The patients were trained in TAI over a four-year period at a single institution. They were classified as adopters if they continued using TAI for at least one year after beginning the treatment or as non-adopters if they stopped. Predictive factors of compliance with TAI were based on pretreatment assessments and trainingprogress. The outcomes of the entire cohort of patients who had been recruited for the TAI treatment were expressed in terms of intention-to-treat.RESULTS Forty-six of the 108(43%) trained patients continued to use TAI one year after their training session. The patients with FI had the best results, with 54.5% remaining compliant with TAI. Only one-third of the patients who complained of slow transit constipation or obstructed defecation syndrome continued TAI. There was an overall discontinuation rate of 57%. The most common reason for discontinuing TAI was the lack of efficacy(41%). However, 36% of the patients who discontinued TAI gave reasons independent of the efficacy of the treatment such as technical problems(catheter expulsion, rectal balloon bursting, instilled water leakage or retention, pain during irrigation, anal bleeding, anal fissure) while 23% said that there were too many constraints. Of the patients who reported discontinuing TAI, the only predictive factor was the progress of the training(OR = 4.9, 1.3-18.9, P = 0.02).CONCLUSION The progress of the training session was the only factor that predicted patient compliance with TAI.展开更多
AIM: To investigate whether there was a dominant sacral root for the motive function of rectum and anal sphincter, and to provide an experimental basis for sacral root electrically stimulated defecation in spinal cord...AIM: To investigate whether there was a dominant sacral root for the motive function of rectum and anal sphincter, and to provide an experimental basis for sacral root electrically stimulated defecation in spinal cord injuries. METHODS: Eleven spinal cord injured mongrel dogs were included in the study. After L4-L7 laminectomy, the bilateral L7-S3 roots were electrostimulated separately and rectal and sphincter pressure were recorded synchronously. Four animals were implanted electrodes on bilateral S2 roots. RESULTS: For rectal motorial innervation, S2 was the most dominant (mean 15.2 kPa, 37.7% of total pressure), S1(11.3 kPa, 27.6%) and S3 (10.9 kPa, 26.7%) contributed to a smaller part. For external anal sphincter, S3 (mean 17.2 kPa, 33.7%) was the most dominant, S2 (16.2 kPa, 31.6%) and S1(14.3 kPa, 27.9%) contributed to a lesser but still a significant part. Above 85% L7 roots provided some functional contribution to rectum and anal sphincter. For both rectum and sphincter, the right sacral roots provided more contribution than the left roots. Postoperatively, the 4 dogs had electrically stimulated defecation and micturition under the control of the neuroprosthetic device. CONCLUSION: S2 root is the most dominant contributor to rectal pressure in dogs. Stimulation of bilateral S2 with implanted electrodes contributes to good micturition and defecation in dogs.展开更多
文摘Digital rectal examination(DRE)is essential for diagnosing anorectal diseases,yet its widespread adoption remains suboptimal among practitioners.While modalities such as anorectal manometry,rectal balloon expulsion tests,pelvic floor electromyography,and dynamic imaging(defecography/pelvic floor magnetic resonance imaging)enable comprehensive assessment of anorectal function,many healthcare facilities lack advanced diagnostic tools and specialized personnel.DRE has notable diagnostic value in the primary evaluation of functional defecation disorders(FDDs),particularly for detecting dyssynergic defecation and structural pelvic floor defects.Its cost efficiency and universal accessibility render it indispensable in resource-limited environments where high-resolution diagnostic technologies(e.g.,high-resolution manometry)are unavailable.This review delineates standardized DRE protocols for assessing FDDs and highlights characteristic imaging features of FDDs with the aim of improving the understanding of DRE.This review will hopefully encourage clinicians to perform DREs in diverse clinical settings.
基金funded by the Chinese Nutrition Society and PepsiCo Inc.
文摘Digestive health is important for overall well-being,but gut health problems are common in the Chinese population.The objective of this study was to investigate the effects of oatβ-glucan-based prebiotic blended formulas in humans on digestive health by assessing defecation frequency,defecation symptoms,stool quality,self-reported digestive feelings,defecation satisfaction,and gut bacteria.A parallel,randomized,double-blind,controlled trial was conducted in 168 eligible adults randomized to 3 groups for 14 days:Intervention groups A and B received 2 different doses of oatβ-glucan-based prebiotic blended formulas and a Control group received oatβ-glucan mixed with hydroxypropylmethyl-cellulose and microcrystalline cellulose.Participants completed a defecation diary and Bristol stool chart daily and digestive system questionnaires weekly.Fecal samples were collected on day 0 and day 14 to evaluate gut bacteria using 16S rDNA analysis.Both formulas improved defecation frequency,stool quality,defecation symptoms,defecation satisfaction,and on digestive health of human,compared with baseline(P<0.05).Both formulas led to increased quantities of Bifidobacterium and Akkermansia bacteria,compared to control,on day 14.This study therefore demonstrated the beneficial effects of oatβ-glucan-based prebiotic blended formulas on gut health in generally healthy Chinese adults.These formulas are a feasible nutritional strategy for digestive health.
文摘Obstructed defecation syndrome(ODS)represents an important cause of constipation,primarily arising from dysfunctions within the pelvic floor.Characterized by an inability to complete defecation or effectively evacuate fecal material despite the urge to defecate,ODS results in a persistent sensation of incomplete evacuation and often requires excessive straining during defecation.Conventional clinical examinations fail to adequately assess the complex dynamic dysfunctions of the pelvic floor and anorectal region.Magnetic resonance defecography(MRD),a sophisticated form of dynamic pelvic floor imaging,provides a comprehensive,non-invasive means of visualizing and quantifying various anorectal and pelvic floor abnormalities.By allowing detailed assessment of structural and functional deficits during the defecation process,MRD plays a crucial role in the diagnostic workup of ODS,enabling colorectal surgeons to formulate more precise and individualized treatment strategies.This manuscript highlights the important anatomical and functional disorders of pelvic floor that are associated with ODS.
文摘BACKGROUND Obstructed defecation syndrome(ODS)is a subtype of constipation that is consi-dered one of the major pelvic floor dysfunctions affecting the aging population,particularly women over 50 seeking medical care.The condition is characterized by the urge to defecate but an impaired ability to expel the fecal bolus.ODS is associated with various anorectal abnormalities,which are not always apparent during a standard physical examination,requiring specialized imaging techniques for proper diagnosis.AIM To study the distribution of causes of ODS in patients with chronic constipation by magnetic resonance defecography(MRD).METHODS This observational study evaluated the causes of ODS in 57 patients with chronic constipation who presented to Bangabandhu Sheikh Mujib Medical University between July 2020 and June 2021.After obtaining institutional review board approval and informed consent,patients underwent history taking,physical exams,and relevant investigations.ODS was diagnosed using Rome III criteria,with colonoscopy ruling out organic causes.Standard MRD was performed in different phases,and images were analyzed by expert radiologists and reported in a stan-dardized format.RESULTS Pelvic floor descent and anorectal junction descent were the most frequent findings,each present in 94.7%of cases.Rectocele was observed in 78.9%of patients,while vaginal or uterine prolapse was seen in 59.4%of females.Less common abnormalities included paradoxical contraction(7%),and there were no cases of sigmoidocele.Functional measurements showed significant differences in pelvic floor dynamics between rest and defecation,particularly in the H-line,M-line,and descent of pelvic organs(P<0.05).CONCLUSION Pelvic floor descent and anorectal descent were the most common findings in patients suffering from ODS,fo-llowed by rectocele.Younger females(<30 years)were most affected.
文摘BACKGROUND Non-operative spinal infections(NOSI)are caused by tuberculosis,brucella,and other specific bacteria.The etiology of the disease is insidious,the onset is slow and the diagnosis and treatment are difficult.Identifying the factors associated with spinal infection and early intervention can reduce the occurrence of the disease.At present,the research mainly focuses on the accurate diagnosis and treatment of spinal infection,and there are few studies on the prevention of spinal infection.The concept of"preventive treatment of diseases"in traditional Chinese medicine may help identify the causes and reduce the occurrence of NOSI.AIM To determine the association of age,bowel movements,and sleep patterns with NOSI.METHODS Data of 69 NOSI patients and 84 healthy controls in a tertiary hospital from January 2019 to June 2024 were collected.Patients with NOSI had imaging evidence(magnetic resonance imaging)of spinal infections(including infections caused by tuberculosis,brucopathy,and other pathogens)and had no history of spinal surgery in the last 1 year were included in the analysis.Patients with spinalinfection due to spinal surgery are excluded in the study.Data including age,sex,place of residence,sleeping status,and bowel movements were collected.SPSS22.0 was used for correlation analysis of all data.RESULTS The mean age of the NOSI group and the control group was 63.55±14.635 years and 59.18±17.111 years,respectively,without statistical difference(P=0.096).There was also no statistically significant difference in gender between the two groups.In the NOSI group,45(65.22%)were over 60 years old,and 44(63.77%)were rural residents.Compared with the control group,the NOSI group had more patients with sleep disorder and defecation disorder,accounting for 69.57%and 68.12%,respectively,with significant statistical difference(both P<0.001).Regression analysis showed that defecation and sleep disorders were closely related to NOSI(both P<0.001).CONCLUSION Most patients with NOSI are older and have sleep disorders and abnormal defecation.
基金Supported by the National Natural Science Foundation of China,No.81500505the Construction of Predominant Disciplines of Zhongnan Hospital of Wuhan University,No.XKJS202017+1 种基金the Medical Science and Technology Innovation Platform of Joint Foundation of Health Commission of Hubei Province,Zhongnan Hospital of Wuhan University,No.PTXM2021025the Hubei Provincial Natural Science Foundation,No.2023AFC013.
文摘BACKGROUND Obstructed defecation syndrome(ODS)represents the most prevalent form of chronic constipation,affecting a diverse patient population,leading to numerous complications,and imposing a significant burden on healthcare resources.Most ODS patients have insufficient rectal propulsion,but the exact mechanism underlying the pathogenesis of ODS remains unclear.AIM To explore the molecular mechanism underlying the pathogenesis of ODS.METHODS A total of 30 pairs of rectal samples were collected from patients with ODS(ODS group)or grade IV prolapsed hemorrhoids without constipation(control group)for quantitative proteomic and bioinformatic analysis.Subsequently,50 pairs of paraffin-embedded rectal specimens were selected for immunohistochemistry and immunofluorescence studies to validate the analysis results.Human intestinal smooth cell contractile function experiments and electrophysiological experiments were conducted to verify the physiological functions of target proteins.Cellular ultrastructure was detected using transmission electron microscopy.RESULTS In comparison to the control group,the expression level of dystrophin(DMD)in rectal specimens from ODS patients was markedly reduced.This finding was corroborated using immunohistochemistry and immunofluorescence techniques.The diminished expression of DMD compromised the contractile function of intestinal smooth muscle cells.At the molecular level,nucleoporin protein 153 and L-type voltage-gated calcium channel were found to be overexpressed in intestinal smooth muscle cells exhibiting downregulated DMD expression.Electrophysiological experiments confirmed an excessive influx of calcium ions into these cells.Moreover,vacuolar-like structures which may be associated with excessive calcium influx were observed in the cells by transmission electron microscopy.CONCLUSION Decreased DMD expression in intestinal smooth muscle may upregulate L-type voltage-gated calcium channel expression,leading to excessive calcium influx which may cause a decrease in rectal propulsion,thereby contributing to the pathogenesis of ODS.
文摘Physicochemical parameters of surface water sources in the study of local government areas (LGAs) were assessed using standard procedures. The mean physicochemical parameters for pH (5.49), NO2 (0.23 mg/L), SO4 (0.77 mg/L), Na (28.72 mg/L), Ca (28.94 mg/L), Mg (17.50 mg/L), Cl (11.65 mg/L), TSS (6.27 mg/L), TDS (104.23 mg/L), BOD (2.83 mg/L) and F (0.87 mg/L) were below WHO standards irrespective of their defecation status. The values for electrical conductivity (EC) (2770.50 µs/cm, turbidity (481.24 NTU), dissolved oxygen (DO) (5.32 mg/L), chemical oxygen demand (COD) (445.50 mg/L), K (125.06 mg/L), PO4 (0.78 mg/L) and Fe (0.57 mg/L) were above the WHO limits for safe water. Higher EC and COD values obtained in the study is evidence of pollution of the water sources by organic matter.
文摘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. Tn 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.
基金Supported by Associazione Italiana Gastroenterologi and Endoscopisti Digestivi Ospedalieri via N Colajanni,4-00191 Roma,ItalySocietà Italiana di Chirurgia Colo-Rettale via Medici,23-10143Torino,Italy
文摘Chronic constipation is a common and extremely troublesome disorder that significantly reduces the quality of life,and this fact is consistent with the high rate at which health care is sought for this condition.The aim of this project was to develop a consensus for the diagnosis and treatment of chronic constipation and obstructed defecation.The commission presents its results in a "Question-Answer" format,including a set of graded recommendations based on a systematic review of the literature and evidence-based medicine.This section represents the consensus for the diagnosis.The history includes information relating to the onset and duration of symptoms and may reveal secondary causes of constipation.The presence of alarm symptoms and risk factors requires investigation.The physical examination should assess the presence of lesions in the anal and perianal region.The evidence does not support the routine use of blood testing and colonoscopy or barium enema for constipation.Various scoring systems are available to quantify the severity of constipation;the Constipation Severity Instrument for constipation and the obstructed defecation syndrome score for obstructed defecation are the most reliable.The Constipation-Related Quality of Life is an excellent tool for evaluating the patient's quality of life.No single test provides a pathophysiological basis for constipation.Colonic transit and anorectal manometry define the pathophysiologic subtypes.Balloon expulsion is a simple screening test for defecatory disorders,but it does not define the mechanisms.Defecography detects structural abnormalities and assesses functional parameters.Magnetic resonance imaging and/or pelvic floor sonography can further complement defecography by providing information on the movement of the pelvic floor and the organs that it supports.All these investigations are indicated to differentiate between slow transit constipation and obstructed defecation because the treatments differ between these conditions.
文摘The management of obstructed defecation syndrome(ODS) is mainly conservative and mainly consists of fiber diet, bulking laxatives, rectal irrigation or hydrocolontherapy, biofeedback, transanal electrostimulation, yoga and psychotherapy. According to our experience, nearly 20% of the patients need surgical treatment. If we consider ODS an "iceberg syndrome", with "emerging rocks", rectocele and rectal internal mucosal prolapse, that may benefit from surgery, at least two out of ten patients also has "underwater rocks" or occult disorders, such as anismus, rectal hyposensation and anxiety/depression, which mostly require conservative treatment. Rectal prolapse excision or obliterative suture, rectoceleand/or enterocele repair, retrograde Malone's enema and partial myotomy of the puborectalis muscle are effective in selected cases. Laparoscopic ventral sacral colporectopexy may be an effective surgical option. Stapled transanal rectal resection may lead to severe complications. The Transtar procedure seems to be safer, when dealing with recto-rectal intussusception. A multidisciplinary approach to ODS provides the best results.
文摘AIM:To evaluate the safety and efficacy of stapled transanal rectal resection(STARR),and to analyze the outcome of the patients 12-mo after the operation.METHODS:From May 2007 to October 2008,50 female patients with rectocele and/or rectal intussusception underwent STARR.The preoperative status,perioperative and postoperative complications at baseline,3,6 and 12-mo were assessed.Data were collected prospectively from standardized questionnaires for the assessment of constipation[constipation scoring system,Longo’s obstructed defecation syndrome(ODS)score system,symptom severity score],patient satisfaction (visual analogue scale),and quality of life(Patient Assessment of Constipation-Quality of Life Questionnaire).RESULTS:At a 12-mo follow-up,significant improvement in the constipation scoring system,ODS score system,symptom severity score,visual analog scale and quality of life(P<0.0001)was observed.The symptoms of constipation improved in 90%of patients at 12 mo after surgery.The self-reported definitive outcome was excellent in 15(30%)patients,fairly good in 8(16%),good in 22(44%),and poor in 5(10%).CONCLUSION:STARR can be performed safely without major morbidity.Moreover,the procedure seems to be effective for patients with obstructed defecation associated with symptomatic rectocele and rectal intussusception.
文摘Obstructed defecation （OD） and fecal incontinence （FI） are challenging clinical problems, which are commonly encountered in the practice of colorectal surgeons and gastroenterologists. These disorders sodally and psychologically distress patients and greatly impair their quality of life. The underlying anatomical and pathophysiological changes are complex, often incompletely understood and cannot always be determined. As a consequence, many medical, surgical, and behavioral approaches have been described, with no panacea. Over the past decade, advances in an understanding of these disorders together with rational and similar methods of evaluation in anorectal physiology laboratories （ARP）, radiology studies, and new surgical techniques have led to promising results. In this brief review, we discuss treatment strategies and recent updates on clinical and therapeutic aspects of obstructed defecation and fecal incontinence.
基金Supported by Research Award Fund of First Affiliated Hospital of Xinjiang Medical University,Fund Serial No.2012YFY30
文摘AIM: To compare biofeedback-guided pelvic floor exercise therapy (BFT) with the use of oral polyethylene glycol (PEG) for the treatment of obstructive defecation.
基金Supported by National Natural Science Foundation of China,No.81500505 and No.81570492Natural Science Foundation of Hubei Province of China,No.2015CFB636
文摘Obstructed defecation syndrome(ODS) is a functional disorder commonly encountered by colorectal surgeons and gastroenterologists, and greatly affects the quality of life of patients from both societal and psychological aspects. The underlying anatomical and pathophysiological changes of ODS are complex. However, intra-rectal intussusception and rectocele are frequently found in patients with ODS and both are thought to play an important role in the pathogenesis of ODS. With the development of evaluation methods in anorectal physiology laboratories and radiology studies, a great variety of new operative procedures, especially transanal procedures, have been invented to treat ODS. However, no procedure has been proved to be superior to others at present. Each operation has its own merits and defects. Thus, choosing appropriate transanal surgical procedures for the treatment of ODS remains a challenge for all surgeons. This review provides an introduction of the current problems and options for treatment of ODS and a detailed summary of the essential assessments needed for patient evaluation before carrying out transanal surgery. Besides, an overview of the benefits and problems of current transanal surgical procedures for treatment of ODS is summarized in this review. A report of clinical experience of some transanal surgical techniques used in the authors' center is also presented.
文摘Obstructive defecation syndrome(ODS) is a common disorder with a considerable impact on the quality of life of affected patients.Surgery for ODS remains a challenging topic.There exists a great variety of operative techniques to treat patients with ODS.According to the surgeon's preference the approach can be transanal,transvaginal,transperineal or transabdominal.All techniques have its advantages and disadvantages.Notably,high evidence based studies are significantly lacking in literature,thus making accurate assessments difficult.Careful patient's selection is crucial to achieveoptimal functional results.It is mandatory to assess not only defecation disorders but also evaluate overall pelvic floor symptoms,such as fecal incontinence and urinary disorders for choosing an appropriate and tailored strategy.Radiological investigation is essential but may not explain complaints of every patient.
文摘AIM:To investigate the effects of the probiotic Bifidobacterium longum BB536 on the health management of elderly patients receiving enteral feeding.METHODS:Two double-blind,placebo-controlled trials were performed with long-term inpatients receiving enteral tube feeding at Kitakyushu Hospital Group,Fukuoka,Japan.BB536 was administered as BB536-L and BB536-H powders that contained approximately 2.5 × 10 10 and 5 × 10 10 cfu of BB536,respectively.In the first trial,83 patients(age range:67-101 years) were randomized into 2 groups that received placebo(placebo group) or BB536-H(BB536 group) powders.In the second trial,123 patients(age range:65-102years) were randomized into 3 groups,and each group received placebo(placebo group),BB536-L(BB536-L group),or BB536-H(BB536-H group) powders.Each patient received the study medication for 16 wk after 1 wk of pre-observation.Fecal samples were collected from each patient prior to and after the intervention during Trial 2.Clinical observations included body temperature,occurrence of infection,frequency of defecation,and fecal microbiota.RESULTS:No significant changes were observed in the frequency of defecation for either treatment in Trial 1.However,a significant change was noted in the BB536-L group(P = 0.0439) in Trial 2 but not in the placebo or BB536-H groups.Subgroup analyses based on the frequency of defecation for each patient during the pre-observation period for both trials revealed significant increases in bowel movements in patients with a low frequency of defecation and significant decreases in the bowel movements of patients with a high frequency of defecation during the intervention period in the BB536 groups.The combination of Trials 1 and 2 data revealed a modulatory effect of BB536 ingestion on the changes in bowel movements.Significantly increased bowel movements were observed in patients in the low frequency subgroup with significant intergroup differences(P < 0.01).Significantly decreased bowel movements were observed in patients in the high subgroup,but no significant intergroup differences were observed compared with the placebo group.BB536 ingestion increased the prevalence of normally formed stools.BB536 intake also significantly(P < 0.01) increased the cell numbers of bifidobacteria in fecal microbiota,and significant intergroup differences were observed at week 16.No adverse events were reported in any group.CONCLUSION:Our results suggest that BB536 ingestion modulated the intestinal environment and may have improved the health care of elderly patients receiving enteral feeding.
基金Supported by the National Natural Science Foundation of China,No.81270461,No.81570483 and No.81770541.
文摘BACKGROUND Although total or subtotal colectomy for slow-transit constipation(STC)has been proven to be a definite treatment,the associated defecation function and quality of life(QOL)are rarely studied.AIM To evaluate the effectiveness of surgery for STC regarding defecation function and QOL.METHODS From March 2013 to September 2017,30 patients undergoing surgery for STC in our department were analyzed.Preoperative,intra-operative,and postoperative 3-mo,6-mo,1-year,and 2-year follow-up details were recorded.Defecation function was assessed by bowel movements,abdominal pain,bloating,straining,laxative,enema use,diarrhea,and the Wexner constipation and incontinence scales.QOL was evaluated using the gastrointestinal QOL index and the 36-item short form survey.RESULTS The majority of patients(93.1%,27/29)stated that they benefited from the operation at the 2-year follow-up.At each time point of the follow-up,the number of bowel movements per week significantly increased compared with that of the preoperative conditions(P<0.05).Similarly,compared with the preoperative values,a marked decline was observed in bloating,straining,laxative,and enema use at each time point of the follow-up(P<0.05).Postoperative diarrhea could be controlled effectively and notably improved at the 2-year follow-up.The Wexner incontinence scores at 6-mo,1-year,and 2-year were notably lower than those at the 3-mo follow-up(P<0.05).Compared with those of the preoperative findings,the Wexner constipation scores significantly decreased following surgery(P<0.05).Thus,it was reasonable to find that the gastrointestinal QOL index scores clearly increase(P<0.05)and that the 36-item short form survey results displayed considerable improvements in six spheres(role physical,role emotional,physical pain,vitality,mental health,and general health)following surgery.CONCLUSION Total or subtotal colectomy for STC is not only effective in alleviating constipation-related symptoms but also in enhancing patients’QOL.
文摘AIM:To prospectively assess the eff icacy and safety of stapled trans-anal rectal resection(STARR) compared to standard conservative treatment,and whether preoperative symptoms and findings at defecography and anorectal manometry can predict the outcome of STARR.METHODS:Thirty patients(Female,28;age:51 ± 9 years) with rectocele or rectal intussusception,a defecation disorder,and functional constipation were submitted for STARR.Thirty comparable patients(Female,30;age 53 ± 13 years),who presented with symptoms of rectocele or rectal intussusception and were treated with macrogol,were assessed.Patients were interviewed with a standardized questionnaire at study enrollment and 38 ± 18 mo after the STARR procedure or during macrogol treatment.A responder was def ined as an absence of the Rome Ⅲ diagnostic criteria for functional constipation.Defecography and rectoanal manometry were performed before and after the STARR procedure in 16 and 12 patients,respectively.RESULTS:After STARR,53% of patients were responders;during conservative treatment,75% were responders.After STARR,30% of the patients reported the use of laxatives,17% had intermittent anal pain,13% had anal leakage,13% required digital facilitation,6% experienced defecatory urgency,6% experienced fecal incontinence,and 6% required re-intervention.During macrogol therapy,23% of the patients complained of abdominal bloating and 13% of borborygmi,and 3% required digital facilitation.No preoperative symptom,defecographic,or manometric finding predicted the outcome of STARR.Post-operative defecography showed a statistically significant reduction(P < 0.05) of the rectal diameter and rectocele.The postoperative anorectal manometry showed that anal pressure and rectal sensitivity were not significantly modified,and that rectal compliance was reduced(P = 0.01).CONCLUSION:STARR is not better and is less safe than macrogol in the treatment of defecation disorders.It could be considered as an alternative therapy in patients unresponsive to macrogol.
文摘AIM To investigate compliance with transanal irrigation(TAI) one year after a training session and to identify predictive factors for compliance.METHODS The compliance of one hundred eight patients [87 women and 21 men; median age 55 years(range 18-83)] suffering from constipation or fecal incontinence(FI) was retrospectively assessed. The patients were trained in TAI over a four-year period at a single institution. They were classified as adopters if they continued using TAI for at least one year after beginning the treatment or as non-adopters if they stopped. Predictive factors of compliance with TAI were based on pretreatment assessments and trainingprogress. The outcomes of the entire cohort of patients who had been recruited for the TAI treatment were expressed in terms of intention-to-treat.RESULTS Forty-six of the 108(43%) trained patients continued to use TAI one year after their training session. The patients with FI had the best results, with 54.5% remaining compliant with TAI. Only one-third of the patients who complained of slow transit constipation or obstructed defecation syndrome continued TAI. There was an overall discontinuation rate of 57%. The most common reason for discontinuing TAI was the lack of efficacy(41%). However, 36% of the patients who discontinued TAI gave reasons independent of the efficacy of the treatment such as technical problems(catheter expulsion, rectal balloon bursting, instilled water leakage or retention, pain during irrigation, anal bleeding, anal fissure) while 23% said that there were too many constraints. Of the patients who reported discontinuing TAI, the only predictive factor was the progress of the training(OR = 4.9, 1.3-18.9, P = 0.02).CONCLUSION The progress of the training session was the only factor that predicted patient compliance with TAI.
基金Supported by the National Science Fundation of China, No. 30440058
文摘AIM: To investigate whether there was a dominant sacral root for the motive function of rectum and anal sphincter, and to provide an experimental basis for sacral root electrically stimulated defecation in spinal cord injuries. METHODS: Eleven spinal cord injured mongrel dogs were included in the study. After L4-L7 laminectomy, the bilateral L7-S3 roots were electrostimulated separately and rectal and sphincter pressure were recorded synchronously. Four animals were implanted electrodes on bilateral S2 roots. RESULTS: For rectal motorial innervation, S2 was the most dominant (mean 15.2 kPa, 37.7% of total pressure), S1(11.3 kPa, 27.6%) and S3 (10.9 kPa, 26.7%) contributed to a smaller part. For external anal sphincter, S3 (mean 17.2 kPa, 33.7%) was the most dominant, S2 (16.2 kPa, 31.6%) and S1(14.3 kPa, 27.9%) contributed to a lesser but still a significant part. Above 85% L7 roots provided some functional contribution to rectum and anal sphincter. For both rectum and sphincter, the right sacral roots provided more contribution than the left roots. Postoperatively, the 4 dogs had electrically stimulated defecation and micturition under the control of the neuroprosthetic device. CONCLUSION: S2 root is the most dominant contributor to rectal pressure in dogs. Stimulation of bilateral S2 with implanted electrodes contributes to good micturition and defecation in dogs.
