Fecal incontinence is one of the common diseases in the field of colorectal and anal surgery. Its etiology is complex, the treatment response is suboptimal, and there are controversies in clinical care. There is no consensus on the clinical practice of fecal incontinence in China currently. Launched by Anorectal Branch of Chinese Medical Doctor Association, Expert Committee on Anorectal Disease of Anorectal Branch of Chinese Medical Doctor Association, and Clinical Guidelines Committee of Anorectal Branch of Chinese Medical Doctor Association, and organized by the editorial board of Chinese Journal of Gastrointestinal Surgery, Chinese experts on this field were convened to write the Chinese expert consensus on clinical practice of fecal incontinence based on relevant references. After rounds of discussion, the final consensus combines the latest evidence and experts' clinical experience. This expert group suggested that a comprehensive assessment of fecal incontinence should be conducted before treatment, including medical history, relevant scales, physical examination and special examinations. Special examinations include anorectal endoscopy, anorectal manometry, transrectal ultrasound, magnetic resonance, rectal sensation and compliance, balloon ejection test, pelvic floor electromyography, defecography, colonoscopy and pudendal nerve terminal motor latency. Treatment methods include life style modification, medication, surgery, traditional Chinese medicine and other treatments. This consensus aims to standardize the algorithm of fecal incontinence management and improve therapeutic efficacy.
Humans ; Fecal Incontinence/etiology* ; East Asian People ; Manometry/adverse effects* ; Rectal Diseases/complications* ; Anal Canal/innervation*

OBJECTIVETo investigate the characteristics of anorectal motility spectrum in children with functional constipation in comparison with healthy children and determine the efficacy of treatment measures based on the results of anorectal manometry.

METHODSAnorectal manometric indexes were detected by the multi-functional manometry in eight patients with functional constipation aged (11.4 +/- 4.8) yrs and ten healthy children aged (10.5 +/- 3.5) yrs from May 2004 to June 2005. The patients received combined treatment including probiotics (Bifid. triple viable), prebiotics (Lactulose) and regular defecation according to the results of anorectal manometry in patients with functional constipation. The efficacy of these conservative measures were estimated during the course of treatment.

RESULTSNo statistical differences were found in the indexes of effective length of anal sphincter, maximal systolic pressure and the duration of more than 50% of maximal systolic pressure between two groups. But minimal sensitivity and maximal tolerated volume between the two groups were significantly different. Seven of eight patients got better with the conservative treatment.

CONCLUSIONAbnormal features exit in the anorectal motility spectrum of the children with functional constipation. The clinical efficacy of the conservative treatment measures based on the results of anorectal manometry is significantly good.

Adolescent ; Anal Canal ; innervation ; physiopathology ; Case-Control Studies ; Child ; Constipation ; drug therapy ; physiopathology ; Defecation ; Female ; Follow-Up Studies ; Gastrointestinal Agents ; therapeutic use ; Gastrointestinal Motility ; Humans ; Lactulose ; therapeutic use ; Male ; Manometry ; Probiotics ; therapeutic use ; Rectum ; innervation ; physiopathology ; Treatment Outcome

Successful assessing intestinal lumen content with ultrasound signals might lay a strong basis for the development of the artificial anal sphincter. In the present study, we utilized a modified MLU02-212 ultrasonic gas bubble detector to test the distal part of proximal colon in each rabbit, for the group of twenty healthy New Zealand rabbits. Voltage signals of solid, liquid, gas and empty content of the lumen were collected and compared. The results indicated that there were significant differences among the voltage signals in the 4 conditions (P = 0.000), respectively. Multiple comparison showed significant differences existed in any pair of the four conditions (P = 0.000). Three signal non-overlapping regions existed in these 4 conditions. Thus it seemed that ultrasound could be utilized to distinguish various contents inside the intestinal lumen and could act as "artificial sensory nerve".
Anal Canal ; innervation ; physiology ; Animals ; Artificial Organs ; Colon ; diagnostic imaging ; Enteric Nervous System ; physiology ; Fecal Incontinence ; surgery ; Female ; Gastrointestinal Contents ; Gastrointestinal Motility ; physiology ; Male ; Rabbits ; Sensory Receptor Cells ; physiology ; Ultrasonography

OBJECTIVETo investigate the clinical effect of lateral lymph nodes dissection and autonomic nerve preservation in anterior resection for rectal cancer.

METHODSOne hundred and twenty-four patients with rectal cancer underwent anterior resection with lateral lymph nodes resection and autonomic nerve preservation. The patients were followed-up through post-operational questionnaire about the function of defecation, urination and sex after the operation. And post-operative survival was analyzed retrospectively.

RESULTSUrinary catheters were removed in 112 cases (90.3%) in 3 days post operation, the mean time of indwelling catheter was (58.3 +/- 2.1) h. Nineteen patients experienced fecal incontinence, 12 cases of them recovered through release-training and one recovered spontaneously. Of the 98 questionnaire respondents, 61 cases (62.3%) could erect normally, and 56 cases (57.1%) had normal sexual function. The max-micturition-desire urine volume was (401.2 +/- 23.1) ml and the residual urine volume was (28.2 +/- 2.2) ml. Five year survival rate of all the patients was 61.2%.

CONCLUSIONSLateral lymph nodes dissection and autonomic nerve preservation in anterior resection for rectal cancer can decrease the post-operative dysfunction of defecation, urination and sex life and does not affect the survival.

Adult ; Anal Canal ; Autonomic Pathways ; Follow-Up Studies ; Humans ; Lymph Node Excision ; methods ; Male ; Middle Aged ; Pelvis ; innervation ; Postoperative Complications ; prevention & control ; Rectal Neoplasms ; mortality ; surgery ; Survival Analysis ; Survival Rate ; Treatment Outcome