Adult ; Anus/*physiopathology ; Constipation/etiology ; Esophagus/physiopathology ; Female ; Human ; Manometry ; Middle Age ; Rectum/*physiopathology ; Scleroderma, Systemic/*physiopathology

Benign anorectal diseases are common. Hemorrhoids, anal fissure and anal fistula are the top three of colorectal surgery for benign anrorectal clinical practice. Postoperative fecal incontinence or stool seepage has not yet got enough attention by specialists. This article elaborates on the clinical status, evaluation process, functional protection and treatment strategies etc. Following the continence protection principle requires specialists to focus on not only the disease itself but the patient-centered quality of life.
Anus Diseases ; physiopathology ; Digestive System Surgical Procedures ; Fecal Incontinence ; Humans ; Quality of Life

OBJECTIVETo observe the clinical efficacy on spastic pelvic floor syndrome (SPFS) treated with electroacupuncture (EA) at Shangliao (BL 31), Ciliao (BL 32), Zhongliao (BL 33) and Xialiao (BL 34).

METHODSThirty-six cases of SPFS were treated with EA at Shangliao (BL 31), Ciliao (BL 32), Zhongliao (BL 33) and Xialiao (BL 34), intermittent wave, 60 times/min in frequency, retained for 20 min. In general, the acupoints on one side were stimulated in each treatment. The bilateral acupoints stimulation was applied in serious cases. The treatment was given once every two days, five treatments made one session and totally three sessions were required. Before and after treatment, the clinical symptoms, anal kinetic indices defecation radiographic changes were observed. The follow-up observation was done in three months after the end of treatment.

RESULTSIn three-months follow-up after treatment, 14 cases were cured, 18 cases improved and 4 cases failed. The total effective rate was 88. 9%. After treatment, the cases of incomplete defecation, difficult defecation, anal pain and anal obstruction were reduced apparently as compared with those before treatment, indicating the statistically significant differences (all P<0.01). After treatment, rectal anal reflex threshold (ARA) was increased, anal maximal contraction pressure (AMCP) was reduced to (16.62±1.54) kPa and anal rest pressure (ARP) was significantly reduced to (7.22±0.36) kPa, indicating the statistical differences as compared with those before treatment (all P<0.01). After treatment, anorectal angle (ARA) in forceful defecation was increased to (116.55±9.42)°, the distance between the anorectal junction and the pubococcygeal line was decreased, and the impression of puborectal muscle was alleviated apparently as compared with that before treatment (P<0.01).

CONCLUSIONEA at Shangliao (BL 31), Ciliao (BL 32), Zhongliao (BL 33) and Xialiao (BL 34) achieves definite efficacy on SPFS and this therapeutic method obviously relieves the symptoms and deserves to be promoted in clinic.

Acupuncture Points ; Adult ; Aged ; Anus Diseases ; physiopathology ; therapy ; Constipation ; physiopathology ; therapy ; Defecation ; Electroacupuncture ; Female ; Humans ; Male ; Middle Aged ; Muscle Spasticity ; physiopathology ; therapy ; Pelvic Floor ; pathology

BACKGROUND/AIMS: The causes of functional anorectal outlet obstruction (outlet obstruction) include functional defecation disorder (FDD), rectocele, and rectal intussusception (RI). It is unclear whether outlet obstruction is associated with rectal hyposensitivity (RH) in patients with functional constipation (FC). The aim of this study was to determine the association between RH and outlet obstruction in patients with FC. METHODS: This was a retrospective study using a prospectively collected constipation database, and the population comprised 107 patients with FC (100 females; median age, 49 years). We performed anorectal manometry, defecography, rectal barostat, and at least two tests (balloon expulsion test, electromyography, or colon transit time study). RH was defined as one or more sensory threshold pressures raised beyond the normal range on rectal barostat. We investigated the association between the presence of RH and an outlet obstruction such as large rectocele (> 2 cm in size), RI, or FDD. RESULTS: Forty patients (37.4%) had RH. No significant difference was observed in RH between patients with small and large rectoceles (22 [44.9%] vs. 18 [31%], respectively; p = 0.140). No significant difference was observed in RH between the non-RI and RI groups (36 [36.7%] vs. 4 [30.8%], respectively; p = 0.599). Furthermore, no significant difference in RH was observed between the non-FDD and FDD groups (19 [35.8%] vs. 21 [38.9%], respectively; p = 0.745). CONCLUSIONS: RH and outlet obstruction are common entities but appear not to be significantly associated.
Adult ; Aged ; Aged, 80 and over ; Anus Diseases/diagnosis/*physiopathology ; Constipation/diagnosis/*physiopathology ; Cross-Sectional Studies ; *Defecation ; Defecography ; Electromyography ; Female ; Humans ; Intussusception/diagnosis/*physiopathology ; Male ; Manometry ; Middle Aged ; Pressure ; Rectocele/diagnosis/*physiopathology ; Rectum/*innervation ; Retrospective Studies ; *Sensory Thresholds ; Young Adult

OBJECTIVETo explore the diagnosis and treatment methods of pediatric anismus.

METHODSTwenty-nine patients with idiopathic chronic constipation, diagnosed with anismus by colon barium contrast and anorectal manometry from Nov. 2001 to Nov. 2004 in our hospital, were investigated retrospectively.

RESULTSThis group consisted of 13 men and 16 women whose mean age was (6.7+/-4.0) years. Hirschsprung diseases were excluded from the patients by colon barium contrast and rectoanal inhibitory reflex (RAIR) examination. Normal RAIR (5-10 ml elicited) was showed on 21 cases while weakened RAIR (15-30 ml elicited) was showed on 8 cases. After the diagnosis, the patients were treated by toilet training, diet regulation and laxative for 1-2 months. 4 cases were recovered, 5 cases were improved and 20 cases were relied on glycerin suppository. Four cases, relied on glycerin suppository, underwent Lynn procedure and had good results after 5-24 months follow-up. Two cases were re-examined by anorectal manometry 3 and 6 months after surgery, the resting pressure and the high pressure zone (HPZ) decreased, but the simulation defecation reflex was still abnormal.

CONCLUSIONSThe diagnosis of pediatric anismus relies on history of constipation, combined with anorectal manometry and colon barium contrast. Lynn procedure could be chosen for the patients unsatisfied in toilet training and other non-operative treatment.

Adolescent ; Anus Diseases ; diagnosis ; surgery ; Child ; Child, Preschool ; Constipation ; diagnosis ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Muscle Hypotonia ; diagnosis ; surgery ; Pelvic Floor ; physiopathology ; Rectal Diseases ; diagnosis ; surgery

Sixteen children of uncontrollable fecal incontinence have been treated with Pickrell's gracilis muscle transposition since 1983: 12 had an imperforate anuses with multiple corrective operative procedures and 4 had traumatic destructions of anal sphincters. We report a series of 11 cases whom we followed-up over a period of 0.8 to 10.5 years (mean; 5.6 years). Seven patients were evaluated by anorectal manometry. All patients except one who had left hemipelvectomy and permanent colostomy showed nearly normal continence during the follow-up period. There was no evidence of fibrosis in the transposed muscles and the tensions of the transposed muscles were well maintained. The voluntary contractions of the transposed muscles were well maintained and efficient in all cases. The general manometric parameters did not correlate well with the functional results; however, there was a strong correlation in the S/R ratio (maximum squeeze pressure/resting pressure) with the functional results. We believe that the good functional outcome of this procedure need not only the meticulous surgical technique but also the personal motivation and the compliance with physiotherapy. In conclusion, although the gracilis muscle transposition never results in normal continence, acceptable continence can be achieved in the selected patients.
Adolescent ; Adult ; Anus/physiopathology ; Case Report ; Child ; Child, Preschool ; Colostomy ; Fecal Incontinence/physiopathology/*surgery ; Female ; Follow-Up Studies ; Human ; Infant ; Longitudinal Studies ; Male ; Manometry ; Muscles/*transplantation ; Postoperative Period ; Reoperation ; Thigh ; Treatment Outcome