Constipation ; diagnosis ; therapy ; Humans ; Medicine, Chinese Traditional ; Rectum ; physiopathology ; Syndrome ; Touch

Child ; Child, Preschool ; Constipation ; diagnosis ; physiopathology ; therapy ; Digestive System ; microbiology ; physiopathology ; Gastrointestinal Hormones ; physiology ; Gastrointestinal Motility ; physiology ; Humans

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

OBJECTIVEThe ability of the rectum to evacuate is valuable information in patients with constipation, or those who find defecation difficult. However, few published studies are available to evaluate this ability in most common examinations of anorectal function. A new, low-radiation, real-time scintigraphic technique has been used by several investigators to outline the 'neo-rectum' following ileoanal pouch anastomosis and the efficiency of rectal evacuation in adult patients with constipation. There was no similar report about the abilities of rectal evacuation in children with constipation. The aim of this study was to investigate the value and reliability of isotope defecography as an objective method for evaluation of anorectal function in patients with chronic idiopathic constipation.

METHODSTwenty five patients (10 were male and 15 were female, range of age was 5 - 15 years, mean age 8.99 years) suffering from chronic idiopathic constipation and 11 normal children were assessed by isotope defecography. The radiopharmaceuticals used were rehydrated potato labelled with 200 MBq (99m)TcO(4)(-). The volume of the potato paste used in each subject was determined by prior balloon proctometrogram studies, which measured the maximum rectal capacity. The patient was seated upright on a commode, and the computer was then set for the dynamic acquisition of 3-second images over 5 min per session. Using a region of interest program on computer, the dynamic radioactivity in anorectum during defecation showed as emptying curves by computer. The half defecation time, the rectal emptying rate and the residual rate could be calculated from the rectal emptying curves. The anorectal angles were measured from the images of anorectum during resting, squeezing and evacuation. All patients underwent X-ray defecography and colonic transit time measurement simultaneously.

RESULTSThe rectal emptying curves showed a prompt evacuation in normal children, but it disappeared in most of patients with idiopathic constipation. The abilities of evacuation were damaged severely in patients. In normal group the half defecation time, the rectal emptying rate and the residual rate were 1.97 +/- 0.86 minutes, 78.30% +/- 12.03% and 20.50% +/- 7.67%, respectively, whereas they were 15.16 +/- 3.67 minutes, 44.84% +/- 14.00% and 53.52% +/- 15.02%, respectively, in patients group. There were significant differences between two groups (P < 0.05). According to the results of colonic transit time there were 6 patients with slow transit constipation, 17 patients with outlet dysfunction and 2 patients with normal colonic transit time. The abilities of evacuation were more seriously impaired in patients with outlet dysfunction compared with those patients with slow transit constipation. For the isotope defecography the mean anorectal angles at resting in patient group and normal group were 109 +/- 12 degrees and 101 +/- 17 degrees. There were no significant differences in anorectal angles between patient group and normal group or by both methods of isotope defecography and X-ray defecography. The correlation coefficients for anorectal angles at resting, squeezing and evacuation were 0.87, 0.82 and 0.73, respectively.

CONCLUSIONThe isotope defecography can be used to evaluate the anorectal function and the ability of defecation dynamically, also it was simple and safe because of the low dose radiation involved.

Adolescent ; Child ; Child, Preschool ; Constipation ; diagnosis ; Female ; Humans ; Male ; Radionuclide Imaging ; methods ; Rectum ; diagnostic imaging ; physiopathology ; Sensitivity and Specificity ; Technetium

A newly-developed gastrointestinal (GI) monitoring system based on a smart capsule is presented in the paper. The unprecedented 130-200 hours battery life and smaller size (10 mm x 20 mm) allows the physician to get total pan-colonic measurements of high-amplitude propagating contractions (HAPCs). To test the in vivo performance of the monitoring system, 15 healthy volunteers and 10 patients with slow transportation constipation (STC) participate in this study. The average of HAPCs occurred in patients is significantly lower than in volunteers (12.4 +/- 3.3 vs. 18.5 +/- 3.7 p = 0.013). The system provides a useful tool for STC diagnosis and treatments of patients.
Adult ; Colon ; physiology ; Constipation ; diagnosis ; physiopathology ; Diagnostic Techniques, Digestive System ; instrumentation ; Equipment Design ; Humans ; Manometry ; instrumentation ; Middle Aged

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

OBJECTIVETo evaluate the sensitivity and feasibility of pelvic floor dynamic MRI combining defecography with homemade high conformable sacculus in the management of obstructed defecation syndrome.

METHODSOne hundred and nine female with pelvic floor disorders, such as difficult defecation, fecal incontinence or urinary incontinence, pelvic pain, were treated from July 2007 to March 2009. Pelvic floor dynamic MRI and defecography with homemade high conformable sacculus was performed in the patients to evaluate pelvic floor anatomy.

RESULTSFifty-four cases (49.6%) of cystocele and 11 cases (10.1%) of rectouterine pouch hernia, 29 cases (26.6%) of perineum prolapse and 71 cases (65.2%) of rectocele were found by dynamic MRI. The dynamic MRI also revealed 19 cases (18.2%) of external sphincter trophy and 32 cases (29.4%) of spastic pelvic floor syndrome. Compared with defecography, dynamic MRI was more positive in diagnosing enterocele. Defecography Of the patients, sacrum-rectal separate was found in 33 cases (30.3%) and rectal mucosal prolapse or internal rectal intussusceptions in 41 cases (37.7%) by defecography, while dynamic MRI found none.

CONCLUSIONSAs a new noninvasive imaging technique to evaluate the pelvic floor function, dynamic MRI is more sensitive, especially for patients with complicated multi-organs prolapse, and its deficiency could be remedied by defecography.

Adult ; Aged ; Constipation ; diagnosis ; physiopathology ; Defecography ; Female ; Humans ; Magnetic Resonance Imaging ; methods ; Middle Aged ; Pelvic Floor ; physiopathology ; Sensitivity and Specificity ; Young Adult

The purpose of this study was to investigate the prevalence, clinical characteristics, and management of functional constipation at pediatric gastroenterology clinics. A prospective survey using the Rome III criteria was distributed to a group of parents of children with a constipation history and its control group in May 2008. The mean prevalence of constipation was 6.4%, which was similar to those in other countries. Statistically significant variables for children without constipation were that more children had a body mass index of below the 10th percentile even though they received more mother's care and ate balanced meals compared to the constipation group. Meanwhile, the constipation group frequently showed a history of constipation in infancy, picky-eating, lack of exercise, and retentive posturing. When analyzed with the Rome III criteria, the children showed greater than 60% rate of hard stools, painful stools, a history of large fecal mass in rectum, and its disappearance of constipation symptoms after passing a large stool. Our study found different approaches amongst pediatric gastroenterologists like rectal examinations, disimpaction, or drug treatment. Several factors addressed in our study can provide better guidelines for clinicians treating constipation and its future research.
Adolescent ; Body Mass Index ; Child ; Child, Preschool ; Constipation/*diagnosis/drug therapy/epidemiology ; Female ; Hospitals ; Humans ; Infant ; Laxatives/therapeutic use ; Male ; Prevalence ; Prospective Studies ; Rectum/physiopathology ; Severity of Illness Index

Constipation is a digestive symptom that is frequently seen in clinical practice. Its prevalence has been reported to be 2% to 20%, depending on geographical region. Despite the rapid development of medical science, systematic studies on constipation have been rarely conducted in Korea. Recently, guidelines on the diagnosis and treatment of functional gastrointestinal disorders, including constipation, were proposed by The Korean Society of Neurogastroenterology and Motility. These guidelines are expected to reflect the current situation regarding treatment of constipation in Korea. In this paper, practical constipation treatment methods that are in current use will be reviewed with reference to these recent guidelines.
*Behavior Therapy ; Constipation/diagnosis/epidemiology/physiopathology/*therapy ; Defecation/*drug effects ; Dietary Fiber/*administration & dosage ; Humans ; Laxatives/*therapeutic use ; Practice Guidelines as Topic ; Prevalence ; Republic of Korea/epidemiology ; *Risk Reduction Behavior ; Treatment Outcome

OBJECTIVETo investigate the application value of colonic transit test (CTT) combined with anorectal manometry (ARM), barium enema (BE) and defecography (DFG) in accurately evaluating colonic lesions of slow transit constipation complicated with adult megacolon.

METHODSClinical data of 47 above patients admitted between October 2007 and February 2015 in the People's Hospital of Hunan Province were analyzed retrospectively. All the patients were examined with≥2 times of CTT combined with ARM and BE, and 42 cases received additional DFG at the same time, to evaluate colonic lesions before operation. Operative biopsy pathology was used as the standard. The sensitivity, specificity, positive predictive value(PPV) and negative predictive value(NPV) of positioning in the ascending colon and caecum, transverse colon and descending colon were calculated, and the consistency was represented by Kappa test(Kappa value≥0.75 indicates good consistency, meanwhile higher Kappa value indicates better consistency). The Heikkinen score was used to evaluate defecation function at postoperative 6 months.

RESULTSThe age of 47 patients was from 18 to 56 years old. Compared with intraoperative findings and biopsy pathology, the diagnostic coincidence rate was 89.4% by CTT combined with BE and DFG positioning, which suggested pathology-changed colonic segment locating in the ascending colon and cecum (n=12), transverse colon (n=26) and descending colon (n=9), while intraoperative findings and biopsy pathology suggested pathology-changed colonic segment locating in the ascending colon and cecum (n=11), transverse colon (n=23) and descending colon (n=13). The sensitivity was 88.3%, specificity 93.5%, PPV 92.1%, NPV 94.9% and Kappa value was 0.827(P<0.001). Procedures performed included segmental colectomy (n=8), subtotal colectomy (n=29), total colectomy (n=10). There was no serious complication during and after operation. Defecatory function was excellent in 24 cases (60.0%), good in 10 (25.0%), and moderate in 6 (15.0%) evaluated by Heikkinen score at postoperative 6 months. A total of 40 patients were followed up from 1 to 7 years (median 3 years) and there was no long-term diarrhea and recurrence of constipation or giant colon after operation.

CONCLUSIONPreoperative detection of CTT combined with ARM, BE and DFG in patients with slow transit constipation complicated with adult megacolon can make a more precise assessment of the extent of colonic lesions in advance, which has a good clinical predictive value.

Adolescent ; Adult ; Barium Enema ; Cecum ; pathology ; physiopathology ; surgery ; Colectomy ; methods ; Colon ; pathology ; physiopathology ; surgery ; Constipation ; complications ; diagnosis ; pathology ; surgery ; Defecography ; Female ; Gastrointestinal Transit ; physiology ; Humans ; Male ; Manometry ; Megacolon ; complications ; pathology ; surgery ; Middle Aged ; Predictive Value of Tests ; Preoperative Period ; Prognosis ; Recovery of Function ; physiology ; Retrospective Studies ; Sensitivity and Specificity