The balloon expulsion test is a simple and useful method for investigating a defecatory disorder assessing the subject's ability to evacuate a simulated stool. However, there is no standard methodology and varying interpretations have been reported. This review discusses the techniques, interpretation and clinical utility of the balloon expulsion test.
Constipation ; Defecation ; Gastrointestinal Diseases

No abstract available.
Biofeedback, Psychology* ; Defecation* ; Humans

PURPOSE: Rectoceles are often associated with anorectal symptoms. Various surgical techniques have been described to repair rectoceles, but the surgical results vary. The aim of this study was to compare transanal repair (TAR) and transanal repair with posterior colporrhaphy (TAR+PC). METHODS: The records of 58 patients operated on during a 56-month period were reviewed. Of those 26 patients had a TAR, and 32 patients had a TAR+PC. Interviews and anorectal physiologic studies were performed preoperatively and postoperatively. RESULTS: The recurrence rate after a TAR+PC was lower than the recurrence rate after a TAR (TAR 19.2% vs. TAR+PC 3.1%). The rectal sensation (sensory threshold: TAR 64.8+/-18.9 ml vs. TAR+PC 56.1+/-23.67 ml; earliest defecation urge: TAR 116.4+/-29.5 ml vs. TAR+PC 104.8+/-31.2 ml) was more improved after a TAR+PC. CONCLUSIONS: A TAR+PC for treatment of a rectocele is safe and effectively corrects obstructed defecation. The improvement probably relates, at least in part, to rectal sensational factors other than the dimensions of the rectocele.
Defecation ; Humans ; Rectocele* ; Recurrence ; Sensation

OBJECTIVE: We report six patients with tuboovarian abscess (TOA) drained through sonographically guided transrectal route, in whom percutaneous or transvaginal approach was not accessible due to the risk of pelvic organ. METHOD: This procedure was performed under the guidance of transrectal ultrasound. Six patients with aged 25-42 years (mean 31.6 years), who had appendectomy(1), C/S(2), hyterectomy(1) and no operaion Hx(2). Size of abscess cavity was variable from three to eight centimeter. Catheter was removed when drainage amount was reduced less than 10 cc and the patient becomes afebrile. RESULT: Drainage was successfully done in all patients without any complication to the procedure. Fecal contamination was not occurred after transrectal drainage due to abdominal pressure and gravity ought to empty the abscess cavity. There was no problem in defecation due to the catheter and in its expulsion by defecation. Catheter was removed after 3-8 days (mean 6 days) without recurrent abscess. CONCLUSION: Transrectal drainage of abscess performed with ultrasound guidance is a safe, feasible procedure, which is well tolerated by patient and relatively easy procedure.
Abscess* ; Catheters ; Defecation ; Drainage* ; Gravitation ; Humans ; Ultrasonography

PURPOSE: This study has carried out to clarify the relationship between changes in the anal sphincter muscle thickness and pressure. Also, this study shows the effect of vaginal delivery and benign anal disease on the function and structure of the anal sphincter. METHODS: Women (n=42; mean age: 33.2 +/- 9.6 years old) without defecation problems or history of anal surgery, who came to Ewha Womans University Hospital between July 1999 and October 1999, were chosen. We measured the resting and the squeezing pressure with anal manometry and the thickness of the internal anal sphincter (IAS) and external anal sphincter (EAS) by endoanal sonography. RESULTS: The mean squeezing and resting pressures were 98.3 +/- 38.2 and 53.9 +/-17.4 cmH2O, and the mean EAS and IAS thicknesses were 4.9+/-0.9 and 1.9+/-0.3 mm, respectively. The thickness of the EAS and squeezing pressure did not correlate. Neither did the IAS thickness and the resting pressure. In cases with a history of vaginal delivery (n=15), the squeezing and the resting pressures were 94.0+/-43.0 and 57.1+/-22.2 cmH2O, and the thicknesses of the EAS and the IAS, 4.6+/-0.9 and 2.0+/-0.4 mm, respectively. The number of deliveries had no correlation with the thickness or the pressure of the anal sphincter. In patients with benign anal lesions (n=11), the squeezing and the resting pressure was 113.0+/-42.9 and 57.0+/-14.0 cmH2O, and the thicknesses of the EAS and the IAS were 5.0+/-1.3 and 2.1+/-0.4 mm, respectively. CONCLUSION: Our data suggest that the function and the structure of the anal sphincter are independent. In adult women, the thickness of the anal sphincter, the history of vaginal delivery, and the existence of benign anal lesions had no effect on anal sphincter function.
Adult* ; Anal Canal* ; Defecation ; Female ; Humans ; Manometry

PURPOSE: The final aim of operation for anorectal malformations (ARMs) is acquisition of normal bowel habit by preserving an anorectal function. This study was performed to assess the functional results after definite correction of the malformations. METHODS: 37 patients (Group 1) without rectocutaneous fistula and 23 patients (Group 2) with rectocutaneous fistula were Included in the study. The authors examined functional assessment of children over 3-years-old, according to Krickenbeck classification, and analyzed the results. RESULTS: Group 1 showed significant soiling in 24.3% and constipation requiring management in 35.1%.But Group 2 showed constipation in only 8.7%. The results of Krickenbeck assessment are as follows: Group 1 showed good results in 64.9% and poor results in 35.1% with improvement over time. Group 2 showed 91.3%, 8.7%, respectively. CONCLUSION: Constipation rather than soiling was the main functional problem after surgical repair of anorectal malformations but improved over time. It seems that more aggressive management of constipation warrants good results after definite surgical repair.
Child ; Constipation ; Defecation ; Fistula ; Humans ; Soil

In Kampo, “lung medicines” are usually used to treat patients with bronchial asthma, according to the type of cough and sputum, and the degree of dyspnea which presents. However, it is also important to exclude exacerbating factors. In Kampo, the lungs and large intestine are thought to have a close relationship. We report three bronchial asthma patients whose cough and dyspnea were ameliorated by improving bowel movements. We discuss the types of bronchial asthma patients who might be effectively treated by controlling their defecation. We suggest that, when patients with mild bronchial asthma who have not previously had trouble with their bowel movements complain of respiratory distress with abnormal bowel movement, it might be effective to apply “large intestine medicines” to relieve their respiratory problems. (122 words)
Asthma ; Respiratory ; Bowel action ; Defecation ; Cases

PURPOSE: To determine optimal maintenance dose and to evaluation the efficacy and safety of polyethylene glycol 4000 (PEG4000) in children with chronic functional constipation. METHODS: This study enrolled 41 children with chronic functional constipation at the Konkuk university hospital August 2005, then June, 2007. Effective maintenance dose was designed as initial amount of PEG4000 that improved frequency, bowel movement, stool consistency for 2 months. Clinical outcome was analysed on the basis of defecation diary. Adverse effect was monitored clinically and biochemically. RESULTS: As a whole group effective maintenance dose of PEG4000 was 0.550.16 g/kg/day (0.25-0.86). With respect to age, 3-5 years (0.600.15), 6-8 years (0.570.16), 9-13 years (0.440.14) (P=0.024). With respect to body weight, <30 kg (0.620.14), 30 kg (0.410.10) (P=0.001). One child comlained apigastric soreness on medication. CONCLUSION: PEG4000 is effective and safe in children with chronic constipation. Initial maintenance dose of PEG4000 was 0.55 g/kg/day.
Body Weight ; Child* ; Constipation* ; Defecation ; Humans ; Polyethylene Glycols* ; Polyethylene*

PURPOSE: To evaluate the correlation between colon transit time (CTT) test value and initial maintenance dose of polyethylene glycol (PEG) 4000 or lactulose. METHODS: Of 415 children with chronic functional constipation, 190 were enrolled based on exclusion criteria using the CTT test, defecation diary, and clinical chart. The CTT test was performed with prior disimpaction. The laxative dose for maintenance was determined on the basis of the defecation diary and clinical chart. The Shapiro-Wilk test and Pearson's and Spearman's correlations were used for statistical analysis. RESULTS: The overall group median value and interquartile range of the CTT test was 43.8 (31.8) hours. The average PEG 4000 dose for maintenance in the overall group was 0.68±0.18 g/kg/d; according to age, the dose was 0.73±0.16 g/kg/d (<8 years), 0.53±0.12 g/kg/d (8 to <12 years), and 0.36±0.05 g/kg/d (12 to 15 years). The dose of lactulose was 1.99±0.43 mL/kg/d (<8 years) or 1.26±0.25 mL/kg/d (8 to <12 years). There was no significant correlation between CTT test value and initial dose of laxative, irrespective of the subgroup (encopresis, abnormal CTT test subtype) for either laxative. Even in the largest group (overall, n=109, younger than 8 years and on PEG 4000), the correlation was weak (Pearson's correlation coefficient [R]=0.268, p=0.005). Within the abnormal transit group, subgroup (n=73, younger than 8 years and on PEG 4000) correlation was weak (R=0.267, p=0.022). CONCLUSION: CTT test value cannot predict the initial maintenance dose of PEG 4000 or lactulose with linear correlation.
Child* ; Colon* ; Constipation* ; Defecation ; Humans ; Lactulose ; Laxatives ; Polyethylene Glycols

BACKGROUND/AIMS: Bacillus Licheniformis, a probiotic used in the treatment of diarrhea, has been shown to suppress the growth of pathologic bacteria. This study was performed to assess the therapeutic efficacy and safety of Zhengchangsheng(R) (Bacillus Licheniformis) in comparison with another probiotic, Bioflor(R) (Saccharomyces Boulardii) for the treatment of diarrhea. METHODS: Patients with diarrhea (n=158) were randomized to receive Zhengchangsheng(R) or Bioflor(R) for 5 days. The existence or non-existence of formed feces, changes in daily stool frequency, improvement of subjective symptoms, and changes in the severity of diarrhea were compared. RESULTS: Of the 158 full analysis set (FAS) patient population, 151 patients comprised the per protocol (PP) analysis. The rates of recovered to formed feces in the Bacillus and Saccharomyces groups were 91.0% vs. 95.0% in the FAS (P=0.326) and 90.5% vs. 96.1% in the PP analysis (P=0.169), respectively. The mean duration of diarrhea changing to formed feces was 3.15+/-1.10 days in the Bacillus group and 3.22+/-1.01 in the Saccharomyces group (P=0.695, FAS). The frequency of defecation, subjective symptoms, and degree of severe diarrhea were improved in both groups, however, there were no statistically significant differences between the 2 groups. Analysis of the 95% confidence intervals for the differences in the rate of recovery to formed feces between the 2 groups met the criteria for non-inferiority of Bacillus compared to Saccharomyces. No significant adverse events were observed during the study period. CONCLUSIONS: Zhengchangsheng(R) is not inferior to Bioflor(R) in therapeutic efficacy and is a safe and useful therapeutic agent for the treatment of diarrhea.
Bacillus ; Bacteria ; Defecation ; Diarrhea* ; Feces ; Humans ; Probiotics* ; Saccharomyces