Biofeedback is the treatment of choice for functional defecation disorders such as idiopathic chronic constipation and neurogenic fecal incontinence. The pre-existing biofeedback systems have many disadvantages. The aims of current project are, first, to develop the biofeedback system into the application software in the Windows environment, and, second, to assess the possibility of clinical usage for patients with functional defecation disorders. The hardware and software of the BASCO (Biofeedback Anal Sphincter Control) system were based on the signal measurement and signal processing of anal sphincter EMG (Electromyography). BASCO system was applied to 5 normal healthy controls and 20 patients with functional defecation disorders. Patients group was categorized as constipation group (N1=15) and incontinence group (N2=5). With use of current system, EMG-based biofeedback therapy was performed, and the outcome was analysed. Anal EMG signal data was processed by the software, and displayed in the monitor of personal computer. The software of EMG-display and database management were adequately operated. In N1 group, a paradoxical elevation or equalized activity of anal EMG pattern was shown in the simulated defecation. In N2 group, low electrical activity was shown. These findings were used for the EMG-based biofeedback therapy as a pilot study. The clinical symptoms were improved in 12 of N1 group and 3 of N2 group in the period of 3.7 (range, 1~12) months follow-up. In Conclusion, newly-developed BASCO system was adequately operated in the volunteer and patients groups. The multi-tasking and multi-processing functions were adequately shown in the real time. Current results could be used for clinical appraisal. Specifically, this system could be used for the practical application of biofeedback therapy in the patients with chronic constipation or fecal incontinence.
Anal Canal* ; Biofeedback, Psychology* ; Constipation ; Defecation* ; Fecal Incontinence ; Follow-Up Studies ; Humans ; Microcomputers ; Pilot Projects ; Volunteers

Biofeedback therapy has emerged as a useful adjunct for patients with functional evacuation disorders over the past decade. The goals of biofeedback retraining may vary and could depend on the underlying dysfunction. In patients with obstructive defecation, the goals are to relax the anal sphincter, improve rectoanal coordination, and improve sensory perception. Methods of biofeedback therapy varied widely between centers. However, no difference was described when EMG-based biofeedback was compared to manometry-based biofeedback, or when visual or auditory feedback was given. In regards to biofeedback adjuncts, including sensory retraining with either an intrarectal balloon, a portable home-training unit or both can be practicable. There are inconsistencies in the literature regarding the patient selection criteria for biofeedback treatment. The patient group is not homogeneous. Different case selection, different regimens and different methods of biofeedback may explain the variability in success rate. Quality research that would assist in predicting outcome is still lacking. Although no specific denominator could possibly be assigned to correctly predict the overall outcome of therapy, biofeedback is not successful in all patients with outlet obstructed constipation. Results with success rates is ranging from 8.3 percent to 100 percent. The treatment of constipation by biofeedback has been viewed with some skepticism as the low success rate may simply be a placebo effect. The majority of scepticism to therapeutic outcome are derived from entry criteria for treatment. Lower success rates have been described when entry criteria were broadened. Prebiofeedback clinical findings which are presupposed to prognostic relevance are age, gender, duration of symptoms and presence of rectal pain, lower motor neuron disease, and psychiatric problems. I feel strongly that informations about the predictive factors are vital to all physicians either performing or recommending biofeedback to their patients. If biofeedback could be undertaken according to specific criteria, we, colorectal surgeon will save a fruitless endeavour, one would expect more improvements in more patients. Additional well-designed controlled trials are needed to establish the clinical and physiologic factors.
Anal Canal ; Biofeedback, Psychology* ; Constipation ; Defecation ; Humans ; Motor Neuron Disease ; Patient Selection ; Placebo Effect

PURPOSE: This study was undertaken to evaluate how well anorectal manometry diagnose anal sphincter injury, especially with regard to the parameter of radial asymmetry. METHODS: Anorectal manometry were performed in 27 male patients with anal fistula of transsphincteric type. The postoperative values of each manometric parameter including radial asymmetry (RA) were compared with preoperative ones. And also, the association between the sites of functional defect assessed by cross-sectional pressure data under station pull-through (SPT) technique and those of anatomical defect made by fistulotomy operation were determined. RESULTS: Under rapid pull-through (RPT) technique, maximum resting pressure (MRP); 113.1 21.3 mmHg (preoperative value) vs 68.0 18.5 mmHg (p=.000) (postoperative value), RA of MRP; 16.7 3.7% vs 24.1 7.5% (p=.002), Maximum squeeze pressures (MSP); 199.0 35.2 mmHg, 169.6 48.7 mmHg (p=.006), RA of MSP; 15.5 3.7%, 22.8 3.5% (p=.000). Under SPT technique, MRP; 100.4 39.5 mmHg vs 71.2 34.6 mmHg (p=.000), RA of MRP; 16.3 7.9% vs 24.2 10.8% (p=.026), MSP; 299.1 71.6 mmHg vs 231.4 90.3 mmHg (p=.004), RA of MSP; 13.0 6.1% vs 22.0 8.4% (p=.001). Sites of functional defects interpreted upon SPT data were coincidental with sites of anatomical defects made by fistulotomy in 88.9% (MRP) and 92.6% (MSP) of cases. CONCLUSIONS: Manometric radial asymmetry could be a useful parameter in diagnosing anal sphincter injury and locating the site of defect.
Anal Canal* ; Diagnosis* ; Humans ; Male ; Manometry ; Rectal Fistula

There are three groups of patients with constipating symptoms; those with obstructed defecation, slow transit constipation, or both. The treatment of obstructed defecation (pelvic outlet obstruction) is often challenging because the underlying disorders are diverse with a wide range of and clinical symptoms. The underlying anatomical and pathophysiological changes in patients with obstructed defecation are complex and often poorly understood. As a consequence, many medical, surgical, and behavioral approaches have been described, with no single panacea. For successful outcomes, preoperative physiologic testing is mandatory to differentiate between obstructed defecation caused by pelvic outlet obstruction and slow transit constipation. Obstructed defecatory disorders can distress patients both socially and psychologically and greatly impair their quality of life. For the great majority of patients, dietary adjustment with an increased fiber and liquid supplement can resolve the symptoms. The surgical approach depends upon the etiology, severity of symptoms, and operative risks. In a small group of patients with a rectocele or a third degree sigmoidocele, surgical intervention yields a high success rate. Division or resection of the puborectalis muscle is not recommended. In patients with a mixed pattern of slow transit colon and pelvic outlet obstruction, surgical intervention alone is often not successful; these patients can experience better outcomes by conservative treatment of pelvic outlet obstruction, followed by a colectomy. Stapled transanal rectal resection has recently become a recommended surgical procedure for obstructed defecation syndrome. One problem when using a transanal stapling device for rectal surgery is the potential damage to the structures located in front of the anterior rectal wall. The laparoscopic approach can shorten the hospital stay with good outcomes and is well tolerated in elderly patients with rectal prolapse. Despite the progress in modern surgery, the choice of the surgical procedure of pelvic outlet obstruction is still controversial. Preoperative counseling of all patients undergoing surgery is of extreme importance, in particular to explain the evolving nature of pelvic floor dysfunction and the possible need for further reconstructive surgery. To identify patients who will benefit from surgery for obstructed defecation, a careful selection of candidate patients remains the crucial issue in the diagnostic assessment. Surgical intervention should be limited only to the patients with identifiable, surgically correctable causes of outlet obstruction. This review gives an overview of surgical treatment options in patients with obstructed defecation.
Aged ; Colectomy ; Colon ; Constipation ; Counseling ; Defecation* ; Humans ; Length of Stay ; Pelvic Floor ; Quality of Life ; Rectal Prolapse ; Rectocele

No abstract available.
Fistula* ; Humans ; Infant*

No abstract available.
Canada* ; Gastrointestinal Tract*

The rectum is a unique visceral organ, of which afferents are not so obvious. In anorectal surgery ablating the rectum and/or perirectal structure, this issue comes with significant meaning about whether to preserve patient's normal defecatory function, or not. So we planned this study to evaluate which nervous system concerns the afferents from the rectum. METHODS: We recorded cerebral evoked potential (EPs) in 16 healthy male subjects after electrical and mechanical stimulation of the rectum, and compared their waving patterns regarding latencies and amplitudes of each peak with those occuring after electrical stimulation of the pudendal nerve. RESULTS: The EPs after electrical stimulation of the rectum showed distinctly different waving patterns in comparison to those after electrical stimulation of the pudendal nerve. But the EPs after mechanical stimulation of the rectum showed very similar waving patterns with those after electrical stimulation of the pudendal nerve. CONCLUSIONS: Rectal afferents of mechanical stimulation seem to be somatosensory, but those of electrical stimulation seem visceral. In that sense, sensory receptors of mechanical stimulation may lie in the perirectal structure, such as pelvic floor muscle and those of electrical stimulation lie in the rectum, itself.
Electric Stimulation ; Evoked Potentials* ; Humans ; Male ; Nervous System ; Pelvic Floor ; Pudendal Nerve ; Rectum ; Sensory Receptor Cells

PURPOSE: The causes of encopresis are complex and multifactorial. Through application of new sophisticated techniques and armamentarium, it has been possible to find more specific aspects of the anorectal function in pediatric patients with refractory defecation disorders. However, quality research of which therapeutic option could be suitable, is still lacking. The current study was designed to assess outcome of treatment according to the treatment algorithm based on the clinical and physiologic findings. METHODS: 22 patients (15 boys, 7 girls) with encopresis were analyzed, retrospectively. For exclusion of the organic cause, barium contrast study and anoscopy were carried out in all cases. Patients were categorized and made treatment algorithm by using leading symptoms and findings of anorectal physiologic tests. Treatment outcomes were analysed in the basis of respective therapeutic options. RESULTS: Patients were categorized as constipation dominant group (n=15) and incontinence dominant group (n=7). Suggested etipathogeneses were as follows; fecal impaction and/or motility disorder (n=7), overflow incontinence (n=6), sensory defect of the rectum (n=4), puborectalis incoordination (n=3), anal hypertonia (n=2). Treatment options were as follows; conventional therapy (CT) only (n=7), CT plus biofeedback (n=9), CT plus balloon sensory retraining (n=4), and CT plus internal sphincterotomy or Nitroglycerine application (n=2). All patients were undertaken a toilet training and psychologic consultation. Regarding to the therapeutic outcome, 19 (86 percent) of overall 22 patients were improved in the mean period of 2.5 (range, 0.1-7) years follow-up. CONCLUSIONS: If therapy could be undertaken according to the optional algorithm based on the clinical and physiologic findings, it could be useful guide for clinical decision making to help the therapy. Moreover, through the combination therapy including medication, psychological consultation, and biofeedback treatment, encopretic children achieve acceptable outcome with a long-term compliance.
Ataxia ; Barium ; Biofeedback, Psychology ; Child ; Compliance ; Constipation ; Decision Making ; Defecation ; Encopresis* ; Fecal Impaction ; Follow-Up Studies ; Humans ; Nitroglycerin ; Rectum ; Retrospective Studies ; Toilet Training ; Treatment Outcome*

BACKGROUND/AIMS: Gradient of resting pressure across the anal canal, which is known to have a role in continence mechanism, has 2 components of determination; pressure and length factor of the anal canal. This study evaluates which factor between them plays more significant role for the determination of the gradient in association with continence function. METHODS: Anal manometric measurements of 69 patients with fecal incontinence and 60 controls were retrospectively reviewed. In addition to resting pressure gradient, typical manometric parameters such as maximum resting pressure, basal resting pressure, length of the anal canal, length of high pressure zone and relative position of highest pressure, which were measured with rapid pull-through technique were all contrasted. RESULTS: Demographics of the 2 groups were similar. Maximum resting pressures of patients with incontinence and controls were 59.1 +/- 28.3, 74.6 +/- 24.0 mmHg (P = 0.001), respectively. Basal resting pressures were 5.7 +/- 6.4 and 7.3 +/- 3.9 mmHg (P = 0.097), lengths of the anal canal were 35.8 +/- 9.1 and 38.1 +/- 8.3 mm (P = 0.133), lengths of high pressure zone were 21.2 +/- 6.7 and 23.3 +/- 6.5 mm (P = 0.091), relative positions of highest pressure were 69.2 +/- 10.6 and 70.1% +/- 14.9% (P = 0.717) and resting pressure gradients were 2.28 +/- 1.08 and 2.74 +/- 1.14 mmHg/mm (P = 0.019), respectively. Difference was significant in maximum resting pressure and resting pressure gradient, but not in length factors such as full length of the anal canal, length of high pressure zone and relative position of highest pressure. CONCLUSIONS: Proximal location of high pressure zone in incontinent patients is not definite and resting pressure gradient of the anal canal depends more on pressure factor than length factor in association with continence function.
Anal Canal ; Demography ; Fecal Incontinence ; Humans ; Manometry ; Retrospective Studies

Hydrogen peroxide solution is commonly used for irrigating and cleaning wounds. When it is applied to tissues, catalase causes its rapid molecular degeneration with the release of oxygen bubbles. We present case report illustrating two hazards ; chemical colitis and oxygen embolus. A 29-year-old previously healthy woman presented to the bloody diarrhea and anal pain after hydrogen peroxide enema. In the colonoscopic examination, severe mucosal edema and ulceration with bleeding was noted from anus to sigmoid colon. With use of anal endosonography, multiple high level echo were noted in the internal and external anal sphincter of the upper anal canal. Microscopically, mononuclear cells were infiltrated in lamina propria and congestion. She had treatment with IV fluid, IV antibiotics and NPO. At 3rd hospital day, anal pain was disappeared. Bloody stool was disappeared next day. At 8th hospital day, mucosal edema and ulceration were disappeared on colonoscopic examination. Recovery was full and the patient was discharged at nine days after the episode.
Adult ; Anal Canal ; Anti-Bacterial Agents ; Catalase ; Colitis* ; Colon, Sigmoid ; Diarrhea ; Edema ; Embolism ; Endosonography ; Enema* ; Estrogens, Conjugated (USP) ; Female ; Hemorrhage ; Humans ; Hydrogen Peroxide* ; Hydrogen* ; Mucous Membrane ; Oxygen ; Ulcer ; Wounds and Injuries