Objective To investigate the clinical symptoms experienced by patients with thoracic spinal tumors and verify the associated symptoms that are predictive of a decline in muscle strength in the lower limbs. Methods A single-center, retrospective cross-sectional study was conducted on in-patients diagnosed with epidural thoracic spinal tumors between January 2011 and May 2021. The study involved a review of electronic medical records and radiographs and the collection of clinical data. The differences in clinical manifestations between patients with constipation and those without constipation were analyzed. Binary logistic regression analyses were performed to identify risk factors associated with a decline in muscle strength in the lower limbs.Results A total of 227 patients were enrolled, including 131 patients with constipation and 96 without constipation. The constipation group had a significantly higher proportion of patients who experienced difficulty walking or paralysis compared to those without constipation prior to surgery (83.2% vs. 17.7%, χ² = 99.035,P < 0.001). Constipation (OR = 9.522, 95%CI: 4.150-21.849, P < 0.001) and urinary retention (OR = 14.490, 95%CI: 4.543-46.213, P < 0.001) were independent risk factors for muscle strength decline in the lower limbs. Conclusions The study observed that patients with thoracic spinal tumors who experienced constipation symptoms had a higher incidence of lower limb weakness. Moreover, the analysis revealed that constipation and urinary retention were independent risk factors associated with a preoperative decline in muscle strength of lower limbs.
Humans ; Constipation/etiology* ; Cross-Sectional Studies ; Lower Extremity ; Muscle Strength ; Retrospective Studies ; Spinal Neoplasms ; Urinary Retention

In recent years, professional societies in China including the Chinese Medical Doctor Association Anorectal Branch have issued many clinical practice guidelines and expert consensus on constipation, which played a positive role in the standardization of diagnosis and surgical treatment of chronic constipation in China. However, the diagnosis and treatment of outlet obstructive constipation (OOC) remain controversial. OOC, the most common subtype of functional constipation, is featured by various clinical symptoms, complex pelvic floor anatomy, functional and psychological aspects. We need a gold standard supported by high-level clinical research evidence. To standardize the diagnosis and treatment process of OOC in China, Chinese Medical Doctor Association Anorectal Branch and its Clinical Guidelines Committee, and jointly sponsored by Professional Committee on Anorectal Diseases of Chinese Society of Integrated Traditional Chinese and Western Medicine, Anorectal Disease Committee of Chinese Medical Women's Association and Chinese Constipation Medical Association, and the Chinese Journal of Gastrointestinal Surgery organized and summoned a Chinese expert taskforce to focus on OOC diagnosis, classification, examination, evaluation, and various treatments (e.g. diet modification, medication, biofeedback therapy, pelvic floor function training, psychological intervention, traditional Chinese medicine and surgical treatment). Based on the latest relevant evidence in China and abroad and experts' clinical experience, the taskforce produced the " Chinese expert consensus on the diagnosis and treatment of outlet obstructive constipation (2022 edition)" after rounds of discussion and revision. The aim is to help anorectal surgeons make clinical decisions, standardize the process of diagnosis and treatment, reduce complications and improve clinical efficacy in OOC.
Humans ; Female ; Consensus ; East Asian People ; Constipation/etiology* ; Rectal Diseases/complications* ; Pelvic Floor

Constipation is a clinical symptom. It can be caused by environment, habit, disease and drugs. Chronic constipation is a disease that can occur at any age and its prevalence increases with age. Transanal administration is a common method to treat all kinds of constipation, especially to relieve stool blockage. However, the method and dose of transanal administration vary by age, drug and preparation types of drugs, and the effect of defecation is also quite different. At present, there is no expert consensus to follow in China or abroad. This consensus was convened by Anorectal Branch of Chinese Medical Doctor Association, Colorectal Surgery Group of Branch of Surgery of Chinese Medical Association and Chinese Journal of Gastrointestinal Surgery, to incorporate the latest evidence in China and abroad. This consensus addressed common transanal preparations, principles of administration, and efficacy for constipation. The evidence quality was assessed and the recommendation intensity was graded according to the GRADE system. The consensus aims to help standardize drug selection in practice and guide clinical application.
Humans ; Consensus ; East Asian People ; Constipation/etiology* ; Feces ; Digestive System Surgical Procedures/adverse effects*

The causes of constipation are extremely complex and are still not fully clear. In addition to secondary factors such as organic diseases and drugs, constipation may also be related to genetics, diet, intestinal flora, age, gender and so on. At present, according to the etiology, chronic constipation is divided into primary constipation and secondary constipation. However, there are significant differences among current clinical guidelines in the clinical classification of primary constipation. Some guidelines classify primary constipation as slow-transit constipation (STC), outlet obstruction constipation (OOC), and mixed constipation; however, some guidelines classify primary constipation as STC, defecation disorder (DD), mixed constipation, and normal-transit constipation (NTC); what's more, some even propose types which are different from the above sub-types. There are also differences in the understanding of the relationship between functional constipation (FC) and primary constipation and the classification of irritable bowel syndrome predominant constipation (IBS-C) among various clinical guidelines. By reviewing domestic and international guidelines and relevant literature on constipation, the following conclusions are drawn: primary constipation can be divided into IBS-C and FC, and FC can be further divided into STC, OOC, and mixed constipation; primary constipation should not be confused with FC, nor should IBS-C be classified as FC.
Humans ; Irritable Bowel Syndrome/complications* ; Constipation/etiology* ; Gastrointestinal Transit

OBJECTIVE: To verify the clinical effect of acupoint embedding therapy on post-stroke constipation. METHODS: The multi-central randomized controlled trial was adopted. 210 patients of post-stroke constipation were divided into an acupoint embedding group (105 cases, 4 cases dropped off) and a sham-embedding group (105 cases, 6 cases dropped off). In the acupoint embedding group, the acupoint embedding therapy was used at Tianshu (ST 25), Daheng (SP 15), Xiawan (CV 10), Zhongwan (CV 12), Qihai (CV 6), Guanyuan (CV 4) and Daju (ST 27). In the sham-embedding group, the sham-embedding therapy was given, in which, the acupoint selection, needle devices and manipulation were the same as the acupoint embedding group. But, no absorbable surgical suture was used in the needle tube. The treatment was given once every two weeks and 4 treatments were required in either group. It was to compare the weekly average complete spontaneous bowel movements (CSBMs) during treatment (from the 3rd to the 8th week) between the two groups, the weekly average spontaneous bowel movements (SBMs), Bristol stool form score (BSFS), the score of the patient assessment of constipation quality of life questionnaire (PAC-QOL) and the score of defecation difficulty before and after treatment. RESULTS: The percentage of the cases with weekly average CSBMs ≥ 3 times in the patients of the acupoint embedding group was higher markedly than the sham-embedding group [91.1% (92/101) vs 43.4% (43/99), <0.01]. Compared with the values before treatment, the weekly average SBMs and BSFS scores after treatment were all increased obviously in the two groups (<0.01), and PAC-QOL score and the score of defecation difficulty were reduced remarkably (<0.01). After treatment, the increase range of SBMs and BSFS scores, as well as the decrease range of PAC-QOL score and the defecation difficulty score in the acupoint embedding group were all higher than the sham-embedding group respectively (<0.05). CONCLUSION The acupoint embedding therapy remarkably increases the spontaneous bowel movements, improves in feces form and defecation difficulty and strengthens the quality of life in the patients of post-stroke constipation.
Acupuncture Points ; Acupuncture Therapy ; Constipation ; etiology ; therapy ; Humans ; Quality of Life ; Stroke ; complications ; Treatment Outcome

OBJECTIVETo observe the multiple symptom distribution, severity and quality of life of female pelvic floor dysfunction(FPFD) patients with constipation as chief complaint.

METHODSOne hundred FPFD patients with constipation as chief complaint from Speciaty Outpatient Clinic, Pelvic Floor Center of Nanjing Municipal Hospital of Traditional Chinese Medicine between September 2015 and February 2017 were retrospectively enrolled in this study. A comprehensive medical history questionnaire survey and systematical evaluation of severity and quality of life of these patients with constipation was conducted. Constipation scoring system scale (CSS) and patient-assessment of constipation quality of life questionnaire (PAC-QOL) were applied to evaluate the constipation. Other scales included: (1)pain visual analogue scale (VAS) and short form-36 questionnaire (SF-36): if combined with chronic functional anal rectal pain; (2) international consultation on incontinence questionnaire-short form (ICIQ-SF) and urinary incontinence quality of life questionnaires (I-QOL):if combined with urinary incontinence; (3) fecal incontinence severity score scale (Wexner-FIS) and fecal incontinence quality of life questionnaire (FI-QOL):if combined with fecal incontinence.

RESULTSThe mean age of 100 FPFD patients was (57.9±13.9) (24-89) years and the mean disease course was (7.0±8.2)(0.5-40.0) years. Seventy-five cases (75%) were complicated with anal pain, 70 with urinary incontinence, 37 with rectocele, 19 with nocturia, 11 with urinary frequency, 10 with defecation incontinence. Complication with only one symptom was observed in 20 cases (20%), and with two or more symptoms was observed in 80 cases (80%). Pelvic floor relaxation syndrome patients were dominant (58 cases, 58%). The severity of constipation (CSS) was 6-22 (13.89±3.79) points and the quality of life (PAC-QOL) was 45-133 (87.13±18.57) points in FPFD patients. VAS and SF-36 of patients combined with chronic functional anal rectal pain were 1-8 (3.0±1.9) points and 14.4-137.0(71.5±31.4) points respectively. ICIQ-SF and I-QOL of patients combined with urinary incontinence were 1-17 (6.1±3.6) points and 52-110 (90.0±15.8) points respectively. Wexner-FIS and FI-QOL of patients combined with fecal incontinence were 1-11 (4.4±3.0) points and 52-116 (83.4±23.3) points respectively.

CONCLUSIONSThe symptoms of FPFD patients with constipation as chief complaint are complex. They are mainly complicated with anal diseases, then urinary incontinence, and mostly with more than 2 symptoms. Their quality of life is poor.

Adult ; Aged ; Aged, 80 and over ; Constipation ; etiology ; Fecal Incontinence ; etiology ; Female ; Humans ; Middle Aged ; Pelvic Floor ; Pelvic Floor Disorders ; complications ; diagnosis ; Quality of Life ; Retrospective Studies ; Surveys and Questionnaires ; Young Adult

OBJECTIVETo investigate the clinical efficacy and safety of modified stapled transanal rectal resection (STARR) combined with perioperative pelvic floor biofeedback therapy (POPFBFT) in treating obstructed defecation syndrome (ODS).

METHODSThirty female ODS patients underwent modified STARR (resection and suture was performed in rectocele with one staple) combined with POPFBFT in Department of Colorectal and Anal Surgery, The First Hospital of Jilin university from October 2013 to March 2015. Before the modified STARR, patients received a course of POPFBFT (20 min/time, 2 times/d, 10 times as a course), and another 2 courses were carried out in clinic after discharge. Efficacy evaluation included general conditions of patients, morbidity of postoperative complication, overall subjective satisfaction (excellent: without any symptoms; good: 1 to 2 times of laxatives per month and without the need of any other auxiliary defecation; fairly good: more than 3 times of laxatives per month ; poor: with no improvement; excellent, good, fairly good are defined as effective), Longo ODS score (range 0 to 40 points, the higher the score, the more severe the symptoms), gastrointestinal quality of life index(GIQLI)(range 0 to 144 points, the lower the score, the more severe the symptoms), anorectal manometry and defecography examination. The follow-up lasted 12 months after operation (ended at April 2016).

RESULTSAverage age of 30 patients was 57(46 to 72) years and Longo ODS score of every patient was ≥9 before operation. The modified STARR was completed successfully in all the 30 patients with average operation time of 25 (18 to 34) min and average hospital stay of 6(4 to 9) d. Postoperative complications included pain(20%, 6/30), urinary retention (16.7%, 5/30), anorectal heaviness (6.7%, 2/30), and fecal urgency(26.7%, 8/30). Anaorectal heaviness and fecal urgency disappeared within 3 months. No severe complications, such as postoperative bleeding, infection, rectovaginal fistula, anastomotic dehiscence and anal incontinence were observed. The effective rate of overall subjective satisfaction was 93.3%(28/30) during the follow-up of 12 months. There was no significant difference in Longo ODS score between pre- POPFBFT and pre-operation (pre- POPFBFT: 32.95±3.22, pre-operation: 32.85±3.62, t=1.472, P=0.163). Compared with pre-POPFBFT, Longo ODS score at 1 week after operation decreased (t=4.306, P=0.000), moreover, score at 1 month after operation was lower than that at 1 week (13.05±7.49 vs. 15.00±7.17, t=7.322, P=0.000), while no significant differences were found among 1, 3, 6, 12 months after operation (F=2.111, P=0.107). Likewise, there was no significant difference in GIQLI score between pre-POPFBFT and pre-operation (pre-POPFBFT: 79.39±17.14, pre-operation: 76.65±17.56, t=1.735, P=0.096). Compared with the pre-POPFBFT, GIQLI score at 1 week after operation increased (t=4.714, P=0.000), moreover, GIQLI score at 1 month after operation was higher than that at 1 week (102.26±19.24 vs 91.31±21.35, t=5.628, P=0.000), while no significant differences were found among 1, 3, 6, 12 months after operation(F=1.211, P=0.313). In comparison with pre- POPFBFT, parameters of defecography examination at 12 months after operation showed obvious improvement: the rectocele decreased from (34.1±0.4) mm to (3.1±0.3) mm (t=6.847, P=0.000), anorectal angle during defecation increased from (123.8±6.7)degree to (134.7±8.5)degree, enlargement of anorectal angle during defecation increased from (29.1±3.5)degree to (37.1±5.3)degree, while no significant differences in descend of perineum, anorectal angles at rest as well as parameters of anorectal manometry were found (all P>0.05).

CONCLUSIONModified STARR combined with POPFBFT is safe and effective for ODS patients.

Aged ; Anal Canal ; surgery ; Biofeedback, Psychology ; physiology ; Constipation ; rehabilitation ; surgery ; Defecation ; Defecography ; Digestive System Surgical Procedures ; methods ; rehabilitation ; Female ; Humans ; Length of Stay ; Middle Aged ; Operative Time ; Pain, Postoperative ; etiology ; Pelvic Floor ; physiology ; Postoperative Complications ; Quality of Life ; Rectocele ; Surgical Stapling ; Suture Techniques ; Treatment Outcome ; Urinary Retention ; etiology

OBJECTIVETo compare the difference among the combined method of oral administration of forlaxand acupoint embedding therapy, the simple acupoint embedding therapy and the simple oral administration of for-lax in the clinical efficacy on diabetic constipation.

METHODSOne hundred and fifty patients were randomized intoa comprehensive group, an acupoint embedding group and a forlax group, 50 cases in each one. In the acupointembedding group, the embedding therapy was applied to bilateral Tianshu (ST 25), Daheng (SP 15), Shangjuxu(ST 37) and Dachangshu (BL 25), once a week. In the forlax group, forlax (polyethylene glycol) was prescribedfor oral administration, once a day, 10 g each time. In the comprehensive group, the acupoint embedding therapyand forlax were combined and the methods were the same as the first two groups. The treatment for 4 weeks wasas one session, and 2 sessions were required in the three groups. Separately, in 4 weeks, 8 weeks of treatment and2 months after treatment, the constipation symptom scores were compared among the three groups. At the end of2 sessions of treatment, the clinical efficacy and adverse reactions were compared among the three groups. In2 months after treatment, the recurrence rate was compared among the three groups.

RESULTSThe total effectiverate was 98. 0% (49/50) in the comprehensive group, better than 86. 0% (43/50) in the acupoint embeddinggroup and 78. 0% (11/50) in the forlax group (both P<0. 01). In the 4 weeks and 8 weeks of treatment, the con-stipation symptom scores were reduced significantly as compared with those before treatment in the three groups(all P<0. 05). The results in the comprehensive group were lower than those in the other two groups (all P<0. 05). In the 4 weeks of treatment, the scores were not different significantly between the acupoint embedding group and the forlax group (P>0.05). In 8 weeks of treatment and 2 months after treatment, the scores in the acupoint embedding group were better tan those in the forlax group (all p<0.05). There were 2 cases of drug adverse reaction in the comprehensive group, 6 cases in the forlax group and 0 case in the acupoint embedding group. The recurrence rate was 8.1% (4/49) in the comprehensive group, lower than 32.6% (14/43) in the acupoint embedding group and 59.0% (23/39) in the forlax group (both P<0.01).

CONCLUSIONthe combined therapy of acupoint embedding and forlax achieves the better clinical efficacy on diabetic constipation and constipation symptom scores as compared with the simple acupoint embedding therapy and the oral administration of forlax the short-term efficacy of the simple acupoint embedding therapy is not different significantly from the simple forlax medication, but the long-term efficacy and safety are better than those of simple forlax medicaiton.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Combined Modality Therapy ; Constipation ; drug therapy ; etiology ; physiopathology ; therapy ; Defecation ; Diabetes Complications ; complications ; physiopathology ; Female ; Humans ; Laxatives ; administration & dosage ; Male ; Middle Aged ; Polyethylene Glycols ; administration & dosage ; Treatment Outcome

The classical triad of abdominal pain, vomiting, and bloody stool is absent in chronic intussusception for more than 2 weeks. Here, we report a 6-year-old female with recurrent abdominal pain for 2 months. Ultrasonography of the abdomen revealed an ileocolic-type intussusception. The lesion accompanying the tight fibrous adhesion was treated by resection and ileocolic anastomosis. It was diagnosed as intussusception with diffuse large B-cell lymphoma. A high index of suspicion for abdominal pain in children should result in the correct diagnosis and appropriate management.
Abdominal Pain/*etiology/ultrasonography ; Child ; Constipation/*etiology ; Diagnosis, Differential ; Female ; Humans ; Intussusception/diagnosis/*etiology/surgery ; Lymphoma, Large B-Cell, Diffuse/*complications/*diagnosis ; Tomography, X-Ray Computed

BACKGROUNDAlthough repair augmented with mesh has been proved its priority in anatomical and functional recovery after anterior compartment reconstruction, the data about posterior compartment are scarce. The aim of this study was to compare bowel functional outcome of posterior vaginal compartment repair with and without mesh in patients with pelvic organ prolapse (POP).

METHODSThis was a prospective, double-blind, clinical pilot study of 22 postmenopausal women with symptomatic POP (overall POP-quantification [POP-Q] Stage III-IV) who underwent total pelvic floor reconstruction. Patients were grouped according to the use of mesh for posterior vaginal compartment repair: A mesh group and a nonmesh group. POP-Q stage, the pelvic floor impact questionnaire short form-7 (PFIQ-7) and anorectal manometry were evaluated before and 3 months after surgery. Anatomical success was defined as POP-Q Stage II or less. A t-test was used to compare preoperative with postoperative data in the two groups.

RESULTSTotally, 17 (71%) were available for the follow-up. POP-Q measurements improved significantly compared to baseline (P < 0.05) in both groups. No recurrence was observed. Subjects in both groups reported improvement in pelvic floor symptoms, and there was no significant difference in the PFIQ-7 score between groups at follow-up (P > 0.05). Compared with baseline, the nonmesh group exhibited a statistically significant decrease in anal residual pressure, a significant increase in the anorectal pressure difference during bowel movement, and a reduced rate of dyssynergia defecation pattern (P < 0.05).

CONCLUSIONSProvided there is sufficient support for the anterior wall and apex of vagina with mesh, posterior compartment repair without mesh may be as effective as repair with mesh for anatomical recovery while providing better anorectal motor function.

Aged ; Constipation ; diagnosis ; etiology ; Double-Blind Method ; Female ; Humans ; Manometry ; Middle Aged ; Pelvic Organ Prolapse ; surgery ; Surgical Mesh ; adverse effects