scholarly journals Acute effects of therapeutic irradiation for prostatic carcinoma on anorectal function

Gut ◽  
1998 ◽  
Vol 43 (1) ◽  
pp. 123-127 ◽  
Author(s):  
E K Yeoh ◽  
A Russo ◽  
R Botten ◽  
R Fraser ◽  
D Roos ◽  
...  
Keyword(s):  
Anal Sphincter ◽  
Faecal Incontinence ◽  
Prostatic Carcinoma ◽  
Anorectal Function ◽  
Sensory Function ◽  
Abdominal Pressure ◽  
Rectal Compliance ◽  
Rectal Distension ◽  
Rectal Sensation ◽  
Faecal Urgency

Aim—The incidence of anorectal symptoms after radiotherapy (RTH) for localised pelvic malignant disease is unclear. In addition, the effects of pelvic irradiation on both anorectal motility and sensory function are poorly defined. A prospective study was therefore performed on 35 patients (55–82 years of age) with localised prostatic carcinoma before and four to six weeks after RTH to assess its effects on anorectal function.Methods—Anorectal symptoms were assessed by questionnaire. Anorectal pressures at rest and in response to voluntary squeeze, rectal distension, and increases in intra-abdominal pressure were evaluated with perfused sleeve side hole manometry. Rectal sensation was tested during graded balloon distension. Rectal compliance was calculated by the pressure-volume relation obtained during the testing of rectal sensation. Ultrasound was used to determine anal sphincter structure and integrity.Results—RTH had no effect on anal sphincter morphology. The frequency of defecation increased after RTH (7 (3–21) v 10 (3–56) bowel actions a week; p<0.01). After RTH, 16 patients had faecal urgency and eight faecal incontinence, compared with five and one respectively before RTH (p<0.01 for each). Basal and squeeze sleeve recorded pressures were reduced after RTH (54 (3)v 49 (3) mm Hg (p<0.05) and 111 (8)v 102 (8) mm Hg (p<0.01), before and after RTH respectively; means (SEM)). Rectal compliance was reduced after RTH (1.2 v 1.4 mm Hg/ml, p<0.05). After RTH, threshold volumes for perception of rectal distension were lower in the 16 patients who either experienced faecal urgency for the first time (13 patients) or reported worsening of this symptom (three patients) compared with the remaining patients (34 (4)v 48 (5) ml respectively, p<0.05).Conclusion—Faecal incontinence (23%) is a common problem four to six weeks after RTH for prostatic carcinoma and is associated with minor reductions in anal sphincter pressures. The high prevalence of faecal urgency in patients after RTH may be related to alterations in rectal perception of stool.

scholarly journals Evaluation of Anorectal Function in Perianal Crohn’s Disease: A Pilot Study

2021 ◽  
Vol 10 (24) ◽  
pp. 5909
Author(s):  
Andreia Albuquerque ◽  
John Casey ◽  
Grace Fairlamb ◽  
Lesley A. Houghton ◽  
Christian Selinger
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Anal Sphincter ◽  
Obstructed Defecation ◽  
Anorectal Function ◽  
Rectal Sensation ◽  
Perianal Crohn’S Disease ◽  
Balloon Expulsion ◽  
Balloon Expulsion Test ◽  
Perianal Crohn's Disease

Background: Perianal Crohn’s disease is a disabling condition, with little known about anorectal function in healed/inactive perianal Crohn’s disease; Aim: To evaluate anorectal function in a cohort of patients with treated/healed perianal Crohn’s disease; Methods: Prospective cohort study, including high-resolution anorectal manometry, balloon expulsion test, and 3D-endoanal ultrasound in all patients; Results: Of the 16 patients studied (mean age ± SD, 42 ± 13 years), 12 (75%) were men. A laceration of the internal anal sphincter and/or anal scarring was seen in nine (56%) patients; there was no laceration of the external anal sphincter. Five (56%) of these nine patients had never experienced faecal incontinence. All had normal anal resting and squeeze pressures. Manometry suggested dyssynergia in 11 (69%) patients, with only one (6%) fulfilling the criteria for obstructed defecation. Hyposensitivity for at least one sensory parameter was seen in 11 (69%) patients and hypersensitivity in five (31%) patients; Conclusions: This study detected sphincter abnormalities in more than half of patients, many of whom were asymptomatic. Alterations in rectal sensation were frequently seen, more commonly with rectal hyposensitivity. Trial registration: ClinicalTrials.gov (NCT03819257).

scholarly journals Ultrastructural changes in internal anal sphincter in neurogenic faecal incontinence.

Gut ◽  
1988 ◽  
Vol 29 (12) ◽  
pp. 1692-1698 ◽  
Author(s):  
M Swash ◽  
A Gray ◽  
D Z Lubowski ◽  
R J Nicholls
Keyword(s):  
Anal Sphincter ◽  
Faecal Incontinence ◽  
Internal Anal Sphincter ◽  
Ultrastructural Changes

scholarly journals Comparison of Anorectal Function Measured using Wearable Digital Manometry and a High Resolution Manometry System

2020 ◽  
Author(s):  
Ali Attari ◽  
William D. Chey ◽  
Jason R. Baker ◽  
James A. Ashton-Miller
Keyword(s):  
High Resolution ◽  
Fecal Incontinence ◽  
Anal Sphincter ◽  
Chronic Constipation ◽  
Anorectal Function ◽  
Puborectalis Muscle ◽  
Myoelectric Activity ◽  
Sphincter Pressure ◽  
High Resolution Manometry ◽  
Anal Sphincter Pressure

AbstractThere is a need for a lower cost manometry system for assessing anorectal function in primary and secondary care settings. We developed an index finger-based system (termed “digital manometry”) and tested it in healthy volunteers, patients with chronic constipation, and fecal incontinence. Anorectal pressures were measured in 16 participants with the digital manometry system and a 23-channel high-resolution anorectal manometry system. The results were compared using a Bland-Altman analysis at rest as well as during maximum squeeze and simulated defecation maneuvers. Myoelectric activity of the puborectalis muscle was also quantified simultaneously using the digital manometry system. The limits of agreement between the two methods were −7.1 ± 25.7 mmHg for anal sphincter resting pressure, 0.4 ± 23.0 mmHg for the anal sphincter pressure change during simulated defecation, −37.6 ± 50.9 mmHg for rectal pressure changes during simulated defecation, and −20.6 ± 172.6 mmHg for anal sphincter pressure during the maximum squeeze maneuver. The change in the puborectalis myoelectric activity was proportional to the anal sphincter pressure increment during a maximum squeeze maneuver (slope = 0.6, R2 = 0.4). Digital manometry provided a similar evaluation of anorectal pressures and puborectalis myoelectric activity at an order of magnitude less cost than high-resolution manometry, and with a similar level of patient comfort. Digital Manometry provides a simple, inexpensive, point of service means of assessing anorectal function in patients with chronic constipation and fecal incontinence.

scholarly journals Recommendations for the Protocol of functional examination of the anorectal zone and disorders classification: the International Anorectal Physiology Working Group consensus and Russian real-world practice

2020 ◽  
Vol 92 (12) ◽  
pp. 105-119
Author(s):  
O. Yu. Fomenko ◽  
S. V. Morozov ◽  
S. Mark Scott ◽  
H. Charles Knowles ◽  
D. A. Morozov ◽  
...  
Keyword(s):  
Real World ◽  
Working Group ◽  
Anorectal Function ◽  
Anorectal Physiology ◽  
Rectal Sensation ◽  
High Resolution Manometry ◽  
Additional Information ◽  
Wide Range ◽  
Balloon Expulsion ◽  
Function Testing

This manuscript summarizes consensus reached by the International Anorectal Physiology Working Group (IAPWG) for the performance, terminology used, and interpretation of anorectal function testing including anorectal manometry (focused on high-resolution manometry), the rectal sensory test, and the balloon expulsion test. Based on these measurements, a classification system for disorders of anorectal function is proposed. Aim to provide information about methods of diagnosis and new classification of functional anorectal disorders to a wide range of specialists general practitioners, therapists, gastroenterologists, coloproctologists all who face the manifestations of these diseases in everyday practice and determine the diagnostic and therapeutic algorithm. Current paper provides agreed statements of IAPWG Consensus and comments (in italics) of Russian experts on real-world practice, mainly on methodology of examination. These comments in no way intended to detract from the provisions agreed by the international group of experts. We hope that these comments will help to improve the quality of examination based on the systematization of local experience with the use of the methods discussed and the results obtained. Key recommendations: the International Anorectal Physiology Working Group protocol for the performance of anorectal function testing recommends a standardized sequence of maneuvers to test rectoanal reflexes, anal tone and contractility, rectoanal coordination, and rectal sensation. Major findings not seen in healthy controls defined by the classification are as follows: rectoanal areflexia, anal hypotension and hypocontractility, rectal hyposensitivity, and hypersensitivity. Minor and inconclusive findings that can be present in health and require additional information prior to diagnosis include anal hypertension and dyssynergia.

scholarly journals Microscopic colitis impacts quality of life in older people

2019 ◽  
Vol 12 (6) ◽  
pp. e228092 ◽  
Author(s):  
Olayinka Ayodele Ogundipe ◽  
Amy Campbell
Keyword(s):  
Quality Of Life ◽  
Faecal Incontinence ◽  
Institutional Care ◽  
Microscopic Colitis ◽  
Faecal Calprotectin ◽  
Treatment Considerations ◽  
Faecal Urgency ◽  
History Of ◽  
Rectal Biopsies

This report describes a frail 92-year-old woman with dementia who presented with a year’s history of chronic watery non-bloody diarrhoea. She had abdominal bloating, weight loss, faecal urgency, nocturnal stools and developed faecal incontinence. Her serum C reactive peptide and faecal calprotectin were elevated. Flexible sigmoidoscopy was macroscopically normal, but demonstrated histological features of microscopic colitis (MC) in sigmoid colon and rectal biopsies. Polypharmacy was reviewed for possible medication-induced MC. Ranitidine, donepezil and simvastatin were discontinued. She was started on oral budesonide with improvement in the abdominal and bowel symptoms. Stool frequency and consistency normalised, and the faecal incontinence resolved with treatment. The outcomes were an improved quality of life, reduced functional dependency, reduced carer strain and avoidance of premature transition from her home into a long-term/institutional care setting. We briefly review terminology, basic epidemiology, notable associations, the importance of establishing a diagnosis and some treatment considerations for MC.

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