An Unusual Cause of Rectal Pressure and Difficult Defecation: Giant Pelvic Myelolipoma

Anal manometry measures circumferential pressures but not axial forces that are responsible for defecation and contribute to fecal continence. Our aims were to investigate these mechanisms by measuring axial rectoanal forces with an intrarectal sphere or a latex balloon fixed at 8, 6, or 4 cm from the anal verge and connected to axial force and displacement transducers. Rectoanal forces and rectal pressures within a latex balloon were measured at baseline (i.e., at rest) and during maneuvers (i.e., squeeze, simulated evacuation, and a Valsalva maneuver) in 12 asymptomatic women and 12 women with symptoms of difficult defecation. Anal resting and squeeze pressures were also assessed by manometry and were similar in control patients and experimental patients. At rest, axial rectoanal forces were directed inward and increased as the device approached the anal verge. Control patients augmented this inward force when they squeezed and exerted an outward force during simulated expulsion and a Valsalva maneuver. The force change during maneuvers was also affected by device location and was highest at 4 cm from the verge. In experimental patients, the force at rest and the change in force during all maneuvers was lower than in control patients. The rectal pressure during a Valsalva maneuver was also lower in experimental patients than in control patients, suggestive of impaired propulsion. In conclusion, a subset of women with defecatory symptoms had weaker axial forces not only during expulsion but also during a Valsalva maneuver and when they squeezed (i.e., contracted) their pelvic floor muscles, suggestive of generalized pelvic floor weakness.

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Rectal metastasis from bladder urothelial carcinoma: a case report

Surgical Case Reports ◽

10.1186/s40792-021-01186-8 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Yuki Ii ◽

Shinya Munakata ◽

Kumpei Honjo ◽

Masaya Kawai ◽

Shingo Kawano ◽

...

Keyword(s):

Urothelial Carcinoma ◽

Tumor Resection ◽

Disease Recurrence ◽

Small Areas ◽

Metastatic Urothelial Carcinoma ◽

Rare Site ◽

Difficult Defecation ◽

Carcinoma Of The Bladder ◽

Transitional Cells ◽

Rectal Metastasis

Abstract Background Urothelial carcinoma arises from transitional cells in the urothelial tract. In advanced cases, it can metastasize locally to surrounding organs or distally to organs such as the lungs, bones, or liver. Here we describe a case of rectal metastasis from urothelial carcinoma treated with multiple sessions of transurethral resection of bladder tumor (TURBT). Case presentation A 72-year-old woman presented to our department with abdominal bloating andobstructed defecation. She had undergone two sessions of TURBT for early urothelial carcinoma in another hospital at 64 and 65 months ago, respectively. Cystoscopy at 3 months after the second TURBT session had indicated disease recurrence, and thus, she had been referred to our hospital for further examination, followed by TURBT for the third time at 59 months ago and for the fourth time at 48 months ago; thereafter, she had been followed up with cystoscopy every 6 months without any recurrence. However, she returned to our hospital, complaining of difficult defecation. Subsequent colonoscopy demonstrated an obstructive tumor in the rectum, which was pathologically diagnosed as metastatic urothelial carcinoma of the bladder. Laparoscopic examination revealed two small areas of peritoneal dissemination in the pelvis. A sigmoid colostomy was performed without rectal tumor resection. She has been receiving chemotherapy and is still alive 10 months after surgery. Conclusions Rectal metastasis is a rare site of metastasis for urothelial carcinomas. It is important to consider the possibility of annular rectal constriction caused by infiltrating or metastasizing urothelial carcinoma when managing patients with urothelial carcinoma and with difficult defecation.

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IS RECTAL PRESSURE A TRUE MEASUREMENT OF ABDOMINAL PRESSURE?

Southern Medical Journal ◽

10.1097/00007611-199408792-00027 ◽

1994 ◽

Vol 87 (Supplement) ◽

pp. S123-S127

Author(s):

Mostafa Sakr ◽

Mohamad S. Shoukry ◽

Gamal M. Ghoniem

Keyword(s):

Abdominal Pressure ◽

Rectal Pressure

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Chronic Abdominal Pain and Difficult Defecation

Gastroenterology ◽

10.1053/j.gastro.2019.03.055 ◽

2019 ◽

Vol 157 (2) ◽

pp. 306-308

Author(s):

Xing Huang ◽

Zhigang Xiao ◽

Zhongcheng Huang

Keyword(s):

Abdominal Pain ◽

Chronic Abdominal Pain ◽

Difficult Defecation

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Laxative Effects of Yangyin Tongmi Capsule on a Model of Diphenoxylate-Induced Constipation in Mice

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2020/1471824 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Shan Liu ◽

Dayun Sui ◽

Wenwen Fu ◽

Xiaofeng Yu ◽

Yuangeng Li ◽

...

Keyword(s):

Low Dose ◽

High Dose ◽

Water Control ◽

Intestinal Hormones ◽

Expression Levels ◽

Laxative Effects ◽

Bowel Movements ◽

Difficult Defecation ◽

Underlying Mechanisms ◽

Related Proteins

Constipation is characterized by reduced number of bowel movements, dry stools, and difficult defecation. Yangyin Tongmi capsule (YTC), a traditional Chinese formula, is used in the treatment of constipation, while the underlying mechanisms remain unknown. Herein, this work attempted to prove the effects of YTC on constipation treatment and its possible mechanisms. KM mice were randomly divided into four groups (n = 10/group) and treated with double distilled water (Control), diphenoxylate (Model: 10 mg/kg), or diphenoxylate plus low-dose YTC (L-YTC: 0.6 g/kg) or high-dose YTC (H-YTC: 1.2 g/kg). The data indicated that YTC can significantly shorten the discharge time of the first black stool, improve intestinal propulsion rate, and increase the water content and quantity of feces in mice. ELISA suggested that YTC regulate the content of intestinal hormones and neurotransmitters, such as motilin (MTL), gastrin (GT), somatostatin (SST), substance P (SP), acetylcholine (Ach), and nitric oxide (NO). The expression levels of aquaporin 3 (AQP3) and aquaporin 8 (AQP8) in the colon were examined by immunohistochemistry. In the meantime, the expression levels of P2X2, C-kit, and stem cell factor (SCF) in the colon were examined by western blot analysis. The results of this study suggest that YTC has mitigative effects on diphenoxylate-induced constipation by regulating the content of intestinal hormones and neurotransmitters and regulating the expression of related proteins in the colon.

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Novel insights into fecal incontinence in men

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.00362.2016 ◽

2017 ◽

Vol 312 (1) ◽

pp. G46-G51 ◽

Cited By ~ 4

Author(s):

Yoav Mazor ◽

Michael Jones ◽

Alison Andrews ◽

John E. Kellow ◽

Allison Malcolm

Keyword(s):

Sex Differences ◽

Fecal Incontinence ◽

Clinical Features ◽

Successful Outcome ◽

Biofeedback Therapy ◽

Tertiary Referral ◽

Future Studies ◽

Tertiary Referral Center ◽

Rectal Pressure

Fecal incontinence (FI) in men is common, yet data on sex differences in clinical features, physiology, and treatment are scarce. Our aim was to provide insights into FI in males compared with females. Prospectively collected data from 73 men and 596 women with FI in a tertiary referral center were analyzed. Anorectal physiology, clinical characteristics, and outcome of instrumented biofeedback (BF) were recorded. Thirty-one men with FI proceeded to BF and were matched with 62 age-matched women with FI who underwent BF. Men with FI had higher resting, squeeze, and cough anal sphincter pressures ( P < 0.001) and were more able to hold a sustained squeeze compared with women ( P = 0.04). Men with FI had higher rectal pressure and less inadequate rectal pressure on strain and higher sensory thresholds ( P < 0.05). Men, but not women, with isolated soiling had higher anal resting and squeeze pressures compared with those with overt FI ( P < 0.05). Men were less likely to undergo BF when offered compared with women. Baseline symptom severity did not differ between the groups. In men, the absence of an organic cause for the FI and the presence of overt FI, but not isolated soiling, were correlated with improvement in patient satisfaction following BF. The outcomes of 50% reduction in FI episodes, physician assessment, symptoms, and quality of life scores after BF all significantly improved in men similarly to women. We conclude that men, compared with women, with FI have unique clinical features and physiology and are less likely to have investigations and treatment despite successful outcome with BF. Future studies to customize treatment in males and determine barriers to therapy are warranted. NEW & NOTEWORTHY Fecal incontinence in men is common, yet data on sex differences in clinical features, physiology, and treatment are scarce. We provide evidence that men, compared with women, with fecal incontinence have unique clinical features and physiology and are less likely to have investigations and treatment despite successful outcome with anorectal biofeedback therapy.

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