Simulated stool for assessment of anorectal physiology

Fecal continence is maintained by several mechanisms including anatomical factors, anorectal sensation, rectal compliance, stool consistency, anal muscle strength, mobility, and psychological factors. The homeostatic balance is easily disturbed, resulting in symptoms including fecal incontinence and constipation. Current technologies for assessment of anorectal function have limitations. Overlap exist between data obtained in different patient groups, and there is lack of correlation between measurements and symptoms. This review describes a novel technology named Fecobionics for assessment of anorectal physiology. Fecobionics is a simulated stool, capable of dynamic measurements of a variety of variables during defecation in a single examination. The data facilitate novel analysis of defecatory function as well as providing the foundation for modeling studies of anorectal behavior. The advanced analysis can enhance our physiological understanding of defecation and future interdisciplinary research for unraveling defecatory function, anorectal sensory-motor disorders, and symptoms. This is a step in the direction of improved diagnosis of anorectal diseases.

Evaluation of prognostic factors for return of urinary and defecatory function in cats with sacrocaudal luxation

Objectives The aim of this study was to evaluate outcomes and prognostic factors for cats with sacrocaudal luxation. Methods Medical records and radiographs were reviewed for cats with sacrocaudal luxation. Information obtained from the clinical records included signalment, clinical presentation, concurrent traumatic injuries, treatment details, outcome and survival time. Severity of neurological signs was graded from 1 to 5, based on previous grading systems for cats with sacrocaudal luxation. Degree of vertebral displacement was calculated on survey radiographs. Outcomes were collected from serial neurological examinations and telephone interviews. Cats had to be given a minimum of 30 days to regain urinary function to be included in the study. Results Seventy cats were included. Fifty-five of 61 cats (90%) regained voluntary urinary function. A higher neurological grade was associated with a decreased likelihood ( P = 0.01) and longer duration ( P = 0.0003) of regaining urinary function. No significant associations were found between urinary outcome and age, sex, anal tone, perineal sensation, tail base sensation, degree of craniocaudal or dorsoventral sacrocaudal displacement, concurrent orthopaedic injury, tail amputation, defecatory function at diagnosis and survival. Cats that regained defecatory function had longer survival times than those that did not recover defecatory function ( P = 0.03). Defecatory outcome was not significantly associated with any other variables. Conclusions and relevance In agreement with previous studies, neurological grade is the most important prognostic indicator for cats with sacrocaudal luxation. Determination of the severity of neurological signs can also aid in advising owners the time frame in which urinary function is expected to return. Faecal incontinence may be a more important prognostic factor than previously suspected.

Theoretical Tools to Analyze Anorectal Mechanophysiological Data Generated by the Fecobionics Device

A mechanical approach is needed for understanding anorectal function and defecation. Fecal continence is achieved by several interacting mechanisms including anatomical factors, anorectal sensation, rectal compliance, stool consistency, anal muscle strength, motility, and psychological factors. The balance is easily disturbed, resulting in symptoms such as fecal incontinence and constipation. Novel technologies have been developed in recent years for studying anorectal function. Especially, the Fecobionics device, a simulated feces, has gained attention recently. This facilitates new analysis of anorectal mechanical function. In this study, a theoretical model is developed to analyze anorectal mechanophysiological data generated by the Fecobionics device. Theoretical approaches can enhance future interdisciplinary research for unraveling defecatory function, sensory-motor disorders, and symptoms. This is a step in the direction of personalized treatment for gastrointestinal disorders based on optimized subtyping of anorectal disorders.

Comparison of defecatory function after laparoscopic total colectomy and ileorectal anastomosis versus a traditional open approach

Introduction Total colectomy and ileorectal anastomosis can result in significant defecatory frequency and poor bowel function. The aim of this study was to assess whether a laparoscopic approach is associated with any improvement in this regard. Methods A single institution retrospective review was undertaken of patients undergoing elective total colectomy and ileorectal anastomosis between 2000 and 2011. Those undergoing emergency surgery and paediatric surgery were excluded. The primary outcome measure was satisfactory defecatory function after surgery. Results Forty-nine patients (24 male, 25 female) were included in the study. The median age was 48 years (range: 20–83 years). Laparoscopic total colectomy (LTC) was performed in 20 patients and open total colectomy (OTC) in 29 patients. Indications for surgery were slow colonic transit (n=17), colorectal cancer (CRC) (n=17), CRC with hereditary colorectal cancer syndrome (n=8), inflammatory bowel disease (n=4) and diverticular disease (n=3). In the LTC group, 85% had a satisfactory defecatory frequency of 1–6 motions per day compared with 45% in the OTC cohort (p=0.006). There was no statistically significant difference in bowel frequency related to primary pathology (benign vs cancer surgery, p=1.0). Postoperative complications for both groups included relaparotomy (n=3), anastomotic leak (n=2), small bowel obstruction (n=2), postoperative bleeding (n=1) and pneumonia (n=1). Conclusions This study indicates that long-term defecatory function is better following LTC than following OTC and ileorectal anastomosis. The mechanism for this improvement is unclear but it may relate to the underlying reason for surgery or possibly to reduced small bowel handling leading to fewer adhesions after laparoscopic surgery.