Bowel Emptying Research Articles

Bowel function in adults who have sustained spinal cord injury in childhood.

The impact of neuropathic bowel dysfunction on bowel habits was studied in 35 adult spinal cord injury (SCI) patients, who had sustained their injury in childhood. The methods used in the study were clinical interview and examination, quantitative scoring of bowel function (BCS) and estimation of bowel transit time with radiopaque markers. Thirty five healthy subjects without previous anorectal disease or surgery and with similar age and sex distribution as the patients served as controls. Most of the SCI patients were content with their bowel function. Nine (26%) out of 35 of the SCI patients were completely satisfied with their bowel function and reported no limitations in social life. The majority (69%) of the patients considered their bowel function to be significantly altered, causing only mild problems in their social life. Two of the patients had major problems of bowel function, which caused severe limitations in their social life. The majority (77%) of the patients declared that they had a low frequency of bowel evacuation. Eight out of 35 patients were using laxatives to promote bowel emptying. The quantitative BCS of the patients was significantly lower than that of the controls (P < 0.001). Moreover, there was a significant difference between the scores of patients with complete high (C2-T6) and complete low (T7-S4-5) lesions. The difference between the BCS and overall satisfaction with bowel function can be explained by good habilitation to SCI and by the prolonged transit times which enables relatively rare and controlled bowel movements and firm consistency of stools.

PHYSIOLOGIC CONSEQUENCES OF VAGOTOMY AND GASTRIC RESECTION

Operations for peptic ulcer have evolved to minimize physiologic disturbance while ulcer recurrence is prevented. Nevertheless, all operations disturb gastrointestinal motility to some extent, and these changes correlate with postoperative side effects. In particular, the pattern of gastric emptying is altered, but small bowel emptying is largely preserved. Alterations in biliary motility increase the risk of gallstone formation after most, but not all, ulcer operations.

Electrical stimulation of the sacral dermatomes in spinal cord injury: Effect on rectal manometry and bowel emptying

The impairment in defecation function that comes as a result of spinal cord injury may have a significant negative impact upon quality of life. Electrical stimulation (ES) of the somatic nervous system has been used to elicit autonomic reflexes in animals, before and after spinal cord transection. To determine whether ES might be used to promote bowel emptying, seven persons with recent spinal cord injury (SCI) and seven control subjects were studied. Electrical stimulation of the second sacral dermatome was applied during rectal manometry in both groups, and ES was added to the bowel programs of SCI patients. A significant rise in the number of rectal pressure spikes was noted in both groups after application of ES (p < .002, f = 6.34). There was no significant differences between the SCI and control groups when measuring the amplitude of spike waves in the colon. No significant change was noted in the time required for SCI patients to initiate a bowel movement, or in the time required to complete bowel emptying. Electrical stimulation of the sacral dermatomes can result in a change in the bowel activity of the recto-sigmoid colon. To date, no clinical effect on bowel emptying has been demonstrated.

Primary constipation: An underlying mechanism

Primary (simple) constipation is a consequence of habitual bowel elimination on common toilet seats. A considerable proportion of the population with normal bowel movement frequency has difficulty emptying their bowels, the principal cause of which is the obstructive nature of the recto-anal angle and its association with the sitting posture normally used in defecation. The only natural defecation posture for a human being is squatting. The alingment of the recto-anal angle associated with squatting permits smooth bowel elimination. This prevents excessive straining with the potential for resultant damage to the recto-anal region and, possibly, to the colon and other organs. There is no evidence that habitual bowel elimination at a given time each day contributes considerably to the final act of rectal emptying. The natural behavior to empty the bowels in response to a strong defecation reflex alleviates bowel emptying by means of the recto anal inhibitory reflex.

Etiology and pathogenesis of diverticulosis coli: a new approach

The paper describes a hypothesis as to the etiology and pathogenesis of diverticulosis coli. Colonic diverticulosis develops as a result of excessive straining at defecation due to habitual bowel emptying in a sitting posture, which is typical of Western man. The magnitude of straining during habitual bowel emptying in a sitting posture is at least three-fold more than in a squatting posture and upon urge. The latter defecation posture is typical of latrine pit users in underdeveloped nations. The bowels of Western man are subjected to lifelong excessive pressures which result in protrusions of mucosa through the bowel wall at points of least resistance. This hypothesis is consistent with recent findings of elastosis of the bowel wall muscles, the distribution of diverticula along the colon, as well as with epidemiological data on the emergence of diverticulosis coli as a medical problem and its geographic prevalence.

Radiological appearances in the post-gastrectomy dumping syndrome.

The gastrointestinal motility of 35 patients after gastric operations for duodenal ulcer has been studied radiographically and compared with that of normal subjects. Opaque meals of non-flocculating barium sulphate microsuspension (Raybar) with and without added glucose were given and the effect of change of posture noted. Rapid gastric emptying and hypermotility of the small bowel can occur after the ingestion of a Raybar-glucose meal without the production of “dumping” symptoms. The hypermotility of the small bowel was not abolished by lying down, in which position “dumping” symptoms did not occur. A lack of definition of the small bowel was seen as often in patients without “dumping” attacks as in those affected. This poor definition was associated with hypermotility of the small bowel.

Multiple sclerosis

Multiple sclerosis

The action of ketocholanic acids upon lower bowel motility

A preparation of sodium ketocholanate was studied for its effect upon lower bowel emptying in rabbit and in man. Administered into the rectum in the form of solution in 5 or 10 ml. quantities, or as a suppository it produces regularly, after a short latent period, copious defecation. Suggestions for its use are described.