Defecation Process Research Articles

Bio-inspired circular soft actuators for simulating defecation process of human rectum.

Soft robots have found extensive applications in the medical field, particularly in rehabilitation exercises, assisted grasping, and artificial organs. Despite significant advancements in simulating various components of the digestive system, the rectum has been largely neglected due to societal stigma. This study seeks to address this gap by developing soft circular muscle actuators (CMAs) and rectum models to replicate the defecation process. Using soft materials, both the rectum and the actuators were fabricated to enable seamless integration and attachment. We designed, fabricated, and tested three types of CMAs and compared them to the simulated results. A pneumatic system was employed to control the actuators, and simulated stool was synthesized using sodium alginate and calcium chloride. Experimental results indicated that the third type of actuator exhibited superior performance in pressure generation, enabling the area contraction to reach a maximum value of 1. The successful simulation of the defecation process highlights the potential of these soft actuators in biomedical applications, providing a foundation for further research and development in the field of soft robotics.

Early safety and efficiency outcomes of a novel interdisciplinary laparoscopic resection rectopexy combined with sacrocolpopexy for women with obstructive defecation syndrome and pelvic organ prolapse: a single center study

BackgroundObstructive defecation syndrome (ODS) defines a disturbed defecation process frequently associated with pelvic organ prolapse (POP) in women that substantially compromises quality of life. Conservative management offers limited relief and a surgical intervention may be required. This is characterized by individual approaches.Aim of the studyThis retrospective single center study evaluated the surgical and clinical short-term outcome of a novel interdisciplinary laparoscopic resection rectopexy (L-RRP) with mesh- sacrocolpopexy (L-SCP) for women suffering from ODS and POP.MethodsThe study participants underwent surgery in an interdisciplinary laparoscopic approach. Safety was the primary endpoint, assessed via postoperative morbidity classified by Clavien-Dindo scale. Secondary outcomes included evaluation of bowel function, fecal and urinary incontinence and pelvic organ prolapse status at 12 months follow-up. Additionally, a biological mesh (BM) was offered to women, who asked for an alternative to synthetic mesh material (SM).ResultsOf the 44 consecutive patients requiring surgery for ODS and POP, 36 patients underwent the interdisciplinary surgical approach; 28 patients with SM and 8 patients with BM. In total 5 complications occurred, four of them were classified as minor. One minor complication was observed in the BM group. One anastomotic leakage occurred in the SM group. The two ODS scores, the bowel dysfunction score, and the incontinence score improved significantly (p = 0.006, p = 0.003, p < 0.001, and p = 0.0035, respectively). Pelvic floor anatomy was fully restored (POP-Q 0) for 29 (80%) patients after surgery. 17 patients (47%) suffered from urinary incontinence before surgery, which was restored in 13 patients (76.5%).ConclusionsThe interdisciplinary approach with L-RRP and L-SCP and the use of a BM in a small subgroup were technically feasible, safe, and effective in this single center setting. The study’s retrospective design, the small sample size and the lack of comparators limit the generalizability of the findings requiring future randomized trials.Trial registrationRetrospectively registered at clinicaltrials.gov, trial number NCT05910021, date of registration 06/10/2023.

The Relationship between Clean and Healthy Living Behavior and Risk of Diarrhea in Toddler

Background: Diarrhea is a process of defecation in which the stool is more liquid which can be accompanied by blood or mucus with the intensity of defecation increasing more than 3 times a day. The occurrence of diarrhea in children is often attributed to inadequate environmental hygiene. This study aimed to examined the relationship between clean and healthy behavior (PHBS) and diarrhea among toddlers in the working area of ​​the Kalijaga Permai Cirebon Community Health Center. Subjects and Method: This was a cross-sectional study conducted at ​​the Kalijaga Permai Cirebon Community Health Center from May to June 2023. A total of 119 mothers with toddlers (aged 0-59 months) was selected for this study. The dependent variable was diarrhea. The independent variable was clean and healthy behavior (PHBS). The data were collected using a questionnaire and analyzed using chi square. Results: Mothers with poor PHBS increased the risk of diarrhea in children by 4.69 times compared to good PHBS (OR= 4.69; 95% CI = 3.04 to 7.24; p&lt;0.001). Conclusion: Implementation of household clean and healthy behavior lower the risk of diarrhea.

Defecation alleviates hangover by terminating intestinal drinking.

The concept of "intestinal drinking" in this study refers to the continued absorption of alcohol in the gastrointestinal tract until adequate defecation occurs. A longitudinal observation of hangover symptoms and alcohol metabolites in healthy humans following binge drinking was conducted. The hangover symptoms resulting from binge alcohol consumption were relieved by defecation. Following the defecation process, not only the blood ethanol levels, but also the concentrations of blood acetaldehyde, methanol, and iso-propanol, exhibited significant reductions. This pilot study provides a different perspective for addressing hangovers and potentially mitigating the risks of alcoholic liver diseases.

Imaging of the pelvic floor (MR defecography) : The surgeon's perspective

Magnetic resonance defecography (MRD) plays acentral role in diagnosing pelvic floor functional disorders by visualizing the entire pelvic floor along with pelvic organs and providing functional assessment of the defecation process. Ashared understanding between radiology and surgery regarding indications and interpretation of findings is crucial for optimal utilization of MRD. This review aims to explain the indications for MRD from asurgical perspective and elucidate the significance of radiological findings for treatment. It intends to clarify for which symptoms MRD is appropriate and which criteria should be followed for standardized results. This is prerequisite to develop interdisciplinary therapeutic approaches. Acomprehensive literature search was conducted, including current consensus guidelines. MRD can provide relevant findings in the diagnosis of fecal incontinence and obstructed defecation syndrome, particularly in cases of pelvic floor descent, enterocele, intussusception, and pelvic floor dyssynergia. However, rectocele findings in MRD should be interpreted with caution in order to avoid overdiagnosis. MRD findings should never be considered in isolation but rather in conjunction with patient history, clinical examination, and symptomatology since morphology and functional complaints may not always correlate, and there is wide variance of normal values. Interdisciplinary interpretation of MRD results involving radiology, surgery, gynecology, and urology, preferably in the context of pelvic floor conferences, is recommended.

PENGARUH PIJAT BAYI TERHADAP KONSTIPASI PADA BAYI USIA 1 - 12 BULAN DI PMB A TAHUN 2023

Constipation is a symptom of difficult bowel movements which is characterized by the consistency of hard stools, large size and decreased frequency of bowel movements. Constipation can cause social and psychological problems. Treatment for constipation is to get used to defecating regularly by means of behavior modification, fiber diet, laxatives, and psychological approaches. Massage provides benefits for constipation by stimulating peristalsis and reducing colonic transit time so that it can increase the frequency of bowel movements. The research design uses a pre-experiment, using a static group comparison research design or a comparison with static groups. Results were analyzed using Univariate and Bivariate using the Chy Square test. Based on the results of my research, it can be seen that out of 15 cases of babies who underwent massage therapy, 2 babies (13.3%) had difficult bowel movements, while 13 babies (86.7%) had smooth bowel movements. According to the researcher's assumption, there is no gap between the results of this study and the theory. Baby massage therapy greatly affects the smooth process of defecation. By doing baby massage techniques can facilitate bowel movements.

Evaluation of Bowel Function on Patient Post Operative Hirschsprung Disease

Highlights:1. All HD patients have good defecation quality after surgery.2. Almost all HD patients can control bowel movements without constipation or social problems after surgery.3. The most common problem patients face after surgery is soiling, which sometimes requires diapers. AbstractIntroduction: Hirschsprung's disease (HD) is a congenital disease in which Meissner and Auerbach's plexus ganglion cells are lost on the distal side of the digestive tract, thus interfering with defecation. The postoperative defecation process was assessed to describe the patient's quality of life. This study aimed to describe the quality of defecation in pediatric HD patients after surgery. Methods: This was a descriptive study on pediatric PD patients who received surgery in Dr. Soetomo General Academic Hospital, Surabaya, from 2018 to 2021. Demographic data came from Dr. Soetomo General Academic Hospital, Surabaya. The incontinence evaluation was assessed using the Rintala Score.Results: A total of 14 pediatric HD patients underwent definitive surgery and had good scores on the Rintala score. There were 2 (14.3%) patients with maximum scores, 6 (42.9%) patients with normal scores, and 6 (42.9%) patients with good scores. The highest distribution in patients was always being able to hold bowel movements (81.8%), uncertain in reporting the desire to defecate (40.9%), 1-2 times a day (68.2%), never dirty (54.5%), never constipated (77.3%), and had no social problems (77.3%).Conclusion: Pediatric HD patients had a good outcome after a definitive operation. The most common demographics with high satisfaction rates were male and female patients with normal nutritional status, above one-year-old, normal birth weight, and term labor.

The Correlation of Post Definitive Surgery and Quality of Life on Patient with Hirschsprung’s Disease: A Literature Review

Hirschsprungs disease is a congenital malformation of parasympathetic ganglion in colon with the result of interfering defecation process. Since Hirschsprungs disease usually diagnoses in the early life of the patients, complain of defecation problem occurs on pediatrics patient. The management of Hirschsprungs disease is definitive surgery. Quality of life described the effectiveness of definitive surgery as the primary management of Hirschsprungs disease. The desired goal of this literature review was to described the pediatric patients quality of life post definitive surgery from previous similar study.

Design, Improvement and Evaluation of a Novel In Situ Implanted Bionic Artificial Anal Sphincter

Abstract Artificial anal sphincter has gradually become an emerging means of treating anal incontinence. However, most of the systems cannot be implanted in the human body for a long time due to insufficient reliability. Therefore, this paper has designed and improved a novel bionic artificial anal sphincter (BAAS). In order to make it work reliably for a long time, we first optimized and improved key parts to increase their strength. Given the humid working environment in the body, we optimized the design of the waterproof pressure sensor and carried out experimental research on the sealing of the circuit board and the overall sealing. When evaluating the improved system, I used simulation to analyze the structural strength and motion characteristics of the BAAS and used underwater experiments to simulate the human environment to evaluate the waterproofness of the system. The results showed that the strength of the key joint increased by 49.4%, the average clamping time and opening time of the prosthesis were 14.5 s and 13.4 s, respectively, and the angular velocity of the pendulum rod approaching the intestine was about 4.5 deg/s, which was in line with the normal defecation process of the human body. The performance is stable and reliable in the 20-day underwater body fluid simulation experiment. BAAS basically meets the application needs of long-term implantation in the treatment of fecal incontinence.

Current perspective and future research directions on defecation clarification for the manufacture of raw sugar

Juice clarification is integral to the sugar-manufacturing process and determines the quality of clarified juice which is subsequently processed to produce sugar. Clarification performance is defined largely by turbidity of the clarified juice, but the presence of soluble impurities, colour and colour precursors, polysaccharides and proteins influence heat-transfer performance of evaporators and evaporating crystallizers, the crystallisation performance in evaporating crystallizers and the achievable yield and quality of sugar. The conventional defecation process is inadequate to remove these nonsucrose impurities, and the gradual worldwide transition to green-cane harvesting is introducing greater levels of impurities into the cane supply. As a result, the clarification station is now having to deal with not only the endogenous impurities (e.g. stalk impurities) but also the trash (leaves and tops) impurities. This paper reviews work that has been conducted over the years to remove these impurities and presents future research directions that should improve clarification performance. Examples of future research directions include development of multi-functional nanoparticles to significantly improve impurity removal; processing strategies to enhance precipitation of proteins and polysaccharides; and ballasting and adsorbent agents.

Recognition of surgical anatomy for intersphincteric resection

Intersphincteric resection (ISR) involves the anatomy of hiatal ligament, internal and external sphincter and conjoined longitudinal muscle. The hiatal ligament is actually a branch of the longitudinal muscle of rectum, shown as an uneven ring attached to the levator ani muscle. The internal sphincter is the end of the circular muscle of rectum which begins at the level of hiatal ligament formation. The distance from the upper boundary of internal sphincter to dentate line is significantly different among individuals. Although there is adipose tissue in the space between the internal and external sphincters, no evidence of mesentery structure in the anal canal is found as in the rectum. The conjoined longitudinal muscle is the remaining branch of the longitudinal muscle, whose return passes through the external sphincter and ends at the anococcygeal ligament/coccyx after reaching the anal margin. The synergistic action of conjoined longitudinal muscle and the hiatal ligament participates in the defecation process. The individualized difference of ISR-related anatomy affects the operation, especially the anastomosis.

New developments in defecatory studies based on biomechatronics

IntroductionDefecation is a complex process that is difficult to study and analyze directly. In anorectal disease conditions, the defecation process may be disturbed, resulting in symptoms including fecal incontinence and constipation. Current state-of-the-art technology measures various aspects of anorectal function but detailed analysis is impossible because they are stand-alone tests rather than an integrated multi-dimensional test. ObjectivesThe need for physiologically-relevant and easy-to-use diagnostic tests for identifying underlying mechanisms is substantial. We aimed to advance the field with integrated technology for anorectal function assessment. MethodsWe developed a simulated stool named Fecobionics that integrates several tests to assess defecation pressures, dimensions, shape, orientation and bending during evacuation. A novelty is that pressures are measured in axial direction, i.e. in the direction of the trajectory. Using this novel tool, we present new analytical methods to calculate physiologically relevant parameters during expulsion in normal human subjects. ResultsData are reported from 28 human subjects with progressively more advanced versions of Fecobionics. A new concept utilizes the rear-front pressure (preload-afterload) diagram for computation of novel defecation indices. Fecobionics obtained physiological data that cannot be obtained with current state-of-the-art technologies. ConclusionFecobionics measures well known parameters such as expulsion time and pressures as well as new metrics including defecation indices. The study suggests that Fecobionics is effective in evaluation of key defecatory parameters and well positioned as an integrated technology for assessment of anorectal function and dysfunction.

PENGARUH PELVIC FLOOR MUSCLE TRAINING TERHADAP FUNGSI DEFEKASI PADA IBU POSTPARTUM SPONTAN.

Persalinan merupakan kejadian alamiah yang dialami oleh setiap ibu hamil. 60% ibu nifas memiliki gangguan defekasi. Faktor yang memengaruhi proses defekasi pada ibu nifas adalah kurang latihan fisik atau imobilisasi pada ibu. Salah satu aktivitas yang dianjurkan untuk dilakukan para ibu setelah melahirkan adalah senam nifas Pelvic Floor Muscle Treatment (PFMT) atau latihan yang dilakukan khusus untuk otot dasar panggul. Penelitian ini bertujuan untuk mengetahui pengaruh Pelvic Floor Muscle Training terhadap defekasi pertama pada ibu post partum spontan dalam pencegahan gangguan fungsi defekasi pada ibu . Metode penelitian menggunakan quasy experiment dengan one group post test design with control. Jumlah sampel keseluruhan adalah 36 orang. Tenik pengambilan sampel dilakukan secara consecutive sampling dengan permutasi random blok. Intrumen pengumpulan data yaitu Lembar observasional adalah melakukan pengamatan secara langsung ke objek penelitian untuk melihat dari dekat kegiatan yang dilakukan. Lembar observasi yang meliputi gerakan Senam Otot dasar panggul (Pelvic Floor Muscle Training ). Hasil Senam Pelvic Floor Muscle Training berpengaruh terhadap percepatan defekasi pertama pada ibu Postpartum dibandingkan dengan tidak melakukan senam. Tenaga kesehatan hendaknya berupaya memberikan penyuluhan dan konseling tentang pentingnya Pelvic Floor Muscle Training .

A simple novel concept to conservatively manage refractory spasm in acute fissure-in-ano: Defecation put on-hold temporarily (DePOT).

Dear Editor The article by Soltany et al. was very informative and highlighted that the botulinum injection was effective in about 85% patients.[1] However, few patients (about 15–20%) would not respond to the botulinum injection and their anal spasm would not be relieved. In these patients, the surgery would be required just to alleviate the pain.[23] It is important to consider that severe spasm and pain in acute fissure-in-ano is primarily aggravated by the act of defecation.[45] The patients suffering from fissures are usually constipated and the shearing force of the hard stools aggravates the spasm.[45] Moreover, the 'narrowed’ anal outlet due to spasm further increases the impact of this shearing force[Figure 1].Figure 1: Overview of the DePOT (defecation is put on-hold temporarily) conceptTherefore, if the defecation is put on-hold temporarily (DePOT) for a week, then it would not only provide immediate pain relief but would also lead to an earlier and faster resolution of the underlying disease (by removing the aggravating factor- defecation process). Thus, it would help to avoid surgery in many, if not all, such patients. It has to be ensured that while implementing DePOT, the daily requirements of protein, minerals, vitamins, water and fats are taken care of. This is done by liquid diet having zero fiber plus full nutrition [oral rehydration solution (ORS), vitamin supplementation and protein (whey) supplementation (50–60 grams/day)]. Once these nutritional needs of the patient are taken care of, then it is not difficult for the patient to sustain on the liquid diet for a week and even longer, as required. An enema is given on the first day to evacuate the rectum. Otherwise, there is risk of hardening of residual stools already present in the rectum, which could create difficulty on resumption of normal diet later. DePOT was also prescribed for seven days to four patients of acute fissure-in-ano with refractory spasm in whom conservative management was not working (26-year/male, 23-year/female, 34-year/female, 29-year/male). All patients except the third patient, had immediate pain relief and the acute spasm improved progressively over next 7–10 days. The third patient had to stop DePOT after 3 days as she developed an intersphincteric abscess and was operated for the same. The ethical approval was taken from Indus Hospital Ethical Committee via reference no. Indus hospital/EC/02-12. The DePOT regimen is very useful to primary care physicians. The patients suffering from refractory acute fissure-in-ano (not responding to the conservative management) usually require surgery and need to be referred to a surgeon.[23] But, with the DePOT regimen, such patients can be easily managed by primary care physicians. To summarize the key points, - The DePOT regimen puts defecation process on hold for a week by zero fiber, full nutrition, liquid diet - It is a simple, economical, safe and easily reproducible concept - DePOT is a new concept which provides immediate relief and helps prevent surgery in acute thrombosed hemorrhoids and acute fissure with refractory spasm (conditions which get aggravated by defecation and often require surgery). This simple logical concept is proposed so that prospective randomized controlled studies can corroborate the efficacy of this regimen. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Периоперационная ишемия neorectum’a. Экспериментальная модель

Objective. To experimentally determine and analyze the role of perioperative tissue tension in the intestinal area brought down to the proper topographic and anatomical position (neorectum) and its vascularization impairments during anorectoplasty. Materials and methods. This experiment performed on laboratory rats consisted of 3 parts: clinical (creation of an operation model and assessment of clinical parameters in the early postoperative period); morphological (histological examination of biopsy specimens taken from the surgical area); and laboratory (measurement of tissue hypoxia markers (including vascular endothelial growth factor-C (VEGF-C) and hypoxia-induced factor 1-alpha (HIF-1-alpha)) in serum and intestinal homogenate using enzyme-linked immunosorbent assay (ELISA) (specimens were collected 3 days postoperatively). Forty laboratory rats weighing from 370 to 550 g (mean weight 482 g) were divided into four equal groups: group I – ‘impaired neorectal vascularization;’ group II – ‘neorectal tension;’ group III – ‘rectal replantation;’ and the control group. During the first stage of the experiment (3 days), we assessed overall condition of the animals, number of stools, type of defecation, and pain severity. The animals received no treatment in the postoperative period. On day 3, all rats were euthanized. Tissue specimens were collected from the neorectum to evaluate its morphological characteristics and to produce intestinal homogenate for subsequent ELISA. Blood specimens were obtained by puncturing the left ventricle and then centrifuged at 3000g for 15 minutes. Blood supernatants and neorectum tissues were stored at -80°C for maximum 1 month before testing. Intestinal tissue samples for histological examination were stored in a 10% formalin solution. The levels of hypoxia biomarkers were measured in serum and intestinal homogenate using the Stat Fax 2100. Data analysis was conducted using the SPSS software (with no preliminary calculation of the sample size). We used the Mann–Whitney U-test [H.B.Mann, D.R.Whitney] and Kruskal–Wallis test [W.Kruskall, W.A.Walles]. The differences were considered significant at р &lt; 0.05. Results. The most common morphological changes were caused by impaired vascularization of the rectum. We have found a significant increase (p &lt; 0.001) in the levels of hypoxia markers in intestinal homogenates in all three experimental compared to controls. However, there was no significant difference in the levels of these markers between the experimental groups. The defecation process was abnormal in rats from groups I and II. Conclusion. In anorectoplasty, excessive mobilization of the rectum with its improper vascularization and formation of the anus under conditions of intestinal tissue tension lead to perioperative neorectal ischemia. This experiment should be continued to evaluate long-term results. The proposed models of perioperative neorectal ischemia can be used to analyze the role of many factors that can potentially affect the outcome of anorectal malformation correction. In the future, this problem may be investigated in clinical studies. Key words: anorectal malformations, perioperative ischemia, neorectum, tension, devascularization

Laxative Activity Test of Gynura procumbens (Lour.) Merr. Leave on White Male Mice Induced by Loperamide

Constipation is a symptom of a problematic, non-smooth and irregular defecation process. While laxative is a substance that stimulates intestinal peristalsis as a reflex of direct stimulation of the intestinal wall that can cause or facilitate defecation. This study aimed to determine the ethanol extract of the leaves of Gynura procumbens (L.) Merr. effect as a laxative in white male mice induced by loperamide. The methods used for laxative testing are defecation patterns and intestinal transit methods. The parameters observed included frequency of defecation, stool consistency, stool weight every 30 minutes for 4 hours, and the length of the activated carbon in the mice's intestine. The extract was administered orally at a dose of 75 mg/kg BW, 150 mg/kg BW and 300 mg/kg BW, as a comparison used negative control (Na CMC). From the results of the study, it was found that the administration of ethanol extracts of Gynura procumbens (Lour.) Merr. leaves at the dose of 150 mg/kg BW gave laxative activity to white male mice (P &lt;0.05).

Role of MRI defecography in assessment of pelvic floor pathologies

Background: Functional disorders of the pelvic floor are a common clinical problem. Diagnosis and treatment of these disorders, which frequently manifest with nonspecific symptoms such as constipation or incontinence, remain difficult. MR Defecography has emerged over the last decade as a modality which additionally images the pelvic floor function in real time besides combining the advantages of previously used modalities and that of magnetic resonance i.e. multiplanar imaging, good temporal resolution and lack of radiation exposure. Dynamic MRI defecography is a relatively new imaging protocol which can be extremely useful in identification of anatomic and functional pelvic floor dysfunction such as organ prolapse, anismus and fecal incontinence. Excellent demonstration of the perirectal soft tissues allows assessment of spastic pelvic floor syndrome and descending perineum syndrome and visualization of enteroceles. The aim of the study was to assess causes of pelvic floor dysfunction.Methods: Authors evaluated 25 patients with cine Magnetic Resonance Defecography at our center between December 2018 and 15th May 2019. MR Defecography was done with help of 3 Tesla Somatom Seimens MRI. Ultrasound jelly was instilled into the rectum of patient via a short flexible tube while the patient lies in the lateral decubitus position on the scanner table before being moved into the gantry and was asked to defecate when instructed. Scanning was done in four phases-resting, straining, squeezing and defecation as per the standard protocol while patient lied supine.Results: Most common complaint encountered was that of constipation. Patients in age group 20-70 years were studied. Maximum patient were of the age group 40-50 years. Most common finding was organ prolapse in total 9 patients with anterior rectocele in 6 patients followed by rectal prolapse.Conclusions: Magnetic resonance defecography is an excellent modality for assessment of pelvic floor disorders. It has very good temporal resolution and high soft tissue contrast, also allows visualization of the pelvic floor function in real-time without any radiation load. Imaging the defecation process in real-time leads to a definitive diagnosis in cases of dysfunctional defecation and a precise diagnostic and pre-operative assessment in cases of organ prolapse.

TRPA1-expressing lamina propria mesenchymal cells regulate colonic motility.

The physiological process of defecation is directly controlled by colorectal motility. The transient receptor potential ankyrin 1 (TRPA1) channel is expressed in small intestine enterochromaffin cells and is involved in gastrointestinal motility via serotonin release. In the colorectum, however, enterochromaffin cell localization is largely distinct from that in the small intestine. Here, we investigated the role of lower gastrointestinal tract TRPA1 in modulating colorectal motility. We found that in colonic tissue, TRPA1 is predominantly expressed in mesenchymal cells of the lamina propria, which are clearly distinct from those in the small intestine. These cells coexpressed COX1 and microsomal prostaglandin E synthase-1. Intracolonic administration of TRPA1 agonists induced colonic contraction, which was suppressed by a prostaglandin E2 (PGE2) receptor 1 antagonist. TRPA1 activation induced calcium influx and PGE2 release from cultured human fibroblastic cells. In dextran sulfate sodium-treated animals, both TRPA1 and its endogenous agonist were dramatically increased in the colonic lamina propria, accompanied by abnormal colorectal contractions. Abnormal colorectal contractions were significantly prevented by pharmacological and genetic inhibition of TRPA1. In conclusion, in the lower gastrointestinal tract, mesenchymal TRPA1 activation results in PGE2 release and consequently promotes colorectal contraction, representing what we believe is a novel physiological and inflammatory bowel disease-associated mechanism of gastrointestinal motility.

An Educational Programme of Sanitation in India: A Mirage to Reality

Sanitation is the need of the present era. It is the basis of disease free, clean environment and healthy aspect of a hygienic and decent life style. According to the World Bank data the 2.3 billion people in the world live without an access to a toilet and almost 892 million people practice open defecation. Only 69% of world’s population have an access to toilets and 38% have managed to go for safe and germs free defecation. It represents a high categorical underprivileged section of a society deprived of basic amenities. The Indian Ministry of Statistics and Programme implementation (MOPS) in its published 2016 report says that usage of toilet is 95.6 percent in rural region and 98.8 percent in urban areas which shows a considerable level of hygienic defecation process practices in Indian households. India has implemented Swacha Bharat Abhiyan (SBA) or Swacha Bharat Mission (SBM) with an objective of cleanliness drive and making India open defecation free. An NSSO survey reveals that 42.5 percent people in rural areas and 87.9 percent in urban areas have access to water facility in toilets. An educational drive or a comprehensive programme is implemented in India with wider application and coverage.

Brain MRI Lesions are Related to Bowel Incontinence in Multiple Sclerosis.

Bowel incontinence in multiple sclerosis might be associated with specific lesion sites. This study intended to determine associations between bowel incontinence and cerebral multiple sclerosis lesions using a voxel-wise lesion symptom mapping analysis. We conducted a retrospective study of multiple sclerosis patients with self-reported bowel incontinence and matched controls. Lesions were manually outlined on T2-weighted MRI scans and transformed into stereotaxic space. We performed a voxel-wise subtraction analysis subtracting the lesion overlap of patients without from patients with bowel incontinence. Finally, we compared the absence or presence of bowel incontinence between patients with and without lesions in a given voxel using the Liebermeister test. A total of 51 patients were included in the study. The analysis yielded associations between bowel incontinence and lesions in the supramarginal gyrus of the left secondary somatosensory cortex and another lesion cluster in the right parahippocampal gyrus and amygdala. Our analysis indicates associations between bowel incontinence and lesions in the left supramarginal gyral area contributing to integrating anorectal-visceral sensation and in the right parahippocampal gyrus and amygdala contributing to generating visceral autonomic arousal states. Moreover, our results suggest left hemispheric dominance of sensory visceral integration, while limbic areas of the right hemisphere seem to contribute to the autonomic component of the defecation process. A limitation of our study is the retrospective evaluation of the bowel incontinence status based on medical records. Further research should evaluate the bowel incontinence status in multiple sclerosis patients prospectively to overcome the limitations of the current study.