Defecation Process Research Articles

Improved Sugar Cane Juice Clarification by Understanding Calcium Oxide-Phosphate-Sucrose Systems

It is accepted that the efficiency of sugar cane clarification is closely linked with sugar juice composition (including suspended or insoluble impurities), the inorganic phosphate content, the liming condition and type, and the interactions between the juice components. These interactions are not well understood, particularly those between calcium, phosphate, and sucrose in sugar cane juice. Studies have been conducted on calcium oxide (CaO)/phosphate/sucrose systems in both synthetic and factory juices to provide further information on the defecation process (i.e., simple liming to effect impurity removal) and to identify an effective clarification process that would result in reduced scaling of sugar factory evaporators, pans, and centrifugals. Results have shown that a two-stage process involving the addition of lime saccharate to a set juice pH followed by the addition of sodium hydroxide to a final juice pH or a similar two-stage process where the order of addition of the alkalis is reversed prior to clarification reduces the impurity loading of the clarified juice compared to that of the clarified juice obtained by the conventional defecation process. The treatment process showed reductions in CaO (27% to 50%) and MgO (up to 20%) in clarified juices with no apparent loss in juice clarity or increase in residence time of the mud particles compared to those in the conventional process. There was also a reduction in the SiO2 content. However, the disadvantage of this process is the significant increase in the Na2O content.

Management of faecal incontinence in acutely ill patients

Faecal incontinence is common in acutely ill patients, and has many predisposing factors. It is important that nursing staff understand the process of normal defecation as well as the adverse effects faecal incontinence has on patients, relatives and carers. New techniques are emerging for the management of faecal incontinence and it is important that nurses are aware of these.

The Pathophysiology of Chronic Constipation

Constipation is broadly defined as an unsatisfactory defecation characterized by infrequent stools, difficult stool passage or both. The common approach to the pathophysiology of constipation groups the disorder into primary and secondary causes. Primary causes are intrinsic problems of colonic or anorectal function, whereas secondary causes are related to organic disease, systemic disease or medications. The normal process of colonic transit and defecation is discussed, and the etiology of constipation is reviewed.

The pathophysiology of chronic constipation

Constipation is broadly defined as an unsatisfactory defecation characterized by infrequent stools, difficult stool passage or both. The common approach to the pathophysiology of constipation groups the disorder into primary and secondary causes. Primary causes are intrinsic problems of colonic or anorectal function, whereas secondary causes are related to organic disease, systemic disease or medications. The normal process of colonic transit and defecation is discussed, and the etiology of constipation is reviewed.

Uso de psyllium para controle de constipação em cães

psyllium (Plantago psyllium) é um vegetal comumente utilizado como adjuvante no tratamento de afecções que resultam em constipação. Com o objetivo de melhor compreender os efeitos dessa fibra em cães, foram realizados dois experimentos. O primeiro avaliou, em cães sadios, inclusões de 0%, 2% e 4% de semente integral moída de psyllium à dieta (com base na matéria natural). Para tanto, foram empregados oito cães da raça Beagles adultos, os quais receberam as dietas experimentais por oito dias. Verificou-se aumento linear da umidade das fezes com a adição de teores crescentes de psyllium (R²=0,54 e P=0,0012), sem alteração do escore fecal e número de defecações por dia. O segundo experimento incluiu avaliação da opinião de 24 proprietários cujos cães receberam suplementação de 2% de psyllium como parte do tratamento de afecções que causaram constipação. Dos proprietários incluídos, 19 (79,2%) relataram melhora da defecação de seus cães durante a administração da fibra. Quinze (62,5%) observaram que as fezes dos animais, antes ressecadas ou endurecidas, tornaram-se normais ou pastosas. Os resultados comprovaram para cães os efeitos laxativos do psyllium já descritos na medicina humana, indicando seu uso no tratamento de suporte de enfermidades que levam à constipação.

The physiology of continence and evacuation

Continence is maintained by the coordinated function of the pelvic floor, rectum and anal sphincters. Evacuation occurs through a relaxed pelvic floor. The rectum acts to either store or expel stool both of which require cortical sensory awareness acting in conjunction with intramural and spinal reflexes that ensure timely defecation. The anal sphincters act individually and in unison in response to rectal distension and the sensation of rectal filling. Reflex relaxation of the internal anal sphincter has an additional sensory function in allowing sampling of rectal contents in the upper anal canal. Voluntary control of the external anal sphincter is key in the voluntary deferring of evacuation until a socially opportune moment. This review describes the physiological roles of each of these continence organs in order to understand the complex process of defecation.

Toilet reading habits in Israeli adults

Although toilet reading (TR) is a common habit, the effect of TR on bowel movements is neglected in the medical literature. Our hypothesis was that TR provides a distraction and acts as an unconscious relaxation technique and allows an easier defecation process. The aim of this study was to assess how common is TR and to map the reading/playing toilet habits in the Israeli adult population. In addition, we aimed to explore a possible connection between TR and the nature of bowel habits in general and constipation and haemorrhoids in particular. Five hundred adults who represent the diverse demographic backgrounds have been asked to fill an anonymous short questionnaire. The subjects were questioned regarding their demographic details, their TR and playing habits, their bowel habits, whether they suffer from haemorrhoids and whether they use some sort of faecal softener. We found that TR is common and involves 52.7% of the population. Males, younger age, secular population, higher education level and white collar workers compose the TR profile. Although toilet readers spent significantly more time in the toilets, no differences were noted for the type or frequency of stools. Nevertheless, the TR group considered themselves to be less constipated (8.0%vs 13.7%) and had more haemorrhoids (23.6%vs 18.2%). These differences, however, were not significant. Toilet reading is a common and benign habit. It is involved with a longer time spent in the toilet. It seems to be more for fun and not necessarily to solve or due to medical problems.

The Constipated Child: Is There a Correlation Between Symptoms and Manometric Findings?

The aim of our study was to evaluate patients referred for care of chronic constipation. We compared results of the anorectal manometry studies with a patient/guardian questionnaire about the patients' constipation. From patients seen for constipation in the department of pediatric gastroenterology, 123 were prospectively enrolled and they completed symptom questionnaires. These patients already were treated with stool softeners, either by the referring primary care physician or by the referring gastroenterologist. Anorectal manometry was performed per standard protocol. Of the 123 patients enrolled in the study, 57.7% were male. Patient age ranged from 0.2 to 17.8 years, and the mean age was 7.5 years. The average duration of constipation was 4.84 years. The average number of stools per week was 3.6. Average time spent in the defecation process was 13.3 minutes. The incidence of hematochezia was 30%. Delayed passage of meconium was reported in 45 of 99 patients (45.5%). Significant correlation was found between frequency of soiling and threshold for rectoanal inhibitory reflex (P = 0.029). The volume of first urge also was positively correlated with frequency of soiling (P = 0.034). There was significant correlation of withholding behavior and the maximum volume tolerated (P = 0.020). The presence of blood in stool was inversely correlated with the maximum volume tolerated (P = 0.004). No correlation was found between severity of complaints and the presence of paradoxical puborectalis contraction. Of the patients, 90.5% had paradoxical puborectalis contraction. Significant correlation was found between frequency of soiling and rectoanal inhibitory reflex, as well as soiling and volume of first urge. There was correlation between withholding behaviors and maximum volume tolerated. The presence of blood inversely correlated with maximum volume tolerated. Anorectal manometry continues to provide additional new information and to assist in managing patients with this common chronic pediatric affliction.

Constipation and Obstructed Defecation

Difficulties with bowel function are common and may be due to several causes including slow colonic transit and obstructed defecation. The anatomical and pathophysiological changes associated with these conditions are varying, often incompletely understood, and in many cases have limited treatment outcomes. Patients present with variable complaints and have previously tried a plethora of over-the-counter medications in an effort to relieve their symptoms. Physicians need an organized approach to manage these patients optimally. Improvements over the past few years in our understanding of the complex process of defecation, along with the increasing use of radiological and anorectal physiology studies, have led to improved treatment results.

Squeezing the glans penis: A possible maneuver for improving the defecation process and preventing constipation

Squeezing the glans penis: A possible maneuver for improving the defecation process and preventing constipation

Prediction of Findings at Defecography in Patients with Genital Prolapse

This study was designed to investigate the ability of defecography to identify abnormalities of the anterior and posterior compartments that might be associated with genital prolapse and require repair during prolapse surgery. Defecography is a technique that assesses the defecation process by recording the expulsion of a barium paste used as a substitute for feces. Study subjects were 82 patients with descensus uteri stages 2-4 who were enrolled in a trial comparing vaginal and abdominal prolapse surgery. All patients underwent a preoperative evaluation, including urogynecologic interview, physical examination, an assessment of genital prolapse using the Pelvic Organ Prolapse Quantification System (POP-Q), and a rectal examination. In addition, 1 to 3 weeks before surgery, study subjects completed a questionnaire about defecation and micturition symptoms. One to 3 months before surgery, defecography was performed according to standard techniques. The rectum is filled with barium paste, which is expelled while the patient is sitting on a radiolucent commode. The process of defecation is recorded on video. The results of defecography were analyzed by 2 physicians and were considered abnormal when an enterocele or rectal intussusception was identified. In this study, an enterocele was defined as a peritoneal sac that is herniated along the anterior rectal wall below the vaginal apex. A rectal intussusception was defined as the presence of a ring pocket formed by the rectal wall folding in toward the rectal lumen. The results of preoperative evaluation, including physical findings at pelvic examination, reported defecation and micturition symptoms, and patient history, were examined for their ability to predict the presence of abnormalities in defecography. Abnormal defecography results were seen in 26 (32%) of the 82 study subjects. Both an enterocele and rectal intussusception were found in 6 (7%) patients. Univariate analysis was performed of variables associated with the presence of rectocele or rectal intussusception, including details of the patient's medical history, results of genital prolapse assessment, and reported defecation and micturition symptoms. A history of pelvic surgery, the degree of genital prolapse as measured by POP-Q (Ap), and a history of constipation emerged as predictors of abnormal defecography. The results were similar after multivariate analysis. Using these 3 variables, the authors developed a model for predicting an abnormal defecography. With the model, a score is assigned to each variable and the total computed using the formula: 3 + 3 X history of abdominal or pelvic surgery + Ap (in centimeters) + 3 X constipation. As an example, for an imaginary patient with no history of pelvic surgery, with a rectocele descending to 1 cm above the hymen (Ap = -1 cm), who reports constipation, the formula would give a score of(3+3×0+-1+3×1). Table 1 shows the results from this series of patients using this model.

The regenerative cells during the metamorphosis in the midgut of bees

The midgut epithelium of bees is formed by the digestive cells, responsible for enzyme secretion and nutrient absorption and for small regenerative cells that are placed in nests scattered among the digestive cells. During metamorphosis, the larval midgut epithelium degenerates and a new adult midgut epithelium is built during larval differentiation of regenerative cells. The present work focuses on the midgut epithelial modifications during the post-embryonic development of the stingless bee Melipona quadrifasciata anthidioides worker and the occurrence of regenerative cell proliferation during midgut metamorphosis in order to test the hypothesis that adult midgut epithelium of worker bees results from regenerative cell proliferation during the pupal stage. Regenerative cell proliferation was detected during larval lifespan. Larval aging is followed by an increase in the number and the size of the nests of regenerative cells. Larval epithelium degeneration begins 2 days after the start of defecation process and in this period the nests of regenerative cells are in contact by means of cytoplasmic extension which have many septate desmosomes and gap junctions. The BrdU immunoreactive regenerative cells were found in the prepupae 12 h after BrdU injection, suggesting that regenerative cell population increase during this larval period. Regenerative cell proliferation results in the increase of the regenerative cell population and not in the formation of new digestive cells because the proliferation of regenerative cells would not be enough to reestablish the nests of regenerative cells and at the same time form new adult digestive cells. In this sense the hypothesis that digestive adult cells originate from regenerative cell proliferation during midgut metamorphosis in M. quadrifasciata anthidioides was rejected.

Childhood Constipation: Is There New Light in The Tunnel?

IntroductionConstipation is a common phenomenon in childhood worldwide. The symptoms vary from mild and short-lived to severe and chronic with faecal impaction and encopresis. Although our understanding of pathophysiology has grown rapidly in recent decades, the causes and management of constipation

Long-term results of surgery for chronic constipation.

Developments in anorectal physiologic testing have facilitated better understanding of the process of defecation and factors that might cause chronic constipation. Patients with severe idiopathic chronic constipation were evaluated using colonic transit and pelvic floor function in an attempt to identify those patients suitable for aggressive surgical intervention. Among 1,009 patients studied using either a marker or scintigraphic transit technique and tests of pelvic floor function, 52 with slow-transit constipation (STC) were identified and underwent abdominal colectomy and ileorectostomy (IRA). Twenty-two patients had pelvic floor dysfunction and STC; these patients underwent initial pelvic floor retraining followed by IRA. A total of 249 patients had pelvic floor dysfunction without evidence of slow-transit and were offered pelvic floor retraining alone. The remaining 597 patients had no quantifiable abnormality of colon or pelvic floor dysfunction; these patients had normal transit constipation/irritable bowel syndrome and were treated medically. There were, thus, 74 patients operated on, 68 women, with a mean age of 53 years and a mean follow-up of 56 months. There was no operative mortality, seven patients (9 percent) had small-bowel obstruction, and nine patients (12 percent) had prolonged ileus. All patients were able to pass a stool spontaneously, 97 percent of patients were satisfied with the results of surgery, and 90 percent have a good or improved quality of life. There was no difference in the outcome of surgery in patients with STC alone compared with STC and pelvic floor dysfunction. Physiologic evaluation reliably identified patients with severe chronic constipation who might benefit from surgery. IRA is safe and effective, resulting in prompt and prolonged relief of constipation.

Nonulcer Dyspepsia: A Look Into the Future

Nonulcer Dyspepsia: A Look Into the Future

MANAGEMENT OF CONSTIPATION AND ENCOPRESIS IN INFANTS AND CHILDREN

Chronic functional constipation is common in childhood. Basic understanding of the defecation process is essential to formulate a rational diagnostic and therapeutic approach to pediatric patients with chronic constipation, with or without encopresis. Primary care physicians can perform a major preventive function by anticipatory guidance and early dietary intervention. Most patients referred to pediatric gastroenterologists can be effectively treated as outpatients with use of an approach consisting of colonic evacuation, stool softeners, dietary manipulations, bowel training, and behavioral management. Avoidance of painful (laxatives) and invasive (suppositories, enemas) modalities is an important part of successful management. Further evaluation, including manometric tests, are reserved for patients with a history or physical findings suggesting an underlying disorder predisposing the patient to difficulty with defecation. Biofeedback therapy is likely destined to play a role in the subgroup who respond poorly to traditional therapeutic methods.

ANALYTICAL CONTROL OF CIDER PRODUCTION BY TWO TECHNOLOGICAL METHODS

Two cider-production procedures involving direct fermentation of apple juice and a prefermentative clarification step or defecation were controlled microbiologically, while chemical monitoring of the major sugars, polyalcohols and organic acids produced during the fermentation was carried out by HPLC. The defecation process markedly slows down alcoholic fermentation and the malolactic conversion. Good correlations between the contents of D(–) lactate and volatile acidity were obtained for the ciders studied, which indicates that the increased volatile acidity of the ciders was basically a result of metabolism mediated by lactic-acid bacteria, the yield being higher in barrels where enzymatic defecation was not applied. Sucrose was rapidly hydrolysed in the first step of the fermentation process, while glucose is the preferential carbon source for the yeasts. Citric acid was produced by the yeasts in the first step of the fermentation process and was later taken up by these micro-organisms. Conversion of quinic and shikimic acids seemed to point to a signicant activity of heterofermentative lactic-acid bacteria in storage and maturation of ciders.

Changes in elimination

A LTERATION in bowel function is one of the most distressing symptoms of cancer and its treatment in terms of self-esteem, daily living, and social acceptance. Changes in elimination patterns associated with cancer can result from a variety of factors, including nutritional intake, physical mobility, neurologic and metabolic functioning, surgery, direct tumor involvement, psychosocial factors, and medication. This article reviews the causes of cancer-related bowel alterations and discusses interventions and areas for future research. The process of defecation is a complex combination of mechanical stimulation, muscle contraction, and timed innervation that leads to an urge to empty the bowel. The process has been described from functional and neurologic points of view.l3 In brief, the intestinal tract digests and absorbs nutrients and fluids and excretes waste matter. Eight to ten liters of liquid from ingested fluids, food, and enzymes produced by the body travel through the digestive system each day. All but 100 mL of fluid is reabsorbed, primarily in the ascending and transverse portion of the large intestine, leaving a soft waste residue. 2.4,5 Waste is assisted through the gastrointestinal tract by peristaltic waves until the rectal vault is reached. As storage reaches its capacity, messages are sent to the brain to signal the urge to defecate, and a process begins which empties the bowel. Under normal circumstances, the number of stools ranges from 3/d to 3/wk. !,4,6 When disruption occurs at any point in the process, diarrhea or constipation may result. Assessment of bowel function should consider the following factors: the individuals' emotional, physiologic, and cultural milieu; any change in frequency, size, and consistency of stool; ease of passage; indications of excessive straining; sensations of incomplete emptying; abdominal distension, cramps or discomfort; and the appearance of stool and bowel sounds. Following assessment, a diagnosis of the alteration can be made. The common types of alteration, constipation and diarrhea, will be the focus of this paper.

Treatment of the spastic pelvic floor syndrome with biofeedback

The spastic pelvic floor syndrome is a functional disorder based on contraction instead of relaxation of the pelvic floor muscle during straining, which inhibits defecation and gives rise to constipation. Until now no adequate treatment has been found for this condition. The treatment described here is aimed at teaching patients to relax their pelvic floor muscle during straining. Treatment consists of a training program with EMG feedback, followed by simulation of the defecation process, using oatmeal porridge. Patients are then given instructions to generalize the relaxation response in their daily lives. Treatment was completely successful in seven of ten patients. The three remaining patients learned to strain in the correct manner, but could not achieve generalization. Two of them underwent subtotal colectomy because of delayed colonic transit times, which subsequently resulted in normal evacuation. In the third patient, the generalization was most likely hampered by psychologic problems, for which she now receives psychotherapy.

Morphometric and cytochemical studies of Dictyostelium discoideum in vegetative phase. Digestive system and membrane turnover.

The morphometric analysis of growing cells shows that the membranes of the digestive apparatus have a surface area equal to the cell surface area. After yeast phagocytosis, the surface area of the membrane surrounding the ingested yeast is equal to 40% of the surface area of the cell membrane. In spite of this internalization, the cell surface remains constant. Its renewal is insured by the translocation of the membrane of the digestive system, the surface area that concomitantly decreases by 40%. This means that the influx of plasma membrane is continually compensated for by the same outflow of internal membranes. During this turnover, the characteristic polysaccharide stainability (two different stains were used) of the plasma membrane is maintained after internalization, at the level of the digestive system, despite the presence of hydrolases in the digestive vacuoles. The cytochemical demonstration of acid phosphatase shows that this enzyme penetrates into phagosomes by fusion between phagosomes and vacloles of various sizes. The debris of digested yeast are released into the culture medium after 2 h. This process of defecation is accompanied by the appearance of new pinocytotic vacuoles, which indicates that the uptake of axenic medium has resumed. A model of membrane turnover is proposed to explain these observations.