Difficult Defecation Research Articles

070. Total Bowel Obstruction and Secondary Renal Impairment Following Bajakah Root Ingestion: Case Report

Background: Total bowel obstruction is a critical condition often caused by malignancies and adhesions or rare caused by foreign bodies. The bajakah root is a herbal medicine in Dayak community (Central Kalimantan), traditionally used to treat any diseases. This report presents a unique case of bowel obstruction due to bajakah root, and renal impairment as a complication. Case: A 62 years old female without any psychiatric disorders with history bajakah root consumtion complaint difficult defecation and green vomiting. Physical examination showed abdominal distention with collapsed rectal ampulla. Laboratory results revealed renal impairment. Imaging studies confirmed total bowel obstruction. Exploratory laparotomy identified ileoileal and ileo-omental adhesions with 0.5x0,5 cm ileum perforation 120 cm distal to the ligament of Treitz and a 2x2 cm wooden foreign body 10 cm distal from the perforation site. Surgical management included adhesiolysis, wedge excision of the ileum, foreign body extraction and anastomosis. Conclusion: Total bowel obstruction, renal impairment, bajakah, foreign body, foreign body extraction.

Prevalence of constipation and associated factors in university hospital inpatients.

We aimed to determine (1) the prevalence of constipation among inpatients, (2) the prevalence and symptoms of difficult defecation among constipated inpatients, and (3) the factors associated with constipation. We performed a retrospective cohort study over a single day at one university hospital. We analyzed the nursing records for inpatients who had been hospitalized for at least 3 days. The survey items included the symptoms associated with defecation difficulty and nutritional intake. The symptoms of difficult defecation were defined as (1) fewer than three spontaneous bowel movements per week; (2) lumpy or hard stools (Bristol stool form scale types 1-2); (3) straining during defecation; and (4) the sensation of incomplete evacuation during defecation, based on the Roma-IV diagnostic criteria. Constipation was defined as the presence of two or more symptoms of defecation difficulty. Univariate and multivariate analyses were performed to determine the constipation status of the patients. The prevalence of constipation in the university hospital was 12.2%, and the department with the highest prevalence of difficulty with defecation was the Psychiatry Department (64.1%). Of the patients with constipation, 36.8% exhibited symptoms of defecation difficulty other than low frequency of defecation. The factor that was significantly associated with constipation after admission was pre-admission constipation (odds ratio=8.92, p<0.01). Subjective assessment has limitations for the accurate determination of constipation status. In addition, patients with a history of constipation before admission require early interventions to aid defecation following their admission.

Botulinum toxin type A injection combined with biofeedback in the treatment of spastic pelvic floor syndrome.

Spastic pelvic floor syndrome (SPFS) is a refractory pelvic floor disease characterized by abnormal (uncoordinated) contractions of the external anal sphincter and puborectalis muscle during defecation, resulting in rectal emptation and obstructive constipation. The clinical manifestations of SPFS are mainly characterized by difficult defecation, often accompanied by a sense of anal blockage and drooping. Manual defecation is usually needed during defecation. From physical examination, it is commonly observed that the patient's anal muscle tension is high, and it is difficult or even impossible to enter with his fingers. To investigate the characteristics of anorectal pressure and botulinum toxin A injection combined with biofeedback in treating pelvic floor muscle spasm syndrome. Retrospective analysis of 50 patients diagnosed with pelvic floor spasm syndrome. All patients underwent pelvic floor surface electromyography assessment, anorectal dynamics examination, botulinum toxin type A injection 100 U intramuscular injection, and two cycles of biofeedback therapy. After the botulinum toxin A injection combined with two cycles of biofeedback therapy, the patient's postoperative resting and systolic blood pressure were significantly lower than before surgery (P < 0.05). Moreover, the electromyography index of the patients in the resting stage and post-resting stages was significantly lower than before surgery (P < 0.05). Botulinum toxin A injection combined with biofeedback can significantly reduce pelvic floor muscle tension in treating pelvic floor muscle spasm syndrome. Anorectal manometry is an effective method to evaluate the efficacy of treatment objectively. However, randomized controlled trials are needed.

Rectal duplication in adult presented with constipation: a case report and literature review

BackgroundRectal duplication is a rare congenital disease which is mostly diagnosed during childhood. Diagnosis in adulthood could be obscured as the presenting symptoms including difficult defecation, bloating, and abdominal distension would lead to other diagnosis. Constipation is common in female adult and conservative treatment is usually successful. Refractory constipation requires further work-up. However, rectal duplication is a rare cause of adult constipation.MethodsWe reported a 42-year-female who presented with chronic constipation which became intractable after total abdominal hysterectomy. Barium enema, CT scan, and colonoscopy revealed an additional rectal pouch connecting to the native rectum containing large fecaloma. Anorectal manometry showed dyssynergic defecation, rectal hyposensitivity but presence of rectoanal inhibitory reflex.ResultsTransabdominal resection of the rectal duplication pouch and protective colostomy was performed. After a course of biofeedback, the colostomy was reversed. The patient remains healthy at 4 years of follow up.ConclusionRectal duplication could be a cause of refractory constipation in adulthood. A collection of fecal material via a connection with the native rectum led to a large symptomatic fecaloma.

How to assess the long-term recovery outcomes of patients with cauda equina syndrome before surgery: a retrospective cohort study.

Factors influencing recovery after decompression surgery for cauda equina syndrome (CES) are not completely identified. We aimed to investigate the most valuable predictors (MVPs) of poor postoperative recovery (PPR) in patients with CES and construct a nomogram for discerning those who will experience PPR. 356 patients with CES secondary to lumbar degenerative diseases treated at *** Hospital were randomly divided into training (N=238) and validation (N=118) cohorts at a 2:1 ratio. Moreover, 92 patients from the **** Hospital composed the testing cohort. Least Absolute Shrinkage and Selection Operator regression (LASSO) was used for selecting MVPs. The nomogram was developed by integrating coefficients of MVPs in the logistic regression, and its discrimination, calibration, and clinical utility were validated in all three cohorts. After 3 to 5 years of follow-up, the residual rates of bladder dysfunction, bowel dysfunction, sexual dysfunction, and saddle anesthesia were 41.9%, 44.1%, 63.7%, and 29.0%, respectively. MVPs included stress urinary incontinence, overactive bladder, low stream, difficult defecation, fecal incontinence, and saddle anesthesia in order. The discriminatory ability of the nomogram was up to 0.896, 0.919, and 0.848 in the training, validation, and testing cohorts, respectively. Besides, the nomogram showed good calibration and clinical utility in all cohorts. Furthermore, the optimal cut-off value of the nomogram score for distinguishing those who will experience PPR was 148.02, above which postoperative outcomes tend to be poor. The first pre-treatment nomogram for discerning CES patients who will experience PPR was developed and validated, which will aid clinicians in clinical decision-making.

Difficult defecation in constipated patients: Diagnosis by minimally invasive diagnostic tests.

Defecation Disorders (DD) are a frequent cause of refractory chronic constipation. DD diagnosis requires anorectal physiology testing. Our aim was to evaluate the accuracy and Odds Ratio (OR) of a straining question (SQ) and a digital rectal examination (DRE) augmented by abdomen palpation on predicting a DD diagnosis in refractory CC patients. Two hundred and thirty-eight constipated patients were enrolled. Patients underwent SQ, augmented DRE and balloon evacuation test before entering the study and after a 30-day fiber/laxative trial. All patients underwent anorectal manometry. OR and accuracy were calculated for SQ and augmented DRE for both dyssynergic defecation and inadequate propulsion. "Anal Muscles" response was associated to both dyssynergic defecation and inadequate propulsion, with an OR of 13.6 and 5.85 and an accuracy of 78.5% and 66.4%, respectively. "Failed anal relaxation" on augmented DRE was associated with dyssynergic defecation, with an OR of 21.4 and an accuracy of 73.1%. "Failed abdominal contraction" on augmented DRE was associated with inadequate propulsion with an OR >100 and an accuracy of 97.1%. Our data support screening constipated patients for DD by SQ and augmented DRE to improve management and appropriateness of referral to biofeedback.

P499 Anorectal Motility Disorders In Inflammatory Bowel Disease Patients

Abstract Background In spite of prolonged disease remission of IBD patients, induced by the new biological molecules, a significant number of them suffer from persistent debilitating symptoms with major impact on the quality of life. Frequently, these symptoms are due to post-inflammatory motility changes and misinterpreted as functional disorders. Our aim is to identify and characterize the anorectal motility dysfunction in IBD patients. Methods We are conducting an ongoing prospective study started in August 2019, which includes the IBD patients admitted in a Tertiary Gastroenterology Centre in Bucharest, with specific symptoms (anorectal pain, incontinence, difficult defecation). We perform high resolution anorectal manometry using Sandhill Scientific systems, the parameters being analysed using InSIGHT software. The manometric testing comprise measurements of anorectal pressure at rest, during squeeze, simulated evacuation, rectoanal inhibitory reflex (RAIR) and rectal sensory testing, in compliance with International Anorectal Physiology Working Group protocol Results We studied 30 patients (18 patients with Ulcerative Colitis and 12 patients with Crohn’s Disease, 18 females and 12 males, mean age 40 (±12.85) years. Only 33% (10 patients) had rectal active involvement. Symptoms were reported by 87% (26) patients: anal incontinence (85%), difficult evacuation (35%) and urgency (46%); rectal inflammation was not correlated with the presence of symptoms in our study group (p=0.28). Perianal surgical interventions didn’t represent a risk factor for fecal incontinence (p=0.18), or for dyssinergic defecation (p=0.1). Modified manometric parameters were found in 23 patients (79%). Low resting pressures were registered in 48% of patients; 55% of them presented low squeeze pressures; during push maneuvers, 34% of patients had insufficient rectal propulsive force, presenting low rectal pressures and 59% of them lacked anal canal relaxation. We performed sensibility testing on 18 patients: 9 patients presented criteria for hypersensitivity, hence reduced rectal compliance; 7 patients presented rectal hyposensitivity, while only 2 patients had normal rectal sensation. Recto-anal inhibitory reflex (RAIR) was present only in 28% of the patients, reflecting the dysfunction of the enteric neural system. Conclusion Patients with inflammatory bowel disease (IBD) have significantly higher rates of functional anorectal disease. Therefore, pelvic floor investigation is an essential tool in the investigation and management of IBD patients with ongoing symptoms not thought to be related to an IBD flare.

Bowel movement frequency and difficult defecation using constipation assessment scale in patients with isolated REM sleep behavior disorder

IntroductionThis study evaluated constipation, including reduced bowel movement frequency and difficult defecation, in patients with isolated rapid eye movement sleep behavior disorder (IRBD), which is prodromal Parkinson’s disease (PD) or dementia with Lewy bodies (DLB) in middle-aged and older adults. MethodsWe used a validated Japanese version of the Constipation Assessment Scale (CAS-J) to evaluate bowel habits over 1 month in 117 men aged 50–86 years and 34 women aged 56–86 years with video-polysomnography-confirmed IRBD and 22 controls. Furthermore, we performed a longitudinal assessment of outcomes at follow-up visits. ResultsThe CAS-J score was higher in the 22 IRBD patients than in 22 age- and gender-matched paired controls. In 151 IRBD patients, the CAS-J score was higher for women than for men. At baseline, the CAS-J score was similar between patients who developed PD and DLB, but the three IRBD patients who developed multiple system atrophy had a low CAS-J score. Those with constipation (CAS-J score ≥ 2) converted to PD or DLB in a significantly shorter time duration (i.e., time frame for phenoconversion) than those with CAS-J score < 2 (log-rank test, p < 0.001). When adjusted for age and gender, Cox hazards analysis revealed that the CAS-J score significantly predicted phenoconversion to PD or DLB (hazard ratio: 5.9, 95 % confidence interval: 1.8–19.1, p = 0.003). ConclusionsConstipation, i.e., reduced bowel movement frequency and difficult defecation, was common in middle-aged and elderly patients with IRBD, and CAS-J score predicted phenoconversion to PD or DLB.

Clinical outcomes of LeFort colpocleisis: A single-center experience from Turkey

Background/Aim. LeFort colpocleisis (LFC) is a procedure for treating pelvic organ prolapse (POP) in women. The aim of the study was to assess the sociodemographic characteristics, anatomical outcomes, satisfaction, and clinical outcomes of patients who underwent LFC for POP. Methods. The study retrospectively and consecutively included 103 patients who underwent LFC for stage III and stage IV POP between January 2010 and December 2022. The participants? sociodemographic characteristics and clinical outcomes were documented. The Turkish version of the Pelvic Floor Distress Inventory (PFDI-20) questionnaire was used to determine quality of life. Results. The patients? mean age was 73.1 ? 26.7 years, mean body mass index 27.4 ? 3.8 kg/m2, parity 4.8 ? 1.5, smoking rate 12.6%, POP quantification (POP-Q) stage III 30.1%, and POP-Q stage IV 69.9%. Their satisfaction rate results were 93.3%. Significant differences were observed in the preoperative period compared to the postoperative period in constipation (40.7% vs. 26.2%; p = 0.038), difficult defecation (22.3% vs. 8.7; p = 0.012), fecal incontinence (18.4% vs. 7.7%; p = 0.039), stress urinary incontinence (25.2% vs. 4.8%; p &lt; 0.001), urge incontinence (49.5% vs. 27.1%, p = 0.001), voiding dysfunction (37.8% vs. 23.3%; p = 0.002), and urinary retention (42.7% vs. 12.6%; p &lt; 0.001). Postoperative PFDI-20 scores were also significantly lower compared to the preoperative period (57.19 ? 16.57 vs. 21.62 ? 6.96; p &lt; 0.001). Conclusion. This study showed that LFC has been established as a surgical procedure with high anatomical success, high patient satisfaction rates, and minimal complications, especially in advanced POP with age-related comorbidities.

Cecal dilatation in cattle ingesting Megathyrsus maximus (syn. Panicum maximum) cv. Mombaça and cv. Tanzânia

Nine outbreaks of cecal dilatation are reported in cattle in rotationally-grazed pastures of Megathyrsus maximus during the rainy season with one day grazing and rest intervals of 23–28 days. Clinical signs, observed 6–24 h after entering the pasture, were inappetence, long periods in sternal recumbency, rough hair coat, arched back, tenesmus with difficult defecation, dry stools, reduced ruminal movements, intestinal tympany with right abdominal distention, and decreased milk production. The animals recovered 8–12 h after their removal from the pastures. All pastures were fertilized at 80–120 kg/ha of urea/year. In six farms, in addition to urea, chicken litter (CL) was also added. Water-soluble carbohydrates (WSC), non-fiber carbohydrates (NCF) and starch concentrations in the pastures causing tympany were higher (P < 0.05) than in control pastures. To demonstrate the relationship of the disease with fertilization of the pastures, a pasture of M. maximus was divided into five blocks of 16 m2 and each block subdivided into four plots each, totaling 20 plots. One plot of each block was randomly chosen for 1 of 4 different treatments: 1. fertilized with 8 t/ha of CL; 2. fertilized with 16 t/ha of CL; 3. fertilized with 180 kg/ha urea; 4. control without fertilization. In general, plots fertilized with urea or with CL had higher NFC and starch concentrations (p < 0,05) than the control plots. In another experiment a pasture of M. maximus was divided into 23 paddocks and rotationally grazed. Ten paddocks were fertilized with 180 kg/ha of urea and five fertilized with 8 t/ha of CL. The concentration of NFC and starch were significantly higher (p < 0.05) in the pastures fertilized with urea and with urea plus CL. These results suggest that cecal dilatation may be caused by the high concentrations of NFC and starch in the pastures fertilized with urea and/or poultry litter.

Constipation in Parkinson's Disease.

Constipation is one of the most common gastrointestinal features of Parkinson's disease (PD), occurring in over 50% of all PD patients during the course of their disease. Furthermore, constipation is now recognized as an important, prodromal symptom and may predate the onset of the classical motor symptoms by decades. Thereafter, the prevalence and severity of constipation in PD tend to parallel the course of both motor and nonmotor phenomena such as cognitive decline and depression. Difficult defecation (obstructed defecation, dyssynergia) is the primary pathophysiology underlying constipation and likely reflects involvement by the PD process of one or more of the many skeletal muscle groups that are involved in effecting defecation. Management of constipation in PD may be complicated by several patient factors including dysphagia, cognitive impairment, depression, and weak sphincter tone. While the armamentarium available to those who treat constipation, in general, has expanded considerably in recent years, the evidence supporting any therapy in the management of this symptom in PD has remained slim.

The effect of spinal magnetic stimulation on the management of functional constipation in adults

BackgroundFunctional constipation is a type of functional bowel disorder characterized by difficult defecation with a sense of incomplete evacuation. It is a common disorder with an increasing prevalence, and the underlying cause is poorly identified. Nonpharmacological management of functional constipation includes lifestyle and dietary modification, regular physical activity, advice about toileting posture, and behavioral therapy. Biofeedback training as part of the behavioral training showed great efficacy with long-term results. Spinal magnetic stimulation is the application of extracorporeal magnetic stimuli to the spinal nerves and deep pelvic muscles to enhance bowel evacuation without surgical drawbacks. This study was designed to enhance bowel elimination in functional constipation patients through the dual effect of biofeedback and spinal magnetic stimulation. This work aimed to study the efficacy of spinal magnetic stimulation and biofeedback training versus biofeedback alone in the management of functional constipation.ResultsThere was a statistically significant difference between before and after the intervention in both studied groups regarding the mean weekly spontaneous bowel movement, a Numerical Rating Scale for pain assessment, and the Patient Assessment of Constipation Quality of Life questionnaire. When comparing the two groups after the intervention, the spinal magnetic stimulation showed superiority in the mean weekly spontaneous bowel movement and manometric anal pressure at rest.ConclusionsSpinal magnetic stimulation in addition to biofeedback pelvic floor muscle training could increase the mean weekly complete spontaneous bowel movements and manometric anal pressure at rest in patients with functional constipation. It did not show any additive benefits in improving pain during defecation or patient quality of life.Trial registrationClinicalTrials.gov, 0305398. https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000BQ0H&selectaction=Edit&uid=U0004JW0&ts=2&cx=-xmnims

Fu Brick Tea Alleviates Constipation via Regulating the Aquaporins-Mediated Water Transport System in Association with Gut Microbiota.

This study aimed to investigate the amendatory effects of Fu brick tea aqueous extract (FTE) on constipation and its underlying molecular mechanism. The administration of FTE by oral gavage (100 and 400 mg/kg·bw) for 5 weeks significantly increased fecal water content, improved difficult defecation, and enhanced intestinal propulsion in loperamide (LOP)-induced constipated mice. FTE also reduced colonic inflammatory factors, maintained the intestinal tight junction structure, and inhibited colonic Aquaporins (AQPs) expression, thus normalizing the intestinal barrier and colonic water transport system of constipated mice. 16S rRNA gene sequence analysis results indicated that two doses of FTE increased the Firmicutes/Bacteroidota (F/B) ratio at the phylum level and increased the relative abundance of Lactobacillus from 5.6 ± 1.3 to 21.5 ± 3.4% and 28.5 ± 4.3% at the genus level, subsequently resulting in a significant elevation of colonic contents short-chain fatty acids levels. The metabolomic analysis demonstrated that FTE improved levels of 25 metabolites associated with constipation. These findings suggest that Fu brick tea has the potential to alleviate constipation by regulating gut microbiota and its metabolites, thereby improving the intestinal barrier and AQPs-mediated water transport system in mice.

Blood lead level evaluation in children presenting with chronic constipation in Tehran-Iran: a cross-sectional study

Constipation is a common reason for children seeking medical care worldwide. Abdominal complaints and constipation are also common in lead-poisoned children. This study evaluates the prevalence of abnormal blood lead levels (BLL) among pediatric and adolescent patients and examines the association of constipation with elevated BLL. This was a prospective data collection of patients younger than 18 years old with the chief complaint of constipation seen in the Mofid Children’s Hospital gastroenterology clinic and Loghman Hakim pediatric and pediatric gastroenterology clinics were eligible for enrollment in this study. Constipation was defined as infrequent or difficult defecation according to ROME IV criteria lasting 2 months or more. BLL was measured with a fresh capillary whole blood capillary sample. The LeadCare II device assays BLL using an electrochemical technique (anodic stripping voltammetry). A total of 237 patients were enrolled in the study. 122 (51.48%) were female and 115 (48.52%) were male. About one fifth of patients (49; 20.67%) had BLL ≥ 5 µg/dL. The mean BLL in the sample was 3.51 µg/dL. Abdominal pain was the most common symptom accompanying constipation (134; 56%). Multivariate analysis found endoscopic evaluation (P values 0.024, OR 3.646, 95% CI 1.189–11.178), muscle pain (P values 0.020, OR 24.74, 95% CI 1.67–365.83), and maternal education (P values 0.02, OR 4.45, 95% CI 1.27–15.57) with significant differences in groups of patients with normal and elevated BLL. Elevated BLL necessitates an assessment and plans to reduce childhood lead exposure. BLL screening in childhood constipation with refractory chronic abdominal pain may also eradicate the need for invasive procedures like endoscopic evaluation.

P027 Anorectal Motility Disorders in Inflammatory Bowel Disease patients

Abstract Background In spite of prolonged disease remission of IBD patients, induced by the new biological molecules, a significant number of them suffer from persistent debilitating symptoms with major impact on the quality of life. Frequently, these symptoms are due to post-inflammatory motility changes and misinterpreted as functional disorders. Our aim is to identify and characterize the anorectal motility dysfunction in IBD patients. Methods We are conducting an ongoing prospective study started in August 2019, which includes the IBD patients admitted in a Tertiary Gastroenterology Centre in Bucharest, with specific symptoms (anorectal pain, incontinence, difficult defecation). We perform high resolution anorectal manometry using Sandhill Scientific systems, the parameters being analysed using InSIGHT software. The manometric testing comprise measurements of anorectal pressure at rest, during squeeze, simulated evacuation, rectoanal inhibitory reflex (RAIR) and rectal sensory testing, in compliance with International Anorectal Physiology Working Group protocol. Results We studied 21 patients (12 patients with Ulcerative Colitis and 9 patients with Crohn’s Disease, 15 females and 6 males, mean age 40 (±11.43) years. Only 23.1% (5 patients) had rectal active involvement. Symptoms were reported by 81.0% (17) patients: pain (57.1%), anal incontinence (94.1%), difficult evacuation (29.4%), urgency (64.7%) and intolerance of rectal therapies (35.3%); rectal inflammation was not correlated with the presence of symptoms in our study group (p= 0.53). Modified manometric parameters were found in 81.0% patients and were associated with previous pelvic surgical interventions (p&amp;lt;0.05); although, the latter does not seem to increase the risk of incontinence (p=0.33). In 61.9% cases the manometric measurements correlated with the symptoms. 85% of the patients with passive incontinence presented lower resting pressure and 57.1% of those with active incontinence were found with lower squeeze pressures. Changes compatible with dyssynergia were detected in 61.9% of the cases. Sensory testing revealed alterations in 46.2% of patients, and RAIR was negative in 33.3% of the cases. Conclusion There is a considerable number of patients with anorectal motility changes. Therefore, pelvic floor investigation is an essential tool in the management of IBD patients with anorectal symptoms.

Analysis of living habit risk factors for esophageal cancer in central China: A bi-center case-control study.

Esophageal cancer remains a public health problem in many countries, especially developing countries. The early lifestyle preventive measures mentioned in the treatment guidelines for esophageal cancer are very limited. We aimed to evaluate the risk factors for esophageal cancer in a high-incidence area in China and to provide evidence for clinical intervention in esophageal cancer prevention. Symptom and lifestyle/habit questionnaires including 19 items were designed. The correlation between the occurrence of esophageal cancer and living habits was analyzed retrospectively through questionnaire survey. A total of 708 subjects (365 esophageal cancer, 343 non-esophageal cancer) enrolled from two hospitals in central China (Linzhou Esophageal Cancer Hospital and The Third Xiangya Hospital of Central South University) completed symptom and lifestyle/habit questionnaires. We used conditional logistic regression to estimate the odds ratio (OR) with consideration of 95% confidence interval (CI). The composition ratio analysis showed that the top five lifestyle factors related to esophageal cancer were eating too fast, drinking, hot drinks, smoking and overeating. Univariate analysis showed that 15 factors, including male sex, smoking, drinking, eating too fast, overeating, hot drinks, greasy food, acidic food, hard food, strong tea, coffee, bedtime immediately after meals, eating food before bedtime, difficult defecation, and an overtight belt, were associated with esophageal cancer (all P <0.05). Logistic multivariate regression analysis showed, drinking (OR 3.609, 95%CI 2.223-5.859; P=0.000); hot drinks (OR 2.672, 95%CI 1.786-3.997; P=0.000); overeating (OR 2.110, 95%CI 1.411-3.154; P=0.000); eating too fast (OR 1.879, 95%CI 1.274-2.772; P=0.001); strong tea (OR 1.882, 95%CI 1.171~3.023; P=0.009); hard food (OR 1.723, 95%CI 1.113-2.667; P=0.015); smoking (OR 1.686, 95%CI 1.045-2.720; P=0.032), which were significantly associated with the development of esophageal cancer. The unhealthy lifestyles of patients in high-incidence areas of esophageal cancer in central China are significantly associated with the incidence of esophageal cancer. Lifestyle changes that address these factors, especially overeating and eating too fast, which are rarely studied or discussed despite being common, may improve esophageal cancer management and treatment outcomes. The present results may be used as a reference for preventive education and treatment.

A population-based study on prevalence and predisposing risk factors of infant functional gastrointestinal disorders in a single center in Southern Fujian.

Background and aimThe prevalence of infant functional gastrointestinal disorders (FGIDs) varies across different areas but is largely unknown in southern Fujian. The aim of this study is to evaluate the prevalence of infant FGIDs in southern Fujian according to Rome IV diagnostic criteria.MethodsA cross-sectional prospective questionnaire-based survey was conducted among healthy infants between 0 and 3 months of age in southern Fujian. A total of 1,006 infants who received a physical examination from October 2017 to October 2018 were recruited in this study. Parents or caregivers provided demographic information and completed the questionnaire on gastrointestinal symptoms for infants. Infants with FGIDs were diagnosed using the Rome IV criteria.ResultsBased on the Rome IV criteria, the prevalence of having a FGID in infants is 58.3% (586/1,006). The most common FGIDs in infants were regurgitation (45.7%, 460/1,006), followed by difficult defecation (3.6%, 36/1,006), functional constipation (3.2%, 32/1,006), and colic (2.4%, 24/1,006). No infants fulfilled diagnostic criteria for rumination syndrome and cyclic vomiting syndrome. Among the infants with FGIDs, 457 cases (78.0%, 457/586) were found with single FGID. Combined FGIDs were diagnosed in 129 (22.0%, 129/586) infants; of whom, 21.2% (124/586) had double disorders and 0.9% (5/586) had triple disorders. The most common combined FGIDs were regurgitation and difficult defecation (12.8%), followed by regurgitation and colic (2.4%). Risk factor analysis revealed that younger paternal age (B = 0.424, P = 0.004), paternal history of FGIDs (B = 0.821, P = 0.000), maternal history of FGIDs (B = 0.427, P = 0.012), and probiotics received in infant (B = 0.324, P = 0.032) were associated with an increased risk of infant FGIDs, whereas vitamin D supplementation after birth (B = −0.690, P = 0.000) can reduce the risk of developing FGIDs.ConclusionFGIDs are common in infants living in southern Fujian according to Rome IV diagnostic criteria. The most common FGIDs in infants were regurgitation, difficult defecation, and functional constipation. Factors including younger paternal age, parental history of FGIDs, and the probiotic supplementation in infant showed a significant association with infant FGIDs. Whereas, vitamin D supplementation in infant was found to be a protective factor against FGIDs.

Rectocele: Incidental or important? Observe or operate? Contemporary diagnosis and management in the multidisciplinary era.

More common in older women than younger women, rectoceles may be secondary to pelvic floor weakness and/or pelvic floor dysfunction with impaired rectal evacuation. Rectoceles may be small (&lt;2 cm), medium (2-4 cm), or large (&gt;4 cm). Arguably, large rectoceles are more likely to be associated with symptoms (e.g., difficult defecation). It can be challenging to ascertain the extent to which a rectocele is secondary to pelvic floor dysfunction and/or whether a rectocele, rather than associated pelvic floor dysfunction, is responsible for symptoms. Surgical repair should be considered when initial treatment measures (e.g., bowel modifying agents and pelvic floor biofeedback therapy) are unsuccessful. We summarize the clinical features, diagnosis, and management of rectoceles, with an emphasis on outcomes after surgical repair. This review accompanies a retrospective analysis of outcomes after multidisciplinary, transvaginal rectocele repair procedures undertaken by three colorectal surgeons in 215 patients at a large teaching hospital in the UK. A majority of patients had a large rectocele. Some patients also underwent an anterior levatorplasty and/or an enterocele repair. All patients were jointly assessed, and some patients underwent surgery by colorectal and urogynecologic surgeons. In this cohort, the perioperative data, efficacy, and harms outcomes are comparable with historical data predominantly derived from retrospective series in which patients had a good outcome (67%-78%), symptoms of difficult defecation improved (30%-50%), and patients had a recurrent rectocele 2 years after surgery (17%). Building on these data, prospective studies that rigorously evaluate outcomes after surgical repair are necessary.

Comparison of the effect of polyethylene glycol 40% and fig syrups on the treatment of chronic functional constipation in children: A randomized clinical trial

Background and aims: None of the available constipation treatments for children are completely successful. Therefore, the present study aimed to evaluate the effect of the polyethylene glycol (PEG) solution 40% and fig syrup on the treatment of chronic constipation in children. Methods: In this double-blind clinical trial, 120 patients with chronic functional constipation were selected and divided into two groups. The first group received 5 mL of fig syrup without senna 3 times daily, and the second group took PEG 40% syrup at 1 mL/kg of body weight per day (the dose was adjustable according to the patient’s condition and need). At weeks 0, 2, 4, and 6, a checklist containing questions about children’s constipation was completed by the researcher, and the data were analyzed by SPSS version 24. Results: Changes in the frequency of abdominal pain at fourth times 0, 2, 4, and 6 weeks demonstrated statistically significant differences between the two groups (P=0.044), and it was significantly lower the in PEG group; however, the defecation was not statistically significant (P=0.902). After six weeks, the frequency of painful defecation, difficult defecation straining during defecation, and fear of defecation was significantly lower in the group given PEG syrup compared to the fig syrup-receiving group (P=0.001). Conclusion: Overall, PEG syrup was significantly effective in treating chronic functional constipation in children compared to the fig syrup.

A Study on the Impact of Perioperative Pain Care Management on Pain, Comfort, and Defecation of Patients in Anorectal Surgery.

Purpose The aim of the study is to explore the impact of perioperative pain care management on patients' pain, comfort, and defecation in anorectal surgery. Methods From January to December 2021, 126 patients who underwent anorectal surgery in our department were selected for the study and were randomly divided into a study group and a control group of 63 patients each after consent was obtained from the patients. The control group was given the usual care protocol and the study group was given the perioperative pain care management on top of the usual care. The two groups of patients were compared in terms of postoperative anal pain rating, comfort score, time to first bowel movement and time spent in bowel movement, the Pittsburgh sleep quality index (PSQI) scores at night, related complications, and satisfaction with care. Results ① Postoperative anal pain was less severe in the study group than in the control group (P < 0.05). ② Postoperative comfort scores were higher in the study group than in the control group (P < 0.05). ③ The time to first bowel movement and its duration after surgery were shorter in the study group than in the control group (P < 0.05). ④ Patients in the study group had lower postoperative night-time PSQI scores than the control group (P < 0.05). ⑤ Patients in the study group had a lower rate of postoperative complications than the control group (P < 0.05). ⑥ Patients in the study group had higher postoperative care satisfaction scores than the control group (P < 0.05). Conclusion The application of perioperative pain care management to patients undergoing anorectal surgery plays an important role in reducing anal pain, improving treatment comfort, and relieving difficult defecation symptoms, with significant improvement in postoperative sleep quality and reduction in complications. It is worthy of clinical reference and promotion.