Evacuation Of Faeces Research Articles

Public toilets and their potential impact on an individual's health.

In modern society, people engage in social interactions and activities outside their own home. When in public settings people may need to eliminate bodily waste, so public toilets are required. Accessibility, availability and adaptability are essential principles for safe, private, and purposeful visits to public toilets. A diverse range of individuals use public toilets: various age profiles, all gender groups, vulnerable individuals and people with additional needs. Public toilets essentially need to be a place of privacy, safety and cleanliness to facilitate elimination of urine, evacuation of faeces, management of menstruation, and changing/disposing of continence wear products in a secure environment.

Rheology of human faeces and pathophysiology of defaecation.

Rectal evacuation involves multiple mechanisms that are not completely understood. The aim of this study was to quantify the rheologic property, i.e., yield stress, which governs the ease of deformation of a range of faeces of differing consistency and understand its influence on the pathophysiology of defaecation. Yield stresses of faeces of differing consistencies and Bristol scores were determined by the Vane test. We then explored the effects of this property on ease of defecation using a simple static model of the recto-anal junction based on the laws of flow for yield stress pastes and checked the conclusions by X-ray defaecography experience. The yield stress of faeces increased exponentially with their solid content, from 20 to 8000Pa. The static model of the recto-anal junction showed that evacuation of faeces of normal consistency and yield stress is possible with moderate dilatation of the anal canal, whilst the evacuation of faeces with higher yield stress requires greater dilatation of the anal canal. X-ray defaecography showed that such increases occurred in vivo. The diameter of the recto-anal junction is increased to enable the passage of feces with high yield stress. The finite limits to such dilation likely contribute to fecal impaction. Hence, difficulties in defaecation may result either from unduly high yield stress or pathologies of reflex recto-anal dilatation or a combination of the two.

Su1549 Colonic Preparation Before Colonoscopy: Evaluation of a New Method With Intracolonic Infusion of Water Compared to Classical Administration of PEG

Bowel cleansing before colonoscopy is currently based upon lavage solutions of polyethylene glycol (PEG) or NaP with large amounts of fluids ingested in a splitted manner. This prospective randomized study compared a PEG protocol with a new method of bowel cleansing based upon infusion of water into the colon at low pressure (PrepSystem, novoGI, Netanya, Israel). Patients and Method: The device for water infusion (novoGI, Lifestream, Austin, TX) is made of a reservoir of water maintained at 37°C. The patient is installed on an adapted seat allowing easy evacuation of water and faeces. Water is infused by gravity through a cannula, into the rectum. Patients with an indication of colonoscopy and no history of colorectal surgery or IBD were randomly assigned to PEG preparation (2L PEG in the evening before and 2L in the morning of colonoscopy) or the Prepsystem. All patients followed a low residue diet for 5 days. In the Prepsystem group, sennosides (Pursennide 80mg, Novartis, Rueil Malmaison, France) were administered in the evening before and patients underwent 2 cleansing cycles, by infusion of 35L tap water each, about one hour before the colonoscopy. Quality of bowel cleansing was assessed with the Boston score by an endoscopist blinded to the preparation type. Boston scores in both groups were compared with a non-parametric test, with a signifcance level of 5%.

HCA study day: long-term bowel management

Teams of healthcare assistants (HCAs) supply most of the day-to-day care needs of spinal cord injury patients within their own homes, including establishing and maintaining a long-term bowel management regime. There can also be similar care needs for continuing healthcare patients (e.g. motor neurone, multiple sclerosis, stroke patients) when HCAs will work as part of a district nursing team providing bowel management care. A training need was identified for staff to secure competencies in Digital Rectal Examination (DRE) and Manual Evacuation of Faeces (MEF) as well as basic bowel and peri-anal assessment. One area which was highlighted as an urgent training need was the recognition and identification of the life-threatening emergency condition of autonomic dysreflexia, which only affects spinal cord injury patients.

Review of the efficacy and safety of transanal irrigation for neurogenic bowel dysfunction

Neurogenic bowel dysfunction (NBD) is a common occurrence after spinal cord injury (SCI) and in patients with spina bifida or multiple sclerosis. The impact of NBD on well-being is considerable, affecting both physical and psychological aspects of quality of life. Transanal irrigation (TAI) of the colon promotes the evacuation of faeces by introducing water into the colon and rectum through a catheter inserted into the anus. Regular and controlled evacuation in this manner aims at preventing both constipation and faecal soiling. The aim of this study was to review current evidence for the efficacy and safety of TAI in patients with NBD. A literature search was conducted in PubMed. All identified papers were assessed for relevance based on the title and abstract; this yielded 23 studies that were considered to be of direct relevance to the topic of the review. A multicentre, randomized, controlled trial has supported observational reports in demonstrating that TAI offers significant benefits over conservative bowel management in patients with SCI, in terms of managing constipation and faecal incontinence, reducing NBD symptoms and improving quality of life. Among other populations with NBD, TAI shows the greatest promise in children with spina bifida; however, further investigation is required. The overall safety profile of TAI is good, with few, and rare, adverse effects. Building on the positive data reported for patients with SCI, continued evaluation in the clinical trial setting is required to further define the utility of TAI in other populations with NBD.

Function of the human colon.

Despite the volume of research on human colonic dysfunction, little is known about colonic function in health. This has stemmed partly from the difficulty in obtaining access to the organ. Two approaches have been used: studies on patients with stomas, and intestinal intubation techniques. The colonoscope has also recently been used to gain access. All these methods have limitations and results must be interpreted with caution. The accepted roles of the colon include the conservation of water and electrolytes and the controlled evacuation of faeces. Recent research has demonstrated its importance as a metabolic organ with an influence on overall metabolism, an effect that may in large part be attributed to the activity of colonic microflora. Evidence demonstrating that the defunctioned colon behaves differently from the functioning colon in the same individual has implications for a proper understanding of the organ, as practically all previous in vivo studies have been conducted in cleansed or defunctioned human colon.

The law and intimate examinations and treatments

District nurse Sister Mary Green cares for a patient left bed-bound when a road traffic accident damaged her spine. Continence management is a particular nursing problem and, following discussion with her consultant at the spinal injury centre, her GP is now recommending manual evacuation of faeces as the best form of bowel management. Sister Green is concerned by this proposal as the patient has become extremely distressed on previous occasions when a simple digital rectal examination was performed. She wonders if such intimate procedures are lawful.

Anale Inkontinenz

Das Spektrum der analen Inkontinenz, das heisst der Verlust der willkürlichen Kontrolle von Darminhalt, reicht von geringen Stuhlspuren in der Unterwäsche über den Verlust von Winden bis hin zu massiven Episoden des unkontrollierbaren Abganges von weichem oder festem Stuhl. Es handelt sich dabei um beschämende Symptome, deren Ursachen vielschichtig und komplex sein können. Der häufigste ätiologische Faktor bei Frauen ist die geburtstraumatische Schädigung des Beckenbodens. Fachärzte/innen und Allgemeinmediziner/innen sind sich häufig nicht bewusst, dass es sich bei der analen Inkontinenz um ein behandelbares Leiden handelt, das mit geeigneten diagnostischen Tests und anschliessender, individueller Therapie die Lebensqualität der Betroffenen signifikant verbessern kann.

The prevalence of constipation in institutionalized people with intellectual disability.

Constipation is a common problem in people with intellectual disability (ID). Laxatives are frequently prescribed with disappointing results. The prevalence of constipation was investigated in a random population of 215 people with ID (IQ < 50) and constipation was correlated with clinical symptoms. All subjects were scored for bowel habits. Constipation was defined as having a bowel movement less than three times a week or the necessity of using laxatives more than three times a week. Further possible accompanying factors were evaluated. The control subjects were defined as individuals who did not use laxatives. Subjects with constipation were defined as patients and were compared to subjects without constipation (controls). One hundred and forty-nine out of 215 cases (69.3%) showed constipation. Constipation was significantly correlated with non-ambulancy, cerebral palsy, the use of anticonvulsive medication or benzodiazepines, H2-receptor antagonists or proton pump inhibitors, food refusal, and an IQ < 35. Fifty-eight per cent of the patients used bisacodyl or magnesium oxide, 39% lactulose, 13% sodiumlaurylsulphoacetate/sodium citrate/sorbitol and only 10% were given sodium phosphate enemas. Faecal soiling was found in 15% of subjects, while manual evacuation of faeces was performed in nearly 7% of cases. Constipation was randomly demonstrated in almost 70% of the population with ID. Subjects with the above-mentioned accompanying factors are especially at risk for constipation. Contrary to the general population, constipation in people with ID is associated with little use of phosphate enemas, microlax, a low incidence of faecal soiling and manual evacuation of faeces, suggesting an aetiology without distal faecal impaction. The regimen and effect of therapy has to be studied to define adequate treatment schedules.

Evacuation of faeces

Evacuation of faeces

Control of defecation in patients with spinal injuries by stimulation of sacral anterior nerve roots.

To observe the effects of stimulation of the sacral anterior roots on anorectal and low colonic pressures and to programme implanted stimulators to produce defecation. Prospective study of 12 consecutive patients. Spinal injuries unit and university gastrointestinal physiology department. 12 Patients with complete supraconal spinal cord lesions. Their injuries had been sustained at least two years before the study. A Brindley-Finetech intradural sacral anterior root stimulator was implanted in all patients. Three months postoperatively the stimulator settings were adjusted after measurement of simultaneous anorectal and low colonic pressures. Full defecation. Six patients achieved complete rectal evacuation of faeces using the implant and subsequently did not require manual help for defecation. For all but one of the patients the total time taken to complete defecation was reduced, and all were free from constipation, the most prevalent gastrointestinal symptom in patients with spinal injuries. Sacral anterior root stimulators can be programmed to achieve complete unassisted defecation and can considerably improve the quality of life of patients with spinal injuries.