Hard Stools Research Articles

Ayurvedic Review On Vibandha in Pediatric Age

Constipation is a disease condition resembling Vibandha or Badhapurish described in Ayurveda. Vibandha is a commoncondition seen in childhood and one of the main reasons for increased parental concerns. It presents with the difficulty child facesin defecation associated with hard stools and infrequent bowel movements. The peak incidence of constipation in the Pediatricage group is at 2–5 years of age. Most children report constipation due to Hetus like Vata Dushita Stanya Sevana, Krimi, Parish Vega-Vidharana, etc. It leads to the vitiation of Samprapti Ghatak like Amotpatti, Vata Prakopa, and Jatharagni Mandya, which ultimatelycauses Vibandha to the child. Vibandha has various complications like Chardana, Rasa Kshaya, Karshya, etc. Constipation is easier toprevent than to treat by following maintenance with adequate exercise, fluid intake, and a high-fiber diet. The treatment of Vibandhaincludes Nidan Parivarjana and Dipan, Pachan Anulomana, Bhedana, Rechana, etc. Here one attempt is made to introduce Vibandhaas a disease in children. The main objectives are to introduce Vibandha as a disease by detailing Nidan Panchak, especially the Rupa,Samprapti, etc., and to establish a missing link between them.

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.

Efficacy of washed microbiota transplantation for therapeutic targets of refractory functional constipation and the influencing factors: a single-center, retrospective, 24-week follow-up study

BackgroundThe efficacy of washed microbiota transplantation (WMT) in terms of refractory functional constipation (FC)-related therapeutic targets and influencing factors have not been elucidated. This study aimed to assess the efficacy and influencing factors of WMT in treating refractory FC-related therapeutic targets.MethodsThe clinical data of patients diagnosed with refractory FC and received with WMT were retrospectively collected. The therapeutic targets included straining, hard stools, incomplete evacuation, a sense of anorectal obstruction, manual maneuvers, and decreased stool frequency. Each target was recorded as 1 (yes) or 0 (no). All patients were followed up for approximately 24 weeks from the end of the first course of WMT. The primary outcomes were the improvement rates for the individual therapeutic targets and the overall response in respect of the therapeutic targets decreased by 2 at weeks 4, 8, and 24. The secondary outcomes were the clinical remission rate (i.e., the proportion of patients with an average of 3 or more spontaneous complete bowel movements per week), clinical improvement rate (i.e., the proportion of patients with an average increase of 1 or more SCBMs/week or patients with remission), stool frequency, Wexner constipation score, Bristol Stool Form Scale (BSFS) score, and adverse events. The factors influencing the efficacy were also analyzed.ResultsOverall, 63 patients with 112 WMT courses were enrolled. The improvement rates at weeks 8 and 24 were 45.6% and 35.0%, 42.9% and 38.6%, 45.0% and 35.7%, 55.6% and 44.4%, and 60.9% and 50.0%, respectively, for straining, hard stools, incomplete evacuation, a sense of anorectal obstruction, and decreased stool frequency. The overall response rates were 49.2%, 50.8%, and 42.9%, respectively, at weeks 4, 8, and 24. The rates of clinical remission and clinical improvement were 54.0% and 68.3%, respectively, at weeks 4. The stool frequency, BSFS score, and Wexner constipation score tended to improve post-WMT. Only 22 mild adverse events were observed during the 112 WMT courses and the follow-up. The number of WMT courses was identified to be the independent factor influencing the efficacy.ConclusionsWMT is efficacious in improving refractory FC-related therapeutic targets. The effectiveness of WMT in the management of FC is enhanced with the administration of multiple courses.

Prospective evaluation of bowel function and quality of life after colon cancer surgery – is it time for routine screening for late sequelae?

Aim Bowel dysfunction after colon cancer (CC) surgery is widely neglected in current follow up programmes. This study explored changes in bowel function and quality of life (QoL) from three (3 m) to twelve months (12 m) after surgery in CC patients undergoing right- or left-sided colon resection (RightSCR/LeftSCR) and investigated differences between the two groups 12 m after surgery. Method CC patients undergoing surgical resection in 2018–2020 at five surgical departments were included in this population-based prospective cohort study. Included patients completed electronic surveys consisting of a collection of validated scores 3 m and 12 m after surgery. Results A total of 708 CC patients (423 RightSCR, 285 LeftSCR) were included. In RightSCR, no improvement was observed from 3 m to 12 m in most scores/items, on the contrary, symptom worsening in flatus- and faecal incontinence and urgency was observed (p < 0.05). Also, the proportion of patients rating their bowel function as very good/good decreased (p < 0.05) in this group. In LeftSCR improvement was found in flatus and faecal incontinence, urgency and night-time defaecation (p < 0.02), while no improvement was observed in the remaining scores/items. At 12 m, higher proportions of RightSCR than LeftSCR reported loose stools, incontinence and urgency (all p < 0.001), whereas LeftSCR more often reported hard stools and flatus incontinence (p < 0.05). Among all CC patients 18.3% reported bowel-related impairment of QoL at 12 m with no differences between the two groups. Conclusion From 3 m to 12 m no significant change was observed in the majority of bowel function and QoL scores/items, however, some symptoms worsened in RightSCR, while a few improved in LeftSCR. Bowel dysfunction and impaired QoL were still common in both groups at 12 m, although the symptom pattern differed between the groups. These findings call for a systematic screening for bowel dysfunction to ensure early treatment of symptoms.

Co-occurrence of fecal incontinence with constipation or irritable bowel syndrome indicates the need for personalized treatment.

This study aimed to compare the prevalence and symptoms of fecal incontinence (FI) in relation to irritable bowel syndrome (IBS-associated FI), constipation (constipation-associated FI), and isolation (isolated FI). Data were analyzed from 3145 respondents without organic comorbidities known to influence defecation function from the general Chinese population who filled in the online Groningen Defecation and Fecal Continence questionnaire. FI, IBS, and constipation were evaluated with the Rome IV criteria. The prevalence of FI was 10.5% (n = 329) in the non-comorbidity group. After multivariable logistic regression analysis, IBS (odds ratio [OR]: 12.55, 95% confidence interval [CI]: 9.06-17.36) and constipation (OR: 4.38, 95% CI: 3.27-5.85) were the most significant factors contributing to FI. Based on this finding, 106/329 (32.2%) had IBS-associated FI, 119/329 (36.2%) had constipation-associated FI, and 104/329 (31.6%) had isolated FI. Among the 329 FI respondents, there was a high prevalence of IBS and constipation-related symptoms, including abdominal pain (81.5%) and abdominal bloating (77.8%) for IBS and straining during defecation (75.4%), incomplete defecation (72.3%), defecation blockage (63.2%), anal pain during defecation (59.3%), and hard stools (24%) for constipation. The patients with IBS-associated FI asked for specialists' help less frequently than those with isolated FI. Interestingly, among the patients with constipation-associated FI, 56.3% used anti-diarrhea medicine. The prevalence of IBS-associated FI, constipation-associated FI, and isolated FI is comparably high. It is important to diagnose and target the cause of FI to provide personalized and cause-targeting care instead of treating only the FI symptoms.

Ayurveda management of jaundice: A case study

Abstract Jaundice is a yellow discoloration of the body’s tissues from excess bilirubin (hyperbilirubinemia). According to the Ayurveda perspective, the clinical presentation of jaundice can be correlated with that of the disease Kamala. We present a case of a 10-year-old female patient who attained the outpatient department with complaints of anorexia, poor appetite, general weakness, abdominal pain, and hard stools since 10 days. The examination revealed yellow discoloration of the sclera, oral mucosa, skin, urine, and hard yellowish stool, and the blood investigation revealed elevated level of serum bilirubin, serum glutamic-oxaloacetic transaminase, serum glutamic-pyruvic transaminase, and alkaline phosphatase. The case was managed with Tab Liv 52 DS, 1 tab twice a day and Tab Nirocil, 1 tab twice daily before food with lukewarm water. Mridu Virechana (mild purgation) was done using a combination of Avipatikar Churna 2 gm twice a day and Kutki Churna (powder of Picrorhiza kurrooa) 1 gm twice a day with lukewarm water for 4 weeks. These medications effectively improved the clinical symptoms, and the appetite increased, the patient became more active, and the icterus decreased. The patient also started passing normal stool and urine. complete blood count, liver function test , and urine examination revealed that the values were within the reference range. This combination can be utilized for symptoms of Koshthashrita Kamala.

Bowel movement frequency, stool consistency, and risk of disabling dementia: a population-based cohort study in Japan

ObjectivesThis population-based study aimed to evaluate the association between bowel habits from midlife and dementia. Study designThis was a cohort study using certification records for national long-term care insurance in Japan. MethodsParticipants aged 50 to 79 years who reported bowel habits from eight districts within the Japan Public Health Center-based Prospective Study (JPHC Study) were followed from 2006 to 2016 for incident dementia. Hazard ratio (HR) and 95% confidence interval (CI) were estimated for men and women separately using Cox proportional hazards models accounting for various lifestyle factors and medical histories. ResultsAmong 19,396 men and 22,859 women, 1889 men and 2685 women were diagnosed with dementia. In men, the multivariable-adjusted HRs compared with bowel movement frequency (BMF) of once/day were 1.00 (95% CI: 0.87–1.14) for twice/day or more, 1.38 (1.16–1.65) for 5–6 times/week, 1.46 (1.18–1.80) for 3–4 times/week, and 1.79 (1.34–2.39) for <3 times/week (P for trend <0.001). In women, the corresponding HRs were 1.14 (0.998–1.31), 1.03 (0.91–1.17), 1.16 (1.01–1.33), and 1.29 (1.08–1.55) (P for trend = 0.043). Harder stool was associated with higher risk (P for trend: 0.0030 for men and 0.024 for women), with adjusted HRs compared to normal stool of 1.30 (1.08–1.57) for hard stool and 2.18 (1.23–3.85) for very hard stool in men, and 1.15 (1.002–1.32) and 1.84 (1.29–2.63) in women. ConclusionsLower BMF and harder stool were each associated with higher risk of dementia.

What are Normal Defecation Patterns in Healthy Children up to Four Years of Age? A Systematic Review and Meta-Analysis

To summarize available data on defecation frequency and stool consistency of healthy children up to age 4 in order to estimate normal references values. Systematic review including cross-sectional, observational, and interventional studies published in English, that reported on defecation frequency and/or stool consistency in healthy children 0-4years old. Seventy-five studies were included with 16 393 children and 40 033 measurements of defecation frequency and/or stool consistency. Based on visual inspection of defecation frequency data, a differentiation was made between two age categories: young infants (0-14weeks old) and young children (15weeks-4years old). Young infants had a mean defecation frequency of 21.8 per week (95 % CI, 3.9-35.2) compared with 10.9 (CI, 5.7-16.7) in young children (P<.001). Among young infants, human milk-fed (HMF) infants had the highest mean defecation frequency per week (23.2 [CI, 8.8-38.1]), followed by formula-fed (FF) infants (13.7 [CI 5.4-23.9]), and mixed-fed (MF) infants (20.7 [CI, 7.0-30.2]). Hard stools were infrequently reported in young infants (1.5%) compared with young children (10.5%), and a reduction in the frequency of soft/watery stools was observed with higher age (27.0% in young infants compared with 6.2% in young children). HMF young infants had softer stools compared with FF young infants. Young infants (0-14weeks old) have softer and more frequent stools compared with young children (15weeks-4years old).

Outcome of Functional Constipation in Children Age 1 to 12 Year in Tertiary Care Hospital

Background: Both parents and children are bothered by constipation. Even then, it continues to go untreated, delaying medical intervention. It causes both physical and psychological morbidity. It has an impact on children's quality of life. The issue is exacerbated by delayed medical care. The young person could become less confident. Children may experience impaction of the faeces in 1%–3% of cases, which can result in faecal matter soiling. Aim: To investigate the outcomes of functional constipation in children between the ages of 1 and 12 in tertiary care facilities. Methodology: After receiving ethical approval from the committee, this cross-sectional study was conducted at Lady Reading Hospital in Peshawar from June 2021 to May 2022. The study included a total of 381 children’s. After obtaining parental assent, the ROME IV criteria was applied to the children who had functional constipation, and the children were treated according to the recommended recommendations and protocols. Result: 381 kids were enrolled in a study using the Rome IV criteria for constipation manifestation. The ratio was highest when passing 188 hard stools (49.34%) and lowest when passing 13 unpleasant stools (22.30%). Similar high ratio was observed in type-1 129(33.83%) of Bristol stool type. The ratio of males to females in the age range 3-6 year group was highest in the age group 6-12 year group, with 166 males and 63 females. The majority of restrooms (65.09%) were located outside door 248. Constipation-causing factors were shown to be highest in avoiding school lavatory use 181(47.50%) and lowest in opposing behavior 73(19.16%). History of food intake revealed a high ratio of 211(55.38%) from stores and a low ratio of 13(3.41%) from home-cooked meals. The hygienic care ratio was 178(46.71%) for not using water and soap and 19(4.98%) for using soap after using the loo.By exposing the concerns and their solutions for the health of their children, this will raise mothers' knowledge and be beneficial to society as a whole. Conclusion: All children need hygienic care and adequate education as a foundation. Dietary nutrition is crucial for growth. Children who are taken to the hospital may develop phobias and parents may experience problems. Children who are not properly treated for constipation are more likely to have serious psychological harm and bowel dysfunction. Keywords: Children, constipation, phobia, temper, education, food

CLINICAL PROFILE OF FUNCTIONAL CONSTIPATION IN CHILDREN

Introduction:Constipation causes physical, psychological morbidity and poor quality of life Data from developed countries shows that prevalence of childhood constipation in general population ranges from 0.7-29.6%. Various studies have showed pain of passing hard stools in infancy and early childhood is the principal contributing factor for acute childhood constipation, leading to constipation and soiling in adulthood. Because of lack of awareness regarding common occurrence of childhood constipation and its proper management, it is often underdiagnosed and sub optimally managed. Hence, this study was conducted to study the frequency of constipation and risk factors in children attending tertiary care hospital in rural Bangalore. Materials and methods: A total of 50 children attending pediatric OPD with constipation were surveyed at MVJ Medical College and Research Hospital, Bangalore. Children who fulfilled the ROME III criteria for constipation were analyzed for demographic profile, socio-economic status, psychosocial aspects and dietary habits affecting bowel pattern. Data was collected and recorded from the parents in pre-fixed proforma which also included Stool frequency and type of stool passed . Results: A total of 50 children fulfilled the ROME III criteria for functional constipation. The constipation in children had male preponderance and majority were aged 2-4 years. Majority of constipated children (62%, n=31) had retention behavior in the form of abnormal posturing. In children with constipation, the average number of stools passed in a week is 2.05. Conclusions: Constipation is an iceberg disorder. Skipping breakfast, early toilet practicing, low intake of vegetables and fruits , marital disharmony, sibling rivalry ,temper tantrums , school phobia , aversion to use school toilet were factors leading to constipation.

Effects of dietary fibers or probiotics on functional constipation symptoms and roles of gut microbiota: a double-blinded randomized placebo trial

ABSTRACT Dietary fibers/probiotics may relieve constipation via optimizing gut microbiome, yet with limited trial-based evidences. We aimed to evaluate the effects of formulas with dietary fibers or probiotics on functional constipation symptoms, and to identify modulations of gut microbiota of relevance. We conducted a 4-week double-blinded randomized placebo-controlled trial in 250 adults with functional constipation. Intervention: A: polydextrose; B: psyllium husk; C: wheat bran + psyllium husk; D: Bifidobacterium animalis subsp. lactis HN019 + Lacticaseibacillus rhamnosus HN001; Placebo: maltodextrin. Oligosaccharides were also included in group A to D. 16S rRNA sequencing was used to assess the gut microbiota at weeks 0, 2, and 4. A total of 242 participants completed the study. No time-by-group effect was observed for bowel movement frequency (BMF), Bristol stool scale score (BSS), and degree of defecation straining (DDS), while BSS showed mean increases of 0.95–1.05 in group A to D (all P < 0.05), but not significantly changed in placebo (P = 0.170), and 4-week change of BSS showed similarly superior effects of the interventions as compared placebo. Group D showed a marginal reduction in plasma 5-hydroxytryptamine. Group A resulted in a higher Bifidobacterium abundance than placebo at week 2 and 4. Fourteen genera showed intervention-specific increasing or decreasing trends continuously, among which Anaerostipes showed increasing trends in groups B and C, associated with BMF increase. Random forest models identified specific baseline microbial genera panels predicting intervention responders. In conclusion, we found that the dietary fibers or probiotics may relieve hard stool, with intervention-specific changes in gut microbiota relevant to constipation relief. Baseline gut microbiota may predispose the intervention responsiveness. ClincialTrials.gov number, NCT04667884.

Efficacy of Palashgudavarti and Diclofenac Sodium Suppository in the management of Acute fissure in ano

Introduction: Parikartika is most common ano-rectal disorder. The text of parikartika is mentioned in Samhitas. In this disease there are symptoms such as bleeding per rectum, hard stools, burning sensation around anal region. In this trial, group A (n=30) included Palashadigudavarti, whereas group B included Diclofenac sodium suppository for administration over Parikartika (acute anal fissures). Gandharva haritaki choorna acts as laxative and helps to relieve constipation and sitz bath was given to both group as conservative management.. Materials and method: Literary aspect of the study was collected from classical Ayurvedic and contemporary text and updated with recent medical journals, previous research work done on same topic. Observation and results: Assessment was done by the parameters such as pain, bleeding and itching as Subjective and healing as Objective Parameter. Results were obtained by statistical analysis. Discussion: In this research work Palash, Goghrita and Beewax as suppository base was used in the form of varti application (advanced anal Suppository) for managing Anal fissure. There is need of ayurvedic suppository easily available in market which will relieves anorectal symptoms instantly, because repeated use of diclofenac sodium have side effect to the body. In the present case series, it proved to be significant in managing Fissure in ano, it reduced pain, itching, bleeding and promoted healing. Conclusion: In the treatment of Parikartika, Palashadigudavarti was more effective than Diclofenac sodium suppository&#x0D; Keywords: Parikartika, fissure in ano, Palashadigudavarti, Diclofenac Sodium Suppository.

Effects of Tiaopi Xiezhuo decoction on constipation and gut dysbiosis in patients with peritoneal dialysis

Context A Chinese herbal formula, Tiaopi Xiezhuo decoction (TXD), is developed from a classical Chinese prescription Sanhuang Xiexin decoction. Objective To investigate the regulatory effect of TXD on gut dysbiosis, as a treatment of constipation in patients with peritoneal dialysis (PD). Materials and methods The chemical content of TXD was assessed by high-performance liquid chromatography. A total of 29 PD patients were enrolled and treated with TXD orally (3 g crude drug/each/twice/day) for 3 months. Blood and faecal samples were collected at the beginning and end, to determine the changes in biochemical characteristics and gut microbial composition. The stool conditions were asked to be scored. Additional 30 healthy individuals were recruited as a control for the analysis of gut microbiota. Results Although having no significant effects on serum biochemical characteristics, 3-month TXD intervention improved constipation in PD patients: decreased 80% abdominal distention (p < 0.01), increased 2.6-fold sloppy stools (p < 0.05) and eliminated hard stool completely (p < 0.01). The analysis of gut microbiota showed that, compared to the healthy group, the microbial richness was reduced in PD patients. After a 3-month TXD treatment, this reduced richness was raised, and Paraprevotella clara, Lachnospiraceae bacterium 2-146FA, Phascolarctobaterium succinatutens, Lachnospiraceae bacterium 2-1-58FAA, Fusobacterium mortiferum, and Prevotella copri were accumulated in the intestinal flora. Furthermore, the bacterial species enriched by TXD correlated with the improvement of constipation. Discussion and conclusions TXD treatment may improve constipation by modulating gut dysbiosis in PD patients. These findings provide data to support the further application of TXD in the adjuvant treatment of PD.

A descriptive study on symptoms of Parkinson’s disease in an Indian cohort from Karnataka

Introduction and Aim: Parkinson’s Disease (PD) is a multifactorial neurodegenerative disorder with ever-changing motor and nonmotor symptoms. Disease treatment is modified accordingly with the progression of the disease. The present study was carried out to understand the symptoms reported by PD subjects in different phases of the disease.&#x0D; &#x0D; Materials and Methods: Demographic and clinical details were obtained using questionnaires to evaluate the frequency and severity of various motor and nonmotor symptoms experienced by the PD subjects.&#x0D; &#x0D; Results: Ageing was strongly associated with the onset of disease, whereas the BMI category adversely correlated with other motor symptoms (OMS), nonmotor symptoms (NMS), and specifically gastrointestinal symptoms. Tremors were the most troublesome cardinal motor symptoms, followed by stiffness and bradykinesia. The most common NMS were fatigue/tiredness, anxiety/depression, insomnia, constipation, and cognitive impairment. Anxiety and depression were positively associated with other NMS symptoms such as insomnia, fatigue and exhaustion, apathy, and gastrointestinal problems. More than half of our patients reported gastrointestinal discomfort, early satiety, appetite decrease, and bloating. In our present investigation, the most common gastrointestinal symptoms linked with constipation were straining evacuation, lumpy hard stool, and incomplete evacuation.&#x0D; &#x0D; Conclusion: We have analysed the frequency and trend of various symptoms associated with PD in an Indian population from Karnataka. A significant correlation exists between motor and nonmotor symptoms, which impacts the quality of life in PD during the course of the disease.

Atopic dermatitis is associated with abnormal stool form: a population-based cross-sectional study in college students.

Atopic dermatitis (AD) is a chronic inflammatory skin disorder. Bristol Stool Form Scale (BSFS) is a widely used stool scoring method that could indirectly reflect intestinal function. To evaluate the associations of AD with BSFS. This was a population-based cross-sectional study of freshmen in five universities of China. AD diagnosis was performed by dermatologists according to the guideline from the American Academy of Dermatology. BSFS and covariates were collected through an online questionnaire survey. Chronic itch scores were assessed by the numeric rating scales and grouped into quartiles (Q). Mixed logistic regression models were used. Subgroup analysis was conducted by covariates. P value < 0.05 was considered statistically significant. The prevalence of hard stools and loose stools were 8.9% and 7.6%, respectively (20,049 participants). After adjusting covariates, AD was significantly associated with hard stools (OR = 1.38, P < 0.001) and loose stools (OR = 1.24, P = 0.037). In subgroup analysis of hard stool, a stronger effect was observed in intake of milk (> 3days/week), yogurt (> 3days/week), pork (< 1day/week), and higher itch scores (Q4). This study found the relationship between AD and abnormal stool forms, and the association with hard stools might be modified by dietary factor.

A234 PARASITIC INFECTION MIMICKING CROHN'S DISEASE: AN UNUSUAL PRESENTATION OF LOWER GASTROINTESTINAL SCHISTOSOMIASIS

Abstract Background Chronic intestinal schistosomiasis (CIS) is a disease caused in humans by infection with one of seven schistosome species. These species are predominantly found in Africa, South America, and East Asia. Symptoms of CIS include abdominal pain, anorexia, weight loss and diarrhea. In cases of large parasitic burden, overt gastrointestinal bleeding can occur. To our knowledge there are only three other cases of CIS mimicking Crohn's Disease that have been published in the literature. In each of these cases, this was associated with ileal disease, perianal fistulas, or both. Purpose We present the first case of CIS in North America that mimicked Crohn's Disease on imaging with no associated ileal or visible perianal disease. Method Case report of a patient presenting to a tertiary care hospital in Edmonton, Alberta. Result(s) A 47 year old man who recently immigrated from Eritrea presented to the emergency department in June 2020 with red blood per rectum. Digital rectum exam revealed small external hemorrhoids. He was discharged with a plan for outpatient abdominal CT scan and colonoscopy. He presented again to the emegency department in January 2021 where he complained of back pain exacerbated by bowel movements productive for small, hard stool. He also began seeing white discharge mixed with his stool. His back pain, white discharge, and blood-streaked bowel movements persisted for over a year, and he developed perianal pain that was exacerbated by valsalva. A CT scan of the abdomen/pelvis revealed extensive soft tissue swelling in the anorectal region, extraluminal gas, and a 15mm fluid collection adjacent to the coccyx. A diagnosis of fistulizing Crohn's Disease was suspected. A digital rectal exam and colonoscopy were performed September 19, 2022 which revealed small hemorrhoids but otherwise endoscopically normal colonic and ileal mucosa. Biopsies from the rectum revealed eosinophilic granulomas associated with parasitic ova; a diagnosis of schistosomiasis was made. Image Conclusion(s) CIS is a rare diagnosis in North America. It is unusual for this disease entity to present is a mimic of fistulizing Crohn's Disease. This case report reminds the clinician that a high index of suspicion in patients presenting from endemic regions is required to make this diagnosis. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

An Integrative Ayurvedic Approach In Management Of Shashtrakruta (Post-Operative) Complicated Gudajacharmakeela Arsha(Anal Warts) – A Rare Case Report

CharmakeelaArsha (Anal warts) are small growths in and around the anal region caused by the human papillomavirus (HPV). The patient, the age 39- years female, came to O.P.D. of shalyatantra complaining of baddhamalapravruti (hard stools), sarakta malapravruti (bleeding per rectum on and off), Guda pradeshi Mamsankura prachiti (feeling of mass at anal region), sashoola malapravruti (pain during and after defecation) since six months. Clinically diagnosed patient as a case of Charmakeelaarsha (anal warts) with internal piles and sentinel tag. Chedana (Excision) of anal warts and Sentinel tag by Agnikarma (electric cautery) was performed with ligation haemorrhoidectomy under spinal anaesthesia. It is challenging to manage post-operative wound healing with simple ointments. So there is a need to intervene in the ayurvedic ointments and treatment of post-operative wounds to heal them faster with no complications. After the operative procedure, the patient was managed with Ayurvedic protocols like laghu ahara, deepana, panchana, Virecheniya dravya, and Vranaropaka ointment for 15 days. The patient was assessed by Subjective and Objective parameters like the Numerical pain Scale, WHO are bleeding Scale, and VranaPariksha based on signs and Symptoms. The patient showed improvement in signs and Symptoms on the 15th Day. After two months of follow-up, the patient recovered well, and no recurrence or complaint was observed. Hence, such a study is more important for better wound healing and pain management. Instead of taking more extended oral therapies or anaesthetic blocks in post-operative management, the short procedure, like the present study, can save time. This case proved the efficacy of ayurvedic management in Shashtrakruta Charmakeela Arsha.

Clinical significance and related factors of rectal hyposensitivity in patients with functional defecation disorder.

Rectal hyposensitivity (RH) is not uncommon in patients with functional defecation disorder (FDD). FDD patients with RH are usually unsatisfied with their treatment. The aim of this study was to find the significance of RH in patients with FDD and the related factors of RH. Patients with FDD first completed clinical questionnaires regarding constipation symptoms, mental state, and quality of life. Then anorectal physiologic tests (anorectal manometry and balloon expulsion test) were performed. Rectal sensory testing (assessing rectal response to balloon distension using anorectal manometry) was applied to obtain three sensory thresholds. Patients were separated into three groups (non-RH, borderline RH, and RH) based on the London Classification. The associations between RH and clinical symptoms, mental state, quality of life, and rectal/anal motility were investigated. Of 331 included patients with FDD, 87 patients (26.3%) had at least one abnormally elevated rectal sensory threshold and 50 patients (15.1%) were diagnosed with RH. Patients with RH were older and mostly men. Defecation symptoms were more severe (p = 0.013), and hard stool (p < 0.001) and manual maneuver (p = 0.003) were more frequently seen in the RH group. No difference in rectal/anal pressure was found among the three groups. Elevated defecatory desire volume (DDV) existed in all patients with RH. With the number of elevated sensory thresholds increasing, defecation symptoms got more severe (r = 0.35, p = 0.001). Gender (male) (6.78 [3.07-15.00], p < 0.001) and hard stool (5.92 [2.28-15.33], p < 0.001) were main related factors of RH. Rectal hyposensitivity plays an important role in the occurrence of FDD and is associated with defecation symptom severity. Older male FDD patients with hard stool are prone to suffer from RH and need more care.

Genjer Extract As An Alternative Preventing Constipation In Pregnancy

Background : Constipation is a problem that is always disturbing in pregnant women, in general trimester pregnant women 3. Constipation is a difficult condition or unable to defecate, hard stool, a sense of defecation is not complete (there is a sense of wanting to defecate but unable to remove it) accompanied by complaints of the stomach feeling full and bloating. If this problem is left alone it will have an impact on the process of childbirth and childbirth. Objectives : The purpose of this study can be seen the effect of giving genjer extract as an alternative to prevent constipation during pregnancy at PMB Rusmiati Karang Tengah Tarumajaya Research Methods : This research design uses the quasi-experimental study method with pretest-posttest with control group design with a total of 32 respondents. The technique used in this study is a saturated sample. Results : The results of the study were found that after consuming the genjer extract of pregnant women who experience constipation into non-constipation it is shown in the occurrence of chapters for 2 weeks in pregnant women to normal. Conclusion : There is an effectiveness of the effect of providing genjer extract consumption as an alternative to prevent constipation during pregnancy.

Management of a Female Patient with Irritable Bowel Syndrome and Somatoform Disorder

Aim: to demonstrate the management of a patient with somatization disorder and irritable bowel syndrome.Key points. A 41-yo female patient was admitted with complains of spastic lower abdomen pain, hard stool once every 1–2 days under laxative treatment (macrogol), bloating, anxiety, waiting for confirmation of a life threatening illness, internal stress, difficulty in falling asleep, shallow sleep. Has a long history of disease, characterized by the appearance of a variety of somatic symptoms (headache, tachycardia, joint pain, stool disorders, abdominal pain, etc.) during periods of emotional tension, lack of data suggesting organic disease. No abnormal changes were detected in examination at the clinic (complete blood count, serum chemistry tests, urinalysis or fecal tests, hydrogen and methane breath tests with lactulose, abdominal ultrasound, esophagogastroduodenoscopy, colonoscopy). With the prior agreement of patient, she was consulted by a psychiatrist and diagnosed with somatization disorder and mild anxiety disorder. On discharge from hospital recommended cognitive-behavioral therapy, continue taking macrogol, as well as treatment with Kolofort. After 3 months of complex treatment, there was a significant decrease in the severity of both the symptoms of irritable bowel syndrome and anxiety disorder.Conclusion. For patients whose complaints meet the diagnostic criteria for IBS, a two-stage differential diagnosis may be justified: at the first stage, differentiation of IBS and organic diseases of the gastrointestinal tract is carried out; at the second stage - IBS and somatization disorder. Kolofort can be the drug of choice both in patients with IBS and the pharmacological part of therapy in patients with somatization disorder.