Sensation Of Incomplete Evacuation Research Articles

Pharmacologic Treatment of Chronic Constipation.

Chronic constipation is a common disease that can impair the quality of life, with a prevalence of 14% globally and 16.5% in South Korea. Straining, hard stools, the sensation of incomplete evacuation, the sensation of anorectal blockage, and manual maneuvers to facilitate defecation are the related symptoms of chronic constipation. On the other hand, medications commonly referred to as laxatives are the essentials of treatment for constipation compared to non-pharmacological treatment, such as lifestyle modifications, biofeedback, or surgery. Unfortunately, there is still an unmet need to determine if pharmacological treatment for constipation is being administered appropriately. Therefore, there are many disadvantages as to whether the indications and side effects of laxatives are adequately considered and prescribed as the primary treatment modality for constipation in a real clinical situation in Korea. Laxatives are generally recommended as the next step for patients in whom organic causes have been excluded and have not responded to initial non-pharmacologic therapies such as dietary fiber intake and exercise. Laxatives can be classified as bulk-forming laxatives, osmotic laxatives, stimulant laxatives, and other novel laxatives. On the other hand, there are distinct mechanisms underlying constipation, and appropriate administration is the most decisive. Therefore, the present investigators prepared this review to discuss appropriate pharmacological strategies for chronic constipation in Korea. Moreover, this paper also includes suggestions for appropriate pharmacological treatment options for special patient populations.

Diagnosis of Chronic Constipation.

Patients with chronic constipation (CC) usually complain of mild to severe symptoms, including hard or lumpy stools, straining, a sense of incomplete evacuation after a bowel movement, a feeling of anorectal blockage, the need for digital maneuver to assist defecation, or reduced stool frequency. In clinical practice, healthcare providers need to check for 'alarm features' indicative of a colonic malignancy, such as bloody stools, anemia, unexplained weight loss, or new-onset symptoms after 50 years of age. In the Seoul Consensus on the diagnosis and treatment of chronic constipation, the Bristol stool form scale, colonoscopy, and digital rectal examination are useful for objectively evaluating the symptoms and making a differential diagnosis of the secondary cause of constipation. If patients with CC improve to lifestyle modification or first-line therapies, the effort to determine the subtypes of CC is usually not considered. On the other hand, if conventional therapeutic strategies fail, diagnostic testing needs to be considered to distinguish between the different subtypes of functional constipation (normal-transit constipation, slow transit constipation, or defecatory disorder) because these subtypes of constipation have different therapeutic implications and a correct diagnosis is critical. In the Seoul consensus, physiological testing is recommended for patients with functional constipation who have failed to respond to treatment with available laxatives (for a minimum of 12 weeks and recommended a therapeutic regimen) or who are strongly suspected of having a defecatory disorder. The Seoul consensus contains statements of physiological testing, including balloon expulsion test, anorectal manometry, defecography, and colon transit time.

Defecation Symptoms in Relation to Stool Consistency Significantly Reflect the Dyssynergic Pattern in High-resolution Anorectal Manometry in Constipated Patients.

To evaluate the usefulness of a 2-week patient-completed bowel habit and symptom diary as a screening tool for disordered rectoanal coordination (DRC). DRC is an important subgroup of chronic constipation that benefits from biofeedback treatment. Diagnosis of DRC requires a dyssynergic pattern (DP) of attempted defecation in high-resolution anorectal manometry (HRAM) and at least 1 other positive standardized examination, such as the balloon expulsion test or defecography. However, HRAM is generally limited to tertiary gastroenterology centres and finding tools for selecting patients for referral for further investigations would be of clinical value. Retrospective data from HRAM and a 2-week patient-completed bowel habit and symptom diary from 99 chronically constipated patients were analyzed. Fifty-seven percent of the patients had a DP pattern during HRAM. In the DP group, 76% of bowel movements with loose or normal stool resulted in a sense of incomplete evacuation compared with 55% of the non-DP group ( P =0.004). Straining and sensation of incomplete evacuation with the loose stool were significantly more common in the DP group ( P =0.032). Hard stool was a discriminator for non-DP ( P =0.044). Multiple logistic regression including incomplete evacuation and normal stool predicted DP with a sensitivity of 82% and a specificity of 50%. The sensation of incomplete evacuation with loose or normal stool could be a potential discriminator in favor of DP in chronically constipated patients. The bowel habit and symptom diary may be a useful tool for stratifying constipated patients for further investigation of suspected DRC.

Magnetic resonance imaging and functional constipation

With the rapid development of society, the incidence of functional constipation (FC) is steadily increasing annually. As it poses an elevated risk for various physical and neuropsychiatric illnesses, the occurrence and development mechanisms of FC have garnered escalating attention from researchers. Accumulating evidence from studies using magnetic resonance imaging (MRI) suggests that FC is associated with alternations in brain function and structure, particularly within brain regions and networks involved in emotion regulation, motor control, somatic sensation, and self-reference. Specifically, significant differences in baseline brain activity and functional connectivity integrity exist between patients with FC and healthy controls. Patients with FC exhibit abnormal cortical morphometry, a lower gray/white matter volume, and impaired white matter integrity. These changes correlate with somatic symptoms, such as the difficulty level of defecation and the sensation of incomplete evacuation. Differences between patients with anxiety/depressive disorders (FCAD) and those without such disorders (FCNAD) underscore the pivotal role of psychiatric factors in FC development. In addition, studies have verified that female patients experience decreased emotional regulation, contributing to a higher prevalence of FC and more severe constipation symptoms than their male counterparts. This paper provides a comprehensive literature review, drawing upon existing MRI studies to explore the various brain abnormalities evident in patients with FC. Through the analysis of these studies, our aim is to shed light on the underlying neural mechanisms and offer valuable insights into the development of novel and effective treatments for FC.

Systematic review with meta-analysis: effects of probiotic fungi on irritable bowel syndrome

Abstract Treatment of irritable bowel syndrome (IBS) remains challenging for clinicians. Probiotic fungi may act as candidate options for IBS treatment, but systematic evaluation of their clinical value remains scarce. This study is aimed to assess the efficacy and the safety of probiotic fungi for IBS treatment by means of systematic review and meta-analysis. PubMed, Embase, Web of Science, and the Cochrane Library, were searched up to June 2022. Randomised controlled trials recruited subjects with prescriptions of probiotic fungi were eligible. Efficacy and safety of probiotic fungi were re-evaluated. Continuous data were pooled to obtain standardised difference in means (SMD) with a 95% confidence interval. The search strategy identified 120 articles of which 7 trial assessing 883 subjects were included in the analysis. Systematic data support that Saccharomyces helps to relieve abdominal pain/discomfort (SMD = −0.205, ), and presented potential improvements on psychological outcomes, stool form for IBS patients. It is hard to demonstrate favourable effects on other symptoms (including distension, mucus passage, sense of incomplete evacuation, urgency, straining). The incidence of mild complications ranged from 0 to 51.4%, but no serious complications were observed in the included trials. Therefore, the partial response and the relative safe of probiotic fungi for IBS treatment have been demonstrated from the existing trials. However, it is premature to eventually declare the practical effects of probiotic fungi. Conducting more high-quality and large-scale trials and real-world studies, or even developing new fungal strains, is still necessary.

Obstructed Defecation Syndrome in Young Women

Obstructed Defecation Syndrome (ODS) is characterized by excessive straining at stool, incomplete rectal evacuation, and needing for perineal splinting. This condition is prevalent in young women suffering from constipation, approximating 7-15% [6]. ODS is refractory to laxative use. Typically, the block is found in the rectosigmoid portion. The main causes are divided into mechanical and functional. Mechanical causes interfere with stool passage, as can be found for instance in rectal prolapse. Functional causes include various neurologic or behavioral disorders, leading to pelvic floor dysfunction, discoordination of the defecatory process, and impaired rectal sensation. In dyssynergic defecation, that affects many young women with chronic constipation, there is an inability to coordinate the abdominal and pelvic floor muscles to evacuate stools. Paradoxical contraction of the pelvic floor muscles during defecation hinders evacuation [10-12]. ODS is characterized by persistent sensation of rectal fullness and painful prolonged or excessive straining, accompanied by a sensation of incomplete evacuation and clustering, often, digital manipulation. Hemorrhoids and fissures are also related to functional ODS due to the psychological condition to avoid pain during defecation. A holistic approach is needed for patients with ODS, considering that most of these young women present with psychological distress, either anxiety or depression. Anismus affects many ODS patients [8].

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

Relationship between mental disorders, psychotropic drugs, and constipation in psychiatric outpatients.

Constipation has been reported to be more common in patients with mental disorders than in the general population. However, its relationships with psychiatric diagnosis, medication, age, and sex have not been fully identified.A total of 875 patients from the outpatient department were included in the study. As a retrospective observational study, the psychiatric diagnoses and psychotropic medications were examined based on the medical charts. Fecal conditions, including problems with defecation, abdominal pain, sense of incomplete evacuation, use of laxatives, frequency of defecation, and stool characteristics according to the Bristol Scale, were investigated.The study included 368 males and 507 females, with median ages of 48 and 52 years, respectively. The most common psychiatric diagnoses were depressive disorders (33%), followed by anxiety disorders (19%). Females had significantly higher rates of problems with defecation and laxative use than males (P < .001, P < .0001, respectively). The frequency of laxative use increased significantly with age (P < .0001). The multivariate analyses revealed the close relationship between hypnotics and problems of defecation and that between hypnotics, antipsychotics, and laxative use.In psychiatric outpatients, females had significantly higher rates of problems with defecation and laxative use than males. The use of laxatives significantly increased with age. Problems with defecation were significantly more common in patients taking hypnotics and laxative use was significantly more common in patients taking hypnotics and antipsychotics.

Best Practices for the Management of Chronic Idiopathic Constipation and Irritable Bowel Syndrome With Constipation: A Roundtable Discussion and Review.

Chronic idiopathic constipation (CIC) and irritable bowel syndrome with constipation (IBS-C) are highly prevalent conditions that affect a significant proportion of the US population. Pathogenic, diagnostic, and treatment paradigms for patients with constipation have changed considerably over time. A clinical roundtable consisting of experts from across the United States was convened (virtually) to discuss the burden of constipation and current evidence-based diagnostic and management tools at a mechanistic level, with a primary goal of determining realistic clinical strategies to improve outcomes in patients with CIC or IBS-C. This 4-part supplement provides a critical review and discussion of the burden of illness and strategies for the diagnosis and management of CIC and IBS-C. These common and bothersome disorders of gut–brain interaction present a spectrum of stool-related symptoms such as infrequent bowel movements, hard stools, excessive straining, and an overall sensation of incomplete evacuation or obstruction. In addition, patients commonly report a variety of non‒stool-related abdominal symptoms that are often directly related to the patients' severity of CIC or IBS-C. The overlapping symptomatology of CIC and IBS-C have a significant impact on health-related quality of life, with individuals reporting frustration, shame, and embarrassment, along with an overall sense of helplessness. Many patients cycle through multiple treatment options in an attempt to manage their abdominal symptoms and to regulate bowel frequency and stool consistency. For healthcare providers, central to the management of patients with CIC or IBS-C is the utilization of a patient-centered communication approach that ensures understanding of symptom type and intensity, accurate symptom reporting, and compliance to treatment. Although treatment strategies for patients with CIC and IBS-C can often be challenging—with many patients unaware of available treatment options and instead choosing to self-medicate with diet or over-the-counter strategies—it is vital that patients are educated about symptomatology and available treatments, actively monitored for changes in symptom severity and response to treatment, and appropriately managed to maximize clinical outcomes such as patient adherence and cost benefit. My colleagues and I hope that this supplement provides practitioners, such as gastroenterologists, and the medical community at-large with a better understanding of the burden and unmet needs of patients with CIC or IBS-C. With this recognition, we hope to improve management outcomes. CONFLICTS OF INTEREST Guarantor of the article: Darren M. Brenner, MD. Specific author contributions: Darren M. Brenner moderated and participated in the advisory board discussions, contributed to the drafting of the manuscript, provided critical revision of all manuscript drafts for important intellectual content, and approved the final version for publication. Financial support: This supplement was funded by Salix Pharmaceuticals, Inc. Potential competing interests: D.M.B. is a consultant, advisor, and/or speaker for Salix, AbbVie (Allergan), Ironwood, Takeda, RedHill, Alnylam, AlphaSigma, Bayer, Arena Pharmaceuticals, GI Health Foundation, IFFGD, and the Rome Foundation. His research is sponsored by an unrestricted grant from the Irene D. Pritzker Foundation.

LUTS-Normal Stent VS Carbothene Stent in a Health Center- Retrospective and Prospective Study

Background: Ureteral stent removal is associated with some post operative symptoms such as changes in the frequency of urine,frequent nocturia, occasional episodes of blood stained urine,pain in the suprapubic region which occurs due to the material composition and the dimensions of the stent as well. Polyurethane stent are regularly used in the operation theatres but in the recent years carbothane stent has showed some efficacy and hence necessitates a comparison.&#x0D; Objectives: To study the prevalence of symptoms of lower urinary tract symptoms in patients with polyurethane stent and carbothane stents&#x0D; Materials and Methodology: A prospective study was conducted among patients who had their stent removed to the Department of Urology in a tertiary health care hospital from January 2021 to April 2021. A simple random sampling technique was employed and 40 patients were identified for the study. The relationship between the different stents and the onset of symptoms&#x0D; Results: It is seen that the onset of lower urinary tract symptoms had an equal incidence among the two genders hence the presence of symptoms plays a crucial role in distinguishing the efficacy of the stents. Here in this study only 5% of carbothane stent patients had changes in frequency of micturition where as 65% polyurethane stent patients reported change frequency similarly 60% of polyurethane stent patients had changes in Frequency of nocturia whereas same was reported in 20% of the patients. Loss of urine before reaching the toilet was the primary complaint in 30 % of polyurethane stent patients but only 2% of carbothane stent patients occasionally had this complaint. Apparently the stream of urine was occasionally continuous in 70% of polyurethane stent patients but was always continuous in 85% of carbothane stent patients. A sense of incomplete evacuation was experienced by 40% of polyurethane stent patients but only 1% of carbothane stent patients had such complications Similarly pain in the suprapubic region, straining oneself while micturition and presence of hematuria was experienced by a greater percentage of polyurethane stent patients than that of carbothane stent patients.&#x0D; Conclusion: It is seen that carbothane stent have a better patient compliance and a low onset of lower urinary tract symptoms when compared to the normal polyurethane stent and hence medical management of the symptoms was required in the postoperative period

Gastrointestinal Symptoms in Women With Endometriosis and Microscopic Colitis in Comparison to Irritable Bowel Syndrome: A Cross-Sectional Study.

Gastrointestinal (GI) symptoms similar to irritable bowel syndrome (IBS) are often present in women with endometriosis and microscopic colitis (MC). The objective of this study was to estimate GI symptoms in IBS, endometriosis, and MC, to compare the clinical expression of the diseases. Women with IBS, endometriosis, and MC were identified by diagnosis codes at a tertiary center. The patients had to complete the visual analog scale for IBS to estimate specific GI symptoms. Women fulfilling Rome III criteria for IBS were diagnosed as IBS (n = 109) and divided into subgroups depending on predominating symptoms. Women diagnosed with endometriosis (n = 158) and MC (n = 88) were evaluated whether they also fulfilled the Rome III criteria for IBS. Women with IBS experienced aggravated abdominal pain, diarrhea, bloating and flatulence, nausea and vomiting, the urgency to defecate, the sensation of incomplete evacuation and intestinal symptom's influence on daily life, and impaired psychological wellbeing, compared to women with endometriosis. When patients with endometriosis also fulfilled the criteria for IBS, all symptoms in the 2 cohorts, except intestinal symptom's influence on daily life, were equal. Women with IBS or diarrhea-predominated IBS experienced aggravated abdominal pain, bloating and flatulence, intestinal symptom's influence on daily life, and impaired psychological well-being compared to MC, but at equal levels as MC with IBS-like symptoms. Women with IBS generally experience aggravated GI symptoms and impaired psychological well-being compared to endometriosis and MC. Patients with endometriosis or MC, in combination with IBS, express similar symptoms as patients with sole IBS.

STRESS AND CONSTIPATION (VIBANDHA) - CRITICAL REVIEW

Thoughts and emotions triggered by stress can have an effect on stomach and bowel movement. Physical signs and symptoms of stress overload include chest pain, rapid heartbeat, loss of sexual drive, diarrhoea/ constipation. In this article we have tried to enlighten the association of stress and constipation. The mainly observed clinical features of Vibandha are Hard Stools, Excessive Straining, Sense of Incomplete Evacuation, Flatulence and Lower Abdominal Fullness. The stress hormone may contribute to constipation.

Gastrointestinal Bleeds.

Gastrointestinal Bleeds.

Imaging modalities for the detection of posterior pelvic floor disorders in women with obstructed defaecation syndrome.

Imaging modalities for the detection of posterior pelvic floor disorders in women with obstructed defaecation syndrome.

Roles of Gut Microbiota and Metabolites in Pathogenesis of Functional Constipation.

Functional constipation (FC), a condition characterized by heterogeneous symptoms (infrequent bowel movements, hard stools, excessive straining, or a sense of incomplete evacuation), is prevalent over the world. It is a multifactorial disorder and can be categorized into four subgroups according to different pathological mechanisms: normal transit constipation (NTC), slow transit constipation (STC), defecatory disorders (DD), and mixed type. Recently, growing evidence from human and animals has pointed that there was a strong association between gut microbiota and FC based on the brain-gut-microbiome axis. Studies have reported that the main characteristics of gut microbiota in FC patients were the relative decrease of beneficial bacteria such as Lactobacillus and Bifidobacterium, the relative increase of potential pathogens, and the reduced species richness. Gut microbiota can modulate gut functions through the metabolites of bacterial fermentation, among which short-chain fatty acids (SCFAs), secondary bile salts (BAs), and methane occupied more important positions and could trigger the release of gut hormones from enteroendocrine cells (EECs), such as 5-hydroxytryptamine (5-HT), peptide YY (PYY), and glucagon-like peptide-1 (GLP-1). Subsequently, these gut hormones can influence gut sensation, secretion, and motility, primarily through activating specific receptors distributed on smooth muscle cells, enteric neurons, and epithelial cells. However, research findings were inconsistent and even conflicting, which may be partially due to various confounding factors. Future studies should take the associated confounders into consideration and adopt multiomics research strategies to obtain more complete conclusions and to provide reliable theoretical support for exploring new therapeutic targets.

The Effect of Arabinoxylan on Gastrointestinal Tolerance in Generally Healthy Adults: A Randomized, Placebo-Controlled, Crossover Study

Abstract Objectives Arabinoxylan (AX) is a non-digestible carbohydrate composed of (1→4)-β-D-xylan polymers that contain arabinose and varying uronic acid residues. AX was formally identified as a dietary fiber by the U.S. FDA for its effect on maintenance of healthy blood glucose levels. The primary objectives of this human trial were to examine the effects of a novel prebiotic AX wheat fiber extract (87.9% AX) produced by upcycling crop leftovers, such as wheat straw, on gastrointestinal (GI) tolerance, bowel habits, and stool consistency in adults. Methods A randomized, double-blind, placebo-controlled, crossover trial with three test periods separated by 2-week washout periods was conducted. Forty-five subjects (M/F: 29/16, aged 47.8 ± 9.6 y, 27.9 ± 4.4 kg/m2) were randomly assigned to consume maltodextrin placebo (PLA) or AX wheat fiber extracts providing 6.37 g AX/d (LAX) or 12.74 g AX/d (HAX) for 3 weeks. Study products were mixed thoroughly with 16 oz. water and consumed twice a day, once each in the morning and evening, with or without food. During the 7 days prior to the start of any intervention (baseline) and prior to the end of each test period, GI symptoms, as well as bowel movement ratings and stool consistency and frequency, were evaluated using the GI Tolerability Questionnaire (GITQ), which assesses abdominal cramping, bloating, burping, flatulence, nausea, reflex, and stomach rumbling, and the Bowel Habits Diary with Bristol Stool Scale. Results There were no statistically significant differences between PLA, LAX, and HAX in the area under curve of the GITQ composite score, as well as severity rating of individual symptoms (P &amp;gt; 0.05). Additionally, stool frequency (median ranging 7.5–8.0 over 7 days), stool consistency (median ranging 3.71–3.84), straining during bowel movements, discomfort during bowel movements, and sensation of incomplete evacuation did not differ between interventions (P &amp;gt; 0.05). There were no reported adverse events that were judged to be related to the AX wheat fiber extract product. Conclusions Consumption of prebiotic AX wheat fiber extract product containing 6.37 or 12.74 g AX per day for 3 weeks did not affect GI tolerance symptom severity and bowel habits and stool consistency in adults and did not result in related adverse events, suggesting that the product is safe and well-tolerated. Funding Sources Comet Bio.

478-P: Effect of Nonpharmacological Management of Chronic Constipation in Diabetic Patients

Background: Chronic constipation is highly prevalent in diabetic patients. The treatment of chronic constipation in general patients is mainly lifestyle modification and pharmacological therapy. The efficacy of non-pharmacological treatment, i.e., behavioral therapy to improve lifestyle and defecation habits, for chronic constipation in diabetic patients is not well known. This study aimed to determine the efficacy of non-pharmacological management for chronic constipation in diabetic patients. Methods: We conducted a questionnaire on defecation for diabetic patients aged 20 to 75 years at Asama General Hospital outpatient clinic. Patients diagnosed with chronic constipation according to Rome IV criteria were randomly assigned to two groups. The intervention group instructed behavior therapy to improve constipation. Specifically, we provided guidance on defecation behavior, exercise, water and dietary fiber intake, and guidance on a defecation diary recording daily defecation status. The other group received usual medical care as a control group. The questionnaire was conducted again at the next outpatient clinic. Results: Eighty of 545 diabetic patients (14.7%) had chronic constipation. The average age of constipated patients was 59.3 years, frequency of defecation 3.7 times/week, stool form (Bristol Stool Form Scale) 2.8, straining during defecations 78,8% and sensation of incomplete evacuation of defecations 42.5%. After the intervention, there was a significant increase in the frequency of defecation (4.8 vs. 3.9 times/week, P=0.008) and improvement in constipation symptoms (P=0.018) in the intervention group compared to the control group. In addition, stool form and straining during defecations were significantly improved before and after comparison within the intervention group (P &amp;lt;0.05). Conclusion: Our findings suggest that non-pharmacological management, including behavioral therapy for chronic constipation in diabetic patients, was effective. Disclosure E. Nishimori: None. M. Naka: None.

PELVIC FLOOR MUSCLE TRAINING USING BIOFEEDBACK THERAPY VERSUS BILATERAL POSTERIOR TIBIAL NERVE STIMULATION FOR TREATMENT OF OBSTRUCTED DEFECATION A RANDOMISED CONTROLLED TRIAL

Obstructed defecation syndrome (ODS) is a type of constipation characterized by two or more of the following symptoms in more than 25 percent of defecation trials: straining, lumpy or hard stools, urgency, sense of incomplete evacuation, pelvic heaviness and manual maneuvers to promote defecation.obstructed defecation is of two basic types: functional and mechanical. The functional type involves idiopathic megarectum, anismus (pelvic floor dys-synergy), and descending perineal syndrome, while the mechanical type includes rectocele, enterocele, internal rectal intussusception and overt rectal prolapse.An excessive straining is likely to be the “primummovens”, causing tissue weakness and organ descent, and often is due to longterm anxiety, muscle tension and resulting in non-relaxing puborectalis muscle. The increased straining causes pudendal nerve stretch which may lead to a pudendal neuropathy which affects the rectal sensations.ODS has been also defined as an “iceberg syndrome”, as the two most frequent lesions, i.e., rectocele and rectal internal mucosal prolapse, present in more than 90% of patients with ODS, are easily detectable and may be considered “emerging rocks”, whereas the “surgical ship” is likely to “sink” due to the “underwater rocks”, i.e., the occult lesions.

The Prevalence of Enteropathy Symptoms from the Lower Gastrointestinal Tract and the Evaluation of Anorectal Function in Diabetes Mellitus Patients.

Complications affecting the gastrointestinal tract often occur in the course of diabetes mellitus (DM). The aim of this study was to evaluate enteropathy symptoms and anorectal function using high-resolution anorectal manometry (HRAM). Fifty DM patients and 20 non-DM controls were enrolled into the study. Clinical data and laboratory tests were collected, physical examination and HRAM were performed. Symptoms in the lower gastrointestinal tract were reported by 72% of patients. DM patients with a long disease duration reported anal region discomfort (p = 0.028) and a sensation of incomplete evacuation (p = 0.036) more often than patients with shorter diabetes duration. Overall, DM patients had a lower maximal squeeze pressure (MSP) (p = 0.001) and a higher mean threshold of minimal rectal sensation (p < 0.01) than control subjects. They presented with enhanced features of dyssynergic defection than the control group. MSP and maximal resting pressure (MRP) were significantly lower in the group of long-term diabetes (p = 0.024; p = 0.026 respectively) than in patients with a short-term diabetes. The same observation was noted for patients with enteropathy symptoms that control for MSP (p < 0.01; p < 0.01; p = 0.03) and MRP (p < 0.001; p = 0.0036; p = 0.0046), respectively, for incontinence, constipation, and diarrhea. Symptoms in the lower gastrointestinal tract are often reported by DM patients. All DM patients have impaired function of the external anal sphincter and present enhanced features of dyssynergic defecation and also impaired visceral sensation. Patients with long-standing DM and patients with enteropathy symptoms have severely impaired function of both anal sphincters.

Efficacy of Bifidobacterium bifidum G9-1 in improving quality of life in patients with chronic constipation: a prospective intervention study.

Chronic constipation is a functional disorder that decreases a patient’s quality of life (QOL). Because dysbiosis has been associated with constipation, we aimed to investigate the efficacy of Bifidobacterium bifidum G9-1 (BBG9-1) in improving QOL in patients with constipation. This was a prospective, single-center, non-blinded, single-arm feasibility trial. A total of 31 patients with constipation and decreased QOL received BBG9-1 treatment for 8 weeks, followed by a 2-week washout period. The primary endpoint was change in the overall Japanese version of the patient assessment of constipation of QOL (JPAC-QOL) score after probiotic administration relative to that at baseline. Secondary endpoints included changes in gut microbiota, stool consistency, frequency of bowel movement, degree of straining, sensation of incomplete evacuation, and frequency of rescue drug use. The overall JPAC-QOL scores and frequency of bowel movement significantly improved after BBG9-1 administration from those at baseline (p<0.01 and p<0.01, respectively). There were no statistically significant changes in other clinical symptoms. Subset analysis revealed that patients with initial Bristol Stool Form Scale stool types of <4 had improvements in stool consistency, a significant increase in the frequency of bowel movements, and a significant alleviation in the degree of straining, following BBG9-1 administration. At the genus and species levels, Sarcina and Sarcina maxima were significantly increased. Functional analysis showed that butanoate metabolism increased significantly, whereas methane metabolism decreased significantly. We concluded that BBG9-1 is safe and improves QOL in patients with constipation. The underlying improvements may be due to changes in stool consistency.