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Bowel disorders
Published in Henry J. Woodford, Essential Geriatrics, 2022
Faecal impaction or diarrhoea are both frequent precipitants in nursing home populations. In a community-based sample of people (aged 65–93 years) around 60% of those with FI had either an associated chronic diarrhoea or constipation.4 Other risk factors include the presence of neurological disease, reduced mobility, cognitive decline and old age.56 Laxatives may be a precipitant. FI can occur with overflow diarrhoea secondary to faecal impaction (see next section). Autonomic neuropathy in diabetes may induce diarrhoea and FI. It commonly develops in advanced dementia where, similar to urinary problems, there may be reduced mobility, decreased awareness of the need to defecate or disinhibited behaviour. It frequently occurs in the early post-stroke period when both cognition and mobility can be impaired. It can also be precipitated by neurological conditions affecting sphincter function. FI in older people is associated with a reduced anal resting pressure and reduced anal sensation.57 Internal anal sphincter dysfunction may be an important factor. Rectal prolapse and subsequent disruption of the innervation can provoke FI, which is more common in post-partum women.58 The causation of FI is often multi-factorial in frail older people and a ‘proctoscopic' view, that focuses only on the bowel and stool, should be avoided.
Postpartum Care
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Elena R. Magro-Malosso, Sarah K. Dotters-Katz, Daniele Di Mascio
There are currently no controlled studies that compare the various techniques or various suture materials for anal mucosa repair. Traditionally, the anal mucosa is approximated using closely spaced interrupted or running sutures with delayed absorbable materials 4/0 or 3/0 polyglactin. The indications on the injury repair technique of the internal anal sphincter (IAS) are limited. The IAS is identified as a glistening, white, fibrous structure placed between the rectal mucosa and the external anal sphincter (EAS). The IAS may be retracted laterally, and placement of Allis clamps on the muscle ends facilitates repair with continuous 2/0 polyglactin sutures [8].
Applied Surgical Anatomy
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Vishal G Shelat, Andrew Clayton Lee, Julian Wong, Karen Randhawa, CJ Shukla, Choon Sheong Seow, Tjun Tang
How would you do a conventional haemorrhoidectomy?Lithotomy, lateral or prone positionInfiltration of local anaesthetic (optional, for postoperative pain relief)The piles are grasped and excised (using scissors, diathermy or energy device)Care should be taken to preserve the internal anal sphincter. The use of a proctoscope will help to identify the internal anal sphincter (see picture). The piles are tented radially to allow safe dissection from the sphincterAdequate area of anoderm (perianal skin or mucocutaneous bridges) should be preserved to reduce risks of anal stenosisThe vascular pedicle may be ligated (or sealed with diathermy or energy device)The wound may be closed with absorbable sutures or left opened
Utility of botulinum toxin injection for post-operative pain management after conventional hemorrhoidectomy: a systematic review and meta-analysis of clinical trials
Published in Scandinavian Journal of Gastroenterology, 2023
Hendry Lie, Patrick Putra Lukito, Taufik Sudirman, Antonius Agung Purnama, Rudy Sutedja, Andre Setiawan, Wifanto Saditya Jeo, Andry Irawan, Willi Satriya, Heru Sutanto Koerniawan, Timotius Ivan Hariyanto
Fecal incontinence is the main concern in recto-anal BTX application side effects [22]. But those studies show otherwise. There is no increased risk of fecal incontinence by using BTX internal sphincter injection. One study explained that BTX is a striated muscle relaxant that inhibits acetylcholine from presynaptic axon terminals [23]. BTX mechanism of action in external and internal anal sphincter is different. In the external anal sphincter, BTX decreases the tone because it is a striated muscle, on the other hand in smooth muscle internal anal sphincter leads to a decreased maximum resting pressure that is related to lower pain sensation, but only a small effect on squeezed pressure which related with the physiology of fecal incontinence and does not eliminate voluntary sphincter control. Weakness occurs but does not disturb physiology and impulse transmission will recommence following the regrowth of new neuromuscular junctions within 3–4 months [12].
Angiotensin converting enzyme and angiotensin converting enzyme inhibitors in dermatology: a narrative review
Published in Expert Review of Clinical Pharmacology, 2022
The pathogenesis of anal fissures is mainly related to the hypertonia of the internal anal sphincter (IAS) [16]. De Godoy et al. reported higher levels of renin and ACE expression in the IAS in vitro [17]. Furthermore, a correlation between ATII and spontaneously hypertensive rats was found, compared to normotensive rats [18]. The same study also showed that captopril and losartan normalized the IAS pressure in spontaneously hypertensive rats, which may indicate its role in the treatment of anal fissures. However, topical captopril did not demonstrate any effect in decreasing the mean anal resting pressure on healthy individuals according to one human pilot study [19]. One randomized controlled trial reported that the efficacy of topical captopril and diltiazem for chronic fissures was equal [20], but topical captopril was not recommended due to the side effect of high incidences of pruritus. Due to the limited number of articles, there are doubts on the role of ACEI for treating anal fissures.
Digital rectal stimulation as an intervention in persons with spinal cord injury and upper motor neuron neurogenic bowel. An evidenced-based systematic review of the literature
Published in The Journal of Spinal Cord Medicine, 2021
Mary Elizabeth S. Nelson, Merle Orr
Two studies focused solely on DRS as an intervention, one directly, and one through the application of pressure to the rectum with extrapolation of findings to DRS. The first study, Korsten et al.8 included 6 males with SCI and UMN-NB, age 44–55. Manometric evaluation of peristaltic contraction via insertion of a probe into the left colon was performed. Subjects served as their own controls and were evaluated before and after DRS was applied. The mean number of peristaltic waves per minute significantly increased during and after DRS (P = 0.05). Full evacuation of the bowels was noted after three to five cycles of DRS, with the longest duration of time to complete evacuation being 13 min. Shafik et al.'s9 study was a controlled randomized study of the effect of dilatation of the anal canal by a balloon-tipped catheter on rectal pressure. Eighteen healthy volunteers (10 men and 8 women,) and nine patients with SCI and UMN-NB (6 men and 3 women,) were evaluated. Repeated measures were taken before and after pudendal nerve block to paralyze the external anal sphincter to isolate the effects of internal anal sphincter dilation from external. The researcher found that distention of the anal canal resulted in a significant (P < 0.001) pressure rise. This data was extrapolated to simulate DRS on rectal pressures and the evacuation of bowels.