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Chronic Idiopathic Constipation
Published in Kevin W. Olden, Handbook of Functional Gastrointestinal Disorders, 2020
If rectal sensation is impaired, as often occurs in patients with severe constipation, it is helpful to know whether there is increased rectal compliance or megarectum. Rectal compliance can be measured by sequentially inflating a balloon placed in the rectum and measuring pressures at each level of distension. One should indicate the volume at which the first urge to expel the balloon occurs and also any symptoms elicited with increasing inflation of the balloon. Patients with “spastic constipation” often have low compliance and tolerate distension poorly, in contrast to patients with megarectum.
Motility disorders
Published in Michael JG Farthing, Anne B Ballinger, Drug Therapy for Gastrointestinal and Liver Diseases, 2019
Patients with idiopathic megacolon typically present in adulthood, and rarely develop faecal impaction. In contrast, patients with idiopathic megarectum have a dilated rectum but the colon is of normal calibre. Patients typically present in childhood and faecal impaction is common. The pathophysiology is imperfectly understood. The enteric innervation is generally intact,103 although some studies have demonstrated neuronal loss.104 The majority of studies on smooth muscle abnormalities in these conditions demonstrate muscle hypertrophy.103,105 Patients with idiopathic megarectum demonstrate a maximum anal resting pressure below normal, implying sphincter damage.103 Both groups of patients show an altered rectal sensitivity to distension, implying impaired sensory function.103
Colon, rectum and anus
Published in Michael Gaunt, Tjun Tang, Stewart Walsh, General Surgery Outpatient Decisions, 2018
Laxatives are unlikely to be effective if the haustral pattern of the colon has been lost or there is megacolon or megarectum. In these patients anorectal manometry is useful to identify underlying disorders such as Hirschsprung’s. Patients who have an absent rectosphincteric reflex and evidence of megacolon/rectum should undergo a full thickness rectal biopsy to exclude Hirschsprung’s.
Faecal impaction causing bilateral pelvic venous thrombosis
Published in Acta Chirurgica Belgica, 2018
Maxime Dewulf, Yves Blomme, Cedric Coucke
Hussain et al. [1] identified heart disease, bed rest, diabetes, malignancy and neurological disorder as the main risk factors for the development of FI. In this case, none of those were present. Yet, a megacolon and megarectum – both being important anatomic risk factors for FI – are. In our patient a diagnosis of idiopathic megacolon and megarectum can be made, as the long-standing problem of intestinal dilatation (and associated constipation) occurs in the absence of an organic cause [3,4].
The effects of connective tissue manipulation and Kinesio Taping on chronic constipation in children with cerebral palsy: a randomized controlled trial
Published in Disability and Rehabilitation, 2018
Ceren Orhan, Ozgun Kaya Kara, Serap Kaya, Turkan Akbayrak, Mintaze Kerem Gunel, Gül Baltaci
Constipation is one of the most common gastrointestinal problems in children with Cerebral Palsy (CP) due to several causes including insufficient nutrition, malnutrition, increased muscle tone, decreased defecation, and immobilization.[1–4] Studies have revealed that 74% of children with CP experience constipation, which represents a much higher fraction than the incidence of constipation about their healthy peers.[4,5] Constipation is associated with decreased quality of life and can cause many complications such as megarectum, variation in bowel movements, anal fissures, and soiling if it is not treated in early stage.[6] Effective bowel management program requires recognizing predisposing factors and determining defecation problems in children with disabilities.[7] Conservative therapies for constipation in children with cerebral palsy include pharmacological and non-pharmacological approaches.[7] Stool softeners and stimulant medications can be helpful to children. However, these drugs are only temporarily effective in relieving symptoms of constipation and some side effects may occur.[6,7] Physiotherapy methods such as abdominal massage, electrical stimulation (ES), biofeedback, exercise, connective tissue manipulation (CTM), and Kinesio Taping® (KT) can accordingly be used to manage childhood constipation;[8,9] however, there is a limited literature to date describing the use of physiotherapy methods in the management of constipation in children with disabilities. Few previous studies reported the benefits of the abdominal massage in children with CP on symptoms of constipation, quality of life aspects, such as sleep, appetite, and irritability, and other symptoms related to constipation including voluntary retention of defecation, anal fissures, and crying during defecation.[10,11] Besides the abdominal massage, Kajbafzadeh et al. [12] reported that the use of transcutaneous interferential ES in children with myelomeningocele was effective, safe, and noninvasive.