Impairment of swallowing, liver, and defecation functions
Ramar Sabapathi Vinayagam in Integrated Evaluation of Disability, 2019
Defecation refers to expulsion of waste and undigested food as fecal matter (8). Inability to control bowel movement results in incontinence. Inability to initiate bowel movement results in constipation. In neurogenic bowel dysfunction, there is also loss of sensation of bowel fullness and loss of sensation of bowel movement. Neurological cause, frequency of bowel movement, response to fiber supplements and suppositories, need for prokinetic agents, and mandate for colostomy are essential variables to define impairment class in constipation. Integrated Evaluation of Disability assigns an impairment of 37% for incontinence, that is, inability to control bowel movement associated with lack of sensation of bowel fullness and movement. Table 12.3 describes various impairments of defecation function.
Rectal Prolapse and Other Causes of Fecal Obstruction
Linda Cardozo, Staskin David in Textbook of Female Urology and Urogynecology - Two-Volume Set, 2017
obstructed defecAtion is defined As difficulty in evAcuAting the rectum despite the urge to defecAte [34]. This leAds to incomplete evAcuAtion, frequent And prolonged defecAtion, digitAl support during defecAtion, And rectAl pAin. The most frequent cAuse is internAl rectAl prolApse (intussusception), As described previously [34]. other cAuses Are enterocele, or rectocele. rectocele involves bulging of the rectAl wAll, usuAlly Anteriorly, due to expAnsion of the rectovAginAl septum. This is often AsymptomAtic. symptomAtic cAses primArily receive conservAtive treAtment As described for conservAtive mAnAgement of rectAl prolApse. surgicAl correction is only performed if relevAnt symptoms persist despite conservAtive therApy [35]. other possible cAuses of obstructed defecAtion Are neurologicAl disorders such As multiple sclerosis or spinAl cord injuries. treAtment is difficult. If possible, the underlying diseAse is treAted, And the pAtient Also receives conservAtive therApy As described eArlier [36,37].
Gastrointestinal Complications of Diabetes Mellitus
Jack L. Leahy, Nathaniel G. Clark, William T. Cefalu in Medical Management of Diabetes Mellitus, 2000
formation, and soluble forms of psyllium are likely to empty from the stomach more easily; however, their effectiveness in alleviating constipation in diabetic patients has not been formally studied. If constipation persists, proctosigmoidoscopy should be directed toward identification of a rectal or colonic mucosal lesion, such as cancer or a stricture caused by diverticulitis. If mucosa is normal, evaluation of anorectal and pelvic floor function is essential, as disorders of the defecation dynamics (see Fig. 6) may be present either from complications of diabetes, or from an unrelated problem. Outlet obstruction to defecation is an important cause of constipation in the general population. Clinically, these disorders present as an inability to initiate defecation, digitation to facilitate defecation, assumption of contorted postures during elimination of the fecal bolus, a sense of incomplete evacuation, or rectal discomfort, and the frequent and often ineffective use of laxatives or enemas. As for the investigation of incontinence, anorectal manometry, and anal ultrasound are essential. Neurophysiological evaluation of the pelvic floor muscles or pudendal nerve are needed in only a few patients. If pelvic function is normal, colonic transit time should be evaluated using noninvasive, reliable, and inexpensive tests, such as radiopaque markers or scintigraphy. Simultaneous measurement of gastric emptying and small-bowel transit also allows assessment for associated symptoms, such as nausea, vomiting, and bloating.
Statistical shape modeling of the pelvic floor to evaluate women with obstructed defecation symptoms
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2021
Megan R. Routzong, Ghazaleh Rostaminia, Shaniel T. Bowen, Roger P. Goldberg, Steven D. Abramowitch
Rectum stability plays a critical role in the passage of stool during defecation. It is generally believed that the presence of rectocele, enterocele, or rectal intussusception can cause stool entrapment by pocketing or folding the rectum, contributing to ODS (Pescatori et al. 2007; Cavallaro et al. 2019). Our team previously described rectal folding and pocketing as rectum hypermobility using magnetic resonance (MR) defecography and pelvic floor dynamic ultrasound, establishing an association between rectal hypermobility and ODS (Rostaminia et al. 2020). In addition to providing rectal stability, a normally supported pelvic floor resists downward motion during increases in intraabdominal pressure, creating a stable backstop during defecation. The excessive descent of the pelvic floor and levator plate at rest and during Valsalva have been described as pelvic floor relaxation (Hsu et al. 2006; Rostaminia et al. 2015). These findings motivate further investigation of pelvic floor anatomy and quantification of deviations from normal structure and function.
Botulinum toxin type-A infiltration of the external anal sphincter to treat outlet constipation in motor incomplete spinal cord injury: pilot cohort study
Published in Scandinavian Journal of Gastroenterology, 2021
Margarita Vallès, Sergiu Albu, Hatice Kumru, Fermín Mearin
Spinal cord injury (SCI) is a first-magnitude medical, social and economic problem. It mainly affects young people, which may determine persistent disability and health-related problems, impairing quality of life [1,2]. Restoring bowel and bladder function, along with motor recover, emerge as priorities for individuals with SCI [3]. Neurogenic bowel is a major physical and psychological problem for persons with SCI, as changes in bowel motility and sphincter control, along with impaired mobility and hand dexterity, make bowel management a major life-limiting problem. However, bowel dysfunction treatment in patients with SCI has changed little since rehabilitation treatments were established by L. Guttmann in the mid-twentieth century [4]. Most treatments of neurogenic bowel consist of a regular routine, diet, sufficient intake of fluids, physical activity and use of laxatives. Different defecatory methods (including mechanical rectal stimulation, chemical rectal stimulation with suppositories, manual defecation, and attempted defecatory manoeuvres) are also advised, in order to achieve a predictable defecation within a reasonable time and to reduce or eliminate fecal incontinence episodes [5–7]. However, its design and modifications rely on an empirical approach, as no studies exist to demonstrate whether or not the various guidelines are effective [6].
Physiotherapist management of a patient with spastic perineal syndrome and subsequent constipation: a case report
Published in Physiotherapy Theory and Practice, 2021
Shankar Ganesh, Mritunjay Kumar
Constipation is a multi-factorial disorder and is defined as less than three bowel movements per week (Drossman, Sandler, McKee, and Lovitz, 1982). Constipation affects 2–28% of adults in the general population (Stewart et al., 1999) and negatively influences their quality of life (Glia and Lindberg, 1997). Constipation is classified as normal-transit constipation, obstructed defecation (functional type), or slow-transit constipation. In normal-transit constipation, there is normal coordination of the enteric neurons and gastrointestinal muscles. There is normal stool movement throughout the colon. However, the patients complain of constipation due to defecation disorder such as harder stools. Slow transit constipation is characterized by reduced motility in the gastrointestinal tract resulting in decreased and infrequent bowel movements. Obstructed defecation includes pelvic floor dyssynergia and anatomical abnormalities, such as rectocele, internal rectal prolapse, and solitary rectal ulcer (Beck, 2008).
Related Knowledge Centers
- Gastrointestinal Tract
- Muscle
- Digestion
- Peristalsis
- Rectum
- Feces
- Anus
- Shit
- Toilet Humour
- Large Intestine