Pelvic afferent reflex control of rectal motility and lumbar colonic efferent discharge mediated by the pontine sympatho-inhibitory region in guinea pigs

Rectal motility and the efferent discharge of lumbar colonic nerves (LCED) have previously been shown to be affected by reflex activity activated by rectal stimulation. The sensory limb of this reflex is represented by afferent fibers in pelvic nerves. The present study revealed that this reflex is modulated by supraspinal sympatho-inhibitory regions. Pelvic afferent stimulation led to rectal contraction through the withdrawal of a tonic inhibitory influence of lumbar colonic nerves. The supraspinal region responsible for this antagonism ofthe rectal-inhibitory colonic nerve activity was localized to the pons. Neither the intravenous administration of atropine nor that of guanethidine (and Eisai compound 865–123, another adrenergic neuron blocking agent) effected the ability of pelvic afferent stimulation to inhibit tonic discharge of lumbar colonic efferent nerves; nervertheless, both agents eliminated the mechanical response of the rectum to stimulation of pelvic afferents. These observations suggest that lumbar sympathetic nerves may tonically inhibit the release of acetylcholine from excitatory neurons in the rectal myenteric plexus. We conclude that descending fibers from the pons are activated as a result of pelvic afferent nerve stimulation. These descending pontine fibers in turn inhibit the firing of sympathetic lumbar colonic nerves. Removal of this tonic restraint leads to rectal contraction.     

Hysterectomy Does Not Cause Constipation

Purpose  This study was designed to evaluate the risk on development and persistence of constipation after hysterectomy. Methods  We conducted a prospective, observational, multicenter study with three-year follow-up in 13 teaching and nonteaching hospitals in the Netherlands. A total of 413 females who underwent hysterectomy for benign disease other than symptomatic uterine prolapse were included. All patients underwent vaginal hysterectomy, subtotal abdominal hysterectomy, or total abdominal hysterectomy. A validated disease-specific quality-of-life questionnaire was completed before and three years after surgery to assess the presence of constipation. Results  Of the 413 included patients, 344 (83 percent) responded at three-year follow-up. Constipation had developed in 7 of 309 patients (2 percent) without constipation before surgery and persisted in 16 of 35 patients (46 percent) with constipation before surgery. Preservation of the cervix seemed to be associated with an increased risk of the development of constipation (relative risk, 6.6; 95 percent confidence interval, 1.3–33.3; P = 0.02). Statistically significant risk factors for the persistence of constipation could not be identified. Conclusions  Hysterectomy does not seem to cause constipation. In nearly half of the patients reporting constipation before hysterectomy, this symptom will disappear. Presented at the Congress of the International Uro-Gynecology Association, Athens, Greece, September 6 to 9, 2006. Reprints are not available.     

Clinical significance of obstructive defecatory symptoms in women with pelvic organ prolapse

Objective

To determine whether the presence of obstructive defecatory symptoms is associated with the site and severity of pelvic organ prolapse. Methods: A cross-sectional study was performed of women with pelvic organ prolapse of grade 2 or greater who had completed a validated questionnaire that surveyed pelvic floor symptoms. Associations between patient characteristics, site and severity of prolapse, and obstructive bowel symptoms were investigated.

Results

Among 260 women with pelvic organ prolapse, women with posterior vaginal wall prolapse were more likely to report obstructive symptoms, such as incomplete emptying (41% vs 21%, P = 0.003), straining at defecation (39% vs 19%, P = 0.002), and splinting with defecation (36% vs 14%, P < 0.001) compared with women without posterior vaginal wall prolapse. There was no significant association between any bowel symptom and increasing severity of prolapse.

Conclusions

Obstructive bowel symptoms are significantly associated with the presence of posterior vaginal wall prolapse, but not with the severity of prolapse.     

排便功能训练对保肛术后患者排便功能的影响

目的 探讨低位直肠癌保肛手术患者进行排便功能训练对肛门排便功能的影响。方法 将110例行低位前切除术的直肠癌患者按吻合口距齿状线的距离分为两组(A组:1.0~2.0cm,B组:2.0~3.0cm),术后对其进行排便功能训练,分别在术后3个月及1年进行Wexner评分,术后1年进行大便失禁生活质量问卷(FIQL)调查。结果 术后2～6周,患者排便次数控制在6～8次/d。8～14周,大便成形,次数控制在3～4次/d,并随着时间推移逐渐减少。术后3个月,A组的Wexner评分高于B组(P＜0.05);1年后,两组的Wexner评分无统计学意义(P＞0.05)。术后1年的FQIL问卷调查中,A、B两组各项指标均接近正常。结论 排便功能训练使患者的排便自控能力及生活质量得到不同程度的改善。     

结肠贮袋改善直肠癌术后排便功能的临床观察

目的:评价直肠癌低位前切除术后采用结肠贮袋吻合对术后排便功能的影响。方法:将1999年1月至2003年10月行低位前切除术的直肠癌患者70例随机分为两组,一组采用结肠J型贮袋吻合术(colon J-pouch anastomosis,CAP)30例,制作J型贮袋长约5cm。另一组采用结肠、直肠(肛管)端端吻合术(end to end anastomosis,EEA)40例,通过术后6、9、12、18个月随访比较两组直肠测压结果与排便功能。结果:术后并发症中,两组均无死亡病例、无临时性造口病例,无吻合口瘘发生,CAP组和EEA组分别发生吻合口狭窄1例和2例,术后肠梗阻CAP组1例,CAP组9～18个月复发1例。术后6个月时直肠测压结果及排便功能CAP组优于EEA组,差异有统计学意义(P<0.05);术后9个月时两组各项指标比较,仅大便失禁评分CAP组优于EEA组,差异有显著性(P<0.05),其他各项指标比较均无明显差异(P>0.05);术后12个月以上两组上述指标基本正常,两组比较,差异无统计学意义(P>0.05)。结论:对于中下段直肠癌在行根治性手术的前提下采用J型贮袋吻合术可以明显改善术后9个月内排便功能,并且不增加术后并发症。     

急性心肌梗死早期患者不同排便方式的效果观察

目的 探讨急性心肌梗死早期患者不同排便方式的效果,为临床护士指导急性心肌梗死早期患者采取合理、有效的排便措施,减少排便引起并发症的发生提供依据.方法 将50例急性心肌梗死患者随机分为实验组25例和对照组25例,实验组采用床旁坐便椅坐位方式排便,对照组为传统床上平卧位排便.排便过程中持续心电血压监测,比较两组患者排便时间、有无解出、排便费力程度、舒适度.结果 实验组与对照组在排便时间上差异无统计学意义,在有无解出、费力程度、舒适度上差异均有统计学意义（P＜0.05）.结论 床上平卧位排便结果 不佳,且未能有效减少并发症的发生;急性心肌梗死早期无严重并发症,血流动力学稳定患者床旁使用坐便椅坐位排便是一种合理、科学的选择.     

Factors associated with defecation patterns in 0–24-month-old children

To identify the normal defecation patterns and the factors affecting these patterns in the first two years of life, a questionnaire was given to the parents of 1,021 children who were followed in a well-child clinic. The time of first meconium passage, presence of colic symptoms, frequency, color, and consistency of stools were recorded.Mann Whitney U, Wilcoxon, chi-square, and correlation tests were used in the statistical analyses. The median number of defecations per day was six in the first month of life. This decreased to once in the second month and almost all cases remained so until the end of the 24th month. At the second month of age, 39.3% of infants passed stools less than once a day. This pattern of rare defecation was seen until the end of 6 months, when supplemental foods were started. Stool frequency was higher in exclusively breast-fed infants (p = 0.0001). Infants who had colic symptoms in the first 2 months had less frequent defecation during the first 2 years of life (p = 0.0001). In addition to confirming the previously observed defecation patterns of 0–2-year-old infants, this study provides the relationship between colic symptoms and stool frequency, and showed that the second month of life was unique in the sense that the frequency of stooling decreased to half of the previous month and 39.3% of these infants defecated less than once a day.