AIM: To investigate coping mechanisms, constipation symptoms and anorectal physiology in 80 constipated subjects and 18 controls.METHODS: Constipation was diagnosed by Rome Ⅱ criteria.Coping ability and anxiety/depre...AIM: To investigate coping mechanisms, constipation symptoms and anorectal physiology in 80 constipated subjects and 18 controls.METHODS: Constipation was diagnosed by Rome Ⅱ criteria.Coping ability and anxiety/depression were assessed by validated questionnaires. Transit time and balloon distension test were performed.RESULTS: 34.5% patients were classified as slow transit type of constipation. The total colonic transit time (56 h vs 10 h, P＜0.0001) and rectal sensation including urge sensation (79 mL vs 63 mL, P = 0.019) and maximum tolerable volume (110 mL vs95 mL, P = 0.03) differed in patients and controls. Constipated subjects had significantly higher anxiety and depression scores and lower SF-36 scores in all categories. They also demonstrated higher scores of'monitoring' coping strategy (14+6 vs9+3, P = 0.001),which correlated with the rectal distension sensation (P = 0.005), urge sensation (P=0.002), and maximum tolerable volume (P = 0.035). The less use of blunting strategy predicted slow transit constipation in both univariate (P = 0.01) and multivariate analysis (P = 0.03).CONCLUSION: Defective or ineffective use of coping strategies may be an important etiology in functional constipation and subsequently reflected in abnormal anorectal physiology.展开更多
AIM: To determine the indicated referrals to a tertiary centre for patients with anorectal symptoms, the effect of the advised treatment and the discomfort of the tests.METHODS: In a retrospective study, patients refe...AIM: To determine the indicated referrals to a tertiary centre for patients with anorectal symptoms, the effect of the advised treatment and the discomfort of the tests.METHODS: In a retrospective study, patients referred for anorectal function evaluation (AFE) between May 2004 and October 2006 were sent a questionnaire, as were the doctors who referred them. AFE consisted of anal manometry, rectal compliance measurement and anal endosonography. An indicated referral was defined as needing AFE to establish a diagnosis with clinical consequence (fecal incontinence without diarrhea, 3rd degree anal sphincter rupture, congenital anorectal disorder, inflammatory bowel disease with anorectal complaints and preoperative in patients for re-anastomosis or enterostoma, anal fissure, fistula or constipation). Anal ultrasound is always indicated in patients with fistula, anal manometry and rectal compliance when impaired continence reserve is suspected. The therapeutic effect was noted as improvement, no improvement but reassurance, and deterioration.RESULTS: From the 216 patients referred, 167 (78%) returned the questionnaire. The referrals were indicated in 65%. Of these, 80% followed the proposed advice. Improvement was achieved in 35% and a reassurance in 57% of the patients, no difference existed between patient groups. On a VAS scale (1 to 10) symptoms improved from 4.0 to 7.2. Most patients reported no or little discomfort with AFE. CONCLUSION: Referral for AFE was indicated in 65%. Beneficial effect was seen in 92%: 35% improved and 57% was reassured. Advice was followed in 80%. Better instruction about indication for AFE referral is warranted.展开更多
Objective To explore the clinical effects of heat-sensitizing moxibustion on functional anorectal pain. Methods Thirty six patients with functional anorectal pain were treated with moxibustion on heat-sensitive acupun...Objective To explore the clinical effects of heat-sensitizing moxibustion on functional anorectal pain. Methods Thirty six patients with functional anorectal pain were treated with moxibustion on heat-sensitive acupuncture points.The heat-sensitized points include Chángqiáng（长强 GV l）, Cìliáo（次髎 BL 32）, Yāoshū（腰俞 GV 2）, and local perianal points. A course of treatment consisted of treatment at each heat-sensitized point for 15 min once per day for 10 days. The therapeutic effects were observed after continuous treatment for 3 treatment cycles. Results Twelve cases were cured, eleven cases had effective results, and 3 cases were ineffective. The total effectiveness rate was 91.7%. The visual analog scale（VAS） total score was 6.1±1.52 before treatment and was 1.63±1.05 after treatment, showing a statistically significant difference（P〈0.01）. Conclusion Heat-sensitization moxibustion can significantly relieve functional anorectal pain.展开更多
To investigate the anorectal status in patients with lumbosacral spinal cord injury （SCI）. Methods： Twenty six patients （23 males, 3 females） with lumbosacral SCI and 13 normal volunteers were enrolled into this...To investigate the anorectal status in patients with lumbosacral spinal cord injury （SCI）. Methods： Twenty six patients （23 males, 3 females） with lumbosacral SCI and 13 normal volunteers were enrolled into this study as controls. The median age was 43.7 years （ranging 17-68 years） and the median time of patients since injury was 59.1 months （ ranging 8 months-15 years）. They were diagnosed as complete lumbosacral SCI （n=2, American Spinal Injury Association （ASIA） score A）, or incomplete lumbosacral SCI （n =24, ASIA score B- D） with mixed symptoms of constipation and/or fecal incontinence, and were studied by anorectal manometry. None of the patients had any medical treatments for neurogenic bowel prior to this study. Results： The maximum anal resting pressure in lumbosacral SCI patients group was slightly lower than that in control group （ One-way ANOVA： P = 0. 939 ）. During defecatory maneuvers, 23 of 26 （ 88. 5 %） patients with lumbosacral SCI and I of 13 （ 7. 7 % ） in the control group showed pelvic floor dysfunction （PFD） （Fisher＇ s exact test： P〈0.0001）. Rectoanal inhibitory reflex （RAIR） was identified in both patients with lumbosacral SCI and the controls. The rectal volume for sustained relaxation of the anal sphincter tone in lumbosacral SCI patients group was significantly higher than that in the control group （Independent-Samples t test： P〈0.0001）. The mean rectal volume to generate the first sensation was 92.7 ml ± 57.1 mi in SCI patients, 41. S ml ± 13.4 ml in the control group （ Independent-Samples t test： P 〈0.0001 ）. Conclusions： Most of the patients with lumbosacral SCI show PFD during defecatory maneuvers and their rectal sensation functions are severely damaged. Some patients exhibit abnormal cough reflex. Anorectai manometry may be helpful to find the unidentified supraconal lesions. RAIR may be modulated by central nervous system （CNS）.展开更多
文摘AIM: To investigate coping mechanisms, constipation symptoms and anorectal physiology in 80 constipated subjects and 18 controls.METHODS: Constipation was diagnosed by Rome Ⅱ criteria.Coping ability and anxiety/depression were assessed by validated questionnaires. Transit time and balloon distension test were performed.RESULTS: 34.5% patients were classified as slow transit type of constipation. The total colonic transit time (56 h vs 10 h, P＜0.0001) and rectal sensation including urge sensation (79 mL vs 63 mL, P = 0.019) and maximum tolerable volume (110 mL vs95 mL, P = 0.03) differed in patients and controls. Constipated subjects had significantly higher anxiety and depression scores and lower SF-36 scores in all categories. They also demonstrated higher scores of'monitoring' coping strategy (14+6 vs9+3, P = 0.001),which correlated with the rectal distension sensation (P = 0.005), urge sensation (P=0.002), and maximum tolerable volume (P = 0.035). The less use of blunting strategy predicted slow transit constipation in both univariate (P = 0.01) and multivariate analysis (P = 0.03).CONCLUSION: Defective or ineffective use of coping strategies may be an important etiology in functional constipation and subsequently reflected in abnormal anorectal physiology.
文摘AIM: To determine the indicated referrals to a tertiary centre for patients with anorectal symptoms, the effect of the advised treatment and the discomfort of the tests.METHODS: In a retrospective study, patients referred for anorectal function evaluation (AFE) between May 2004 and October 2006 were sent a questionnaire, as were the doctors who referred them. AFE consisted of anal manometry, rectal compliance measurement and anal endosonography. An indicated referral was defined as needing AFE to establish a diagnosis with clinical consequence (fecal incontinence without diarrhea, 3rd degree anal sphincter rupture, congenital anorectal disorder, inflammatory bowel disease with anorectal complaints and preoperative in patients for re-anastomosis or enterostoma, anal fissure, fistula or constipation). Anal ultrasound is always indicated in patients with fistula, anal manometry and rectal compliance when impaired continence reserve is suspected. The therapeutic effect was noted as improvement, no improvement but reassurance, and deterioration.RESULTS: From the 216 patients referred, 167 (78%) returned the questionnaire. The referrals were indicated in 65%. Of these, 80% followed the proposed advice. Improvement was achieved in 35% and a reassurance in 57% of the patients, no difference existed between patient groups. On a VAS scale (1 to 10) symptoms improved from 4.0 to 7.2. Most patients reported no or little discomfort with AFE. CONCLUSION: Referral for AFE was indicated in 65%. Beneficial effect was seen in 92%: 35% improved and 57% was reassured. Advice was followed in 80%. Better instruction about indication for AFE referral is warranted.
文摘Objective To explore the clinical effects of heat-sensitizing moxibustion on functional anorectal pain. Methods Thirty six patients with functional anorectal pain were treated with moxibustion on heat-sensitive acupuncture points.The heat-sensitized points include Chángqiáng（长强 GV l）, Cìliáo（次髎 BL 32）, Yāoshū（腰俞 GV 2）, and local perianal points. A course of treatment consisted of treatment at each heat-sensitized point for 15 min once per day for 10 days. The therapeutic effects were observed after continuous treatment for 3 treatment cycles. Results Twelve cases were cured, eleven cases had effective results, and 3 cases were ineffective. The total effectiveness rate was 91.7%. The visual analog scale（VAS） total score was 6.1±1.52 before treatment and was 1.63±1.05 after treatment, showing a statistically significant difference（P〈0.01）. Conclusion Heat-sensitization moxibustion can significantly relieve functional anorectal pain.
基金This research was supported by the Ministry of Science and Technology of China
文摘To investigate the anorectal status in patients with lumbosacral spinal cord injury （SCI）. Methods： Twenty six patients （23 males, 3 females） with lumbosacral SCI and 13 normal volunteers were enrolled into this study as controls. The median age was 43.7 years （ranging 17-68 years） and the median time of patients since injury was 59.1 months （ ranging 8 months-15 years）. They were diagnosed as complete lumbosacral SCI （n=2, American Spinal Injury Association （ASIA） score A）, or incomplete lumbosacral SCI （n =24, ASIA score B- D） with mixed symptoms of constipation and/or fecal incontinence, and were studied by anorectal manometry. None of the patients had any medical treatments for neurogenic bowel prior to this study. Results： The maximum anal resting pressure in lumbosacral SCI patients group was slightly lower than that in control group （ One-way ANOVA： P = 0. 939 ）. During defecatory maneuvers, 23 of 26 （ 88. 5 %） patients with lumbosacral SCI and I of 13 （ 7. 7 % ） in the control group showed pelvic floor dysfunction （PFD） （Fisher＇ s exact test： P〈0.0001）. Rectoanal inhibitory reflex （RAIR） was identified in both patients with lumbosacral SCI and the controls. The rectal volume for sustained relaxation of the anal sphincter tone in lumbosacral SCI patients group was significantly higher than that in the control group （Independent-Samples t test： P〈0.0001）. The mean rectal volume to generate the first sensation was 92.7 ml ± 57.1 mi in SCI patients, 41. S ml ± 13.4 ml in the control group （ Independent-Samples t test： P 〈0.0001 ）. Conclusions： Most of the patients with lumbosacral SCI show PFD during defecatory maneuvers and their rectal sensation functions are severely damaged. Some patients exhibit abnormal cough reflex. Anorectai manometry may be helpful to find the unidentified supraconal lesions. RAIR may be modulated by central nervous system （CNS）.
