References: Laxative
Dis Colon Rectum. 1995 Jul;38(7):695-9.
Four-contrast defecography: pelvic "floor-oscopy".
Altringer WE, Saclarides TJ, Dominguez JM, Brubaker LT, Smith CS.
Section of Colon and Rectal Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA.
PURPOSE: This study was designed to determine the accuracy of physical examination (as judged by four-contrast defecography) for women with pelvic floor relaxation disorders. METHODS: Sixty-two women (mean age, 59 years) who had obstructed defecation or constipation, vaginal prolapse, urinary difficulty, or pelvic pain underwent four-contrast defecography. Oral, vaginal, bladder, and rectal contrast were administered selectively and fluoroscopy was performed. Radiographic findings were compared with physical examination diagnosis. RESULTS: Four-contrast defecography changed the diagnosis in 46 patients (75 percent); 26 percent of presumed cystoceles, 36 percent of enteroceles, and 25 percent of rectoceles were not present on defecography. Defecography also revealed unsuspected coexisting defects in addition to known abnormalities detected on physical examination. In contrast, when physical examination was negative for these defects, 63 percent of patients were found to have cystoceles, 46 percent to have enteroceles, and 73 percent to have rectoceles on four-contrast defecography. The discovery of Grade 2 or 3 unsuspected abnormalities was significant, especially so for enteroceles. For posterior vaginal eversions extending to or past the introitus, physical examination was accurate in only 61 percent. Physical examination of large anterior defects was more accurate, with 74 percent of patients being correctly diagnosed. CONCLUSIONS: Physical examination diagnosis of pelvic floor relaxation disorders is frequently inaccurate, especially for large vaginal eversions. Four-contrast defecography improves diagnostic accuracy, helps to identify all pelvic floor defects before surgery, and can assist with planning the corre
World J Surg. 1992 Sep-Oct;16(5):811-9.
Autonomic influences on colorectal motility and pelvic surgery.
Varma JS.
Department of Surgery, Western General Hospital, Edinburgh, Scotland.
The nervous control of the motility of the human distal bowel was investigated by two physiological studies of electrical stimulation of sacral parasympathetic outflow in patients with high spinal injuries and in patients with intractable constipation following pelvic surgery. Identical and reproducible motility responses of the left colon, rectum, and anal sphincters were obtained by sequential electrical stimulation of anterior sacral roots S2, S3, and S4 in patients with spinal injury. S2 stimulation provoked isolated low-pressure colorectal contractions. S3 stimulation initiated frequency-dependent high-pressure colorectal motor activity which appeared peristaltic and was enhanced with repetitive stimuli. S4 stimulation increased colonic and rectal tone. Quantitative responses were maximal at the splenic flexure and rectum. Pelvic floor activity was stimulated in increasing magnitude from S2 to S4. These results of distal bowel motility were achieved by an implanted Brindley stimulator. A newer generation of externally active stimulators are envisaged for the control of lower bowel in fecal incontinence. Women with intractable constipation following hysterectomy had significantly increased rectal volume and compliance together with deficits of rectal sensory function. Following stimulation with Prostigmine (neostigmine) a colorectal motility gradient was paradoxically reversed in the patients following hysterectomy, thus constituting a functional obstruction. Denervation supersensitivity was demonstrable in 2 patients tested with carbachol provocation. These findings suggest dysfunction in the autonomic innervation of the hindgut in some patients following hysterectomy.
Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1462613&dopt=Abstract constipation laxative colon cleansing
Clin Nurs Res. 1995 Aug;4(3):335-45.
Hmong cultural practices and beliefs: the postpartum period.
Jambunathan J.
The purpose of this study was to explore the cultural practices and beliefs of the Hmong in the postpartum period. Using the qualitative research method of in-depth interviewing, data were collected through semistructured interviews. A convenience sample of 52 childbearing Hmong women was interviewed with the help of Hmong interpreters. The interviews were audiotaped and transcribed for analysis. Data analysis revealed cultural practices and beliefs categories related to diet, rest period, appropriate clothing, breast feeding, and sex practices in the postpartum period. Implications for nursing include both cultural sensitivity and an understanding of such traditional practices, before suggesting or implementing any health-promotion activities.
PIP: In this exploratory descriptive study, the qualitative research method of in-depth interviewing was used. A convenience sample of 52 postpartum Hmong women from northeastern and north central Wisconsin were interviewed through semistructured interviews. They ranged in ages from 18 to 44 years, with a mean age of 27.3 years. All were married, and had 1-11 children. The women's length of stay in this country ranged from 1 month to 15 years, with a mean of 5.3 years. Seven of the women were primiparas. The majority (88%) were homemakers. 75% of the women did not speak English. Their educational levels ranged from either no education to English as a second language, or to more than 12 years of education (25%). All of the Hmong women stated that they followed their cultural beliefs and practices in taking care of themselves and their babies during the postpartum period. Diet usually consisted of warm chicken and rice, with no fluids, to prevent diarrhea and stomach cramps. The belief was that increased fat consumption would lead to constipation. Pork or beef was considered fatty stuff and would clog the blood. A general beli
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