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References: Laxative






Z Gastroenterol. 1990 Jul;28(7):335-8.
The plain abdominal radiograph in the assessment of constipation.

Starreveld JS, Pols MA, Van Wijk HJ, Bogaard JW, Poen H, Smout AJ.

Department of Gastroenterology, University Hospital, Utrecht.

To investigate the value of the plain abdominal radiograph in the assessment of constipation we prospectively studied 30 patients (20 females, 10 males, mean age 48.6 years, range 21-76 years). These patients underwent the following tests: plain abdominal radiograph in supine position, measurement of stool weight (mean of 5 days) and whole gut transit time (20 radioopaque pellets, fluoroscopy of stools). All patients completed a questionnaire regarding their defaecation characteristics (a.o. average defaecation frequency and faecal consistency). The abdominal films were coded and independently scored for the degree of faecal stasis in ascending, transverse, descending colon and rectosigmoid by four gastroenterologists. To each of these parts of the colon a score of 1 (no faeces) to 4 (loaded with faeces) was assigned. The film scores given by the four observers were significantly correlated (p less than 0.001). Significant correlations were found between the radiograph scores and frequency of defaecation, faecal consistency and stool weight. The strength of these correlations were of the same order of magnitude as those between the other subjective and objective defaecation variables. The scores for the left colon (descending colon and rectosigmoid) showed a better correlation with the other defaecation parameters than the scores for the right colon. It is concluded that in the assessment of constipation a simple plain abdominal radiograph is as reliable as measurement of faecal weight or marker transit and can thus be advocated as the first procedure. When an abdominal radiograph is used for this purpose the stasis in the descending and sigmoid colon provides most information.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2238762&dopt=Abstract constipation laxative colon cleansing



Minerva Chir. 1994 May;49(5):383-92.
[The functional and manometric results of 2 surgical methods of posterior abdominal rectopexy]

[Article in Italian]

Scaglia M, Ribero F, Comotti F, Campra D, Delaini GG, Hulten L.

I Divisone di Chirurgia Generale, Ospedale Maria Vittoria, Torino.

Functional changes after posterior abdominal rectopexy for the treatment of rectal prolapse are not fully understood. We studied the effects of Wells' or Ripstein's rectopexy on functional characteristics as related to anal sphincter function, rectal volume and sensory function in 31 patients with complete or internal rectal prolapse. We have observed an improvement of continence over 70% in both groups. However, an absent or a decreased call to stool, constipation and evacuation difficulties are the aftermath of Wells' rectopexy, while these complaints appear basically unaffected by Ripstein's technique. Maximal squeeze pressure was slightly increased after Ripstein's rectopexy, whereas no significant effects were found on anal pressures. Postoperatively the rectal capacity was reduced by Well's procedure (p < 0.05), while no significant changes were observed with Ripstein's operation. After the Wells procedure patients developed at the threshold for the relaxation of the internal sphincter progressively lower rectal volumes, reaching one year after rectopexy the statistical significance. Sensory thresholds for sense of filling and urge were significantly raised after Wells' rectopexy even one year after operation, whereas after Ripstein's operation sense of filling was not significantly affected and while sense of urge was increased early postoperatively, it was not significantly changed at one hear postoperative control. In conclusion, when fecal incontinence appears associated to a rectal prolapse has good chances to improve postoperatively. Preoperative evacuation difficulties seem to be unaffected by a posterior abdominal rectopexy, Wells or Ripstein, but an extensive dissection of the rectum



Z Gastroenterol. 1994 Jun;32(6):328-31.
Endosonography of the anal sphincters: incontinent and continent patients and healthy controls.

Schafer A, Enck P, Heyer T, Gantke B, Frieling T, Lubke HJ.

Heinrich Heine University Hospitals, Department of Gastroenterology, Dusseldorf, Germany.

It has previously been shown that in healthy subjects anal sphincter functions as assessed by anorectal manometry and anal sphincter anatomy as measured by endoluminal ultrasound are poorly correlated. It remains to be shown, however, whether this is true for a larger series of patients with anorectal dysfunctions such as incontinence, and what is the clinical relevance of anal sonography. Anal sonography was performed in 42 consecutive patients with fecal incontinence, in 19 patients with constipation and/or anal pain, and in 15 healthy volunteers to determine anal sphincter integrity and the dorsal diameter of the internal and external anal sphincter muscles. Conventional multilumen anorectal manometry was performed in all subjects and patients to determine, among others, external and internal sphincter (EAS, IAS) performance at rest and during squeezing. It was shown that healthy subjects exhibit significantly higher muscle diameters of the IAS than both patient groups, but the EAS was similar in all groups. In 11/42 cases of incontinent patients, in 3/19 constipated patients, but in none of the controls a muscle defect of the EAS was found with sonography. Thirteen of these 14 patients were women with previous birth traumas. EAS but not IAS muscle thickness and muscle performance (squeezing and resting, respectively) were significantly correlated. Across all groups, women had smaller EAS muscle diameters than men. It is concluded, that in incontinent patients anal sonography may reveal additional information of clinical relevance in a substantial fraction of patients, and, thus, both anal manometry and anal ultrasound are of clinical value.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7975761&dopt=Abstract constipation laxative colon cleansing



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