Anorectal function in elderly patients with fecal impaction

Read, N W; Abouzekry, Laila; Read, Maria G.; Howell, Pauline; Ottewell, D.; Donnelly, T. C.

doi:10.1016/0016-5085(85)90194-5

Cited by 143 publications

(73 citation statements)

References 23 publications

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“…Patients with fecal incontinence secondary to fecal impaction were reported to demonstrate impaired balloon expulsion. 19,20 In another literature, 86% of patients with fecal incontinence have little difficulty with balloon expulsion. 20,21 A study showed 92% of patients with fecal incontinence could expel the balloon and the mean expulsion time was 50 seconds.…”

Section: Discussionmentioning

confidence: 99%

Balloon Expulsion Test Does Not Seem to Be Useful for Screening or Exclusion of Dyssynergic Defecation as a Single Test

Lee

Hong

Kim

et al. 2017

J Neurogastroenterol Motil

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Background/AimsBalloon expulsion test (BET) is regarded as a screening tool of dyssynergic defecation (DD). However, some patients with normal BET results may be treated effectively by biofeedback training. This study aims to validate BET as a single screening test. MethodsTwo hundred and thirty-two patients who were diagnosed with functional constipation or irritable bowel syndrome with constipation who underwent anorectal manometry (ARM) and BET at Seoul National University Hospital were enrolled. We evaluated the validity of BET based on ARM and electromyography (EMG) during biofeedback training. ResultsIf BET ≤ 1 minute was defined as normal, sensitivity and negative predictive value (NPV) of BET in predicting paradoxical contraction based on ARM findings were 71.4% and 13.9%. If BET ≤ 3 minutes was defined as normal, sensitivity and NPV were 35.2% and 6.6%. Specificity and positive predictive value (PPV) of BET ≤ 3 minutes criteria were 84.8% and 93.3%. Same analysis was conducted in 107 patients who underwent EMG during biofeedback training. With 1-minute criteria, sensitivity and NPV of BET were 70.3% and 14.3%. With 3 minutes criteria, sensitivity and NPV of BET was 38.6% and 8.8%. Specificity and positive predictive values were both 100.0%. ConclusionsBased on either ARM or EMG during biofeedback training, sensitivity was at most 71.4% and NPV was less than 15.0% irrespective of whether BET was within 1minute or within 3 minutes. BET seems to have a limitation as both a screening test for dyssynergic defecation and a simple assessment to rule out the necessity of biofeedback training.

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Section: Discussionmentioning

confidence: 99%

Balloon Expulsion Test Does Not Seem to Be Useful for Screening or Exclusion of Dyssynergic Defecation as a Single Test

Lee

Hong

Kim

et al. 2017

J Neurogastroenterol Motil

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show abstract

“…[11][12][13] Excessive perineal descent during straining may lead to further damage to the pudendal nerve from compression against the ischeal spine. 12 Straining in older persons of both genders may also be an indicator of rectal dyschezia, in which rectal sensation and contractility are impaired, 9,11,13,14 and the clinical risk of both fecal incontinence and recurrent rectal impaction is potentially increased. 12,14 Report of hard bowel movements has been correlated with prolongation of rectosigmoid transit time.…”

Section: Discussionmentioning

confidence: 99%

“…12 Straining in older persons of both genders may also be an indicator of rectal dyschezia, in which rectal sensation and contractility are impaired, 9,11,13,14 and the clinical risk of both fecal incontinence and recurrent rectal impaction is potentially increased. 12,14 Report of hard bowel movements has been correlated with prolongation of rectosigmoid transit time. 11,15 Hard stools require higher intra-abdominal pressures to be effectively evacuated from the rectum, so straining is often an associated symptom.…”

Section: Discussionmentioning

confidence: 99%

How Do Older Persons Define Constipation? Implications for Therapeutic Management

et al. 1997

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This study examined the relation between bowel-related symptoms and self-report of constipation in 10,875 subjects aged 60 years and over, who participated in the 1989 National Health Interview Survey. Subjects reporting constipation "always" or "mostly" over the past 12 months ( n ‫؍‬ 594) were compared with those who reported never having the symptom ( n ‫؍‬ 4,192). Straining (adjusted odds ratio 66.7; 95% confidence interval 31.5, 142.4) and hard bowel movements (25.6; 16.7, 38.7) were most strongly associated with self-report of constipation. These findings suggest that treatment for constipation in the older population should be directed as much or more at facilitating comfortable rectal evacuation, as increasing bowel movement frequency.

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“…old was found in 68% of the constipated children (Meunier et al, 1979a;. Lower rectal pressures were also recorded during rectal distension in the constipated group than in the control (Read et al, 1985). The mean values for percent of activity and surface area under the contraction curves were significantly lower in the constipated than in the control children (Loening-Baucke & Younoszai, 1984).…”

Section: Systemic and Local Functional Factorsmentioning

confidence: 98%

“…A survey performed in the United Kingdom indicated that 10% of adults reported constipation in the preceding 2 weeks (Murtag, 1990). Its occurrence appears to be more frequent in incapacitated or institutionalised elderly people, where 42% of the patients admitted to geriatric wards were diagnosed (Read et al, 1985). Faecal impaction was the main reason for admission in 18% of acutely ill and in 27% of chronically ill patients (Read et al, 1985).…”

Section: Epidemiologymentioning

confidence: 99%

Mild dehydration: a risk factor of constipation?

Arnaud

2003

Eur J Clin Nutr

111

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Constipation defined as changes in the frequency, volume, weight, consistency and ease of passage of the stool occurs in any age group. The most important factors known to promote constipation are reduced physical activity and inadequate dietary intake of fibres, carbohydrates and fluids. Fluid losses induced by diarrhoea and febrile illness alter water balance and promote constipation. When children increase their water consumption above their usual intake, no change in stool frequency and consistency was observed. The improvement of constipation by increasing water intake, therefore, may be effective in children only when voluntary fluid consumption is lower-than-normal for the child's age and activity level. In the elderly, low fluid intake, which may be indicative of hypohydration, was a cause of constipation and a significant relationship between liquid deprivation from 2500 to 500 ml per day and constipation was reported. Dehydration is also observed when saline laxatives are used for the treatment of constipation if fluid replacement is not maintained and may affect the efficacy of the treatment. While sulphate in drinking water does not appear to have a significant laxative effect, fluid intake and magnesium sulphate-rich mineral waters were shown to improve constipation in healthy infants. In conclusion, fluid loss and fluid restriction and thus de-or hypohydration increase constipation. It is thus important to maintain euhydration as a prevention of constipation.

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Anorectal function in elderly patients with fecal impaction

Cited by 143 publications

References 23 publications

Balloon Expulsion Test Does Not Seem to Be Useful for Screening or Exclusion of Dyssynergic Defecation as a Single Test

Balloon Expulsion Test Does Not Seem to Be Useful for Screening or Exclusion of Dyssynergic Defecation as a Single Test

How Do Older Persons Define Constipation? Implications for Therapeutic Management

Mild dehydration: a risk factor of constipation?

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