Causes and assessment of faecal incontinence

Faecal incontinence remains a taboo subject and patients frequently conceal their symptoms, because of fear and embarrassment. Sensitive and appropriate assessment will encourage people to seek advice and treatment if required. This article discusses the causes and assessment of faecal incontinence. It explains the structure and function of the anal sphincters in maintaining continence. Assessment of bowel control is discussed in depth. Questions are suggested which will help to identify problems and thereby enable access to appropriate care

Magnetic resonance imaging evaluation after anorectal pull-through surgery for anorectal malformations : a comprehensive review

Anorectal malformations (ARM) include congenital anomalies of the distal anus and rectum with or without anomalies of the urogenital tract. Posterior sagittal anorectoplasty (PSARP) and minimally invasive laparoscopically assisted anorectal pull-through (LAARP) procedure are now mainly used to surgically treat ARMs. Magnetic resonance imaging (MRI) is the modality of choice for interval follow-up assessment of structural and functional outcome after these surgeries to assess future bowel continence. Well-developed pelvic musculature has been found to be a reflector of better anal continence after ARM surgery. Thus, MRI plays an important role in evaluating the external sphincter complex, puborectalis, and levator ani muscles. Other parameters that need to be noted include the position of the neoanus, rectal diameter, anorectal angle, presence or absence of megarectum, and other ancillary anomalies in the spine. Thus, MRI due to superior soft-tissue resolution is the modality of choice and indispensable for post-operative pelvic evaluation in children

A nursing assessment tool for adults with fecal incontinence.

Fecal incontinence affects slightly more than 1% of community-dwelling adults. This article describes an assessment format, with a research basis when available, that has been developed in a specialist nursing clinic in the United Kingdom. The focus is on how to obtain the most useful information from the patient to plan appropriate nursing interventions. A subsequent article will describe the biofeedback program developed as part of a package of care to meet individual needs of persons with fecal incontinence

Aetiology of thrombosed external haemorrhoids: a questionnaire study

<p>Abstract</p> <p>Background</p> <p>It is important to better understand the aetiology of thrombosed external haemorrhoids (TEH) because recurrence rates are high, prophylaxis is unknown, and optimal therapy is highly debated.</p> <p>Findings</p> <p>We conducted a questionnaire study of individuals with and without TEH. Aetiology was studied by comparison of answers to a questionnaire given to individuals with and without TEH concerning demography, history, and published aetiologic hypotheses. Participants were evaluated consecutively at our institution from March 2004 through August 2005.</p> <p>One hundred forty-eight individuals were enrolled, including 72 patients with TEH and 76 individuals without TEH but with alternative diagnoses, such as a screening colonoscopy or colonic polyps. Out of 38 possible aetiologic factors evaluated, 20 showed no significant bivariate correlation to TEH and were no longer traced, and 16 factors showed a significant bivariate relationship to TEH. By multivariate analysis, six independent variables were found to predict TEH correctly in 79.1% of cases: age of 46 years or younger, use of excessive physical effort, and use of dry toilet paper combined with wet cleaning methods after defaecation were associated with a significantly higher risk of developing TEH; use of bathtub, use of the shower, and genital cleaning before sleep at least once a week were associated with a significantly lower risk of developing TEH.</p> <p>Conclusion</p> <p>Six hypotheses on the causes of TEH have a high probability of being correct and should be considered in future studies on aetiology, prophylaxis, and therapy of TEH.</p

Rethinking the effectiveness of defecation postures and practices: it’s not what you do it’s the way that you do it!

This paper reports on a piece of research to investigate the effectiveness of defecation postures and anal cleansing method. The research compared how long each bowel movement took on a pedestal toilet with and without a footstool. Volunteers were asked to compare the two positions for speed as well as stress/strain on the body. The effectiveness of the method of anal cleansing was also rated by a subset of the volunteers. Although the study was conducted using volunteers in the UK, the findings have international relevance for sanitation marketing and hygiene promotion programmes

Management of Pediatric Constipation

Constipation is a common problem in children. It accounts for 20–30% of pediatric outdoor office. It is common in both rich and poor countries despite the belief that developing countries consume food rich in fiber. Normal bowel movement in breastfed babies may range from several times a day to once in every 10 days. Constipation can be both functional and pathological. Functional constipation has no underlying cause and is the most common type of constipation found in children. My main focus will be on this common type of constipation. In functional constipation routine, digital rectal examination is not recommended unless impaction is suspected. Abdominal radiography is recommended only in equivocal clinical examination or if impaction is suspected and examination not conclusive. Dietary and behavior modifications, toilet training, and parent education are important in the management of functional constipation. Initial management of functional constipation includes disimpaction of stools. Lactulose is safe in all age groups. Polyethylene glycol is more effective than lactulose but is costly. Maintenance therapy may take some time till constipation improves. Some rare situations such as refractory and slow transient constipation are also discussed in this chapter

Do we at all need surgery to treat thrombosed external hemorrhoids? Results of a prospective cohort study

Ole Gebbensleben1, York Hilger2, Henning Rohde31Park-Klinik Berlin-Weissensee, Berlin, Germany; 2Institut f&amp;uuml;r Biostatistik, Freiburg im Breisgau, Germany; 3Praxis f&amp;uuml;r Endoskopie und Proktologie, Berlin, GermanyBackground: It is unknown whether surgery is the gold standard for therapy of thrombosed external hemorrhoids (TEH).Methods: A prospective cohort study of 72 adults with TEH was conducted: no surgery, no sitz baths but gentle dry cleaning with smooth toilet paper after defecation. Follow-up information was collected six months after admission by questionnaire.Results: Despite our strict conservative management policy 62.5% (45/72) of patients (95% confidence interval [CI]: 51.0&amp;ndash;74.0) described themselves as &amp;ldquo;healed&amp;rdquo; or &amp;ldquo;ameliorated&amp;rdquo;, and 61.1% (44/72, 95% CI: 49.6&amp;ndash;72.6) found our management policy as &amp;ldquo;valuable to test&amp;rdquo; or &amp;ldquo;impracticable&amp;rdquo;. 13.9% (10/72, 95% CI: 5.7&amp;ndash;22.1) of patients suspected to have recurrences. 4.2% did not know. Twenty-two of the 48 responding patients reported symptoms such as itching (18.8%), soiling (12.5%), pricking (10.4%), or a sore bottom (8.3%) once a month (59.1%, 13/22), once a week (27.3%, 6/22), or every day (13.6%, 3/22). Conclusions: The dictum that surgery is the gold standard for therapy for TEH should be checked by randomized controlled trials.Keywords: hemorrhoids, acute hemorrhoidal disease, thrombosed external hemorrhoid, perianal thrombosis, conservative therapy, surger

Ending open defecation in rural Tanzania: which factors facilitate latrine adoption?

Diarrheal diseases account for 7% of deaths in children under five years of age in Tanzania. Improving sanitation is an essential step towards reducing these deaths. This secondary analysis examined rural Tanzanian households sanitation behaviors and attitudes in order to identify barriers and drivers to latrine adoption. The analysis was conducted using results from a cross-sectional study of 1000 households in five rural districts of Tanzania. Motivating factors, perceptions, and constraints surrounding open defecation and latrine adoption were assessed using behavioral change theory. Results showed a significant association between use of improved sanitation and satisfaction with current sanitation facility (OR: 5.91; CI: 2.95-11.85; p = 0.008). Livestock-keeping was strongly associated with practicing open defecation (OR: 0.22; CI 0.063-0.75; p &lt; 0.001). Of the 93 total households that practiced open defecation, 79 (85%) were dissatisfied with the practice, 62 (67%) had plans to build a latrine and 17 (18%) had started saving for a latrine. Among households that planned to build a latrine, health was the primary reason stated (60%). The inability to pay for upgrading sanitation infrastructure was commonly reported among the households. Future efforts should consider methods to reduce costs and ease payments for households to upgrade sanitation infrastructure. Messages to increase demand for latrine adoption in rural Tanzania should integrate themes of privacy, safety, prestige and health. Findings indicate a need for lower cost sanitation options and financing strategies to increase household ability to adopt sanitation facilities

Pengaruh Penerapan Teknik Token Economy Terhadap Toilet Training Pada Anak Usia 2-3 Tahun Di Tpa IT Future Islamic School Kecamatan Payung Sekaki Kota Pekanbaru

The aims of this research to know the influence application of token economy techniques to toilet training 2-3 years old children at Day Care IT Future Islamic School Kecamatan Payung Sekaki Pekanbaru City. The samples in this study are children aged 2-3 years in Day Care IT Future Islamic School Payung Sekaki District Pekanbaru City. The sample in this research are 5 childrens. The method used is experimental method to find the influence of token economy technique to toilet training. Data collection techniques used are observation and assisted by observation sheet. Data analysis technique used t-test with SPSS 17.0 program. The research hypothesis is the application of token economy techniques have an influence on the success of toilet training at age-3 years in Day Care IT Future Islamic School Payung Sekaki District Pekanbaru City. This can be known from the analysis of data obtained zhitung = 2.032 and Sig. (2-tailed) = 0.042. Because Sig. (2-tailed) = 0,04 <0,05 it can be concluded that there is difference of children toilet training ability significantly after application of token economy technique in learning. So it means Ho is rejected and Ha accepted which means there is a very significant difference between before and after doing experiments by applying token economy technique. The influence of the application of token economy technique to toilet training 2-3 years old children in TPA IT Future Islamic School Payung Sekaki District, Pekanbaru City is 35.5%

Management of Rectal Prolapsed in Children at ‎Medical City

هدف الدراسة:تقييم دور &nbsp;العلاج التحفظي في علاج هطول المستقيم في الأطفال .&nbsp; الاساليب: أجريت دراسات مستقبلية&nbsp; ل80حالة من للمرضى الذين يعانون هطول المستقيم في مركز مدينة الطب مستشفى حماية الطفل قسم جراحة الأطفال، بين يناير 2014- اكتوبر 2015. النتائج: تم علاج &nbsp;80 &nbsp;طفل يعانون من &nbsp;هطول المستقيم وكانت&nbsp; اعمارهم تتراوح من 6 أشهر إلى 12 عاما. وكانت الفئة العمرية الأكثر شيوعا من العمر (1-3) سنة في)53.7%) &nbsp;والنوع الرئيسي ( 80 ٪)&nbsp; &nbsp;كان سمك هبوط المستقيم جزئي. وكانت مدة الأكثر شيوعا لهطول المستقيم &nbsp;&nbsp;(50٪)هي (1-3) شهر . &nbsp;وكان الإسهال&nbsp; السبب الأكثر شيوعا في 28 مريضا (35٪) في حين كان الإمساك السبب الثاني في 30 مريض (24٪).خمسون مريضا &nbsp;( 62.5 ٪) استجابوا للعلاج التحفظي في حين أن ثلاثون مريضا(37.5%) &nbsp;تطلبوا التداخل الجراحي.سبعة وثلاثون (74٪) مريضا&nbsp; الذين اعمارهم أقل من 3 سنوات&nbsp; استجابوا للعلاج التحفظي &nbsp;وخمسة عشر (75٪) مريضا&nbsp; الذين استجابوا لعملية الحقن بمادة&nbsp; الكلوكوز (25٪) &nbsp;كانت&nbsp; أعمارهم اقل من 3 سنوات. اجريت عملية الحقن بمادة&nbsp; الكلوكوز (25٪) &nbsp;لخمسة وعشرون من&nbsp; المرضى ، وكانت نسبة النجاح بعد الحقن الثاني (77٪) . اجريت عملية الثيرش لست مرضى ، وكانت نسبة النجاح هي (66.6٪) . الاستنتاجات العلاج التحفظي لا يزال أفضل علاج ل هبوط المستقيم لآنها تحمل فرصة جيدة للشفاء وخاصة في الأطفال الذين تقل أعمارهم عن 3سنوات . عملية الحقن بمادة&nbsp; الكلوكوز (25٪)&nbsp; هو أفضل طريقة لعلاج المرضى الذين يعانون هطول المستقيم واعمارهم أقل من 3سنوات وخاصة اذا كان&nbsp; سمك هبوط المستقيم الجزئي.Background: Rectal prolapse is defined as circumferential descend or protrusion through the anus of one or more coats of the rectum.&nbsp; Prolapse can be either partial or complete, any condition which suddenly increase&nbsp; abdominal pressure may precipitate abnormal descend of bowel wall , the straining during defecation , and long periods of sitting on the toilet, allows stretching of the pelvic diaphragm and other less well-defined rectal suspensory structures which results in prolapse. Aim : To evaluate the different type of treatment for rectal prolapse in children. Patients &amp; methods: This is prospective study of 80 patients of rectal prolapse was admitted &nbsp;at children welfare teaching hospital at medical city, were admitted to the pediatric surgical department from January 2014 to October 2015. Results: In our study of 80 child with rectal prolapse the age of the patient ranging from&nbsp; 6months to&nbsp; 12 year .Most common age group of presentation was (1-3) year in 43 patient&nbsp; (53.7%) and main type 64 patients&nbsp; (80%) was partial thickness rectal prolapse . Most common duration of prolapse &nbsp;was (1-3) months in forty patients (50.0%), all patients presented (100%)&nbsp; with protruding mass and 42 patients (52.5%) &nbsp;presented with incontinence . Diarrhea was the common associated condition in 28 patients (35%),while constipation was the second associated condition in &nbsp;24 patients(30%).Fifty patients (62.5%)respond to conservative treatment while 30 patients &nbsp;(37.5%) patients required surgical interference . Thirty seven patients with age less than 3 years (74%) responded to conservative treatment&nbsp; and 15 patients (75%) who responded to injection sclerotherapy aged less than 3 years. Twenty fife patients receive injection sclerotherapy , success rate after 2nd Injection was (77%) , about (75%) of them aged less than 3 year and (70%) of them was presented with partial thickness rectal prolapsed Six&nbsp; patients receive&nbsp; Thiersch operation with Success Rate 66.6% , five of them with full-thickness rectal prolapse &amp;aged more than 3 years. No mortality was conducted in this study . Conclusion Conservative treatment still the best treatment for rectal prolapse because it carry good chance for healing specially in children younger than 3 year. Injection sclerotherapy is the best method for treatment in patients with age less than 3 year specially in partial thickness rectal prolaps