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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Fifty patients attending for surgical treatment of chronic constipation (n = 21) or faecal incontinence (n = 29) were studied using two psychiatric screening tests: the Hospital Anxiety and Depression (HAD) scale and the General Health Questionnaire (GHQ). Each patient was assessed preoperatively and 6-12 months postoperatively. Results were compared with age and sex-matched controls (n = 50). Constipated patients had significantly higher HAD depression scores compared with controls (median and range): 6 (2-12) versus 4 (0-8), P less than 0.05. Constipated patients who were improved by operation (n = 13) had significantly lower preoperative HAD anxiety scores compared with those who were not improved (n = 8): 8 (3-14) versus 15 (10-19), P less than 0.01; they also had significantly lower HAD depression scores: 4 (2-12) versus 7 (5-11), P less than 0.05. Using these parameters incontinent patients did not differ from controls, but patients who had a bad result after operation (n = 15) had significantly higher HAD anxiety scores than those who obtained clinical benefit (n = 14): 10 (2-15) versus 6 (2-12), P less than 0.05; HAD depression scores were also greater: 5 (2-15) versus 3 (0-9), P less than 0.05; and GHQ scores were greater: 12 (0-47) versus 4 (0-41), P less than 0.05.
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PMID:Psychiatric screening for patients with faecal incontinence or chronic constipation referred for surgical treatment. 272 Mar 44

Idiopathic faecal incontinence in middle-aged people has been found to be commonly associated with neurogenic damage to the anal sphincter musculature. Because neurogenic atrophy of skeletal muscle is a common feature of ageing, we have investigated the possibility that faecal incontinence in elderly people might be due to age-related denervation of the anal sphincter musculature. The technique of single fibre electromyography was used to measure the motor unit fibre density in the external and sphincter muscle in ten patients aged 78 to 99 years. Those patients whose continence was impaired had a markedly increased fibre density. Our findings suggest that neurogenic damage to the anal sphincter musculature may so reduce its functional reserve in elderly people that incontinence occurs when other factors, such as looseness of stool or depression of cerebral function, co-exist.
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PMID:A neurogenic factor in faecal incontinence in the elderly. 712 56

This prospective study was undertaken to assess personality differences among patients with chronic pelvic floor disorders. Sixty patients (43 females and 17 males) of a mean age of 58 (range, 33-87) years with fecal incontinence (n = 19), constipation (n = 30), or levator spasm (n = 11) had a mean duration of symptoms of 35 (range, 2-50) years. The Minnesota Multiphasic Personality Inventory (MMPI) was utilized for psychologic assessment for all patients prior to treatment. Mean scores for scales 1 (hypochondriasis), 2 (depression), and 3 (hysteria) were significantly elevated for the levator spasm group (71, 75, and 73, respectively). A similar pattern was seen for the constipation group, where the mean scores for scales 1 and 2 were significantly elevated (70 and 74, respectively) with a moderate elevation on scale 3 (68). The hypochondriasis (1), depression (2), and hysteria (3) scales are referred to as the "neurotic triad," and profile patterns such as these indicate that these subjects may manifest their psychologic distress as physical symptoms. By contrast, the fecal incontinence patients were within the normal range on all scales. The information from these MMPI profiles can be used to understand the personality and emotional composition of these patients to assist in their evaluation and treatment.
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PMID:MMPI assessment of patients with functional bowel disorders. 850 Mar 78

It is estimated that 10-20% of patients with multiple sclerosis (MS) have a chronic progressive (CP) course characterized by an insidious onset of neurological deficits followed by steady progression of disability in the absence of symptomatic remission. To date no therapeutic modality has proven effective in reversing the clinical course of CP MS although there are indications that prolonged treatment with picotesla electromagnetic fields (EMFs) alters the clinical course of patients with CP MS. A 40 year-old woman presented in December of 1992 with CP MS with symptoms of spastic paraplegia, loss of trunk control, marked weakness of the upper limbs with loss of fine and gross motor hand functions, severe fatigue, cognitive deficits, mental depression, and autonomic dysfunction with neurogenic bladder and bowel incontinence. Her symptoms began at the age of 18 with weakness of the right leg and fatigue with long distance walking and over the ensuing years she experienced steady deterioration of functions. In 1985 she became wheelchair dependent and it was anticipated that within 1-2 years she would become functionally quadriplegic. In December of 1992 she began experimental treatment with EMFs. While receiving regularly weekly transcortical treatments with AC pulsed EMFs in the picotesla range intensity she experienced during the first year improvement in mental functions, return of strength in the upper extremities, and recovery of trunk control. During the second year she experienced the return of more hip functions and recovery of motor functions began in her legs. For the first time in years she can now initiate dorsiflexion of her ankles and actively extend her knees voluntarily. Over the past year she started to show signs of redevelopment of reciprocal gait. Presently, with enough function restored in her legs, she is learning to walk with a walker and is able to stand unassisted and maintain her balance for a few minutes. She also regained about 80% of functions in the upper limbs and hands. Most remarkably, there was no further progression of the disease during the 4 years course of magnetic therapy. This patient's clinical recovery cannot be explained on the basis of a spontaneous remission. It is suggested that pulsed applications of picotesla EMFs affect the neurobiological and immunological mechanisms underlying the pathogenesis of CP MS.
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PMID:Treatment with electromagnetic fields reverses the long-term clinical course of a patient with chronic progressive multiple sclerosis. 935 26

In developed countries, postpartum care begins in the hospitals where most women give birth. In the UK, midwives continue postpartum care with home visits up to the 10th day, which can be extended to the 28th day if necessary. Then care is transferred to the health visitor who performs child health surveillance to age 5 years. Family physicians usually perform the 6-week postpartum maternal check-up. This routine, which was more appropriate in days when serious postpartum maternal infection was prevalent, seeks to promote and monitor maternal and infant health but its ability to meet these goals is questionable (this includes the value of a 6-week vaginal exam). Common and persistent maternal problems such as backache, perineal pain, urinary or bowel incontinence, sexual problems, hemorrhoids, depression, or exhaustion are not addressed by this routine. Research in Australia suggests that the timing as well as the content of maternal care should be reexamined. In this case/control study, no differences were found in health outcomes at 3- and 6-month follow-up among women who received their postpartum exam at 1 week from those who were examined at 6 weeks. It may be beneficial to base postpartum care on women's individual needs rather than on routine, but this must be investigated in order to devise proper guidelines and distinguish the roles of various health professionals. Reorganization of the delivery of postpartum care to improve its impact on women's health is a priority in the UK, and several research trials are in progress.
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PMID:What does postnatal care do for women's health? 1023 54

Pneumatosis intestinalis is defined as the presence of gas within the bowel wall. Small bowel pneumatosis is less commonly reported and more severe than colonic disease in adults. Pneumatosis coli is characterised by multiple collections of encysted gas occurring within the sub-mucosa and subserosa of the colon and rectum. It is an uncommon condition which typically presents in late middle age and has been associated with a number of gastrointestinal (e.g. pyloric stenosis, sigmoid volvulus and ischaemic bowel) and non-gastrointestinal (e.g. chronic obstructive pulmonary disease, depression and multiple sclerosis) diseases. Some cases, however, are idiopathic or primary. Symptoms can include diarrhoea, constipation, mucus per rectum, bleeding, flatus, abdominal pain and, rarely, faecal incontinence. We report on two patients, one of whom presented with faecal incontinence, the other who had troublesome lower gastrointestinal symptoms including faecal incontinence. Both responded well to continuous oxygen therapy.
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PMID:Pneumatosis coli: an uncommon but treatable cause of faecal incontinence. 1062 93

Fecal incontinence is a symptom of many disorders that can affect the nerves and muscles controlling defecation; it is not just due to exceptionally voluminous diarrhea. Underlying problems should be identified and treated, because that may improve incontinence. If treatment of the underlying problem does not correct incontinence, several approaches can be employed successfully. General approaches include stimulation of defecation at intervals to empty the rectum under supervised conditions; treatment of diarrhea, if present; addressing coexisting psychologic problems, such as depression; use of continence aids, such as adult diapers; and perineal skin care to prevent skin breakdown. Drug therapy includes use of constipating drugs, such as loperamide or diphenoxylate, that can impede the gastrocolic reflex, thereby limiting rectal filling and the likelihood of incontinence. Biofeedback training is useful in patients with some ability to sense rectal distention and to contract the external anal sphincter; instrumental learning using manometric or electromyographic biofeedback can be used to reinforce the rectoanal contractile response to rectal distention. Improvement in continence has been noted in up to 70% of suitable candidates with a single biofeedback training session. Patients with external anal sphincter disruption due to childbirth injury or other trauma may benefit from direct external anal sphincter repair (sphincteroplasty). In others, tightening up the anal canal by encirclement with nonabsorbable mesh (Thiersch procedure), perianal injection of fat, collagen, or synthetic gel, or radiofrequency electrical energy (Stretta procedure) may provide some palliation. Creation of a new sphincter mechanism by muscle transposition and encirclement of the anal canal is another approach that has been improved by use of electrical stimulators to keep the neosphincter contracted. Artificial anal sphincters patterned after artificial urinary sphincters have met with some success, but local infection remains problematic. When all else fails, fecal diversion (ileostomy, colostomy) can be effective in rehabilitating patients.
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PMID:Treatment of Fecal Incontinence. 1284 41

Failure to control the elimination of urine or stool causes psychological stress, complicates medical illnesses and management, and has major economic consequences. Patients often describe the impact of both fecal and urinary incontinence in terms of shame and embarrassment and report that it causes them to isolate themselves from friends and family. Incontinence frequently results in an early decision to institutionalize elderly relatives because families have difficulty coping with incontinence at home. Not surprisingly, there is an increase in symptoms of depression and anxiety in patients with incontinence as well as degradation in quality of life that has been documented by standardized assessment instruments. The direct health care costs for urinary incontinence are estimated to be 16.3 billion dollars per year (1995 costs). Separate cost estimates for fecal incontinence are not available. There is an acute need for methodologically sound studies to document the economic and personal impact of incontinence to develop guidelines for the allocation of health care resources and research funding to this major public health problem. This need is especially great for fecal incontinence, for which there is much less health care economic data than for urinary incontinence.
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PMID:Economic and personal impact of fecal and urinary incontinence. 1497 33

This article reviews self-reporting instruments to measure severity and quality of life in fecal incontinence. Severity instruments assess the frequency, type, and amount of stool loss and the impact of fecal incontinence on coping mechanisms and lifestyle/behavioral change. Non-weighted instruments use simple numerical totals to gauge severity; however, the use of vague quantifiers to describe severity can make the results highly subjective. In weighted surveys, every possible response (indicating the frequency of each type of incontinence) is multiplied by a weight that reflects the average severity assigned by a representative group of patients (or physicians), and the weighted responses are added to compile a total score. When variables such as coping mechanisms and lifestyle changes are included in severity questionnaires, the results tend to reflect patient functioning more than severity and should be interpreted cautiously. Quality-of-life scales assess variables that are not directly observable and are highly subjective. Quality-of-life scales are divided into 3 categories: (1) generic scales permit the measurement of gross change and compare the experience of the target population to other populations; (2) specialized scales are most useful in trying to isolate effects of specific variables, such as depression; and (3) condition-specific quality-of-life scales measure the relationship between specific medical conditions or treatments, and quality of life outcomes. Future research should focus on the need for weighting, further evaluation of the use of coping mechanisms as an indicator of severity, and how to integrate measures of urgency. In the area of quality of life, "modules" are needed that can be appended to established instruments to help assess and compare the experience of specific populations.
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PMID:Incontinence severity and QOL scales for fecal incontinence. 1497 46

An estimated 15% to 30% of adults over the age of 60 years have urinary incontinence, which is often reported as severe. Although psychological symptoms, especially anxiety and depression, are often associated with urinary incontinence, it seems likely that psychological distress is not a cause but a consequence of suffering from the condition. Cognitive deficits that directly interfere with the neurologic function of the bladder and/or diminish the ability to communicate appear to be important contributors to urinary incontinence. The incidence of fecal incontinence is high in children up to the age of 9 years and ranges from 7% to nearly 10% in adults over the age of 65 years. Although it has been suggested that psychological symptoms can cause fecal incontinence, data are lacking to support a causative association. Psychological disorders and incontinence of urine and feces appear to be common comorbidities. Studies are needed to determine whether the incidence of psychological symptoms in persons with incontinence is comparable for those who seek treatment and those who do not and to compare psychometric and quality-of-life measures before and after treatment to help determine the role of psychological symptoms in persons with fecal and urinary incontinence.
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PMID:Psychological and cognitive variables affecting treatment outcomes for urinary and fecal incontinence. 1497 52


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