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Query: UMLS:C0042024 (incontinence)
 13,409 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Functional disorders of the distal part of the colon in neonates and infants should be diagnosed by X-ray investigations (defecograms), double-suction biopsies (Erlanger children suction biopsy apparatus), anorectal and sigmoidal manometry and coloscopic functional investigations. 90% of all disorders of the distal colon can be diagnosed by manometric studies, in 40% X-ray investigations will lead to an exact diagnosis, in 12% double suction biopsies and in 10% coloscopic investigations establish the right diagnosis. The double suction biopsy is important for the exclusion of aganglionosis. Either a conservative or a surgical treatment is necessary, depending on the primary lesion. Wash outs, sphinctertraining, toilet training are necessary in cases of prolonged constipation following sigmaresection with restmegacolon, in cases of rectal inertia syndrom, and in cases of overflow incontinence. A pressure reducing operation (a sphincteromyotomy) is indicated in ultrashort aganglionic segments, in special cases of elongated sigma, in cases of prolonged constipation after sigma resection and with disturbed reflex mechanism, in cases of sphincter inhibition syndrome, and in children with paradox reflex mechanism. A resection is indicated in Hirschsprung disease, mechanical obstruction of the bowel, very large and severe cases of sigma elongatum and in cases of overflow-incontinence.
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PMID:[Functional disorders of distal colon in children (author's transl)]. 31 46

Dysfunction of smooth muscles is not unusual in adults suffering from myotonic dystrophy but has not yet been reported in patients with the congenital form of the disease. Of two brothers, the younger one presented with the typical features of congenital myotonic dystrophy at birth. He developed severe constipation due to megacolon during his second year of life. In the older brother disturbances of gastrointestinal motility, causing repeated bouts of subileus during the newborn period, sprue-like symptoms during early childhood, and megacolon with constipation and incontinence later on, remained the only manifestation of myotonic dystrophy until the age of eight years when the diagnosis could be finally established by electromyography.
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PMID:Smooth muscle involvement in congenital myotonic dystrophy. 57 31

In rectal constipation chronic filling of the rectum with feces will cause continuous rectal dilatation, a permanent stimulus for defecation and finally rectal incontinence. Reduction of rectal volume and perfect continence may be achieved in these cases by surgical removal of part of the elongated colon; thus surgery may have its place as an alternative to medical treatment of this disease. Patients with rectal constipation do not have an aganglionic segment of the colon, as is the case in Hirschsprung's disease; the dilated part of the colon is characterized on the contrary by hypertrophic intestinal wall.
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PMID:[Surgical management of incontinence in rectal constipation (author's transl)]. 76 64

84 of 89 cases were traced 18 to 27 years after Swenson's operation. Seven had long segments. All were alive and in good general health except one who had renal transplant for hypertension due to pyelonephritis in a residual solitary kidney. 61 are married of whom 34 have children. None of the children have Hirshsprung's disease. 48 were fully normal within one year of operation. 29 had constipation enough to require treatment. Seven had diarrhoea which in three required hospitalisation for electrolyte disturbances and dehydration. 39 had some degree of soiling, but in only nine was this troublesome. Recovery of normal bowel control was more rapid in those with a good social background. Eight had postoperative strictures, but treatment has remained successful in the long-term in seven of these. Five patients had inadequate resections and are well after further surgery. Nine had urinary incontinence of which seven had only nocturnal enuresis. All are fully recovered. Two male patients have absence of ejaculation and two females are infertile with scarred Fallopian tubes. 83 of the 84 now have normal bowel control and good health. One has a permanent ileostomy.
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PMID:Long-term results of Swenson's operation for Hirschsprung's disease. 86 91

The anorectal function in 3 patients with bilateral and 4 patients with unilateral well-defined loss of sacral nerves after radical tumour excision was studied by clinical examination and by simultaneous registration of the following variables: volume and pressure in the rectum, pressure in the internal anal sphincter area and myoelectrical activity in the external anal sphincter. The patients with bilateral loss of sacral nerves had serious impairment of function. Constipation was their only safeguard against incontinence. The preservation of the first and second sacral nerves bilaterally was not sufficient for discrimination between different qualities of rectal contents passing the anal canal. The sensation of rectal distension was also impaired. The reflex pattern of the internal anal sphincter was, however, intact. The external anal sphincter displayed a weak spontaneous myoelectrical activity in the patients who had at least one second sacral nerve intact, and a weak increase of the activity could be induced voluntarily. The normal transient increase of myoelectrical discharge from the external anal sphincter in response to rectal distension could not, however, be elicited. In patients with total unilateral loss of the sacral nerves no significant impairment of anorectal function was noted. Total one-sided denervation implied deficient sensibility of the anal canal unilaterally, but no disturbance of sphincter function as judged from the reflex response of the internal and external anal sphincters to rectal distension.
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PMID:Anorectal function after major resections of the sacrum with bilateral or unilateral sacrifice of sacral nerves. 95 50

The results of electromanometric studies of the anorectum in 40 children are presented. Owing to a constant flow of rinsing water through the recording tube and owing to a repeated tracing during the same session, there is a more sensitive picture of the anorectal pressure profile than reported hitherto. In addition, the anorectal pressure values are higher. In healthy infants and in most children with constipation and/or encopresis, the anorectal pressure profile can be divided in 2 different parts. These can be differentiated by their amplitude and according to their shape. In a few patients with constipation, there is no difference between the two parts concerning the shape of the anorectal pressure profile, and the values of the anorectal pressures are below normal. But all children with anal sphincter incontinence have a distinctively abnormal anorectal pressure profile, there is not even a numerical difference between the two parts of the anorectal pressure profile, and the anorectal pressures are very low. The relationship between these two parts of the anorectal pressure profile and the muscles of the pelvic floor are discussed and the significance of the mentioned technique evaluated with regard to the diagnosis and treatment of the anorectal disturbances in childhood.
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PMID:[Reflections on the anorectal pressure profile]. 95 37

Forty-two patients have been operated upon with the Duhamel-Grob-Martin operation to which has been added a partial sphincterotomy. Three patients developed anastomotic leaks and one of these died. In follow-up studies from 2 months to 9 years after operation, all patients were relieved of distension and constipation, except two, who were considered to have had an incomplete proximal resection of aganglionic bowel. There were two children with repeated attacks of enterocolitis after operation. Fecal control was good in all and, in spite of the retention of a considerable spur, there have been no problems from this. It is considered that the internal sphincter is involved in the disease and the possibility of persistent obstructive symptoms is reduced by the internal sphincterotomy which has not resulted in incontinence.
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PMID:Experience with a modification of Duhamel-Grob-Martin operation for the treatment of Hirschsprung's disease. 109 22

The encopresis of faecal impaction is a paradoxical incontinence found with constipation or faecal retention due to somatic or psychic causes. Normal continence comprises the possibility to delay passages of stools and the avoidance of leakage of stool in the meantime. Continued delay of defaecations causes faecal impaction and paradoxical leakage of stool. It is necessary to break the vicious circle by emptying the rectal ampulla and to avoid further constipation by means of laxatives and diet. Uderlying psychological disturbances must be recognized and treated. Two individual cases among our patients illustrate various aspects of the problem.
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PMID:[Overflow incontinence (author's transl)]. 125 Jun 23

Electromanometric studies were performed in a serie of 149 chronically constipated children. One third of the cases showed manometrically an organic and spincter achalasia. In the other two thirds the constipation was functional or psychogenic. In 73 patients a sphincter myotomy was performed. In 50 of these cases the histology of the internal anal sphincter taken by biopsy revealed a close relationship to the electromanometric results. Patients electromanometrically diagnosed at having an organic cause of the achalasia showed histologically in all except one, severe chronic inflammation, fibrosis, hyperplasia of the smooth muscle, or an absence of the ganglion cells in the upper part of the sphincter muscle. In 17 cases with a functional or psychogenic cause only one showed histopathologic findings. Of the 73 patients who were operated upon, 66 had excellent results. In 7 cases encopresis and constipation persisted. The reasons for this are discussed. Pre- and postoperative electromanometric measurements were performed in 30 children, postoperative measurements alone in 59 others. The most important electromanometrically criteria in evaluating the results of the sphincteromyotomy are normalisation of the anorectal pressure profile and the return of regular anorectal fluctuations. Signs of incontinence could not be observed.
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PMID:[Results of spincteromyotomy in anal-spincter achalasia. Histology and postoperative continence]. 127 63

Adequate bowel elimination is essential for physiologic functioning and daily comfort of older patients. A careful assessment of normal bowel elimination patterns will help to prevent unnecessary bowel problems when the older patient is hospitalized or admitted to a long-term care facility. Constipation and incontinence are the two most common bowel elimination problems affecting older adults. Many simple nursing interventions exist that will help to prevent major complications that can occur when constipation or incontinence is present.
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PMID:Anticipation and early detection can reduce bowel elimination complications. 131 10


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