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Çetinkaya O, Ovayolu Ö. The Effect on Constipation of Abdominal Massage Applied to the Elderly in the Nursing Home: A Randomized Controlled Experimental Study. Gastroenterol Nurs 2024:00001610-990000000-00105. [PMID: 39235867 DOI: 10.1097/sga.0000000000000830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 04/15/2024] [Indexed: 09/07/2024] Open
Abstract
The aim of this study was to evaluate how abdominal massage affects the constipation of the elderly in the nursing home. This randomized controlled experimental study was conducted with an intervention group ( n = 30) and a control group ( n = 31) in the nursing home of a government institution. A 15-minute abdominal massage was applied to the intervention group once a day, 5 days a week for 1 month. The control group received only routine treatment. The data were collected with a questionnaire, the Constipation Severity Instrument, the Visual Analogue Scale, the Bristol Stool Scale, and the defecation diary. It was determined that the Constipation Severity Instrument mean score, which was 40.6 ± 10.0 before the massage in the intervention group, decreased to 16.0 ± 11.6 after the application. The Visual Analogue Scale total score of the intervention and control groups, which was 40.2 ± 8.4 and 33.2 ± 5.9 before the massage, decreased to 18.7 ± 9.3 and 29.1 ± 6.58, respectively, at the end of the fourth week; the decrease was higher in the intervention group, and this difference between the groups was significant ( p < .05). It was determined that abdominal massage applied to elderly individuals residing in a nursing home reduced constipation. In this sense, it is recommended for nurses to implement abdominal massage in the management of constipation for elderly individuals.
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Affiliation(s)
- Onur Çetinkaya
- About the authors: Onur Çetinkaya, PhD, is a Lecturer, Vocational School of Health Services, Osmaniye Korkut Ata University, Osmaniye, Turkey
- Özlem Ovayolu is affiliated with Faculty of Health Science, Department of Nursing, Gaziantep University, Gaziantep, Turkey
| | - Özlem Ovayolu
- About the authors: Onur Çetinkaya, PhD, is a Lecturer, Vocational School of Health Services, Osmaniye Korkut Ata University, Osmaniye, Turkey
- Özlem Ovayolu is affiliated with Faculty of Health Science, Department of Nursing, Gaziantep University, Gaziantep, Turkey
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Sperber AD, Freud T, Palsson OS, Bangdiwala SI, Simren M. The aging gastrointestinal tract: Epidemiology and clinical significance of disorders of gut-brain interaction in the older general population. Aliment Pharmacol Ther 2024; 60:446-456. [PMID: 38837277 DOI: 10.1111/apt.18103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 04/28/2024] [Accepted: 05/23/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Most previous reports on the prevalence of disorders of gut-brain interaction (DGBI) show higher rates in younger individuals. Exceptions are faecal incontinence and functional constipation. AIM To compare prevalence rates for 22 DGBI and 24 primary symptoms, by age, using the Rome Foundation Global Epidemiology (RFGES) study dataset. METHODS The RFGES dataset enables diagnosis of 22 DGBI among 54,127 participants (≥18 years) in 26 countries. Older age was defined as ≥65 years. We assessed differences between age groups by sex, geographic region, somatisation, abnormal anxiety and depression scores, quality of life (QoL), individual gastrointestinal symptoms and disease severity for irritable bowel syndrome (IBS). RESULTS Rates for any DGBI were 41.9% and 31.9% in the <65 and ≥65 age groups, respectively. For all Rome IV diagnoses except faecal incontinence, rates were higher in the younger group. The older group had lower scores for any DGBI by geographic region, non-gastrointestinal somatic symptoms, abnormal anxiety and depression scores, and IBS severity, and better scores for QoL. The mean number of endorsed symptoms and their frequency were higher in the younger group. CONCLUSIONS In this large general population study, the prevalence and impact of DGBI, apart from faecal incontinence, were higher in the younger group. Despite this, DGBI rates are still high in absolute terms in the ≥65 age group and necessitate clinical awareness and, perhaps, an age-specific treatment approach.
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Affiliation(s)
- Ami D Sperber
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Freud
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Siaal Research Center for Family Medicine and Primary Care, Division of Community Health, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Olafur S Palsson
- Center for Functional GI & Motility Disorders, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shrikant I Bangdiwala
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Magnus Simren
- Center for Functional GI & Motility Disorders, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Di Lorenzo C. Faecal incontinence: Retentive, non-retentive and when to suspect organic pathology. Aliment Pharmacol Ther 2024; 60 Suppl 1:S54-S65. [PMID: 38924573 DOI: 10.1111/apt.17832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/13/2023] [Accepted: 11/28/2023] [Indexed: 06/28/2024]
Abstract
BACKGROUND Faecal incontinence is a highly prevalent and very distressing condition that occurs throughout the entire paediatric age. AIM To summarise advances in the understanding of the epidemiology, pathophysiology, evaluation and treatment of children with faecal incontinence due to either disorders of gut-brain interaction or organic diseases. METHODS Literature review on prevalence, impact, diagnosis and treatment options for children with faecal incontinence, interspersed with observations from the author's lifelong career focused on evaluation of children with motility disorders. RESULTS Faecal incontinence in children is most commonly due to unrecognised or insufficiently treated functional constipation with overflow incontinence. Non-retentive faecal incontinence (NRFI) is probably more common than previously thought and is particularly challenging to treat. Organic diseases such as anorectal malformations (ARMs), Hirschsprung disease and spinal defects are often associated with faecal incontinence; in these conditions, faecal incontinence has a profound impact on quality of life. Recognition of the different pathophysiologic mechanisms causing the incontinence is essential for a successful treatment plan. A thorough physical examination and history is all that is needed in the diagnosis of the causes of faecal incontinence related to disorders of gut-brain interaction. Colonic transit studies or x-rays may help to differentiate retentive from NRFI. Manometry tests are helpful in determining the mechanisms underlying the incontinence in children operated on for ARMs or Hirschsprung diseases. Multiple behavioural, medical and surgical interventions are available to lessen the severity of faecal incontinence and its impact on the daily life of affected individuals. CONCLUSIONS Recent advances offer hope for children with faecal incontinence.
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Affiliation(s)
- Carlo Di Lorenzo
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
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Hierink GM, Brinkman LAM, Malmberg GGA, van Eijndhoven HWF, Trzpis M, Broens PMA. Association of Constipation with Modes of Delivery: A Retrospective Questionnaire-based Study. Int Urogynecol J 2024; 35:1477-1485. [PMID: 38847821 PMCID: PMC11315744 DOI: 10.1007/s00192-024-05824-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/29/2024] [Indexed: 08/10/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic floor damage can contribute to pelvic floor dysfunction, including constipation. Most studies focus on constipation during pregnancy, whereas information regarding the mode of delivery in relation to constipation is limited. We hypothesise that women with a history of vaginal delivery report constipation more often than women with a history of caesarean section. METHODS This was a retrospective cross-sectional multicentre study conducted in the Netherlands. All included patients (n = 2,643) completed the Groningen Defecation and Fecal Continence questionnaire to assess bowel problems of the last 6 months. Parametric tests, Chi-squared, univariable and multivariable regression analyses were performed. RESULTS Among 2,643 parous women, 2,248 delivered vaginally (85.1%) and 395 (14.9%) by caesarean section. Altogether, 649 women (24.6%) suffered from constipation. Women in the vaginal delivery group were constipated more often than women in the caesarean section group (25.5% versus 19.0%, p = 0.005). For women who had delivered vaginally, multivariable regression analysis showed an odds ratio for constipation of 1.47 (95% confidence interval, 1.109-1.938, p = 0.007). The odds ratio for constipation in women with a spontaneous perineal tear was 1.4 times higher than in women with an intact perineum (p = 0.030). Furthermore, the vaginal delivery group reported difficulties regarding bowel emptying (p = 0.048), straining (p = 0.027), incomplete defecation (p = 0.043), not able to defecate daily (p = 0.018), manually assisted defecation (p = 0.015) and had higher Renzi scores (p = 0.043) more often. CONCLUSIONS Women in the vaginal delivery group have higher prevalences and odds ratios for constipation. Furthermore, a perineal tear during vaginal delivery increases the odds ratio for constipation.
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Affiliation(s)
- G Marije Hierink
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30 001, 9700 RB, Groningen, The Netherlands
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lauret A M Brinkman
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30 001, 9700 RB, Groningen, The Netherlands
| | - G G Alec Malmberg
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Monika Trzpis
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30 001, 9700 RB, Groningen, The Netherlands
- Department of Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul M A Broens
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30 001, 9700 RB, Groningen, The Netherlands.
- Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Mack I, Hahn H, Gödel C, Enck P, Bharucha AE. Global Prevalence of Fecal Incontinence in Community-Dwelling Adults: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2024; 22:712-731.e8. [PMID: 37734583 PMCID: PMC10948379 DOI: 10.1016/j.cgh.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND & AIMS Fecal incontinence (FI) can considerably impair quality of life. Through a systematic review and meta-analysis, we sought to determine the global prevalence and geographic distribution of FI and to characterize its relationship with sex and age. METHODS We searched PubMed, Web of Science, and Cochrane Library databases to identify population-based surveys of the prevalence of FI. RESULTS Of the 5175 articles identified, the final analysis included 80 studies; the median response rate was 66% (interquartile range [IQR], 54%-74%). Among 548,316 individuals, the pooled global prevalence of FI was 8.0% (95% confidence interval [CI], 6.8%-9.2%); by Rome criteria, it was 5.4% (95% CI, 3.1%-7.7%). FI prevalence was greater for persons aged 60 years and older (9.3%; 95% CI, 6.6%-12.0%) compared with younger persons (4.9%; 95% CI, 2.9%-6.9%) (odds ratio [OR], 1.75; 95% CI, 1.39-2.20), and it was more prevalent among women (9.1%; 95% CI, 7.6%-10.6%) than men (7.4%; 95% CI, 6.0%-8.8%]) (OR, 1.17; 95% CI, 1.06-1.28). The prevalence was highest in Australia and Oceania, followed by North America, Asia, and Europe, but prevalence could not be estimated in Africa and the Middle East. The risk of bias was low, moderate, and high for 19 (24%), 46 (57%), and 15 (19%) studies, respectively. Exclusion of studies with high risk of bias did not affect the prevalence of FI or heterogeneity. In the meta-regression, the high study heterogeneity (I2 = 99.61%) was partly explained by age. CONCLUSIONS Approximately 1 in 12 adults worldwide have FI. The prevalence is greater among women and older people.
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Affiliation(s)
- Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Heiko Hahn
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Celina Gödel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Adil E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
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ten Hoor MB, Trzpis M, Broens PM. The Severity of Fecal Problems Is Negatively Associated With Quality of Life in a Dutch Population Without Bowel Function Comorbidities. Dis Colon Rectum 2024; 67:448-456. [PMID: 37962140 PMCID: PMC10846588 DOI: 10.1097/dcr.0000000000003048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Constipation and fecal incontinence negatively influence quality of life. The association between the severity of fecal problems and quality of life has not been investigated in the general population without bowel function comorbidities. OBJECTIVE To investigate the association between the severity of constipation and fecal incontinence and quality of life in patients without comorbidities influencing bowel function. DESIGN A population-based, cross-sectional study. SETTINGS The study involved 3668 Dutch study participants. PATIENTS A survey company conducted a population-wide study of the general Dutch population. Altogether, 5000 Dutch citizens completed the Groningen Defecation and Fecal Continence and Short Form-36 questionnaires. The data on 3668 respondents without comorbidities that could influence bowel function were included for analysis (study group). MAIN OUTCOME MEASURES The severity of constipation (Agachan score) and fecal incontinence (Wexner score) in relation to the quality-of-life scores. RESULTS In the study group (n = 3668), 487 had constipation (13.3%), 116 had fecal incontinence (3.2%), and 64 had 2 coexisting fecal problems (1.7%). In the multivariable analysis, all quality-of-life domains were negatively associated with the severity of constipation and fecal incontinence. The associations between the severity of constipation and quality of life were stronger (highest: ß = -2.413; 95% CI, -2.681 to -2.145; p < 0.001) than those of fecal incontinence (highest: ß = -1.280; 95% CI, -1.681 to -.880; p < 0.001). We also found that a longer duration of bowel complaints coincided with higher severity scores, especially for constipation. Respondents mostly rated their defecation health as positive, regardless of the severity of their fecal problems. LIMITATIONS Cross-sectional design. CONCLUSIONS The severity of constipation and fecal incontinence is significantly associated with reduced quality of life, with the severity of constipation having stronger associations than fecal incontinence. Given respondents' unawareness of their fecal problems and the progressive character, timely intervention is advocated. See Video Abstract . LA GRAVEDAD DE LOS PROBLEMAS FECALES SE ASOCIA NEGATIVAMENTE CON LA CALIDAD DE VIDA EN UNA POBLACIN HOLANDESA SIN COMORBILIDADES DE LA FUNCIN INTESTINAL ANTECEDENTES:El estreñimiento y la incontinencia fecal influyen negativamente en la calidad de vida. La asociación entre la gravedad de los problemas fecales y la calidad de vida no se ha investigado en la población general sin comorbilidades de la función intestinal.OBJETIVO:Investigar la asociación entre la gravedad del estreñimiento y la incontinencia fecal y la calidad de vida en la población holandesa general sin comorbilidades que influyan en la función intestinal.DISEÑO:Estudio transversal de base poblacional.ENTORNO CLINICO:El estudio involucró a 3668 participantes holandeses.PACIENTES:Una empresa de encuestas realizó un estudio poblacional de la población holandesa en general. En total, 5.000 ciudadanos holandeses completaron los cuestionarios Groningen Defecation and Fecal Continence y Short-Form 36. Se incluyeron para el análisis los datos de 3668 encuestados sin comorbilidades que pudieran influir en la función intestinal (grupo de estudio).PRINCIPALES MEDIDAS DE RESULTADO:La gravedad del estreñimiento (puntuación de Agachan) y la incontinencia fecal (puntuación de Wexner) en relación con las puntuaciones de calidad de vida.RESULTADOS:En el grupo de estudio (n = 3668), 487 tenían estreñimiento (13,3%), 116 tenían incontinencia fecal (3,2%) y 64 tenían 2 problemas fecales coexistentes (1,7%). En el análisis multivariable, todos los dominios de calidad de vida se asociaron negativamente con la gravedad del estreñimiento y la incontinencia fecal. Las asociaciones entre la gravedad del estreñimiento y la calidad de vida fueron más fuertes (más alta: ß = -2,413; IC del 95 %, -2,681 a -2,145; p < 0,001) que las de la incontinencia fecal (más alta: ß = -1,280; 95 IC %: -1,681 a -0,880; p < 0,001). También encontramos que una mayor duración de las molestias intestinales coincidió con puntuaciones de gravedad más altas, especialmente para el estreñimiento. La mayoría de los encuestados calificaron su salud en la defecación como positiva, independientemente de la gravedad de sus problemas fecales.LIMITACIONES:Diseño transversal.CONCLUSIONES:La gravedad del estreñimiento y la incontinencia fecal se asocia significativamente con una calidad de vida reducida; la gravedad del estreñimiento tiene asociaciones más fuertes que la incontinencia fecal. Dado el desconocimiento de los encuestados sobre sus problemas fecales y el carácter progresivo, se recomienda una intervención oportuna. (Traducción- Dr. Francisco M. Abarca-Rendon ).
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Affiliation(s)
- Maaike B.C. ten Hoor
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Monika Trzpis
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul M.A. Broens
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Division of Pediatric Surgery, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Busby-Whitehead J, Whitehead WE, Sperber AD, Palsson OS, Simrén M. The aging gut: Symptoms compatible with disorders of gut-brain interaction (DGBI) in older adults in the general population. J Am Geriatr Soc 2024; 72:479-489. [PMID: 37945291 DOI: 10.1111/jgs.18679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/02/2023] [Accepted: 10/15/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Little is known about changes in gastrointestinal symptoms compatible with disorders of gut-brain interaction (DGBI) with increasing age at the population level. The objective of this study was to describe the patterns of DGBI in individuals 65 years of age and above and contrasting them with those of younger adults. METHODS A community sample of 6300 individuals ages 18 and older in the US, UK, and Canada completed an online survey. Quota-based sampling was used to ensure equal proportion of sex and age groups (40% aged 18-39, 40% aged 40-64, 20% aged 65+) across countries, and to control education distributions. The survey included the Rome IV Diagnostic Questionnaire for DGBI, demographic questions, questionnaires measuring overall somatic symptom severity and quality of life, and questions on healthcare utilization, medications, and surgical history. RESULTS We included 5926 individuals in our analyses; 4700 were 18-64 years of age and 1226 were ages 65+. Symptoms compatible with at least one DGBI were less prevalent in participants ages 65+ vs. ages 18-64 years (34.1% vs. 41.3%, p < 0.0001). For symptoms compatible with upper GI DGBI, lower prevalence for most disorders was noted in the 65+ group. For lower GI DGBI, a different pattern was seen. Prevalence was lower in ages 65+ for irritable bowel syndrome and anorectal pain, but no differences from younger participants for the disorders defined by abnormal bowel habits (constipation and/or diarrhea) were seen. Fecal incontinence was the only DGBI that was more common in ages 65+. Having a DGBI was associated with reduced quality of life, more severe non-GI somatic symptoms, and increased healthcare seeking, both in younger and older participants. CONCLUSION Symptoms compatible with DGBI are common, but most of these decrease in older adults at the population level, with the exception of fecal incontinence which increases. This pattern needs to be taken into account when planning GI health care for the growing population of older adults.
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Affiliation(s)
- Jan Busby-Whitehead
- Division of Geriatric Medicine, Department of Medicine and Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - William E Whitehead
- Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ami D Sperber
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Olafur S Palsson
- Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Magnus Simrén
- Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
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Shen F, Wang Q, Ullah S, Pan Y, Zhao M, Wang J, Chen M, Feng F, Zhong H. Ligilactobacillus acidipiscis YJ5 modulates the gut microbiota and produces beneficial metabolites to relieve constipation by enhancing the mucosal barrier. Food Funct 2024; 15:310-325. [PMID: 38086666 DOI: 10.1039/d3fo03259k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Constipation is a prevalent gastrointestinal (GI) problem affecting a large number of individuals. This study aimed to investigate peristalsis-promoting potential characteristics of Ligilactobacillus acidipiscis YJ5 and the underlying molecular mechanism. The study demonstrated the relieving effect of L. acidipiscis YJ5 on constipation in both zebrafish and mouse models. L. acidipiscis YJ5 intervention significantly increased intestinal peristalsis by reducing the peak time and increasing the fluorescence disappearance rate in the zebrafish model. In the mouse model, the symptoms of constipation relief induced by L. acidipiscis YJ5 included a shortened first black stool time, an increased number of defecation particles, an accelerated propulsion rate of the small intestine, and an increase in fecal water content. L. acidipiscis YJ5 was found to reduce the expression of colonic aquaporins to normalize the colonic water transport system of constipated mice. Additionally, L. acidipiscis YJ5 reversed loperamide-induced morphological damage in the ileum and colon and increased the colonic mucosal barrier. The results of the 16S rRNA gene analysis indicated that L. acidipiscis YJ5 could reverse the structure of gut microbiota to a near-normal group, including levels of β-diversity, phylum, family, and genus. Furthermore, the fermentation supernatant of L. acidipiscis YJ5 was shown to relieve constipation, and metabolomics analysis revealed that these positive effects were related to its metabolites like malic acid and heliangin.
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Affiliation(s)
- Fei Shen
- College of Biosystems Engineering and Food Science, National-Local Joint Engineering Laboratory of Intelligent Food Technology and Equipment, Zhejiang Key Laboratory for Agro-Food Processing, Zhejiang University, Hangzhou, 310058, China.
| | - Qianqian Wang
- College of Biosystems Engineering and Food Science, National-Local Joint Engineering Laboratory of Intelligent Food Technology and Equipment, Zhejiang Key Laboratory for Agro-Food Processing, Zhejiang University, Hangzhou, 310058, China.
- College of Food and Health, Zhejiang A & F University, Hangzhou 311300, China
| | - Sami Ullah
- ZhongYuan Institute, Zhejiang University, Zhengzhou, 450001, China
| | - Ya Pan
- College of Biosystems Engineering and Food Science, National-Local Joint Engineering Laboratory of Intelligent Food Technology and Equipment, Zhejiang Key Laboratory for Agro-Food Processing, Zhejiang University, Hangzhou, 310058, China.
| | - Minjie Zhao
- College of Biosystems Engineering and Food Science, National-Local Joint Engineering Laboratory of Intelligent Food Technology and Equipment, Zhejiang Key Laboratory for Agro-Food Processing, Zhejiang University, Hangzhou, 310058, China.
| | - Jing Wang
- Ningbo Research Institute, Zhejiang University, Ningbo, 315100, China
| | - Ming Chen
- Hangzhou Kangyuan Food Science & Technology Co., Ltd., Hangzhou 310012, China
| | - Fengqin Feng
- College of Biosystems Engineering and Food Science, National-Local Joint Engineering Laboratory of Intelligent Food Technology and Equipment, Zhejiang Key Laboratory for Agro-Food Processing, Zhejiang University, Hangzhou, 310058, China.
- Ningbo Research Institute, Zhejiang University, Ningbo, 315100, China
- ZhongYuan Institute, Zhejiang University, Zhengzhou, 450001, China
| | - Hao Zhong
- College of Food Science and Technology, Zhejiang University of Technology, Hangzhou 310014, China.
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Chaichanavichkij P, Vollebregt PF, Keshishian K, Knowles CH, Scott SM. The Clinical Impact of Obesity in Patients With Disorders of Defecation: A Cross-Sectional Study of 1,155 Patients. Am J Gastroenterol 2023; 118:2247-2257. [PMID: 37417793 DOI: 10.14309/ajg.0000000000002400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Obesity is a global epidemic. Its clinical impact on symptoms of fecal incontinence (FI) and/or constipation and underlying anorectal pathophysiology remains uncertain. METHODS This is a cross-sectional study of consecutive patients meeting Rome IV criteria for FI and/or functional constipation, with data on body mass index (BMI), attending a tertiary center for investigation between 2017 and 2021. Clinical history, symptoms, and anorectal physiologic test results were analyzed according to BMI categories. RESULTS A total of 1,155 patients (84% female) were included in the analysis (33.5% normal BMI; 34.8% overweight; and 31.7% obese). Obese patients had higher odds of FI to liquid stools (69.9 vs 47.8%, odds ratio [OR] 1.96 [confidence interval: 1.43-2.70]), use of containment products (54.6% vs 32.6%, OR 1.81 [1.31-2.51]), fecal urgency (74.6% vs 60.7%, OR 1.54 [1.11-2.14]), urge FI (63.4% vs 47.3%, OR 1.68 [1.23-2.29]), and vaginal digitation (18.0% vs 9.7%, OR 2.18 [1.26-3.86]). A higher proportion of obese patients had Rome criteria-based FI or coexistent FI and functional constipation (37.3%, 50.3%) compared with overweight patients (33.8%, 44.8%) and patients with normal BMI (28.9%, 41.1%). There was a positive linear association between BMI and anal resting pressure (β 0.45, R 2 0.25, P = 0.0003), although the odds of anal hypertension were not significantly higher after Benjamini-Hochberg correction. Obese patients more often had a large clinically significant rectocele (34.4% vs 20.6%, OR 2.62 [1.51-4.55]) compared with patients with normal BMI. DISCUSSION Obesity affects specific defecatory (mainly FI) and prolapse symptoms and pathophysiologic findings (higher anal resting pressure and significant rectocele). Prospective studies are required to determine whether obesity is a modifiable risk factor of FI and constipation.
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Affiliation(s)
- Pam Chaichanavichkij
- National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, United Kingdom
| | - Paul F Vollebregt
- National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, United Kingdom
| | - Karekin Keshishian
- Department of Colorectal Surgery, The Royal London Hospital, Whitechapel Road, London, United Kingdom
| | - Charles H Knowles
- National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, United Kingdom
| | - S Mark Scott
- National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, United Kingdom
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Pelizzari L, Antoniono E, Giraudo D, Ciardi G, Lamberti G. Fecal Incontinence after Severe Brain Injury: A Barrier to Discharge after Inpatient Rehabilitation? Neurol Int 2023; 15:1339-1351. [PMID: 37987457 PMCID: PMC10660697 DOI: 10.3390/neurolint15040084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND In this study, we aimed to investigate the incidence of fecal incontinence (FI) after severe acquired brain injuries (sABIs) and to determine whether this symptom can lead to an inability to return home after rehabilitation. METHODS This was a retrospective observational cohort study. In total, 521 acute sABI inpatients were enrolled from the Department of Neurorehabilitation at an academic tertiary care hospital. Patients were divided into two groups, with and without FI, at the end of the rehabilitation phase. The primary and secondary endpoints were the incidence of persistent FI and any difference in the discharge destination. RESULTS Upon admission, new-onset FI was found in 443 (85%) patients, of which 38% had traumatic sABI. Moreover, 62.7% of all patients had FI upon admission. At discharge, 53.3% (264/495) of patients still had FI. Of these, 75.4% (199/264) had a Rancho Level of Cognitive Functioning Scale (LCFS) ≥3. A statistically significant correlation between FI at discharge and the presence of frontal lesions, autonomic crises, and increased LCFS scores was noted. Among the patients discharged to their homes, the proportion with persistent FI was lower (34% vs. 53.3). CONCLUSIONS FI was significantly persistent after sABI, even after recovery from unconsciousness, and must be considered as a consequence of, rather than an independent risk factor for, unfavorable outcomes.
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Affiliation(s)
- Laura Pelizzari
- Department of Rehabilitative Medicine, AUSL Piacenza, 29017 Fiorenzuola d’Arda, PC, Italy; (L.P.); (G.C.)
| | - Elena Antoniono
- Neurorehabilitation Unit, AUSL CN1, 12045 Fossano, CN, Italy;
| | - Donatella Giraudo
- Department of Urology, IRCCS San Raffaele Scientific Institute, 20127 Milano, MI, Italy;
| | - Gianluca Ciardi
- Department of Rehabilitative Medicine, AUSL Piacenza, 29017 Fiorenzuola d’Arda, PC, Italy; (L.P.); (G.C.)
| | - Gianfranco Lamberti
- Department of Rehabilitative Medicine, AUSL Piacenza, 29017 Fiorenzuola d’Arda, PC, Italy; (L.P.); (G.C.)
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Karasu AFG, Cetin C, Pasin Ö, Karacabay M, Tanoglu FB, Ilhan G. Prevalence of urinary incontinence and anal incontinence: an internet-based cross-sectional study of female Turkish University students. Int Urogynecol J 2023; 34:2309-2315. [PMID: 37266726 DOI: 10.1007/s00192-023-05573-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/01/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this cross-sectional, epidemiological study was to characterize urinary tract and bowel symptom prevalence and the extent of discomfort/bother associated with them. Additionally, the authors aimed to explore factors associated with both conditions among Turkish female university students. Also, an insight into women's "communication regarding urinary incontinence and anal incontinence" with their family members was sought. METHODS This is an internet-based national cross-sectional study. A study-specific 30-item questionnaire containing validated measures of symptom prevalence and bother (Urogenital Distress Inventory questionnaire short form and Colorectal-Anal Distress Inventory) were incorporated into the survey. Out of a total of 2,125 e-mail invitations that were sent, 1,226 responded with data included in this analysis. RESULTS The age and BMI of all respondents were 26.53 ± 10.082, 23.45 ± 6.609 respectively. Nine hundred and eighty-five (80.5%) respondents claimed that they did not suffer a UI episode in the last year, whereas 10 people (0.08%) claimed that they had a urinary incontinence episode every day. Three hundred and fifty-seven responders (29.1%) stated that they suffered from "gas incontinence," 6 (0.5%) stool incontinence, and 20 (1.6%) declared that they had episodes of both stool and gas incontinence. Five hundred and forty-four participants (44%) reported that they had family relatives with a problem of "urinary incontinence" and 576 (47%) stated they had a conversation on "urinary incontinence." Seventy-five of the responders (6.1%) stated that they had a family member with "anal incontinence" and 246 (20.1%) responded that they had a conversation regarding "anal incontinence" with them. CONCLUSION We have demonstrated that the prevalence of UI was 19.5%. Twenty-nine percent stated they suffered "gas incontinence," 0.5% stool incontinence, and 1.6% declared that they had episodes of both stool and gas incontinence.
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Affiliation(s)
- Ayse Filiz Gokmen Karasu
- Department of Obstetrics and Gynecology, Urogynecology and Pelvic Reconstructive Medicine Unit, Bezmialem Vakif University, Fatih, Turkey.
| | - Caglar Cetin
- Department of Obstetrics and Gynecology, Urogynecology and Pelvic Reconstructive Medicine Unit, Bezmialem Vakif University, Fatih, Turkey
| | - Özge Pasin
- Department of Biostatistics, Bezmialem Vakif University, Fatih, Turkey
| | | | - Fatma Basak Tanoglu
- Department of Obstetrics and Gynecology, Bezmialem Vakif University, Fatih, Turkey
| | - Gulsah Ilhan
- Department of Obstetrics and Gynecology, Suleymaniye Research and Training Hospital, Istanbul, Turkey
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12
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Sun G, Trzpis M, Ding H, Gao X, Broens PMA, Zhang W. Co-occurrence of fecal incontinence with constipation or irritable bowel syndrome indicates the need for personalized treatment. Neurogastroenterol Motil 2023; 35:e14633. [PMID: 37427541 DOI: 10.1111/nmo.14633] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND This study aimed to compare the prevalence and symptoms of fecal incontinence (FI) in relation to irritable bowel syndrome (IBS-associated FI), constipation (constipation-associated FI), and isolation (isolated FI). METHODS Data were analyzed from 3145 respondents without organic comorbidities known to influence defecation function from the general Chinese population who filled in the online Groningen Defecation and Fecal Continence questionnaire. FI, IBS, and constipation were evaluated with the Rome IV criteria. KEY RESULTS The prevalence of FI was 10.5% (n = 329) in the non-comorbidity group. After multivariable logistic regression analysis, IBS (odds ratio [OR]: 12.55, 95% confidence interval [CI]: 9.06-17.36) and constipation (OR: 4.38, 95% CI: 3.27-5.85) were the most significant factors contributing to FI. Based on this finding, 106/329 (32.2%) had IBS-associated FI, 119/329 (36.2%) had constipation-associated FI, and 104/329 (31.6%) had isolated FI. Among the 329 FI respondents, there was a high prevalence of IBS and constipation-related symptoms, including abdominal pain (81.5%) and abdominal bloating (77.8%) for IBS and straining during defecation (75.4%), incomplete defecation (72.3%), defecation blockage (63.2%), anal pain during defecation (59.3%), and hard stools (24%) for constipation. The patients with IBS-associated FI asked for specialists' help less frequently than those with isolated FI. Interestingly, among the patients with constipation-associated FI, 56.3% used anti-diarrhea medicine. CONCLUSIONS AND INFERENCES The prevalence of IBS-associated FI, constipation-associated FI, and isolated FI is comparably high. It is important to diagnose and target the cause of FI to provide personalized and cause-targeting care instead of treating only the FI symptoms.
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Affiliation(s)
- Ge Sun
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Monika Trzpis
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Haibo Ding
- Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xianhua Gao
- Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Paul M A Broens
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wei Zhang
- Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
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Salari N, Ghasemianrad M, Ammari-Allahyari M, Rasoulpoor S, Shohaimi S, Mohammadi M. Global prevalence of constipation in older adults: a systematic review and meta-analysis. Wien Klin Wochenschr 2023; 135:389-398. [PMID: 36826591 DOI: 10.1007/s00508-023-02156-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/14/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND AND OBJECTIVE Constipation is one of the most common functional disorders of the gastrointestinal tract in older adults. To date, no systematic review or previous meta-analysis has estimated the global prevalence of constipation in older adults. The prevalence of this disorder has been reported differently in different studies; therefore, this study aims to systematically review the publications and to perform a meta-analysis of the prevalence of constipation in older adults. METHODS The electronic databases PubMed, Google Scholar, Scopus, Web of Science, and ScienceDirect were systematically searched for studies reporting the prevalence of constipation in older adults up to February 2022. To perform the analysis, the random effects model was used, and heterogeneity was assessed by Cochran's Q test and expressed as I2. RESULTS Out of 5341 evaluated publications, 36 met the eligibility criteria. These studies included 58,405 older adults aged 60-93 years. The overall prevalence of constipation in older adults was 18.9% (95% confidence interval [95% CI]: 14.7-23.9%). The prevalence of constipation in older adults according to Rome II criteria was 16.2% (95% CI: 6.8-33.7), based on Rome III criteria was 19.2% (95% CI: 12.6-28.1), and based on Rome IV criteria was 10.3% (95% CI: 5.8-17.7). The highest prevalence of constipation was found in older adults in Africa at 32.3% (95% CI: 21.5-45.4), and the lowest in Asia at 13.6% (95% CI: 9.1-19.9). Concerning diagnostic tools, the highest prevalence of constipation was found if a self-reporting tool was applied with a value of 19.7% (95% CI: 15.8-24.3). CONCLUSION The results suggest that health policymakers should pay more attention to the prevention of constipation in older adults, including raising public awareness to the importance of nutrition and diet and physical activity in older adults.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | | | - Shabnam Rasoulpoor
- Department of Psychiatric Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Masoud Mohammadi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran.
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Zheng C, Yang Z, Kong L, Gao Z, Lu T, Zhang H. Psychometric evaluation of the Chinese version of the Elderly-Constipation Impact Scale: a translation and validation study. BMC Public Health 2023; 23:1345. [PMID: 37438713 DOI: 10.1186/s12889-023-16231-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/02/2023] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVE The objective of this study was to translate the Elderly-Constipation Impact Scale into Chinese and to examine its reliability and validity in a population of older people suffering from chronic constipation. METHODS In this study, the scale was paraphrased, back-translated, cross-culturally adapted and pre-experimented using the Brislin double translation-back-translation method to create the initial Chinese version of the Elderly-Constipation Impact Scale. A convenience sampling method was used to select 564 study participants who met the inclusion and exclusion criteria in Liaoning and Shanxi, China, to evaluate the reliability and validity of the scale. General information about the study population was using descriptive statistics; item analysis was used to screen the items of the scale. Content validity, exploratory factor analysis, and validation factor analysis were chosen to validate the scales; internal consistency, spilt-half reliability and retest reliability were used determine the reliability of the measurement scales. RESULTS The Chinese version of the Elderly-Constipation Impact Scale contains 7 dimensions and 21 items. The Cronbach's alpha coefficient for the total scale was 0.901 and the range of Cronbach's alpha values for each dimension was 0.707 to 0.918. The split-half reliability of the scale was 0.736 and the retest reliability was 0.763. The exploratory factor analysis showed a KMO value of 0.873 and a Bartlett's spherical test X2 value of 3499.978 (p < 0.001). A total of seven common factors were extracted, namely daily activities, treatment satisfaction, lack of control of bodily function, diet restriction, symptom intensity, anxiety and preventive actions, with a cumulative variance contribution of 77.813%. Each item had a loading value > 0.4 on its common factor. In the validation factor analysis, the model fit results were X2 / df = 1.886, GFI = 0.910, AGFI = 0.874, PGFI = 0.654, IFI = 0.955, TLI = 0.942, CFI = 0.954, RMSEA = 0.056 and PNFI = 0.718. The model fit indicators were all within acceptable limits. CONCLUSION The Chinese version of the E-CIS has good reliability and validity in the chronic constipation population of elderly individuals. The results of the questionnaire can effectively and comprehensively reflect the impact of chronic constipation on the quality of life of elderly individuals. It provides a meaningful reference for identifying targets for intervention.
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Affiliation(s)
- Chen Zheng
- School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Liaoning Province, Jinzhou City, P.R. China
| | - Zhen Yang
- School of Nursing, China Medical University, 77 Puhe Road, Shenyang New District, Shenyang, Liaoning Province, P.R. China
| | - Linghui Kong
- School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Liaoning Province, Jinzhou City, P.R. China
| | - Ziyun Gao
- School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Liaoning Province, Jinzhou City, P.R. China
| | - Tingting Lu
- School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Liaoning Province, Jinzhou City, P.R. China
| | - Huijun Zhang
- School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Liaoning Province, Jinzhou City, P.R. China.
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Verkuijl SJ, Trzpis M, Broens PM. The Prevalence of Bowel and Bladder Function During Early Childhood: A Population-Based Study. J Pediatr Gastroenterol Nutr 2023; 77:47-54. [PMID: 37098114 PMCID: PMC10259211 DOI: 10.1097/mpg.0000000000003804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/11/2023] [Indexed: 04/27/2023]
Abstract
OBJECTIVES Our primary aim was to determine bowel and bladder function in children aged 1 month to 7 years in the general Dutch population. Second, we aimed to identify demographic factors associated with the presence of bowel and bladder dysfunction, and their coexistence. METHODS For this cross-sectional, population-based study, parents/caregivers of children aged from 1 month to 7 years were asked to complete the Early Pediatric Groningen Defecation and Fecal Continence questionnaire. Different parameters of bowel and bladder function were assessed using validated scoring systems such as the Rome IV criteria. RESULTS The mean age of the study population (N = 791) was 3.9 ± 2.2 years. The mean age at which parents/caregivers considered their child fully toilet-trained was 5.1 ± 1.5 years. Prevalence of fecal incontinence among toilet-trained children was 12%. Overall prevalence of constipation was 14%, with a constant probability and severity at all ages. We found significant associations between fecal incontinence and constipation [odds ratio (OR) = 3.88, 95% CI: 2.06-7.30], fecal incontinence and urinary incontinence (OR = 5.26, 95% CI: 2.78-9.98), and constipation and urinary incontinence (OR = 2.06, 95% CI: 1.24-3.42). CONCLUSIONS Even though most children are fully toilet-trained at 5 years, fecal incontinence is common. Constipation appears to be common in infants, toddlers, and older children. Fecal incontinence and constipation frequently coexist and are often accompanied by urinary incontinence. Increased awareness of bowel and bladder dysfunction in infants, toddlers, and young children is required to prevent these problems from continuing at older ages.
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Affiliation(s)
- Sanne J. Verkuijl
- From the Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- the Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Monika Trzpis
- the Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Paul M.A. Broens
- From the Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- the Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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16
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Zhao X, Wang L, Quan L. Association between dietary phosphorus intake and chronic constipation in adults: evidence from the National Health and Nutrition Examination Survey. BMC Gastroenterol 2023; 23:24. [PMID: 36694113 PMCID: PMC9875444 DOI: 10.1186/s12876-022-02629-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 12/20/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Several studies suggest a link between micronutrients and constipation. However, the relationship between constipation and phosphorus has rarely been examined. The main aim of this study was to investigate the association between changes in the prevalence of chronic constipation and dietary phosphorus intake among adult respondents of the National Health and Nutritional Examination Survey (NHANES). METHODS Data were extracted from the NHANES database for the years 2005-2010. A total of 13,948 people were included in the analysis. Dietary information was collected using the respondents' 24-h dietary records. We conducted multiple logistic regression analyses to examine the correlation between phosphorus intake and poor bowel movement. The primary and secondary outcomes was constipation defined by stool consistency and stool frequency, respectively. RESULTS Following multi-variate adjustment in model III, a significant association between chronic constipation and each additional 0.1-g intake of dietary phosphorus (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.95, 1.00; P = 0.034 for stool consistency vs. OR, 0.94; 95% CI, 0.90, 0.99; P = 0.027 for stool frequency) was observed. Following multi-variate adjustment in model III, OR values and 95% CI from the second to fourth quartiles compared to the first quartile (reference group) were 0.92 (0.66, 1.27), 0.73 (0.47, 1.13), and 0.39 (0.20, 0.76), respectively, using the stool frequency definition. CONCLUSIONS This study revealed a negative correlation between phosphorus intake and chronic constipation. This may be due to the fact that dietary phosphorus intake is associated with softer stools and increased stool frequency. Further studies in different settings should be considered to verify these findings.
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Affiliation(s)
- Xuelian Zhao
- grid.464402.00000 0000 9459 9325The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, 250013 Shandong Province People’s Republic of China
| | - Lizhu Wang
- grid.479672.9Department of Anorectal, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250014 Shandong Province People’s Republic of China
| | - Longfang Quan
- grid.410318.f0000 0004 0632 3409Department of Anorectal, China Academy of Chinese Medical Sciences Xiyuan Hospital, Beijing, 100091 People’s Republic of China
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Long-term Bowel Dysfunction and Decline in Quality of Life Following Surgery for Colon Cancer: Call for Personalized Screening and Treatment. Dis Colon Rectum 2022; 65:1531-1541. [PMID: 35982522 PMCID: PMC9645552 DOI: 10.1097/dcr.0000000000002377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Differences in long-term outcomes regarding types of colon resections are inconclusive, precluding patient counseling, effective screening, and personalized treatment. OBJECTIVE This study aimed to compare long-term bowel function and quality of life in patients who underwent right or left hemicolectomy or sigmoid colon resection. DESIGN This was a multicenter cross-sectional study. SETTINGS Seven Dutch hospitals participated in this study. PATIENTS This study included patients who underwent right or left hemicolectomy or sigmoid colon resection without construction of a permanent stoma between 2009 and 2015. Patients who were deceased, mentally impaired, or living abroad were excluded. Eligible patients were sent the validated Defecation and Fecal Continence and Short-Form 36 questionnaires. MAIN OUTCOME MEASURES Constipation, fecal incontinence (both Rome IV criteria), separate bowel symptoms, and generic quality of life were the main outcomes assessed. RESULTS This study included 673 patients who underwent right hemicolectomy, 167 who underwent left hemicolectomy, and 284 who underwent sigmoid colon resection. The median follow-up was 56 months. Sigmoid colon resection increased the likelihood of constipation compared to right and left hemicolectomy (OR, 2.92; 95% CI, 1.80-4.75; p < 0.001 and OR, 1.93; 95% CI, 1.12-3.35; p = 0.019). Liquid incontinence and fecal urgency increased after right hemicolectomy compared to sigmoid colon resection (OR, 2.15; 95% CI, 1.47-3.16; p < 0.001 and OR, 2.01; 95% CI, 1.47-2.74; p < 0.001). Scores on quality-of-life domains were found to be significantly lower after right hemicolectomy. LIMITATIONS Because of the cross-sectional design, longitudinal data are still lacking. CONCLUSIONS Different long-term bowel function problems occur after right or left hemicolectomy or sigmoid colon resection. The latter seems to be associated with more constipation than right or left hemicolectomy. Liquid incontinence and fecal urgency seem to be associated with right hemicolectomy, which may explain the decline in physical and mental generic quality of life of these patients. See Video Abstract at http://links.lww.com/DCR/C13 . DISFUNCIN INTESTINAL A LARGO PLAZO Y DISMINUCIN DE LA CALIDAD DE VIDA DESPUS DE LA CIRUGA DE CNCER DE COLON SOLICITUD DE DETECCIN Y TRATAMIENTO PERSONALIZADOS ANTECEDENTES:Las diferencias en los resultados a largo plazo con respecto a los tipos de resecciones de colon no son concluyentes, lo que impide el asesoramiento preoperatorio del paciente y la detección eficaz y el tratamiento personalizado de la disfunción intestinal postoperatoria durante el seguimiento.OBJETIVO:Comparar la función intestinal a largo plazo y la calidad de vida en pacientes sometidos a hemicolectomía derecha o izquierda, o resección de colon sigmoide.DISEÑO:Estudio transversal multicéntrico.AJUSTES:Participaron siete hospitales holandeses.PACIENTES:Se incluyeron pacientes sometidos a hemicolectomía derecha o izquierda, o resección de colon sigmoide sin construcción de estoma permanente entre 2009 y 2015. Se excluyeron pacientes fallecidos, con discapacidad mental o residentes en el extranjero. A los pacientes elegibles se les enviaron los cuestionarios validados de Defecación y Continencia Fecal y Short-Form 36.PRINCIPALES MEDIDAS DE RESULTADO:Se evaluaron el estreñimiento, la incontinencia fecal (ambos criterios de Roma IV), los síntomas intestinales separados y la calidad de vida genérica.RESULTADOS:Se incluyeron 673 pacientes con hemicolectomía derecha, 167 con hemicolectomía izquierda y 284 con resección de colon sigmoide. La mediana de seguimiento fue de 56 meses (RIC 41-80). La resección del colon sigmoide aumentó la probabilidad de estreñimiento en comparación con la hemicolectomía derecha e izquierda (OR, 2,92, IC 95%, 1,80-4,75, p < 0,001 y OR 1,93, IC 95%, 1,12-3,35, p = 0,019). La incontinencia de líquidos y la urgencia fecal aumentaron después de la hemicolectomía derecha en comparación con la resección del colon sigmoide (OR, 2,15, IC 95%, 1,47-3,16, p < 0,001 y OR 2,01, IC 95%, 1,47-2,74, p < 0,001). Las puntuaciones en los dominios de calidad de vida fueron significativamente más bajas después de la hemicolectomía derecha.LIMITACIONES:Debido al diseño transversal, aún faltan datos longitudinales.CONCLUSIONES:Se producen diferentes problemas de función intestinal a largo plazo después de la hemicolectomía derecha o izquierda, o la resección del colon sigmoide. Este último parece estar asociado con más estreñimiento que la hemicolectomía derecha o izquierda. La incontinencia de líquidos y la urgencia fecal parecen estar asociadas a la hemicolectomía derecha, lo que puede explicar el deterioro de la calidad de vida física y mental en general de estos pacientes. Consulte Video Resumen en http://links.lww.com/DCR/C13 . (Traducción-Dr. Yolanda Colorado ).
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Flankegård G, Mörelius E, Rytterström P. Everyday life with childhood functional constipation: A qualitative phenomenological study of parents' experiences. J Pediatr Nurs 2022; 67:e165-e171. [PMID: 35931621 DOI: 10.1016/j.pedn.2022.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/08/2022] [Accepted: 07/19/2022] [Indexed: 10/16/2022]
Abstract
UNLABELLED Childhood functional constipation (FC) is a worldwide problem with treatment regiments affecting everyday life. AIM To explore parents´ experiences of living with a child with FC and its impact on everyday family life. METHOD A qualitative phenomenological interview study using a reflective lifeworld research approach. Interviews with 15 parents of otherwise healthy children aged 1-14 years affected by FC. FINDINGS Shame is the driving force making parents put everyday life on hold. The quest for control, self-imposed loneliness, guilt, inadequacy, and frustrating battles become essential parts of everyday life to protect it from FC-related shame. CONCLUSION FC has as great an impact on everyday life as any childhood illness. Every part of family life is affected by FC. Continuously family support and guidance are needed. PRACTICE IMPLICATIONS Healthcare professionals need to take FC more seriously, listen to the parents and try to understand their experiences of everyday life to enable custom made care plans with the family-unit in focus. Care with clinical sensitivity might help parents deal with the attendant shame and stigmatization that stem from illness beliefs about FC.
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Affiliation(s)
- Gunilla Flankegård
- Linköping University, Department of Health, Medicine and Caring Sciences, Sweden.
| | - Evalotte Mörelius
- Linköping University, Department of Health, Medicine and Caring Sciences, Sweden; School of Nursing and Midwifery, Edith Cowan University, Australia.
| | - Patrik Rytterström
- Linköping University, Department of Health, Medicine and Caring Sciences, Sweden.
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Cantay H, Turker UA. Prevalence of perianal diseases and associated factors in primigravida women: A hospital-based cross-sectional study. Saudi Med J 2022; 43:1142-1148. [PMID: 36261207 PMCID: PMC9994506 DOI: 10.15537/smj.2022.43.10.20220198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 08/23/2022] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES To define the incidence of anorectal diseases in primigravida women as well as in the first month after delivery and the factors affecting the development of anorectal diseases. METHODS The sample size was determined as 328 primigravida women. Research data were collected from pregnant women who applied to Gynecology and Obstetrics Polyclinic, Kars Harakani State Hospital Gynecology and General Surgery Polyclinic, Kafkas University, Kars, Turkey, between November 2020 and August 2021.The pregnant women were examined and surveyed 4 times; in the second and third trimesters, on the day after delivery, and in the first month after delivery. Chi-square test was used in the analysis of the data determined by counting. Variables which were statistically significant (p<0.05) in the Chi-square test were included in the backward logistic regression analysis. RESULTS Perianal disease was observed in 103 (38.6%) of the pregnant women. The incidence of perianal disease was found to be 4.917 times (confidence interval [CI]: [2.134-11.327]) higher in those with perianal disease compared with those without, 2.936 times (CI:[1.584-5.439]) higher in those who did not consume fiber-rich foods compared with those who did, 9.512 times (CI: [4.583-19.742]) higher in those with constipation compared with those without, and 23.721 times (CI: [5.363-104.915]) higher in those whose pushing stage duration was above average compared with that in those whose pushing stage duration was below average. CONCLUSION In primigravida pregnants, the risk of perianal disease increases in those who have perianal disease before pregnancy, those who do not consume fibrous food, those who have constipation, and those who have a long pushing period.
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Affiliation(s)
- Hasan Cantay
- From the Department of General Surgery (Cantay), Faculty of Medicine, Kafkas University, and from the Obstetrics and Gynecology Clinic (Turker), Kars Harakani Public Hospital, Kars, Turkey.
| | - Ulku Ayse Turker
- From the Department of General Surgery (Cantay), Faculty of Medicine, Kafkas University, and from the Obstetrics and Gynecology Clinic (Turker), Kars Harakani Public Hospital, Kars, Turkey.
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Shi Y, Chen F, Wang Z, Cao J, Li C. Effect and mechanism of functional compound fruit drink on gut microbiota in constipation mice. Food Chem 2022; 401:134210. [PMID: 36122488 DOI: 10.1016/j.foodchem.2022.134210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/23/2022] [Accepted: 09/09/2022] [Indexed: 11/24/2022]
Abstract
Compound fruit drink (CFD) is a functional drink prepared with fruit, Chinese herbs and prebiotic fructooligosaccharide as the main ingredients. Loperamide hydrochloride was used to establish a mouse model of constipation. And the effect of CFD on the improvement of constipation and the impact on gut microbiota were studied. The results showed that CFD significantly enhanced intestinal motility in constipated mice (P < 0.05). It significantly improved serum levels of gastrointestinal regulatory-related peptides, elevated the short-chain fatty acids (SCFAs) content and alleviated colonic injury. Meanwhile, CFD also up-regulated the mRNA expression levels of AQP3, AQP9, SCF and c-Kit and the related protein expression levels. Fecal microbial results showed that the CFD medium-dose group significantly increased species richness. Furthermore, CFD increased the abundance of potentially beneficial bacteria and reduced the number of potentially pathogenic bacteria. This study indicated that CFD was a promising functional drink for effectively relieving constipation.
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Affiliation(s)
- Yali Shi
- Key Laboratory of Food Nutrition and Functional Food of Hainan Province, School of Food Science and Engineering, Hainan University, Haikou 570228, China
| | - Fei Chen
- Key Laboratory of Food Nutrition and Functional Food of Hainan Province, School of Food Science and Engineering, Hainan University, Haikou 570228, China
| | - Ziqi Wang
- Key Laboratory of Food Nutrition and Functional Food of Hainan Province, School of Food Science and Engineering, Hainan University, Haikou 570228, China
| | - Jun Cao
- Key Laboratory of Food Nutrition and Functional Food of Hainan Province, School of Food Science and Engineering, Hainan University, Haikou 570228, China
| | - Chuan Li
- Key Laboratory of Food Nutrition and Functional Food of Hainan Province, School of Food Science and Engineering, Hainan University, Haikou 570228, China; Collaborative Innovation Center of Provincial and Ministerial Co-construction for Marine Food Deep Processing, Dalian Polytechnic University, Dalian 116034, China.
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21
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Wang Q, Shen F, Zhang J, Cai H, Pan Y, Sun T, Gong Y, Du J, Zhong H, Feng F. Consumption of Wheat Peptides Improves Functional Constipation: A Translational Study in Humans and Mice. Mol Nutr Food Res 2022; 66:e2200313. [PMID: 35920293 DOI: 10.1002/mnfr.202200313] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/04/2022] [Indexed: 11/07/2022]
Abstract
SCOPE Wheat peptides (WP) are rich in glutamic acid, glutamine, and other bioactive compounds that may benefit gut function and health. This study aims to evaluate the effects of regular consumption of WP on constipation-induced complications and gut microbiota in humans and mice. METHODS AND RESULTS A randomized trial of 49 functional constipation participants was conducted. The weekly amount of spontaneous bowel movements (SBM) increased by 2.09 per week after WP treatment, and by 0.40 per week among the placebo group (PL). Concomitantly, the secondary outcomes showed significant improvements in the quality of life-related to constipation, constipation severity, and satisfaction with the intervention. In the animal study, WP effectively alleviated constipation symptoms and affected the secretion of intestinal mobility-related neurotransmitters and gastrointestinal hormones in loperamide-induced constipation mice. Additionally, WP regulated the gene and protein expression levels of water-electrolyte metabolism and intestinal mobility. Furthermore, WP treatment decreased the abundance of several gut microbiota positively correlated to constipation (Turicibacter, Bacteroides_f_Bacteroidaceae, and Streptococcus) in mice. CONCLUSION WP ameliorated constipation in humans and mice, which could be partly explained by improving water-electrolyte metabolism, boosting intestinal motility, and reshaping gut microbiota. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Qianqian Wang
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, 310058, China
| | - Fei Shen
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, 310058, China
| | - Junhui Zhang
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, 310058, China
| | - Haiying Cai
- School of Biological & Chemical Engineering, Zhejiang University of Science & Technology, Hangzhou, 310023, China
| | - Ya Pan
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, 310058, China
| | - Tengjia Sun
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, 310058, China
| | - Yihang Gong
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, 310058, China
| | - Juan Du
- Hangzhou Kangyuan Food Science & Technology Co., Ltd, Hangzhou, 310012, China
| | - Hao Zhong
- College of Food Science and Technology, Zhejiang University of Technology, Hangzhou, 310014, China
| | - Fengqin Feng
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, 310058, China
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Relationship between Fatigue and Self-Perception of Constipation in Community-Dwelling Older Adults during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148406. [PMID: 35886257 PMCID: PMC9323158 DOI: 10.3390/ijerph19148406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 02/06/2023]
Abstract
Fatigue and constipation are common symptoms among community-dwelling older adults; however, no studies have explored the relationship between both symptoms in said group. Therefore, this study aimed to examine the relationship between fatigue and self-perception of constipation in community-dwelling older adults during the COVID-19 pandemic. A cross-sectional survey was conducted among 97 older people (response rate: 73.2%) between July and November 2021. Backward−forward stepwise linear regression was performed to identify possible predictors of fatigue among the explanatory variable (self-perception of constipation) and possible confounders, which included (a) age, (b) motor fitness scale, (c) economic satisfaction, (d) subjective memory impairment, (e) subjective health, (f) depression, (g) living alone or not, (h) sex, and (i) frequency of exercise. The intercept of the fatigue score was 42.48 points (95% CI = 32.40 to 49.99, p < 0.001). The results showed that the fatigue score in community-dwelling older adults who had self-perception of constipation was significantly lower (i.e., they had higher fatigue; B = −4.49, 95% CI = −6.58 to −2.40, p < 0.001) compared to those who did not have self-perception of constipation. Therefore, there is a need to develop self-management strategies that older people can use to improve the self-perception of constipation.
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Anorectal dysfunction in adults with spina bifida and associated socio-emotional factors—a retrospective, cross-sectional cohort study. Spinal Cord 2022; 60:679-686. [DOI: 10.1038/s41393-022-00754-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 11/08/2022]
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Silva AD, Costa AQ, Rocha DDM, Borges JWP, Andrade EMLR, Galiza FTD, Vasconcelos CDA. MELHORES PRÁTICAS DE ENFERMEIROS NO MANEJO DA INCONTINÊNCIA FECAL EM CONTEXTO HOSPITALAR: REVISÃO INTEGRATIVA. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2022-0026pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
RESUMO Objetivo analisar, na literatura, as melhores práticas de enfermeiros acerca do manejo da Incontinência Fecal em contexto hospitalar. Método trata-se de uma revisão integrativa da literatura com busca realizada em setembro de 2021 nas bases de dados MEDLINE/PubMed, Web of Science e no banco de dados da Biblioteca Virtual em Saúde, que incluiu as bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde, Base de Dados de Enfermagem e Índice Bibliográfico Español en Ciencias de la Salud. A análise considerou os métodos descritivos e a elaboração de um corpus textual mediante o software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires. Resultados foram incluídos 11 estudos (e a análise destes permitiu evidenciar a prevalência do idioma inglês) publicados entre os anos de 1977 e 2021 e que apresentaram, em maior ocorrência, delineamento metodológico observacional com nível de evidência 2C. Os resultados foram agrupados em duas categorias: “Evidências de cuidados para gerenciamento da Incontinência Fecal”, tendo como maior predominância o uso dos sistemas de drenagem fecal, e “Dispositivos de apoio e prevenção de complicações”, apresentando, com maior ocorrência, os dispositivos de contenção. Conclusão identificou-se que as melhores práticas adotadas pelos enfermeiros no contexto hospitalar estão associadas ao uso de sistemas de drenagem e dispositivos de contenção do conteúdo fecal. Evidenciou-se a limitação da equipe de Enfermagem quanto ao uso de outras práticas benéficas ao paciente com Incontinência Fecal.
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25
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Silva AD, Costa AQ, Rocha DDM, Borges JWP, Andrade EMLR, Galiza FTD, Vasconcelos CDA. NURSES' BEST PRACTICES IN THE MANAGEMENT OF FECAL INCONTINENCE IN THE HOSPITAL CONTEXT: AN INTEGRATIVE REVIEW. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2022-0026en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
ABSTRACT Objective to analyze, in the literature, the nurses' best practices towards management of Fecal Incontinence in the hospital context. Method this is an integrative literature review with a search carried out in September 2021 in the MEDLINE/PubMed and Web of Science, as well as in the Biblioteca Virtual em Saúde database, which included the Literatura Latino-Americana e do Caribe em Ciências da Saúde, Base de Dados de Enfermagem and Índice Bibliográfico Español en Ciencias de la Salud databases. The analysis considered the descriptive methods and elaboration of a textual corpus in the Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires software program. Results a total of 11 studies were included (and their analysis allowed evidencing prevalence of the English language) published between 1977 and 2021 and which presented, in a greater proportion, an observational methodological design with level of evidence 2C. The results were grouped into two categories: “Care evidence for the management of Fecal Incontinence”, with greater predominance of the use of fecal drainage systems; and “Support devices and prevention of complications”, presenting, in a greater proportion, the containment devices. Conclusion it was identified that the best practices adopted by nurses in the hospital context are associated with the use of drainage systems and fecal content containment devices. A limitation was evidenced in the nursing team regarding use of other beneficial practices for patients with Fecal Incontinence.
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26
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Speksnijder L, Oom DMJ, DE Leeuw JW, Steensma AB. Which factors are associated with anal incontinence after obstetric anal sphincter injury? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:476-482. [PMID: 33094517 DOI: 10.1002/uog.23525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 10/05/2020] [Accepted: 10/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Obstetric anal sphincter injury (OASI) is an important factor in the etiology of anal incontinence. This study aimed to evaluate whether anal sphincter defects, levator avulsion or levator ballooning after OASI are associated with severity of anal incontinence. Furthermore, we evaluated whether factors such as constipation and altered stool consistency are associated with symptoms of incontinence after OASI. METHODS In this multicenter prospective observational cohort study, women with OASI were invited to participate at least 3 months after primary repair. All women completed validated questionnaires, including St Mark's incontinence score, Bristol stool scale (BSS) and Cleveland clinic constipation score (CCCS), and underwent four-dimensional (4D) transperineal ultrasound for assessment of the levator ani muscle and anal sphincter. RESULTS In total, 220 women were included. Median follow-up was 4 months (range, 3-98 months). Univariate linear regression analysis showed an association of St Mark's incontinence score with a residual defect of the external anal sphincter (EAS) (β, 1.55 (95% CI, 0.04-3.07); P = 0.045), higher parity (β, 0.85 (95% CI, 0.02-1.67); P = 0.046), BSS (β, 1.28 (95% CI, 0.67-1.89); P < 0.001) and CCCS (β, 0.36 (95% CI, 0.18-0.54); P < 0.001). However, multivariate linear regression found an association of St Mark's incontinence score only with BSS (β, 1.50 (95% CI, 0.90-2.11); P < 0.001) and CCCS (β, 0.46 (95% CI, 0.29-0.63); P < 0.001). CONCLUSIONS Residual defects of the EAS, detected on 4D transperineal ultrasound, are associated with severity of anal incontinence symptoms measured using St Mark's incontinence score 4 months after OASI repair. Furthermore, clinical factors such as constipation and altered stool consistency appear to influence this association and may therefore play a more important role in clinical management. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L Speksnijder
- Department of Obstetrics and Gynecology, Division of Urogynecology, Amphia Hospital, Breda, The Netherlands
| | - D M J Oom
- Department of Obstetrics and Gynecology, Division of Urogynecology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - J-W DE Leeuw
- Department of Obstetrics and Gynecology, Ikazia Hospital, Rotterdam, The Netherlands
| | - A B Steensma
- Department of Obstetrics and Gynecology, Division of Urogynecology, Erasmus Medical Center, Rotterdam, The Netherlands
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Chen H, Gu X, Zhang Y, Feng J, Gu Y. Associated factors with constipation and health-related quality of life in lung cancer patients with platinum-based chemotherapy: A cross-sectional study. Medicine (Baltimore) 2021; 100:e26547. [PMID: 34397686 PMCID: PMC8322559 DOI: 10.1097/md.0000000000026547] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 05/24/2021] [Indexed: 01/04/2023] Open
Abstract
The main purpose of this study was to investigate current state of constipation for lung cancer (LC) patients receiving platinum-based chemotherapy. The relationships between social demography, clinical variables, psychological status, and constipation were analyzed. In addition, quality of life (QoL) in LC patients with constipation was also analyzed. One hundred LC patients participated in this cross-sectional study. Under the guidance of the researchers, Functional Living Index-Emesis, Piper Fatigue Scale, Patient Health Questionnaire, Generalized Anxiety Disorder-7, European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 (version 3.0), Pittsburgh Sleep Quality Index, General Well-being Scale, Social Support Rate Scale, General Self-Efficacy Scale, and other related questionnaires were completed. The result showed the symptom of constipation was observed in 41 (41%) LC patients. The occurrence and development of constipation were associated with gender, food intake, exercise, nausea, fatigue, anxiety, depression, sleep disorders, and happiness. The study also found patients with constipation had significant lower QoL scores, especially the score in the general state. Constipation was very common in LC patients undergoing platinum-based chemotherapy. Reduced food intake and fatigue were the independent factors. Constipation significantly affects the QoL of the patients. Therefore, more attention should be paid to the risk factors of constipation in LC patients undergoing platinum-based chemotherapy, the earlier intervention was done to these patients, the better to improve their QoL.
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Affiliation(s)
- Huamao Chen
- Department of Respiratory, Affiliated Hospital of Nantong University
| | - Xixi Gu
- Medical school, Nantong University, Nantong, Jiangsu Province, China
| | - Yan Zhang
- Department of Respiratory, Affiliated Hospital of Nantong University
| | - Jian Feng
- Department of Respiratory, Affiliated Hospital of Nantong University
| | - Yan Gu
- Department of Respiratory, Affiliated Hospital of Nantong University
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Werth BL, Christopher SA. Potential risk factors for constipation in the community. World J Gastroenterol 2021; 27:2795-2817. [PMID: 34135555 PMCID: PMC8173388 DOI: 10.3748/wjg.v27.i21.2795] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/31/2021] [Accepted: 04/26/2021] [Indexed: 02/06/2023] Open
Abstract
Constipation is a common community health problem. There are many factors that are widely thought to be associated with constipation but real-world evidence of these associations is difficult to locate. These potential risk factors may be categorised as demographic, lifestyle and health-related factors. This review presents the available evidence for each factor by an assessment of quantitative data from cross-sectional studies of community-dwelling adults published over the last 30 years. It appears that there is evidence of an association between constipation and female gender, residential location, physical activity and some health-related factors such as self-rated health, some surgery, certain medical conditions and certain medications. The available evidence for most other factors is either conflicting or insufficient. Therefore, further research is necessary to determine if each factor is truly associated with constipation and whether it can be regarded as a potential risk factor. It is recommended that studies investigating a broad range of factors are conducted in populations in community settings. Multivariate analyses should be performed to account for all possible confounding factors. In this way, valuable evidence can be accumulated for a better understanding of potential risk factors for constipation in the community.
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Affiliation(s)
- Barry L Werth
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney 2006, New South Wales, Australia
| | - Sybele-Anne Christopher
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney 2006, New South Wales, Australia
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Barberio B, Judge C, Savarino EV, Ford AC. Global prevalence of functional constipation according to the Rome criteria: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2021; 6:638-648. [PMID: 34090581 DOI: 10.1016/s2468-1253(21)00111-4] [Citation(s) in RCA: 110] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Functional constipation is a common functional bowel disorder in the community, which has a varying prevalence across cross-sectional surveys. We did a contemporaneous systematic review and meta-analysis of studies using comparable methodology and all iterations of the Rome criteria to estimate the global prevalence of functional constipation. METHODS In this systematic review and meta-analysis, we searched MEDLINE, Embase, and Embase Classic from Jan 1, 1990, to Dec 31, 2020, to identify population-based cross-sectional studies comprising at least 50 participants that reported the prevalence of functional constipation in adults (age 18 years and older) according to Rome I, II, III, or IV criteria. We excluded studies that reported the prevalence of functional constipation in convenience samples. We extracted prevalence estimates of functional constipation from eligible studies, according to the study criteria used to define it. For each study, we extracted data for country; method of data collection; criteria used to define functional constipation; whether the study used the Rome I, II, III, or IV diagnostic questionnaires or approximated these definitions of the condition using another questionnaire; the total number of participants providing complete data; age; the number of participants with the condition; the number of male and female participants; and the number of male and female participants with the condition. We calculated pooled prevalence, odds ratios (OR), and 95% CIs. FINDINGS Of 8174 citations evaluated, 45 studies fulfilled the eligibility criteria, representing 80 separate populations and comprising 275 260 participants. The pooled prevalence of functional constipation was 15·3% (95% CI 8·1-24·4, I2=99·4%) in studies using the Rome I criteria, 11·2% (7·9-14·9; I2=99·6%) in studies that used Rome II criteria, 10·4% (6·5-14·9; I2=99·8%) in those that used Rome III criteria, and 10·1% (8·7-11·6; I2=98·2%) when Rome IV criteria were used. Prevalence of functional constipation was higher in women, irrespective of the Rome criteria used (OR 2·40 [95% CI 2·02-2·86] for Rome I, 1·94 [1·46-2·57] for Rome II, and 2·32 [1·85-2·92] for Rome III; no studies using Rome IV criteria reported prevalence by sex). There was significant heterogeneity between studies in all of our analyses, which persisted even when the same criteria were applied and similar methodologies used. INTERPRETATION Even when uniform symptom-based criteria are used to define the presence of functional constipation, prevalence varies between countries. Thus, environmental, cultural, ethnic, dietary, or genetic factors can influence reporting of symptoms. Future studies should aim to elucidate reasons for this geographical variability. FUNDING None.
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Affiliation(s)
- Brigida Barberio
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padova-Azienda Ospedaliera di Padova, Padova, Italy
| | - Ciaran Judge
- Department of Gastroenterology, St James's University Hospital, Dublin, Ireland
| | - Edoardo V Savarino
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padova-Azienda Ospedaliera di Padova, Padova, Italy
| | - Alexander C Ford
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
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Abstract
Background: Fecal incontinence (FI) has been shown to be a common symptom in Western countries; however, there is few researches focusing on its epidemic condition in Chinese women. We conducted this national population-based epidemiology study to estimate the prevalence and risk factors of FI among adult Chinese women living in urban regions. Methods: This is a subgroup analysis of a national population-based epidemiology study of FI. Total 28,196 adult women from urban regions of six provinces and municipalities participated in this research from 2014 to 2015. They finished the questionnaire under the direction of trained interviewers. FI was defined as accidental leakage of flatus and/or liquid or solid stool at least once in the past. The FI prevalence trend and risk factors were identified by the Cochran-Armitage test, Chi-square test, and multivariable logistic regression. Results: The prevalence of FI in adult females in urban China was 0.43% (95% confidence interval: 0.35%–0.51%). Among women with FI, 42.96%, 82.96%, and 42.22% reported having leakage of solid, liquid stool, and gas, respectively. The overall FI prevalence and the incidence rate of solid stool/liquid stool/gas leakage increased with age. The mean Wexner score was 4.0% and 12.0% FI patients reported Wexner score ≥9. Body mass index ≥24 kg/m2, pelvic organ prolapses, chronic constipation, chronic cough, alcohol consumption, physical diseases including chronic bronchitis and cancer, gynecological diseases like gynecological inflammation are risk factors for FI. Vaginal delivery was the risk factor for FI in females with labor history. Conclusions: FI was not a common symptom in adult Chinese women living in urban areas and there were some potential modifiable risk factors. Trial Registration: Chinses Clinical Trial Registry: ChiCTR-OCS-14004675; http://www.chictr.org.cn/showproj.aspx?proj=4898
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31
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Zhang Q, Zhong D, Sun R, Zhang Y, Pegg RB, Zhong G. Prevention of loperamide induced constipation in mice by KGM and the mechanisms of different gastrointestinal tract microbiota regulation. Carbohydr Polym 2020; 256:117418. [PMID: 33483010 DOI: 10.1016/j.carbpol.2020.117418] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/02/2020] [Accepted: 11/16/2020] [Indexed: 12/18/2022]
Abstract
Constipation is one of the most prevalent gastrointestinal tract diseases. Konjac glucomannan (KGM) dietotherapy can effectively relieve the clinical symptoms of patients with constipation. However, the causal relationship among KGM, constipation and different gastrointestinal microbiome (i.e., the stomach {St}, small intestine {S}, and large intestine {L}) remains poorly understood. In this study, constipated mice were treated with KGM (75, 150, 300 mg/kg bw). Results showed that KGM treatment improved the general physiological state, fecal character, small intestinal propulsive rate, gastric emptying rate, MTL and AchE activities, ET-1, 5-HT, and NO levels, and SCFA concentrations. KGM in the diets of constipated mice reduced the diversity of St and S microbiota, while increased those in the L. The KGM intervention regulated the microbiota profile, which afterwards was closer to the normal mouse group: confirmation was provided by different changes of bacteria like Lactobacillus, Bifidobacterium and Allobaculum spp et al.
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Affiliation(s)
- Qi Zhang
- College of Food Science, Southwest University, Chongqing, 400715, China
| | - Dian Zhong
- Department of Food Science and Technology, University of Georgia, Athens, 30602, United States
| | - Rui Sun
- College of Food Science, Southwest University, Chongqing, 400715, China
| | - Yang Zhang
- College of Food Science, Southwest University, Chongqing, 400715, China
| | - Ronald B Pegg
- Department of Food Science and Technology, University of Georgia, Athens, 30602, United States.
| | - Geng Zhong
- College of Food Science, Southwest University, Chongqing, 400715, China.
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Vollebregt PF, Wiklendt L, Dinning PG, Knowles CH, Scott S. Coexistent faecal incontinence and constipation: A cross-sectional study of 4027 adults undergoing specialist assessment. EClinicalMedicine 2020; 27:100572. [PMID: 33150331 PMCID: PMC7599308 DOI: 10.1016/j.eclinm.2020.100572] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/02/2020] [Accepted: 09/14/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In contrast to paediatric and geriatric populations, faecal incontinence and constipation in adults are generally considered separate entities. This may be incorrect. METHODS Cross-sectional study of consecutive patients (18-80 years) referred to a tertiary unit (2004-2016) for investigation of refractory faecal incontinence and/or constipation and meeting Rome IV core criteria (applied post-hoc) for self-reported symptoms. We sought to determine how frequently both diagnoses coexisted, how frequently coexistent diagnoses were recognised by the referring clinician and to evaluate differences in clinical characteristics between patients with single or both diagnoses. FINDINGS Study sample consisted of 4,027 patients (3,370 females [83·7%]). According to Rome IV criteria, 807 (20·0%) patients self-reported faecal incontinence in isolation, 1,569 (39·0%) patients had functional constipation in isolation, and 1,651 (41·0%) met criteria for both diagnoses (coexistent symptoms). In contrast, only 331 (8·2%) patients were referred for coexistent symptoms. Of the 1,651 patients with self-reported coexistent symptoms, only 225 (13·6%) were recognised by the referrer i.e. 86·4% were missed. Coexistent symptoms were most often missed in patients referred for faecal incontinence in isolation. In this group of 1,640 patients, 765 (46·7%) had concomitant symptoms of functional constipation. Opioid usage, comorbidities, childhood bowel problems, mixed incontinence symptoms, prolapse symptoms and structural abnormalities on defaecography were associated with reclassification. INTERPRETATION Over 40% of adults referred for anorectal physiological investigation had coexistent diagnoses of faecal incontinence and functional constipation, based on validated criteria. This overlap is overlooked by referrers, poorly documented in current literature, and may impact management.
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Affiliation(s)
- Paul F. Vollebregt
- National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - Lukasz Wiklendt
- College of Medicine and Public Health, Flinders University, Australia
| | - Phil G Dinning
- College of Medicine and Public Health, Flinders University, Australia
- Department of Gastroenterology, Flinders Medical Centre, Australia
| | - Charles H. Knowles
- National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - S.Mark Scott
- National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
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Johannessen HH, Mørkved S, Stordahl A, Wibe A, Falk RS. Evolution and risk factors of anal incontinence during the first 6 years after first delivery: a prospective cohort study. BJOG 2020; 127:1499-1506. [DOI: 10.1111/1471-0528.16322] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2020] [Indexed: 12/19/2022]
Affiliation(s)
- HH Johannessen
- Department of Physical Medicine and Rehabilitation Østfold Hospital Trust Sarpsborg Norway
- Department of Health and Welfare Østfold University College Fredrikstad Norway
| | - S Mørkved
- Department of Public Health and Nursing Norwegian University of Science and Technology Trondheim Norway
| | - A Stordahl
- Department of Physical Medicine and Rehabilitation Østfold Hospital Trust Sarpsborg Norway
| | - A Wibe
- Department of Clinical and Molecular Medicine Norwegian University of Science and Technology Trondheim Norway
- Department of Surgery St. Olavs Hospital Trondheim University Hospital Trondheim Norway
| | - RS Falk
- Oslo Centre of Biostatistics and Epidemiology Oslo University Hospital Oslo Norway
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Verkuijl SJ, Meinds RJ, Trzpis M, Broens PMA. The influence of demographic characteristics on constipation symptoms: a detailed overview. BMC Gastroenterol 2020; 20:168. [PMID: 32493265 PMCID: PMC7268616 DOI: 10.1186/s12876-020-01306-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 05/18/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Diagnosing constipation remains difficult and its treatment continues to be ineffective. The reason may be that the symptom patterns of constipation differ in different demographic groups. We aimed to determine the pattern of constipation symptoms in different demographic groups and to define the symptoms that best indicate constipation. METHODS In this cross-sectional study the Groningen Defecation and Fecal Continence questionnaire was completed by a representative sample of the adult Dutch population (N = 892). We diagnosed constipation according to the Rome IV criteria for constipation. RESULTS The Rome criteria were fulfilled by 15.6% of the study group and we found the highest prevalence of constipation in women and young adults (19.7 and 23.5%, respectively). Symptom patterns differed significantly between constipated respondents of various ages, while we did not observe sex-based differences. Finally, we found a range of constipation symptoms, not included in the Rome IV criteria, that showed marked differences in prevalence between constipated and non-constipated individuals, especially failure to defecate (∆ = 41.2%). CONCLUSIONS Primarily, we found that certain symptoms of constipation are age-dependent. Moreover, we emphasize that symptoms of constipation not included in the Rome IV criteria, such as daily failure to defecate and an average duration of straining of more than five minutes, are also reliable indicators of constipation. Therefore, we encourage clinicians to adopt a more comprehensive approach to diagnosing constipation.
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Affiliation(s)
- Sanne J. Verkuijl
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30 001, 9700 RB Groningen, the Netherlands
- Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Rob J. Meinds
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30 001, 9700 RB Groningen, the Netherlands
- Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Monika Trzpis
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30 001, 9700 RB Groningen, the Netherlands
| | - Paul M. A. Broens
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30 001, 9700 RB Groningen, the Netherlands
- Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Abstract
BACKGROUND Bowel dysfunction after low anterior resection is often assessed by determining the low anterior resection syndrome score. What is unknown, however, is whether this syndrome is already present in the general population and which nonsurgical factors are associated. OBJECTIVE The purpose of this study was to determine the prevalence of minor and major low anterior resection syndrome in the general Dutch population and which other factors are associated with this syndrome. DESIGN This was a cross-sectional study. SETTINGS The study was conducted within the general Dutch population. PATIENTS The Groningen Defecation and Fecal Continence Questionnaire was distributed among a general Dutch population-based sample (N = 1259). MAIN OUTCOME MEASURES Minor and major low anterior resection syndrome were classified according to the scores obtained. RESULTS The median, overall score was 16 (range, 0-42). Minor low anterior resection syndrome was more prevalent than the major form (24.3% vs 12.2%; p < 0.001). Bowel disorders, including fecal incontinence, constipation, and irritable bowel syndrome were associated with the syndrome, whereas sex, age, BMI, and vaginal delivery were not. Remarkably, patients with diabetes mellitus were significantly more prone to experience minor or major low anterior resection syndrome. The ORs were 2.8 (95% CI, 1.8-4.4) and 3.7 (95% CI, 2.2-6.2). LIMITATIONS We selected frequent comorbidities and other patient-related factors that possibly influence the syndrome. Additional important factors do exist and require future research. CONCLUSIONS Minor and major low anterior resection syndrome occur in a large portion of the general Dutch population and even in a healthy subgroup. This implies that the low anterior resection syndrome score can only be used to interpret the functional result of the low anterior resection provided that a baseline measurement of each individual is available. Furthermore, because people with low anterior resection syndrome often experience constipation and/or fecal incontinence, direct examination and diagnosis of these conditions might be a more efficient approach to treating patient bowel dysfunctions. See Video Abstract at http://links.lww.com/DCR/B110. ¿CÓMO DEBE INTERPRETARSE LA PUNTUACIÓN DEL SÍNDROME DE RESECCIÓN ANTERIOR BAJA?: La disfunción intestinal después de la resección anterior baja a menudo se evalúa determinando la puntuación del síndrome de resección anterior baja. Sin embargo, lo que se desconoce es si este síndrome ya está presente en la población general y qué factores no quirúrgicos están asociados.Determinar la prevalencia del síndrome de resección anterior baja menor y mayor en la población holandesa general y qué otros factores están asociados con este síndrome.Estudio transversal.Población holandesa general.El cuestionario de defecación y continencia fecal de Groningen se distribuyó entre una muestra general de población holandesa (N = 1259).El síndrome de resección anterior baja menor y mayor se clasificó de acuerdo con las puntuaciones obtenidas.La mediana de la puntuación general fue de 16.0 (rango 0-42). El síndrome de resección anterior baja menor fue más frecuente que la forma principal (24.3% versus 12.2%, (P <0.001). Los trastornos intestinales, incluyendo incontinencia fecal, estreñimiento y síndrome del intestino irritable se asociaron con el síndrome, mientras que el sexo, la edad y el cuerpo el índice de masa y el parto vaginal no lo hicieron. Notablemente, los pacientes con diabetes mellitus fueron significativamente más propensos a experimentar el síndrome de resección anterior baja menor o mayor. Las razones de probabilidad fueron 2.8 (IC 95%, 1.8-4.4) y 3.7 (IC 95%, 2.2 -6.2), respectivamente.Se seleccionaron las comorbilidades frecuentes y otros factores relacionados con el paciente que posiblemente influyen en el síndrome. Existen otros factores importantes que requieren investigación en el futuro.El síndrome de resección anterior baja menor y mayor ocurre en una gran parte de la población holandesa general e incluso en un subgrupo sano. Esto implica que la puntuación del síndrome de resección anterior baja solo se puede utilizar para interpretar el resultado funcional de la resección anterior baja, siempre que esté disponible una medición inicial de cada individuo. Además, dado que las personas con síndrome de resección anterior baja a menudo experimentan estreñimiento y/o incontinencia fecal, el examen directo y el diagnóstico de estas afecciones pueden ser un enfoque más eficiente para tratar las disfunciones intestinales de los pacientes. Consulte Video Resumen en http://links.lww.com/DCR/B110.
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Jonker JE, van Meegdenburg MM, Trzpis M, Broens PMA. The puborectal continence reflex functions independently of the pudendal nerve. Colorectal Dis 2019; 21:1296-1303. [PMID: 31271490 PMCID: PMC6899689 DOI: 10.1111/codi.14750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/03/2019] [Indexed: 12/26/2022]
Abstract
AIM The ability of patients with poor pudendal nerve function to voluntarily contract their external anal sphincter is limited. However, it is not known whether the condition of the pudendal nerve influences voluntary puborectal muscle contraction. Recently, we described the puborectal continence reflex that maintains faecal continence by involuntary contractions of the puborectal muscle. We aim to investigate whether both voluntary and involuntary contractions of the puborectal muscle are influenced by the condition of the pudendal nerve. METHOD We retrospectively analysed 129 adult patients who underwent anorectal function tests at the Anorectal Physiology Laboratory. Anal electrosensitivity was used as a measurement of the pudendal nerve function. Voluntary and involuntary contractions of the puborectal muscle were defined as maximum puborectal muscle contractility and maximum pressure at the level of the puborectal muscle during the balloon retention test. RESULTS Voluntary contraction of the puborectal muscle was significantly decreased in patients with pudendal nerve damage (P = 0.002). Involuntary contractions, however, were not associated with the condition of the pudendal nerve (P = 0.63). Multiple linear regression analysis showed that the condition of the pudendal nerve and patients' sex significantly predicted voluntary contraction but not involuntary contraction. CONCLUSION Voluntary contractions of the puborectal muscle are significantly decreased in patients with pudendal nerve damage, while involuntary contractions of the puborectal muscle are comparable to those of patients without nerve damage. We conclude that the puborectal continence reflex, which controls involuntary contractions of the puborectal muscle, is not regulated by the pudendal nerve.
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Affiliation(s)
- J. E. Jonker
- Department of SurgeryAnorectal Physiology LaboratoryUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - M. M. van Meegdenburg
- Department of SurgeryAnorectal Physiology LaboratoryUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - M. Trzpis
- Department of SurgeryAnorectal Physiology LaboratoryUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - P. M. A. Broens
- Department of SurgeryAnorectal Physiology LaboratoryUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands,Department of SurgeryDivision of Pediatric SurgeryUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
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Linde JM, Nijman RJM, Trzpis M, Broens PMA. Prevalence of urinary incontinence and other lower urinary tract symptoms in children in the Netherlands. J Pediatr Urol 2019; 15:164.e1-164.e7. [PMID: 30583907 DOI: 10.1016/j.jpurol.2018.10.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 10/31/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The International Children's Continence Society (ICCS) defines urinary incontinence (UI) as 'involuntary leakage of urine' [1], a condition that can have a negative impact on a child's life. Although UI is common among children, the reported prevalences worldwide vary. Regarding children in the Netherlands, only a few studies report on the prevalence of UI and other lower urinary tract symptoms (LUTSs). OBJECTIVE The aim was to investigate the prevalence of episodes of UI and other LUTSs along with associated 'risk factors' in children in the Netherlands. STUDY DESIGN In a cross-sectional study, 240 children (8- to 17-year-olds) were included, who completed the Groningen Pediatric Defecation and Fecal Continence Questionnaire. UI was defined in accordance with the ICCS's definition of involuntary leakage of urine. To define a timeframe of episodes of UI, the situation during the past 6 months was specifically asked. The other LUTSs included were intermittency, straining, urinary tract infections, nocturia, and frequency. RESULTS The prevalence of episodes of UI in the total group was 21.7%. Girls experienced UI significantly more often than boys (30.1% versus 14.2%, P = 0.003). Prevalence did not differ between the 8- to 12-year-olds and the 13- to 17-year-olds. The most prevalent form of UI was stress UI (8.8%). After excluding six children with a medical history that could influence bladder function, UI in 20.9% of the remaining 'healthy' children was found. Intermittency was experienced by 18.3% of the children, and 15% strained during micturition. Univariate analysis showed that the presence of straining, intermittency, nocturia, or fecal incontinence was significantly associated with UI. DISCUSSION Of the children studied, episodes of UI occurred in 21.7%, and the condition did not decrease with age. It was found that UI is not limited to 'sick' children because it occurred in 20.9% of the 'healthy' subgroup. Although children with urge UI in daily practice were mainly seen, in this study, it was found that on average, stress UI was the most common form of UI among Dutch children. The prevalence of other LUTSs was also high, with intermittency and straining as the most frequent symptoms (18.3% and 15.0%, respectively). Intermittency and straining are significantly associated with UI, as are nightly nocturia and fecal incontinence. CONCLUSION Episodes of UI and other LUTSs are common conditions among children in the Netherlands, even in the 'healthy' group. It is important that medical practitioners are aware of these phenomena, and they should be alert to the associated symptoms as they may be considered as 'risk factors'.
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Affiliation(s)
- J M Linde
- Department of Urology, Division of Pediatric Urology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, the Netherlands.
| | - R J M Nijman
- Department of Urology, Division of Pediatric Urology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - M Trzpis
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, the Netherlands.
| | - P M A Broens
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, the Netherlands; Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, the Netherlands.
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Meinds RJ, van der Steeg AFW, Sloots CEJ, Witvliet MJ, de Blaauw I, van Gemert WG, Trzpis M, Broens PMA. Long-term functional outcomes and quality of life in patients with Hirschsprung's disease. Br J Surg 2019; 106:499-507. [PMID: 30653654 PMCID: PMC6590339 DOI: 10.1002/bjs.11059] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/18/2018] [Accepted: 10/28/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND It is unclear whether functional outcomes improve or deteriorate with age following surgery for Hirschsprung's disease. The aim of this cross-sectional study was to determine the long-term functional outcomes and quality of life (QoL) in patients with Hirschsprung's disease. METHODS Patients with pathologically proven Hirschsprung's disease older than 7 years were included. Patients with a permanent stoma or intellectual disability were excluded. Functional outcomes were assessed according to the Rome IV criteria using the Defaecation and Faecal Continence questionnaire. QoL was assessed by means of the Child Health Questionnaire Child Form 87 or World Health Organization Quality of Life questionnaire 100. Reference data from healthy controls were available for comparison. RESULTS Of 619 patients invited, 346 (55·9 per cent) responded, with a median age of 18 (range 8-45) years. The prevalence of constipation was comparable in paediatric and adult patients (both 22·0 per cent), and in patients and controls. Compared with controls, adults with Hirschsprung's disease significantly more often experienced straining (50·3 versus 36·1 per cent; P = 0·011) and incomplete evacuation (47·4 versus 27·2 per cent; P < 0·001). The prevalence of faecal incontinence, most commonly soiling, was lower in adults than children with Hirschsprung's disease (16·8 versus 37·6 per cent; P < 0·001), but remained higher than in controls (16·8 versus 6·1 per cent; P = 0·003). Patients with poor functional outcomes scored significantly lower in several QoL domains. CONCLUSION This study has shown that functional outcomes are better in adults than children, but symptoms of constipation and soiling persist in a substantial group of adults with Hirschsprung's disease. The persistence of defaecation problems is an indication that continuous care is necessary in this specific group of patients.
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Affiliation(s)
- R. J. Meinds
- Division of Paediatric Surgery, Department of SurgeryUniversity of Groningen, University Medical Centre GroningenGroningenthe Netherlands
| | - A. F. W. van der Steeg
- Department of Paediatric SurgeryEmma Children's Hospital, Academic Medical Centre and VU University Medical CentreAmsterdamthe Netherlands
- Centre of Research on Psychology in Somatic DiseasesTilburg UniversityTilburgthe Netherlands
| | - C. E. J. Sloots
- Department of Paediatric SurgeryErasmus Medical Centre, Sophia Children's HospitalRotterdamthe Netherlands
| | - M. J. Witvliet
- Department of Paediatric SurgeryWilhelmina Children's Hospital, University Medical Centre UtrechtUtrechtthe Netherlands
| | - I. de Blaauw
- Division of Paediatric Surgery, Department of SurgeryRadboudumc–Amalia Children's HospitalNijmegenthe Netherlands
| | - W. G. van Gemert
- Department of Paediatric SurgeryUniversity Medical Centre Maastricht, University of MaastrichtMaastrichtthe Netherlands
| | - M. Trzpis
- Anorectal Physiology Laboratory, Department of SurgeryUniversity of Groningen, University Medical Centre GroningenGroningenthe Netherlands
| | - P. M. A. Broens
- Division of Paediatric Surgery, Department of SurgeryUniversity of Groningen, University Medical Centre GroningenGroningenthe Netherlands
- Anorectal Physiology Laboratory, Department of SurgeryUniversity of Groningen, University Medical Centre GroningenGroningenthe Netherlands
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Timmerman MEW, Trzpis M, Broens PMA. The problem of defecation disorders in children is underestimated and easily goes unrecognized: a cross-sectional study. Eur J Pediatr 2019; 178:33-39. [PMID: 30264351 PMCID: PMC6311181 DOI: 10.1007/s00431-018-3243-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/28/2018] [Accepted: 09/10/2018] [Indexed: 12/14/2022]
Abstract
We aimed to study constipation and fecal incontinence in terms of prevalence, recognizing the disorders, help-seeking behavior, and associated symptoms. In this cross-sectional study, 240 children (8 to 18 years) from the general Dutch population completed a questionnaire about defecation disorders. After exclusions for anorectal/pelvic surgery or comorbidities, we analyzed 212 children. The prevalence of constipation was 15.6%; in a quarter of the cases, it co-occurred with fecal incontinence. We found 3% fecal incontinence without constipation. Even though children with a defecation disorder rated their bowel habits worse compared to children without defecation disorders (P < 0.001), 46% constipated children and 67% fecally incontinent children rated their bowel habits as good or very good. Moreover, 21 to 50% of children with a defecation disorder did not mention their symptoms to anybody. Interestingly, most constipated children had "normal" stool frequencies (64%) and consistencies (49%).Conclusion: The prevalence of constipation and fecal incontinence is quite high in children. Stool frequency and consistency is normal in half the constipated children, which may complicate the recognition of constipation. Finally, a considerable number of children does not recognize their disorders as constituting a problem and does not seek help, which leads to an underestimation of these disorders. What is Known: • Constipation and fecal incontinence are common in children, but their prevalence rates may be underestimated due to a variety of reasons. • Diagnosing these disorders remains challenging owing to the variety of symptoms and co-existence with other diseases. What is New: • The prevalence of constipation and fecal incontinence in children is high. • Many children do not recognize their defecation disorders as constituting a problem and do not seek help, which leads to an underestimation of the problem of these disorders.
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Affiliation(s)
- Marjolijn E. W. Timmerman
- Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30 001, 9700 RB Groningen, the Netherlands
| | - Monika Trzpis
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Paul M. A. Broens
- Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30 001, 9700 RB Groningen, the Netherlands
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Verkuijl SJ, Trzpis M, Broens PMA. Normal Rectal Filling Sensations in Patients with an Enlarged Rectum. Dig Dis Sci 2019; 64:1312-1319. [PMID: 30003387 PMCID: PMC6548060 DOI: 10.1007/s10620-018-5201-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/05/2018] [Indexed: 12/09/2022]
Abstract
BACKGROUND Increased rectal volume is believed to be associated with diminished rectal sensation, i.e., rectal hyposensitivity. AIMS To demonstrate that patients with increased rectal volumes do not automatically have diminished rectal filling sensations. METHODS We, retrospectively, observed 100 adult patients with defecation problems, and 44 healthy controls who had undergone anorectal function tests. Using the balloon retention test, we analyzed the distribution of rectal volumes and pressures at different rectal filling sensation levels. RESULTS We found variance in the distribution of rectal volumes at all levels, while rectal pressures showed a normal distribution. We found no correlation between rectal volumes and pressures (constant sensation, r = 0.140, P = 0.163, urge sensation, r = - 0.090, P = 0.375, and maximum tolerable volumes, r = - 0.091, P = 0.366), or when taking age and sex into account. The findings for the patient group were congruent with those for the control group. CONCLUSIONS Participants with increased rectal volumes do not experience increased rectal pressures at any sensation level. This finding, combined with the knowledge that rectal pressure triggers rectal filling sensation, indicates that rectal filling sensations in patients with increased rectal volumes are not diminished. Therefore, "rectal hyposensitivity" should be reserved for patients with increased rectal pressure thresholds, and not for "abnormally" increased rectal volume thresholds.
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Affiliation(s)
- Sanne J. Verkuijl
- 0000 0000 9558 4598grid.4494.dDepartment of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Monika Trzpis
- 0000 0000 9558 4598grid.4494.dDepartment of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul M. A. Broens
- 0000 0000 9558 4598grid.4494.dDepartment of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands ,0000 0000 9558 4598grid.4494.dDepartment of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Meinds RJ, Timmerman MEW, van Meegdenburg MM, Trzpis M, Broens PMA. Reproducibility, feasibility and validity of the Groningen Defecation and Fecal Continence questionnaires. Scand J Gastroenterol 2018; 53:790-796. [PMID: 29703095 DOI: 10.1080/00365521.2018.1465993] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Current questionnaires on defecation disorders are often brief and fail to include questions considering causative factors. Furthermore, adult and pediatric questionnaires differ, which makes it impossible to monitor defecation disorders during the transition from childhood to adulthood. With these points in mind, we developed the Groningen Defecation and Fecal Continence (DeFeC) questionnaire and its pediatric equivalent, the P-DeFeC. The aim of this paper is to introduce the questionnaires and to assess their feasibility, reproducibility and validity. MATERIALS AND METHODS Various Rome IV criteria and scoring tools for constipation and fecal incontinence were incorporated, resulting in nine categories. Feasibility and reproducibility were assessed by performing a test-retest survey in 100 adult participants. Concurrent validity was assessed in 27 patients and 18 healthy volunteers by comparing questionnaire-based diagnoses of constipation and fecal incontinence to final diagnoses based on anorectal function tests. RESULTS There were no remarks on the understandability of any questions. The Cohen's kappa coefficient of all main questions ranged from 0.26 to 1.00, with an average of 0.57. All but one category showed moderate agreement or higher. The sensitivity of the questionnaire-based diagnosis of constipation was 75%; specificity was 100%. The sensitivity of the questionnaire-based diagnosis of fecal incontinence was 77%; specificity was 94%. CONCLUSIONS Overall reproducibility of the Groningen DeFeC questionnaire is acceptable and its validity is good. This makes it a feasible screening tool for defecation disorders and, equally important, with these questionnaires defecation disorders can now be monitored during the transition from childhood to adulthood.
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Affiliation(s)
- Rob J Meinds
- a Department of Surgery, Division of Pediatric Surgery , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands
| | - Marjolijn E W Timmerman
- a Department of Surgery, Division of Pediatric Surgery , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands
| | - Maxime M van Meegdenburg
- b Department of Surgery, Anorectal Physiology Laboratory , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands
| | - Monika Trzpis
- b Department of Surgery, Anorectal Physiology Laboratory , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands
| | - Paul M A Broens
- a Department of Surgery, Division of Pediatric Surgery , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands.,b Department of Surgery, Anorectal Physiology Laboratory , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands
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Schei B, Johannessen HH, Rydning A, Sultan A, Mørkved S. Anal incontinence after vaginal delivery or cesarean section. Acta Obstet Gynecol Scand 2018; 98:51-60. [PMID: 30204238 DOI: 10.1111/aogs.13463] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 08/13/2018] [Accepted: 08/17/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Uncertainties remain as to whether a cesarean section is protective for the short-term and long-term development of anal incontinence. Our aim was to explore whether women who had delivered only vaginally were at greater risk of anal incontinence than nulliparous women and women who had undergone cesarean sections only. MATERIAL AND METHODS Background information, medical history, and data on anal incontinence (defined as fecal or flatus incontinence weekly or more) reported by women participating in a large population-based health survey in Norway (the Nord-Trøndelag Health Study 3) during the period October 2006 to June 2008 were collected and linked to data from the Medical Birth Registry of Norway. The prevalence of anal incontinence was calculated and multivariate logistic regression analyses were applied. RESULTS The mean age of the 12 567 women was 49.9 years. The age and educational level of women who had cesarean sections only were similar to those who had a vaginal delivery and obstetric anal sphincter injuries (OASIS). Nulliparous women and those who had a vaginal delivery and no OASIS were older and had higher educational achievements than women who had delivered by cesarean section exclusively, and women with OASIS. One in four women with OASIS reported anal incontinence compared with one in six of the other women (P < .001). Age, educational level, diarrhea, constipation, birthweight, and OASIS increased the risk of anal incontinence in all women. Parity was associated with anal incontinence in parous women only. No differences were found for fecal urgency. CONCLUSIONS Women with vaginal deliveries complicated by OASIS are at increased risk of anal incontinence. However, no increased risk of anal incontinence was found in nulliparous women or women who had cesarean sections only or vaginal deliveries not complicated by OASIS.
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Affiliation(s)
- Berit Schei
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Gynecology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Hege Hølmo Johannessen
- Department of Physical Medicine and Rehabilitation, Østfold Hospital Trust, Sarpsborg, Norway
| | - Astrid Rydning
- Department of Surgery, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Abdul Sultan
- Croydon University Hospital, Croydon, UK.,St George's , University of London, London, UK
| | - Siv Mørkved
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Research Department, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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van Meegdenburg MM, Meinds RJ, Trzpis M, Broens PMA. Subtypes and symptoms of fecal incontinence in the Dutch population: a cross-sectional study. Int J Colorectal Dis 2018; 33:919-925. [PMID: 29705940 PMCID: PMC6002467 DOI: 10.1007/s00384-018-3051-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE To study the distribution of subtypes and symptoms of fecal incontinence in the general Dutch population. METHODS We performed a cross-sectional study in a representative sample of the general Dutch population. All respondents (N = 1259) completed the Groningen Defecation and Fecal Continence questionnaire. We assigned the respondents to a so-called healthy subgroup (n = 1008) and a comorbidity subgroup (n = 251). The latter subgroup comprised the respondents who reportedly suffered from chronic diseases and who had undergone surgery known to influence fecal continence. We defined fecal incontinence according to the Rome IV criteria. RESULTS The combination of urge fecal incontinence and soiling was the most frequent form of fecal incontinence in the total study group, the "healthy" subgroup, and the comorbidity subgroup (49.0, 47.3, and 51.5%). Passive fecal incontinence was the least frequent form of fecal incontinence in all three groups (4.0, 5.4, and 2.2%). The prevalence and severity of fecal incontinence was significantly higher in the comorbidity subgroup than in the "healthy" subgroup. Only in the comorbidity subgroup did the fecally incontinent respondents feel urge sensation significantly less often before defecating than their fecally continent counterparts (16.5 versus 48.8%, P < 0.001). CONCLUSION Urge fecal incontinence combined with soiling is commonest in the general Dutch population. Chronic diseases and bowel and pelvic surgery both increase and aggravate fecal incontinence.
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Affiliation(s)
- Maxime M van Meegdenburg
- Department of Surgery, Anorectal Physiology Laboratory, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB, Groningen, the Netherlands.
| | - Rob J Meinds
- Department of Surgery, Anorectal Physiology Laboratory, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB, Groningen, the Netherlands
| | - Monika Trzpis
- Department of Surgery, Anorectal Physiology Laboratory, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB, Groningen, the Netherlands
| | - Paul M A Broens
- Department of Surgery, Anorectal Physiology Laboratory, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB, Groningen, the Netherlands
- Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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45
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Bock D, Angenete E, Gonzales E, Heath J, Haglind E. Assessing health, quality of life and urogenital function in a sample of the Swedish general population: a cross-sectional study. BMJ Open 2018; 8:e021974. [PMID: 29730632 PMCID: PMC5942440 DOI: 10.1136/bmjopen-2018-021974] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Evaluate the urinary, bowel and sexual function as well as stress symptoms and depression in a sample of the Swedish population. DESIGN A random sample of Swedish men and women in age groups from 30 to 89 years, a total of 3000 individuals, were contacted and after receiving informed consent, a questionnaire was sent. MAIN OUTCOME MEASURES Measures of urinary, bowel, sexual function and quality of life. RESULTS The questionnaire was sent to 2094 individuals who gave informed consent. The questionnaire was answered by 1078 individuals. Quality of life, stress symptoms and depressed mood were relatively constant across age groups for both men and women. Urinary function differed significantly across gender and age groups, but bowel function was relatively unaffected by age. Overall bowel dysfunction was slightly more prevalent among women compared with men. For both men and women, the frequency of intercourse or other sexual activities decreased with age, whereas sexually associated distress increased by age in men, but decreased among women. CONCLUSIONS In a general population, the urinary function varied across age and sex. Overall bowel dysfunction was slightly more prevalent among women compared with men. Sexually associated distress increased by age for men, but decreased for women. TRIAL REGISTRATION NUMBER NCT02392923; Results.
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Affiliation(s)
- David Bock
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Scandinavian Surgical Outcomes Research Group (SSORG), Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
- Health Metrics Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Angenete
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Scandinavian Surgical Outcomes Research Group (SSORG), Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Elisabeth Gonzales
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Scandinavian Surgical Outcomes Research Group (SSORG), Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Jane Heath
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Scandinavian Surgical Outcomes Research Group (SSORG), Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Eva Haglind
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Scandinavian Surgical Outcomes Research Group (SSORG), Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
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46
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Menees SB, Almario CV, Spiegel BM, Chey WD. Prevalence of and Factors Associated With Fecal Incontinence: Results From a Population-Based Survey. Gastroenterology 2018; 154:1672-1681.e3. [PMID: 29408460 PMCID: PMC6370291 DOI: 10.1053/j.gastro.2018.01.062] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/17/2018] [Accepted: 01/25/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Fecal incontinence (FI) is characterized by uncontrolled passage of solid or liquid stool. We aimed to determine the prevalence and severity of FI in a large sample of US residents. METHODS We recruited a representative sample of patients in October 2015 to complete the National Gastrointestinal (GI) Survey; a mobile app called MyGiHealth was used to systematically collect data on GI symptoms. FI was defined as accidental leakage of solid or liquid stool. Severity of FI was determined by responses to the National Institutes of Health FI Patient Reported Outcomes Measurement Information System questionnaire. Multivariable regression models were used to identify factors associated with FI prevalence and severity. RESULTS Among 71,812 individuals who completed the National GI Survey, 14.4% reported FI in the past; of these, 33.3% had FI within the past 7 days. Older age, male sex, and Hispanic ethnicity increased the likelihood of having FI within the past week. Individuals with Crohn's disease, ulcerative colitis, celiac disease, irritable bowel syndrome, or diabetes were more likely to report FI. Non-Hispanic black and Hispanic individuals and individuals with Crohn's disease, celiac disease, diabetes, human immunodeficiency virus/acquired immunodeficiency syndrome, or chronic idiopathic constipation had more severe symptoms of FI than individuals without these features. CONCLUSIONS In a large population-based survey, 1 in 7 people reported previous FI. FI is age-related and more prevalent among individuals with inflammatory bowel disease, celiac disease, irritable bowel syndrome, or diabetes than people without these disorders. Proactive screening for FI among these groups is warranted.
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Affiliation(s)
- Stacy B. Menees
- Division of Gastroenterology, Michigan Medicine, Ann Arbor, MI,Division of Gastroenterology, Department of Internal Medicine, Ann
Arbor Veterans Affairs Medical Center, Ann Arbor, MI
| | - Christopher V. Almario
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE),
Los Angeles, CA,Division of Digestive and Liver Diseases, Cedars-Sinai Medical
Center, Los Angeles, CA,Division of Health Services Research, Cedars-Sinai Medical Center,
Los Angeles, CA,Division of Informatics, Cedars-Sinai Medical Center, Los Angeles,
CA
| | - Brennan M.R. Spiegel
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE),
Los Angeles, CA,Division of Digestive and Liver Diseases, Cedars-Sinai Medical
Center, Los Angeles, CA,Division of Health Services Research, Cedars-Sinai Medical Center,
Los Angeles, CA,Division of Informatics, Cedars-Sinai Medical Center, Los Angeles,
CA
| | - William D. Chey
- Division of Gastroenterology, Michigan Medicine, Ann Arbor, MI
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47
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Donnelly DW, Donnelly C, Kearney T, Weller D, Sharp L, Downing A, Wilding S, Wright P, Kind P, Catto JWF, Cross WR, Mason MD, McCaughan E, Wagland R, Watson E, Mottram R, Allen M, Butcher H, Hounsome L, Selby P, Huws D, Brewster DH, McNair E, Rivas C, Nayoan J, Horton M, Matheson L, Glaser AW, Gavin A. Urinary, bowel and sexual health in older men from Northern Ireland. BJU Int 2018; 122:845-857. [PMID: 29489050 PMCID: PMC6220963 DOI: 10.1111/bju.14182] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objectives To provide data on the prevalence of urinary, bowel and sexual dysfunction in Northern Ireland (NI), to act as a baseline for studies of prostate cancer outcomes and to aid service provision within the general population. Subjects and Methods A cross‐sectional postal survey of 10 000 men aged ≥40 years in NI was conducted and age‐matched to the distribution of men living with prostate cancer. The EuroQoL five Dimensions five Levels (EQ‐5D‐5L) and 26‐item Expanded Prostate Cancer Composite (EPIC‐26) instruments were used to enable comparisons with prostate cancer outcome studies. Whilst representative of the prostate cancer survivor population, the age‐distribution of the sample differs from the general population, thus data were generalised to the NI population by excluding those aged 40–59 years and applying survey weights. Results are presented as proportions reporting problems along with mean composite scores, with differences by respondent characteristics assessed using chi‐squared tests, analysis of variance, and multivariable log‐linear regression. Results Amongst men aged ≥60 years, 32.8% reported sexual dysfunction, 9.3% urinary dysfunction, and 6.5% bowel dysfunction. In all, 38.1% reported at least one problem and 2.1% all three. Worse outcome was associated with increasing number of long‐term conditions, low physical activity, and higher body mass index (BMI). Urinary incontinence, urinary irritation/obstruction, and sexual dysfunction increased with age; whilst urinary incontinence, bowel, and sexual dysfunction were more common among the unemployed. Conclusion These data provide an insight into sensitive issues seldom reported by elderly men, which result in poor general health, but could be addressed given adequate service provision. The relationship between these problems, raised BMI and low physical activity offers the prospect of additional health gain by addressing public health issues such as obesity. The results provide essential contemporary population data against which outcomes for those living with prostate cancer can be compared. They will facilitate greater understanding of the true impact of specific treatments such as surgical interventions, pelvic radiation or androgen‐deprivation therapy.
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Affiliation(s)
- David W Donnelly
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Therese Kearney
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - David Weller
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Linda Sharp
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Amy Downing
- Leeds Institute of Cancer and Pathology/Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Sarah Wilding
- Leeds Institute of Cancer and Pathology/Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Penny Wright
- Leeds Institute of Cancer and Pathology/Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Paul Kind
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - William R Cross
- Department of Urology, St James's University Hospital, Leeds, UK
| | - Malcolm D Mason
- Division of Cancer and Genetics, School of Medicine, Velindre Hospital, Cardiff University, Cardiff, UK
| | - Eilis McCaughan
- Institute of Nursing and Health Research, Ulster University, Coleraine, UK
| | - Richard Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Eila Watson
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Rebecca Mottram
- Leeds Institute of Cancer and Pathology/Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Majorie Allen
- Leeds Institute of Cancer and Pathology/Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Hugh Butcher
- Yorkshire Cancer Patient Forum, c/o Strategic Clinical Network and Senate, Yorkshire and The Humber, Harrogate, UK
| | - Luke Hounsome
- National Cancer Registration and Analysis Service, Public Health England, Bristol, UK
| | - Peter Selby
- Leeds Institute of Cancer and Pathology/Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Dyfed Huws
- Welsh Cancer Intelligence and Surveillance Unit, Cardiff, UK
| | - David H Brewster
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
| | - Emma McNair
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
| | - Carol Rivas
- Department of Social Science, UCL Institute of Education, University College London, London, UK
| | - Johana Nayoan
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Mike Horton
- Psychometric Laboratory for Health Sciences, Academic Department of Rehabilitation Medicine, University of Leeds, Leeds, UK
| | - Lauren Matheson
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Adam W Glaser
- Leeds Institute of Cancer and Pathology/Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Anna Gavin
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, UK
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48
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van Meegdenburg MM, Trzpis M, Broens PMA. Fecal incontinence and parity in the Dutch population: A cross-sectional analysis. United European Gastroenterol J 2018; 6:781-790. [PMID: 30083341 PMCID: PMC6068786 DOI: 10.1177/2050640618760386] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/25/2018] [Indexed: 12/15/2022] Open
Abstract
Background It is assumed that pregnancy and childbirth increase the risk of developing
fecal incontinence (FI). Objective We investigated the incidence of FI in groups of nulliparous and parous
women. Methods Retrospectively, we studied a cross-section of the Dutch female population
(N = 680) who completed the Groningen Defecation &
Fecal Continence questionnaire. We also analyzed a subgroup of healthy women
(n = 572) and a subgroup of women with comorbidities
(n = 108). Results The prevalence of FI and the Vaizey and Wexner scores did not differ
significantly between nulliparous and parous women. Parous women were 1.6
times more likely to experience fecal urgency than nulliparous women (95%
CI, 1.0–2.6, p = 0.042). Regression analyses showed that
parity, mode of delivery, duration of second stage of labor, obstetrical
laceration or episiotomy, and birth weight seem not to be associated with
the likelihood of FI. Conclusions Pregnancy and childbirth seem not to be associated with the prevalence and
severity of FI in the Dutch population. Vacuum and forceps deliveries,
however, might result in a higher prevalence of FI. Although the duration of
being able to control bowels after urge sensation is comparable between
nulliparous and parous women, parous women experience fecal urgency more
often.
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Affiliation(s)
- Maxime M van Meegdenburg
- Department of Surgery, Anorectal
Physiology Laboratory, University of Groningen, University Medical Center Groningen,
Groningen, the Netherlands
- M.M. van Meegdenburg, Anorectal Physiology
Laboratory, University of Groningen, University Medical Center Groningen, P.O.
Box 30.001, 9700 RB Groningen, the Netherlands.
| | - Monika Trzpis
- Department of Surgery, Anorectal
Physiology Laboratory, University of Groningen, University Medical Center Groningen,
Groningen, the Netherlands
| | - Paul MA Broens
- Department of Surgery, Anorectal
Physiology Laboratory, University of Groningen, University Medical Center Groningen,
Groningen, the Netherlands
- Department of Surgery, Division of
Pediatric Surgery, University of Groningen, University Medical Center Groningen,
Groningen, the Netherlands
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