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Physiology and Pathophysiology of Defaecation

  • M. A. Kamm
Conference paper

Abstract

The process of defaecation is complex and depends on the integration of neurological information from the brain, spinal cord, pelvic floor and colon itself. Once this information has been processed the act of defaecation relies on intact colonic and pelvic floor function. Other factors which contribute to this process include the colonic contents (bile acids, fatty acids, water and fibre content), gender, age, personality and hormonal status.

Keywords

Irritable Bowel Syndrome Pelvic Floor Pelvic Floor Muscle Internal Anal Sphincter Colonic Motility 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Bueno L, Fioramenti J (1991) Cerebral and spinal control of gastrointestinal motor functions. In: Kamm MA, Lennard-Jones JE (eds) Gastrointestinal transit: pathophysiology and pharmacology. Wrightson Biomedical, Petersfield, pp 3–11Google Scholar
  2. 2.
    Smith JR, la Hann TR, Chesnut RM, Carino MA, Horita A (1977) Thyrotropinreleasing hormone: stimulation of colonic activity following intracerebroventricular administration. Science 196: 660PubMedCrossRefGoogle Scholar
  3. 3.
    Gue M, Jenien JL, Bueno L (1991) Conditional emotional response in rats enhances colonic motility through the central release of corticotrophin-releasing factor. Gastroenterology 100: 964–970PubMedGoogle Scholar
  4. 4.
    Porreca F, Fiela A, Burks TF (1982) Spinal cord-mediated opiate effects on gastrointestinal transit in mice. Eur J Pharmacol 86: 135–136PubMedCrossRefGoogle Scholar
  5. 5.
    Porreca F, Mosberg HI, Hurst R, Hruby VJ, Burks TF (1984) Roles of mu, delta and kappa opioid receptors in spinal and supraspinal mediation of gastrointestinal transit effects and hot-plate analgesia in the mouse. J Pharmacol Exp Ther 230: 341PubMedGoogle Scholar
  6. 6.
    Weber J, Denis P, Mihout B, Muller JM, Blanquart F, Galmiche JP, Simon P, Pasquis P (1985) Effect of brain-stem lesion on colonic and anorectal motility. Dig Dis Sci 30: 419–425PubMedCrossRefGoogle Scholar
  7. 7.
    Hinds JP, Eidelman BH, Wald A (1990) Prevalence of bowel dysfunction in multiple sclerosis. Gastroenterology 98: 1538–1542PubMedGoogle Scholar
  8. 8.
    Klauser AG, Voderholzer WA, Heinrich CA, Schindlbeck NE, Muller-Lissner SA (1990) Behavioural modification of colonic function: can constipation be learned? Dig Dis Sci 35: 1271–1275PubMedCrossRefGoogle Scholar
  9. 9.
    Whitehead WE, Bosmajian L, Zanderman AB, Costa PT, Schuster MM (1988) Symptoms of psychological distress associated with irritable bowel syndrome. Gastroenterology 95: 709–714PubMedGoogle Scholar
  10. 10.
    Drossman DA, McKee DC, Sandler RS, Mitchell CM, Cramer EM, Lawman BC, Bunger AL (1988) Psychological factors in the irritable bowel syndrome. Gastroenterology 95: 701–708PubMedGoogle Scholar
  11. 11.
    Preston DM, Pfeffer J, Lennard-Jones JE (1984) Psychiatric assessment of patients with severe constipation. Gut 25: A582–583Google Scholar
  12. 12.
    Brook A (1991) Bowel distress and emotional conflict. J R Soc Med 84: 39–42PubMedGoogle Scholar
  13. 13.
    Bleijenberg G, Kuypers HC (1987) Treatment of spastic pelvic floor syndrome with biofeedback. Dis Colon Rectum 30: 108–111PubMedCrossRefGoogle Scholar
  14. 14.
    Devroede G, Arhan P, Duguay C, Tetreault L, Akoury H, Perey B (1979) Traumatic constipation. Gastroenterology 77: 1258–1267PubMedGoogle Scholar
  15. 15.
    Gunterberg B, Kewenter J, Petersen I, Stener B (1979) Anorectal function after major resections of the sacrum with bilateral or unilateral sacrifice of sacral nerves. Br J Surg 63: 546–554CrossRefGoogle Scholar
  16. 16.
    Narducci F, Bassotti G, Gaburri M, Morelli A (1987) Twenty-four hour manometric recording of colonic motor activity in healthy men. Gut 28: 17–25PubMedCrossRefGoogle Scholar
  17. 17.
    Cannon WB (1902) The movements of the intestines studied by means of the roentgen rays. Am J Physiol 6: 251–277Google Scholar
  18. 18.
    Van der Sijp JRM, Kamm MA, Lennard-Jones JE (1991) Simulated defaecation: demonstration of colonic peristalsis with anal relaxation and rectal contraction. Gut 32: A563Google Scholar
  19. 19.
    Karaus M, Sarna SK (1987) Giant migrating contractions during defaecation in the dog colon. Gastroenterology 92: 925–933PubMedGoogle Scholar
  20. 20.
    Kamm MA, Lennard-Jones JE, Thompson DG, Sobnack R, Garvie NW, Granowska M (1988) Dynamic scanning defines a colonic defect in severe idiopathic constipation. Gut 29: 1085–1092PubMedCrossRefGoogle Scholar
  21. 21.
    Schang JC, Devroede G (1988) Myoelectric propagating spike bursts in the sigmoid colon elicit the rectoanal inhibitory reflex. Gastroenterology 94: A403Google Scholar
  22. 22.
    Halls J (1965) Bowel content shift during normal defaecation. Proc R Soc Med 58: 859–860PubMedGoogle Scholar
  23. 23.
    Bassotti G, Gaburri M, Imbimbo BP, Rossi L, Farrami F, Pelli MA, Morelli A (1988) Colonic mass involvements in idiopathic chronic constipation. Gut 29: 1173–1179PubMedCrossRefGoogle Scholar
  24. 24.
    Matsueda K, Yamato S, Kojima Y, Shoda R, Muraoka A, Kosaka H, Shimojo E, Umeda N, Oda T (1988) A new hypothesis on pathophysiology of diarrhoea and constipation types of irritable bowel syndrome. Gastroenterology 94: 290Google Scholar
  25. 25.
    Milner P, Crowe R, Kamm MA, Lennard-Jones JE, Burnstock G (1990) Vasoactive intestinal polypeptide levels in the sigmoid colon are reduced in idiopathic constipation and increased in diverticular disease. Gastroenterology 99: 666–675PubMedGoogle Scholar
  26. 26.
    Lincoln J, Crowe R, Kamm MA, Lennard-Jones JE, Burnstock G (1990) Levels of serotonin and 5-hydroxyindoleacetic acid are increased in the sigmoid colon in severe idiopathic constipation. Gastroenterology 98: 1219–1225PubMedGoogle Scholar
  27. 27.
    Krishnamurthy S, Schuffler MD, Rohrman CA, Pope CE II (1985) Severe idiopathic constipation is associated with a distinctive abnormality of the colonic myenteric plexus. Gastroenterology 88: 26–34PubMedGoogle Scholar
  28. 28.
    Rogers J, Misiewicz JJ, Henry MM (1987) Increased segmental activity and intraluminal pressures in the sigmoid colon of patients with the irritable bowel syndrome: a new manometric technique. Gut 28: A1344Google Scholar
  29. 29.
    Tucker DM, Sanstead HH, Logan GM, Klevay LM, Mahalko J, Johnson LK, Inman L, Inglett GE (1981) Dietary fibre and personality factors as determinants of stool output. Gastroenterology 81: 879–883PubMedGoogle Scholar
  30. 30.
    Heaton KW (1991) Fibre and bulk preparations. In: Kamm MA, Lennard-Jones JE (eds) Gastrointestinal transit: pathophysiology and pharmacology. Wrightson Biomedical, Petersfield, pp 209–217Google Scholar
  31. 31.
    Sun WM, Read NW, Miner PB, Kerrigan DD, Donnelly TC (1990) The role of transient internal sphincter relaxation in faecal incontinence? Int J Colorectal Dis 5: 31–36PubMedCrossRefGoogle Scholar
  32. 32.
    Bartram CI, Turnbull GK, Lennard-Jones JE (1988) Evacuation proctography: an investigation of rectal expulsion in 20 subjects without defaecatory disturbances. Gastrointest Radiol 13: 72–80PubMedCrossRefGoogle Scholar
  33. 33.
    Shorvon PJ, McHugh F, Diamant NE, Somers S, Stevenson GW (1989) Defecography in normal volunteers: results and implications. Gut 30: 1737–1749PubMedCrossRefGoogle Scholar
  34. 34.
    Preston DM, Lennard-Jones JE (1985) Anismus in chronic constipation. Dig Dis Sci 30: 413–418PubMedCrossRefGoogle Scholar
  35. 35.
    Waldron D, Bowes KL, Kingma YJ, Cole DR (1988) Colonic and anorectal motility in young women with severe idiopathic constipation. Gastroenterology 95: 1388–1394PubMedGoogle Scholar
  36. 36.
    Hallam RI, Williams NS, Melling J, Waldron DJ, Womack NR, Morrison JFB (1988) Treatment of anismus in intractable constipation with Botulinum A toxin. Lancet ii: 714–716Google Scholar
  37. 37.
    Barnes PRH, Hawley PR, Preston DM, Lennard-Jones JE (1985) Experience of posterior division of the puborectalis muscle in the management of chronic constipation. Br J Surg 72: 475–477PubMedCrossRefGoogle Scholar
  38. 38.
    Kamm MA, Hawley PR, Lennard-Jones JE (1988) Lateral puborectalis division in the management of severe constipation. Br J Surg 75: 661–663PubMedCrossRefGoogle Scholar
  39. 39.
    Jones PN, Lubowski DZ, Henry MM, Swash M (1987) Is paradoxical contraction of puborectalis muscle of functional importance? Dis Colon Rectum 30: 667–670PubMedCrossRefGoogle Scholar
  40. 40.
    Duthie GS, Bartolo DCC, Miller R (1991) Laboratory tests grossly overestimate the incidence of anismus. Surgical Research Society (UK), abstract 42, Jan 1991Google Scholar
  41. 41.
    Kamm MA, Lennard-Jones JE (1990) Rectal mucosal electrosensory testing. Evidence for a sensory neuropathy in severe constipation. Dis Colon Rectum 33: 419–423Google Scholar
  42. 42.
    Kamm MA, Hoyle CVH, Burleigh D, Law PJ, Swash M, Martin JE, Nicholls RJ, Northover JMA (1991) Hereditary internal anal sphincter myopathy causing proctalgia fugax and constipation. A newly identified condition. Gastroenterology 100: 805–810Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1993

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  • M. A. Kamm

There are no affiliations available

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