Colorectal Physiology

First published in 1994: Colorectal Physiology reviews recent findings in fecal incontinence, which is becoming a greater concern to physicians and surgeons as our population grows older and becomes better educated. International experts in anorectal physiology and management of incontinence present their personal views and specific clinical experiences on topics such as causes, diagnostic testing, and modes of treatment. The contributors also examine theoretical and practical aspects of current opinion. This book is a useful reference for researchers, colon and rectal surgeons, physicians, and students interested in understanding and managing fecal incontinence.

Three distinct types of contractions perform colonic motility functions. Rhythmic phasic contractions (RPCs) cause slow net distal propulsion with extensive mixing/turning over. Infrequently occurring giant migrating contractions (GMCs) produce mass movements. Tonic contractions aid RPCs in their motor function. The spatiotemporal patterns of these contractions differ markedly. The amplitude and distance of propagation of a GMC are several-fold larger than those of an RPC. The enteric neurons and smooth muscle cells are the core regulators of all three types of contractions. The regulation of contractions by these mechanisms is modifiable by extrinsic factors: CNS, autonomic neurons, hormones, inflammatory mediators, and stress mediators. Only the GMCs produce descending inhibition, which accommodates the large bolus being propelled without increasing muscle tone. The strong compression of the colon wall generates afferent signals that are below nociceptive threshold in healthy subjects. However, these signals become nociceptive; if the amplitudes of GMCs increase, afferent nerves become hypersensitive, or descending inhibition is impaired. The GMCs also provide the force for rapid propulsion of feces and descending inhibition to relax the internal anal sphincter during defecation. The dysregulation of GMCs is a major factor in colonic motility disorders: irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and diverticular disease (DD). Frequent mass movements by GMCs cause diarrhea in diarrhea predominant IBS, IBD, and DD, while a decrease in the frequency of GMCs causes constipation. The GMCs generate the afferent signals for intermittent short-lived episodes of abdominal cramping in these disorders. Epigenetic dysregulation due to adverse events in early life is one of the major factors in generating the symptoms of IBS in adulthood.

First published in 1994: Colorectal Physiology reviews recent findings in fecal incontinence, which is becoming a greater concern to physicians and surgeons as our population grows older and becomes better educated. International experts in anorectal physiology and management of incontinence present their personal views and specific clinical experiences on topics such as causes, diagnostic testing, and modes of treatment. The contributors also examine theoretical and practical aspects of current opinion. This book is a useful reference for researchers, colon and rectal surgeons, physicians, and students interested in understanding and managing fecal incontinence.

This is the first comprehensive book exclusively dedicated to anorectal physiology and the importance of diagnostic tools in guiding the evaluation and treatment of anorectal dysfunction. Functional disorders, and specifically fecal incontinence and evacuatory disorders, are prevalent in the general population, affecting up to 20% of individuals. As many of these conditions have extremely complex mechanisms, a thorough understanding of anorectal physiology is a crucial element in the surgeon’s “arsenal" to ensure accurate evaluation and to inform treatment. At this time, there is no other title that specifically addresses all aspects of anorectal physiology, as well as anorectal and pelvic floor disorders, including fecal incontinence and defecation disorders. Specifically, the book provides detailed descriptions of diagnostic methods and treatment algorithms for a range of anorectal conditions, including modern treatment modalities such as sacral neuromodulation. A unique and comprehensive reference covering all aspects of the evaluation and treatment of anorectal disorders, Anorectal Physiology – A Clinical and Surgical Perspective will be of significant interest to proctologists and coloproctologists, gastroenterologists, colorectal surgeons, gynecologists and all other professionals interested in anorectal physiology.

EMM: Coloproctology presents the state-of-the-art in coloproctology. The topics covered include anatomy, physiology, anal disorders, dermatology, functional disorders, inflammatory bowel disease, benign and malignant tumours, endoscopy, emergencies and pain syndromes. All chapters give a comprehensive overview of aetiology, incidence, epidemiology, diagnostics, medical and surgical treatment, complications and individual special considerations. This work presents surgical trainees with a comprehensive and condensed guide to the core knowledge required for the European Board of Surgery Qualification (EBSQ) examination. The manual will also be of assistance to practising coloproctologists across Europe and beyond who have an interest in continued professional development. Written by an international team of experts who have each made noteworthy contributions in their field, the coverage of most aspects of coloproctology in an easy-to-follow format also makes this manual valuable to other specialists.

This is the first volume in the new Springer Major Reference Work series entitled Coloproctology. The book covers key topics in the anatomy and physiology of the colon, rectum and anus and the diagnosis of colorectal/anal diseases and disorders. It thus forms a sound basis for further volumes in the series that will focus on the treatment of more specific clinical conditions. The subjects addressed in the volume are crucial to effective patient management and the book highlights the fact that adequate diagnostic assessment of a given disease is significantly related to the pathophysiologic interpretation of the pathologic process. The purpose of the volume is to provide readers with up-to-date knowledge on colorectal and anal anatomy and physiology, particularly from a treatment perspective and to describe the methodology to be employed in choosing the best diagnostic work-up in coloproctology.

Advanced Nutrition and Dietetics in Gastroenterology provides informative and broad-ranging coverage of the relation between nutrition and diet and the gastrointestinal tract. It explores dietary factors involved in causation of a variety of gastrointestinal disorders, as well as the effects on diet and the treatments available. It also provides an overview of anatomy and physiology, measurement and assessment of function, and dietary components relevant to gastrointestinal health. ABOUT THE SERIES Dietary recommendations need to be based on solid evidence, but where can you find this information? The British Dietetic Association and the publishers of the Manual of Dietetic Practice present an essential and authoritative reference series on the evidence base relating to advanced aspects of nutrition and diet in selected clinical specialties. Each book provides a comprehensive and critical review of key literature in its subject. Each covers established areas of understanding, current controversies and areas of future development and investigation, and is oriented around six key themes: •Disease processes, including metabolism, physiology, and genetics •Disease consequences, including morbidity, mortality, nutritional epidemiology and patient perspectives •Nutritional consequences of diseases •Nutritional assessment, drawing on anthropometric, biochemical, clinical, dietary, economic and social approaches •Clinical investigation and management •Nutritional and dietary management •Trustworthy, international in scope, and accessible, Advanced Nutrition and Dietetics is a vital resource for a range of practitioners, researchers and educators in nutrition and dietetics, including dietitians, nutritionists, doctors and specialist nurses.

This third edition text provides a completely revised and updated new version of this unique, modern, practical text that covers the strategic evaluation, specific approaches, and detailed management techniques utilized by expert colorectal surgeons caring for patients with complex problems–whether they result from underlying colorectal disease or from complications arising from previous surgical therapy. The format follows that of both a “how to” manual as well as an algorithm-based guide to allow the reader to understand the thought process behind the proposed treatment strategy. By making use of evidence-based recommendations, each chapter includes not only background information and diagnostic/therapeutic guidelines, but also provides a narrative by the author on his/her operative technical details and perioperative “tips and tricks” that they utilize in the management of these complex surgical challenges. Distinctive to this book, is the reliance on experts in the field including past presidents of the ASCRS, as well as multiple other national and internationally recognized surgeons, to lend their personal insight into situations where data may be more sparse, but individual and collective experience is paramount to making sound decisions and thereby optimizing patient outcomes. The text includes chapters on the assessment of risk and methods utilized to minimize perioperative complications. In addition, it incorporates sections covering the medical and surgical therapies for abdominal, pelvic and anorectal disease. Moreover, the technical challenges of managing complications resulting from the original or subsequent operations is addressed. The underlying focus throughout the text is on providing pragmatic and understandable solutions that can be readily implemented by surgeons of varying experience to successfully treat complex colorectal problems. However, it also goes beyond the technical aspects of colorectal surgery and includes special sections highlighting the essence of a surgeon; covering aspects involving the medical-legal, ethical, and economic challenges confronting surgeons. Throughout the text, each author provides an ongoing narrative of his/her individual surgical techniques along with illustrations and diagrams to “personally” take the reader through the crucial steps of the procedure, and key points of patient care inherent to that topic. Additionally, where appropriate, links to online videos give the reader an up-front look into technical aspects of colorectal surgery.