Nick Read » defaecation

It only hurts when I laugh; living with an injured back.

Nick Read — Mon, 22 Jun 2009 08:04:58 +0000

When I was a physiologist, I used to ponder the cause of the sensations I felt in my body, the reactions of my gut, what is was about feeling sick that made me yawn or sweat, why a headache made he muscles on the back of my neck sore. I even thought of writing a book of such observations, but like so many of my grand ideas, it ran into the sand trap of time and was forgotten.

Now the pain protecting the healing bones in my back offers a whole new insight on life. What I originally took for granted, didn’t think about, is suddenly, painfully brought to mind. I have to be careful how I walk. Keep the back straight, let the feet do the work, keep the head up, swing the arms for momentum but not too vigorously. It’s amazing how much we use the trunk, the back, to add fluidity to our walking; the constant balances and adjustments that occur at every step. All of these are now forbidden. The back has to be locked rigid, the damage protected in a rigid case.

Lead off up the stairs with the left food not the right. Any sudden movement with the right foot, brings on a spasm of pain that makes me cry out. Use both arms to support when sitting up. Don’t bend the back; reach down for things by using the knees. Keep the back straight at all times.

Breathe deeply and evenly and try not to cough. Coughing is so painful. The sharp contraction of diaphragm and intercostals jerks the wound, dislodging the broken ends of bone and creates an anguish of spasm. A chest infection is the most dreaded complication of broken ribs. Secretions collect in bruised tissues and can easily become infected. The cells lining the bronchioles and bronchi have a carpet of cilia, tiny hairs that beat in waves wafting the secretions upwards. But this ciliary escalator can only get secretions as far as the trachea, if that. There they collect, tickle and have to be coughed up. Try to suppress the cough reflex, grunt to move the collection and move the phlegm into the pharynx, from where it can be swallowed.

Just as you use the knees to reach down, let your colon do most of the work in defaecation. Learn to relax and take your time. Think, evacuation – a bit of self hypnosis. Imagine your gut like the M1 with the traffic flowing evenly smoothly. Breathe deeply, allow your colon to ease, squeeze the plug of waste down until it is in the firing position. Allow the sensation to build until, almost like orgasm, it demands release. And then just a small graded increase in abdominal pressure will hopefully expel it all in one shot.

Sorry to go on about it so much, but if you’ve hurt your back, constipation can become a real torture. Take plenty of fibre, fruit, drink syrup of figs or prune juice, take a dose of lactulose every night, add a senna – do what it necessary to keep the contents of your colon soft, but not too much that they are liquid and urgent – you don’t want to be caught short. Remember you can’t hurry, even if your bowel wants to. Adjust the dose so your faeces are soft and pliable, then you can relax and let peristalsis do most of the work. So take your time. Remember, laxative and relaxation have the same derivation. The ancients knew it. So should we!

But there is one thing you cannot always prevent. It sneaks up on you when you are relaxed, catching you off guard, tearing into your back and causing the most intense spasms of pain. That is emotion! Not any emotion, but the sudden surges of anger and laughter.

Emotion takes over the control we exert on our lives. It demands expression, satisfaction. Grievance, loss, depression can make it impossible to think of anything else. The chemicals flood the brain, controlling our thoughts and movements, distracting, preoccupying, obsessing with the same insistent thoughts. There can be no escape.

The same happens with acute spasms of emotion. The quick floods of chemical catch you unawares. An attack of frustration while climbing the stairs can cause you to forget, lead off on the wrong foot, unlock and leave you hanging on, wracked with the most intense pain.

And laughter, the repetitive contractions of intercostals, the inescapable build up of tension as you try to stop laughing, is murder. You can die laughing or it seems so. The ridiculous can stab you in the back. Avoid it at all cost. Turn your face and your back to stone – for the time being anyway..

Design for Living? I don’t think it will work. It should be easy, you know. The actual facts are...
Nature cure; a case of living in the moment. When I read Richard Mabey’s book, Nature Cure, I could...
The dangers of going to bed. It had been a long night. Although my hospital bed allowed...

Spinal Injury

admin — Sun, 01 Mar 2009 08:54:01 +0000

Once in a while the opportunity arises to study something that could make a really important difference. People with spinal injury lose control of pelvic function but it is possible to regain a degree of autonomy by stimulating the nerves going to the pelvic organs. Wires are implanted onto the sacral anterior nerve roots and attached to a box inserted under the skin of the chest wall. Stimulation is effected by induction using an external signal. By applying different programmes of stimulation, patients could induce micturition, defaecation and penile erection. Some were able to father their own children ‘naturally’. We had the privilege to documenting the disturbances in anorectal function in patients with spinal injury and testing the prototypes.

MacDonagh, R., Sun, W.M., Smallwood, R.H., Read, N.W. (1990) Control of defecation in patients with spinal injuries by stimulation of sacral anterior nerve roots. Brit. Med. J. 300: 1494-1497.
Sun, W.M., Read, N.W. (1991) Reflex anal dilatation: effect of parting the buttocks on anal function in normal subjects and patients with anorectal and spinal disease. Gut 32: 670-673.
MacDonagh, R., Sun, W.M., Thomas D.G, Smallwood, R., Read, N.W. (1992) Anorectal function in patients with complete supraconal spinal cord lesions. Gut 33: 1532-1538.
Sun, W.M., Mac Donagh, R., Forster, D., Thomas, D.G., Smallwood, R., Read, N.W. (1995). Anorectal function in patients with complete spinal transection before and after sacral posterior rhizotomy. Gastroenterology. 108:990-998.

Anorectal Function The anus is much cleverer than we like to think....
Faecal Incontinence “Harwich for the continent. Sheffield for the incontinent!” With this...
Faecal impaction in the elderly Dr Leila Abouzekry came from Egypt and was working in...

Anorectal Function

admin — Sun, 01 Mar 2009 08:29:59 +0000

The anus is much cleverer than we like to think. Or maybe we don’t like to think about it at all, unless it fails or is too up tight. It is, in fact, two sphincters in one, the outer one under conscious control, the inner not. It is exquisitely sensitive, distinguishing accurately between gas, fluid and solid.
The control of defaecation, so essential for socialization, requires the coordination of colonic propulsion, anorectal sensation and relaxation of internal and external sphincters and the muscles of the pelvic floor.
Continence is protected by the response of the external sphincter and puborectalis muscles to rectal distension and increases in intra-abdominal pressure.
Over the course of nearly twenty years, we worked with colleagues in surgery to describe the function of the anal sphincter in health and disease and helped devise and perfect new procedures to treat disorders of anal sphincter mechanism.

Read, N.W. and Bannister, J.J. (1985). Anorectal manometry: Techniques, measurements in healthy subjects and patients with anorectal disease. In: Proctology and the Pelvic Floor. (Eds. M. Henry and M. Swash). Butterworths, Sevenoaks, pp.65-87.
Bannister, J.J., Davison, P., Timms, J.M., Gibbons, C.G., Read, N.W. (1987). Effect of the stool size and consistency on defaecation. Gut 28: 1246-1250.
Bannister, J.J., Gibbons, C., Read, N.W. (1987) Preservation of faecal continence during rises in intra-abdominal pressure. Is there a role for a flap valve in maintaining normal continence. Gut 28: 1242-1245.
Rao, S.S.C., Holdsworth, C.D., Read, N.W., Davison P.A., Bannister J.J. (1987) Anorectal sensitivity and reactivity in patients with ulcerative colitis. Gastroenterology 93: 1270-1275.
Read, N.W., Sun, W.M. (1988) Disorders of the anal sphincter. In: Functional Bowel Disease (Ed. W.J. Snape), Plenum Press.
Edwards, C.A., Baxter, J., Brown, S., Bannister, J.J., Read, N.W. (1989) Effect of bile acids on anorectal function in humans. Gut 30: 383-386.
Brown, S., Cann, P.A., Read, N.W. (1990) Effect of coffee on distal colon function. Gut 31: 450-453.
Sun, W.M., Prior, A., Daly, J., Cheam, K., Read, N.W., Grundy, D. (1990) Sensory and motor responses to rectal distension vary according to rate and pattern of balloon inflation. Gastroenterology 99: 1008-1015
Prior, A., Stanley, K., Smith, A.R.B., Read, N.W. (1992) Effect of hysterectomy on anorectal and ureathrovesical physiology. Gut 33: 264-267.
Sun WM. Katsinelos P, Horowitz M, Read NW. (1996) Disturbances in anorectal function in patients with diabetes mellitus and faecal incontinence. Euro. J. Gastro. Hep. 8 (l0): 1007-12.

Spinal Injury Once in a while the opportunity arises to study something...
Haemorrhoids The anal cushions are composed or erectile tissue similar to...
Faecal Incontinence “Harwich for the continent. Sheffield for the incontinent!” With this...