Nick Read » rectum

Faecal impaction in the elderly

admin — Sun, 01 Mar 2009 08:40:16 +0000

Dr Leila Abouzekry came from Egypt and was working in a geriatric hospital in Doncaster. She wanted to carry out a research project in her patients. I admit to some feelings of guilt in suggesting she study the physiology of faecal impaction, but nobody had done it before. Her results indicated a blunting of both rectal and perianal sensation and an inhibition of spinal reflexes, suggesting a neurological cause.

Read, N.W., Abouzekry, L., Read, M.G., Howell, P. and Ottewell, D. (1985) Anorectal function in elderly patients with faecal impaction. Gastroenterology 89: 959-966.
Read, N.W. and Abouzekry, L. (1986) Why do patients with faecal impaction have faecal incontinence. Gut 27: 283-287.
Bannister, J.J., Abouzekry, L.A., Read, N.W. (1987). The effect of ageing on anorectal function. Gut 28: 353-357.
Read, N.W. (1992) Colonic disease in the elderly. In: Textbook of Geriatric Medicine. Professor Grimley Evans, 816, pp.236-241.

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Constipation; the thief of time!

admin — Sun, 01 Mar 2009 08:38:13 +0000

“Constipation is the thief of time, diarrhoea waits for no man!”
The literature suggested that idiopathic constipation, which mainly affected young women, could, like faecal incontinence, be caused by one of a number of possible defects. This was not true. Although our studies showed that a range of abnormalities, delays in colonic transit, a blunting or rectal sensitivity and propulsion, inhibition of internal sphincter relaxation and paradoxical contraction of the external sphincter, these all tended to co-exist. Moreover a blunting of spinal reflexes and a parallel inhibition of micturition suggested that it was the cerebral activation of the programme for evacuation that was at fault, even though there was no sign of stroke, tumor or any other neurological disease. This indicated a psychological inhibition and underlined the success of biofeedback and psychological therapies.

Read, N.W., Timms, J.M., Barfield, L.J., Bannister, J.J., Donnelly, T.C. and Read, M.G. (1986) Impairment of defaecation in young women with severe constipation. Gastroenterology 90: 53-60.
Bannister, J.J., Lawrence, W., Thomas, D.G., Smith, A.B.R., Read, N.W. (1988) Urological abnormalities in patients with slow transit constipation. Gut 29: 17-20.
Kerrigan, D., Sun, W.M., Lucas, M.J., Read, N.W. (1989) Idiopathic constipation is associated with impaired urethrovesical and sacral reflex function. Brit. J. Surg. 76: 748-751.
Read, N.W. (1992) Anismus; does biofeedback work after all? Lancet.

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

Rectal Sensitivity

admin — Sun, 01 Mar 2009 08:32:53 +0000

Irritable Bowel Syndome (IBS) is characterized by increased sensitivity of the rectum. We showed that rectal sensitivity is quite variable and identified how stress, inflammation and sleep deprivation could enhance sensitivity while hypnosis, relaxation and a new class of drugs that blocked serotonin receptors could diminish it. The latter became an important new way of treating IBS.

Read, N.W. The importance of gut feelings. J. Gastrointestinal Motility 1992; 4:79-81.
Prior, A., Read, N.W. Reduction of rectal sensitivity and postprandial motility by Granisetron, a 5HT3 antagonist, in patients with IBS. Alimentary Pharmacology Therap. 1993; 7: 175-180.
Bergin, A.J., Read, N.W. The effects of sleep deprivation on rectal sensitivity in healthy volunteers. Eur. J. Gastroenterol. Hepatol. 1993; 5(7): 527-532.
Read NW, Gwee KA.(1994) The importance of 5HT3 receptors in the gut. Alimentary Pharmacology and therapeutics. 62; l59-73.
Read N.W. (2000). Rectal Distension: From Sensation to Feeling. (Editorial). Gastroenterology 118 (5): 972-974.

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