[Irritable bowel syndrome, levator ani syndrome, proctalgia fugax and chronic pelvic and perineal pain]. / Syndrome de l'intestin irritable, syndrome du releveur, proctalgie fugace et douleurs pelvipérinéales chroniques.

OBJECTIVES: To define functional gastrointestinal pain, irritable bowel syndrome (IBS), levator ani syndrome, proctalgia fugax, the pathophysiology of these syndromes and the treatments that can be proposed. MATERIAL AND METHODS: Review of articles published on the theme based on a Medline (PubMed) search and consensus conferences selected according to their scientific relevance. RESULTS: IBS is very common. Patients report abdominal pain and/or discomfort, bloating, and abnormal bowel habit (diarrhoea, constipation or both), in the absence of any structural or biochemical abnormalities. IBS has a complex, multifactorial pathophysiology, involving biological and psychosocial interactions resulting in dysregulation of the brain-gut axis associated with disorders of intestinal motility, hyperalgesia, immune disorders and disorders of the intestinal bacterial microflora and autonomic and hormonal dysfunction. Many treatments have been proposed, ranging from diet to pharmacology and psychotherapy. DISCUSSION: Patients with various types of chronic pelvic and perineal pain, especially those seen in urology departments, very often report associated IBS. This syndrome is also part of a global and integrated concept of pelviperineal dysfunction, avoiding a rigorous distinction between the posterior segment and the midline and anterior segments of the perineum.

Effect of dyssynergic defecation during pregnancy on third- and fourth-degree tear during a first vaginal delivery: a case-control study.

OBJECTIVE: Determine whether dyssynergic defecation is a risk factor for third- or fourth-degree tear during a first vaginal delivery. STUDY DESIGN: A retrospective case-control study was conducted on 549 primiparous women. The case group (n = 140) sustained an anal sphincter tear and the control group (n = 409) had a perineal laceration lower or equal to a second-degree tear. The Knowles-Eccersley-Scott Symptom questionnaire identified women who had dyssynergic defecation. A logistic regression analysis was performed. RESULTS: Anal sphincter tear were 2.94 times higher for women reporting dyssynergic defecation (P = .002; 95% confidence interval [CI], 1.47-5.88). Odds ratios (ORs) were also significant for forceps (P < .001; OR, 6.90; 95% CI, 3.27-14.59), vacuum extraction (P = .009; OR, 2.36; 95% CI, 1.17-4.76), median episiotomy (P = .009; OR, 2.71; 95% CI, 1.54-4.78), and high infant weight (P < .001; OR, 2.25 for each 500 g increase; 95% CI, 1.69-2.99). CONCLUSION: Dyssynergic defecation seems to increase anal sphincter tear, but prospective studies are needed to confirm the association.

Non-invasive stimulation techniques to relieve abdominal/pelvic pain: Is more always better?

Chronic abdominal and pelvic pain is a common condition that has significant impact on quality of life, and causes billions of dollars in direct and indirect costs. Emerging data suggest that transcranial direct current stimulation (tDCS), alone or in combination with transcutaneous electrical nerve stimulation (TENS), could be a promising therapeutic avenue to reduce chronic pain. The encouraging results coming from these studies prompted us to try combining TENS and tDCS in 4 of our patients who suffered from chronic abdominal/pelvic pain and to compare the effect with 5 other patients who received TENS alone. Pain intensity was assessed with a visual analog scale before, during and after the stimulation. We observed that there was a slight decrease in pain which was similar in both patient groups (TENS alone and TENS combined with tDCS). These observations suggest that combining TENS and tDCS in patients suffering from chronic pelvic and/or abdominal pain produces no additional benefit, compared to TENS alone. Future studies, looking at the effect of several/consecutive TENS and tDCS sessions should be conducted.

[Evaluation of the Global Abdominal Method (ABDO-MG) in the treatment of urinary incontinence]. / Evaluation de la technique de rééducation Abdominale Méthode Globale (ABDO-MG) dans le traitement de l'incontinence urinaire.

AIMS OF STUDY: Assessment of the Abdominal Global Method (ABDO-MG) in the treatment of stress urinary incontinence or mixed incontinence with stress predominance in women. METHODS: Thirty patients with clinically and urodynamically proven genuine stress incontinence or mixed incontinence with stress predominance were enrolled. Patients had 4 weeks of ABDO-MG technique under supervision and a home unit to do their exercises, then 8 weeks of home exercises without home unit or supervision. We compared the results for each patient before the treatment, at 4 and 12 weeks post initiation of the technique. Main outcome measures were short Pad test with standardized bladder volume and exercises as well as self-report of degrees of incontinence. RESULTS: The data showed improvement in leakage on short Pad test from 82.0 g before versus 38.8 g and 24.8 g at 4 and 12 weeks respectively (p = 0.0002). Seventeen of thirty patients were completely dry. All patients reported improvement of their condition after 4 weeks of exercises and almost cure at 12 weeks (p = 0.0001). CONCLUSIONS: This is the first study demonstrating the clinical efficacy, both objectively and subjectively, of the technique ABDO-MG in the treatment of genuine stress urinary incontinence and mixed incontinence with stress predominance in women. Our data are encouraging, however long-term study with control group is warranted.

Giant liposarcoma of the esophagus.

Liposarcomas of the gastrointestinal tract are exceedingly rare. Only nine cases of esophageal involvement have been described. A 68-year-old woman presented with an episode of vomiting followed by extrusion of a polypoid mass from the mouth. This 10th case of esophageal liposarcoma is the first in the literature to report a recurrence 25 years after the first episode.

Comparing pain modulation and autonomic responses in fibromyalgia and irritable bowel syndrome patients.

OBJECTIVES: Past studies confirm that patients with fibromyalgia (FM) and irritable bowel syndrome (IBS) show similar pain processing dysfunctions, such as reduced pain inhibition and aberrant autonomic nervous system (ANS) responses. However, patients with FM and IBS have rarely been investigated in the same study. The aim of the present study, therefore, was to compare descending pain inhibition, pain sensitivity, and ANS reactivity to pain in FM, IBS, and healthy controls (HC). METHODS: Female patients with FM (n=10), IBS (n=13), and HCs (n=10) were exposed to multiple cold water (12°C) immersions to study pain sensitivity and descending pain inhibition. Heart rate variability was also assessed during immersions. RESULTS: Pain intensity scores were highest in FM, intermediate in IBS, and smallest in HCs. In contrast, pain inhibition was absent in FM, intermediate in IBS, and strongest in HCs. Importantly, controlling for differences in pain inhibition abolished group differences in pain sensitivity. Heart rate variability analyses confirmed that, in response to mild levels of pain, patients with FM showed greater sympathetic activity whereas HCs showed greater parasympathetic activity. Patients with IBS showed intermediate ANS responses. DISCUSSION: Our results confirm the presence of graded levels of somatic hyperalgesia across patients with IBS and FM. A similar pattern of result was observed for pain inhibitory dysfunctions. These pain processing changes were accompanied by abnormal autonomic responses, which maintained patients (principally patients with FM) in a state of sympathetic hyperactivity. Results suggest that patients with IBS and FM may present common, but graded, pain processing and autonomic dysfunctions.