In patients with long-standing constipation where appropriate treatments have been tried and failed, the first step is diagnostic studies including contrast enema to assess colonic dilation, redundancy, and ensure normal ratio
In Hirschsprung patients status post pull-through, the rectosigmoid brake is removed, and contractions may be seen extending from the right colon all the way to the sphincters.
Motility disorder patients may have a negative pressure gradient during defecation, termed dyssynergia, and may benefit from pelvic floor physical therapy or biofeedback.
The Colorectal Quiz Episode 8: Motility Disorders Part 1
▶Ep 91 · 2:51
clinicalFailure of medical management is defined as appropriate treatment with no appropriate response↗
▶Ep 91 · 2:51
quoteThat's an excellent question, Mark, because defining failure of medical management is multifolded.↗
▶Ep 91 · 3:04
clinicalPatients with persistent symptoms or pain with treatment, or failure to grow, are considered to have failed medical management↗
▶Ep 91 · 3:04
clinicalPatients who cannot take treatment (e.g., kids with autism or other cognitive problems) are considered to have failed medical management↗
▶Ep 91 · 3:21
clinicalFailure of retrograde enemas is considered failure of medical management↗
▶Ep 91 · 5:27
clinicalIn patients with long-standing constipation where appropriate treatments have been tried and failed, the first step is diagnostic studies including contrast enema to assess colonic dilation, redundancy, and ensure normal ratio↗
The Colorectal Quiz Episode 9: Motility Disorders Part 2
▶Ep 93 · 2:24
clinicalA Sitz marker study is recommended to assess colonic transit.↗
▶Ep 93 · 2:35
clinicalAnorectal manometry should assess resting pressure; high resting pressure may indicate a patient amenable to anal Botox.↗
▶Ep 93 · 2:49
clinicalConscious rectal sensitivity threshold is tested by gradually inflating a balloon to determine when the patient has a sensation to defecate.↗
▶Ep 93 · 2:53
quoteGradually blowing up the balloon and getting a sense when the patient actually has a sensation to go to the bathroom.↗
▶Ep 93 · 3:00
clinicalNormal defecation physiology involves pushing from the belly (increasing intraabdominal pressure) and relaxing the anal sphincter, creating a positive pressure gradient.↗
▶Ep 93 · 3:02
quoteIs you're supposed to push from your belly, increasing your intraabdominal pressure, and also relaxing your bottom, creating a positive pressure.↗
▶Ep 93 · 3:09
clinicalMotility disorder patients may have a negative pressure gradient during defecation, termed dyssynergia, and may benefit from pelvic floor physical therapy or biofeedback.↗
▶Ep 93 · 3:39
clinicalSitz marker study is performed by having the patient ingest markers and obtaining an X-ray at day 5.↗
▶Ep 93 · 3:48
clinicalSitz marker study is used as a screening test; if markers are scattered throughout the colon or predominantly on the right side, colonic manometry may be indicated.↗
▶Ep 93 · 4:13
clinicalIf all Sitz markers have disappeared on day-5 X-ray, the patient has stooled, even if they report not having done so; the markers do not dissolve.↗
clinicalSome patients have a true outlet issue with a normal colon on manometry.↗
▶Ep 93 · 8:40
quoteThere are some patients who they have, they truly have an outlet issue, and their colon is actually normal.↗
▶Ep 93 · 8:47
clinicalColonic manometry can characterize whether contractions are well coordinated (neuropathic problem) or low amplitude (myopathic problem).↗
▶Ep 93 · 8:57
quoteSo is there a more of a neuropathic problem, or is there a low amplitude issue and there's Actually a myopathic problem.↗
▶Ep 93 · 9:03
clinicalContractions should propagate from the right colon to the rectum; the rectum does not have the same contractions as the colon.↗
▶Ep 93 · 9:09
quoteYour rectum does not have those same contractions.↗
▶Ep 93 · 9:12
clinicalIn Hirschsprung patients status post pull-through, the rectosigmoid brake is removed, and contractions may be seen extending from the right colon all the way to the sphincters.↗
▶Ep 93 · 9:19
quoteThey no longer have that rectal sigmoid break, and you actually might see contractions going all the way from, uh, the, the, the right side of the colon all the way down to the sphincters.↗
Kahleb's statements about Constipation6 statements
The Colorectal Quiz Episode 8: Motility Disorders Part 1
▶Ep 7 · 2:51
quoteThat's an excellent question, Mark, because defining failure of medical management is multifolded.↗
▶Ep 7 · 2:51
clinicalFailure of medical management is defined as appropriate treatment with no appropriate response↗
▶Ep 7 · 3:04
clinicalPatients who cannot take treatment (e.g., kids with autism or other cognitive problems) are considered to have failed medical management↗
▶Ep 7 · 3:04
clinicalPatients with persistent symptoms or pain with treatment, or failure to grow, are considered to have failed medical management↗
▶Ep 7 · 3:21
clinicalFailure of retrograde enemas is considered failure of medical management↗
▶Ep 7 · 5:27
clinicalIn patients with long-standing constipation where appropriate treatments have been tried and failed, the first step is diagnostic studies including contrast enema to assess colonic dilation, redundancy, and ensure normal ratio↗
Kahleb's statements about Hirschsprung disease25 statements
The Colorectal Quiz Episode 8: Motility Disorders Part 1
▶Ep 39 · 2:51
clinicalFailure of medical management is defined as appropriate treatment with no appropriate response↗
▶Ep 39 · 2:51
quoteThat's an excellent question, Mark, because defining failure of medical management is multifolded.↗
▶Ep 39 · 3:04
clinicalPatients with persistent symptoms or pain with treatment, or failure to grow, are considered to have failed medical management↗
▶Ep 39 · 3:04
clinicalPatients who cannot take treatment (e.g., kids with autism or other cognitive problems) are considered to have failed medical management↗
▶Ep 39 · 3:21
clinicalFailure of retrograde enemas is considered failure of medical management↗
▶Ep 39 · 5:27
clinicalIn patients with long-standing constipation where appropriate treatments have been tried and failed, the first step is diagnostic studies including contrast enema to assess colonic dilation, redundancy, and ensure normal ratio↗
The Colorectal Quiz Episode 9: Motility Disorders Part 2
▶Ep 41 · 2:24
clinicalA Sitz marker study is recommended to assess colonic transit.↗
▶Ep 41 · 2:35
clinicalAnorectal manometry should assess resting pressure; high resting pressure may indicate a patient amenable to anal Botox.↗
▶Ep 41 · 2:49
clinicalConscious rectal sensitivity threshold is tested by gradually inflating a balloon to determine when the patient has a sensation to defecate.↗
▶Ep 41 · 2:53
quoteGradually blowing up the balloon and getting a sense when the patient actually has a sensation to go to the bathroom.↗
▶Ep 41 · 3:00
clinicalNormal defecation physiology involves pushing from the belly (increasing intraabdominal pressure) and relaxing the anal sphincter, creating a positive pressure gradient.↗
▶Ep 41 · 3:02
quoteIs you're supposed to push from your belly, increasing your intraabdominal pressure, and also relaxing your bottom, creating a positive pressure.↗
▶Ep 41 · 3:09
clinicalMotility disorder patients may have a negative pressure gradient during defecation, termed dyssynergia, and may benefit from pelvic floor physical therapy or biofeedback.↗
▶Ep 41 · 3:39
clinicalSitz marker study is performed by having the patient ingest markers and obtaining an X-ray at day 5.↗
▶Ep 41 · 3:48
clinicalSitz marker study is used as a screening test; if markers are scattered throughout the colon or predominantly on the right side, colonic manometry may be indicated.↗
▶Ep 41 · 4:13
clinicalIf all Sitz markers have disappeared on day-5 X-ray, the patient has stooled, even if they report not having done so; the markers do not dissolve.↗
clinicalSome patients have a true outlet issue with a normal colon on manometry.↗
▶Ep 41 · 8:40
quoteThere are some patients who they have, they truly have an outlet issue, and their colon is actually normal.↗
▶Ep 41 · 8:47
clinicalColonic manometry can characterize whether contractions are well coordinated (neuropathic problem) or low amplitude (myopathic problem).↗
▶Ep 41 · 8:57
quoteSo is there a more of a neuropathic problem, or is there a low amplitude issue and there's Actually a myopathic problem.↗
▶Ep 41 · 9:03
clinicalContractions should propagate from the right colon to the rectum; the rectum does not have the same contractions as the colon.↗
▶Ep 41 · 9:09
quoteYour rectum does not have those same contractions.↗
▶Ep 41 · 9:12
clinicalIn Hirschsprung patients status post pull-through, the rectosigmoid brake is removed, and contractions may be seen extending from the right colon all the way to the sphincters.↗
▶Ep 41 · 9:19
quoteThey no longer have that rectal sigmoid break, and you actually might see contractions going all the way from, uh, the, the, the right side of the colon all the way down to the sphincters.↗
Kahleb's statements about Intestinal Rehab25 statements
The Colorectal Quiz Episode 8: Motility Disorders Part 1
▶Ep 41 · 2:51
quoteThat's an excellent question, Mark, because defining failure of medical management is multifolded.↗
▶Ep 41 · 2:51
clinicalFailure of medical management is defined as appropriate treatment with no appropriate response↗
▶Ep 41 · 3:04
clinicalPatients with persistent symptoms or pain with treatment, or failure to grow, are considered to have failed medical management↗
▶Ep 41 · 3:04
clinicalPatients who cannot take treatment (e.g., kids with autism or other cognitive problems) are considered to have failed medical management↗
▶Ep 41 · 3:21
clinicalFailure of retrograde enemas is considered failure of medical management↗
▶Ep 41 · 5:27
clinicalIn patients with long-standing constipation where appropriate treatments have been tried and failed, the first step is diagnostic studies including contrast enema to assess colonic dilation, redundancy, and ensure normal ratio↗
The Colorectal Quiz Episode 9: Motility Disorders Part 2
▶Ep 41 · 2:24
clinicalA Sitz marker study is recommended to assess colonic transit.↗
▶Ep 41 · 2:35
clinicalAnorectal manometry should assess resting pressure; high resting pressure may indicate a patient amenable to anal Botox.↗
▶Ep 41 · 2:49
clinicalConscious rectal sensitivity threshold is tested by gradually inflating a balloon to determine when the patient has a sensation to defecate.↗
▶Ep 41 · 2:53
quoteGradually blowing up the balloon and getting a sense when the patient actually has a sensation to go to the bathroom.↗
▶Ep 41 · 3:00
clinicalNormal defecation physiology involves pushing from the belly (increasing intraabdominal pressure) and relaxing the anal sphincter, creating a positive pressure gradient.↗
▶Ep 41 · 3:02
quoteIs you're supposed to push from your belly, increasing your intraabdominal pressure, and also relaxing your bottom, creating a positive pressure.↗
▶Ep 41 · 3:09
clinicalMotility disorder patients may have a negative pressure gradient during defecation, termed dyssynergia, and may benefit from pelvic floor physical therapy or biofeedback.↗
▶Ep 41 · 3:39
clinicalSitz marker study is performed by having the patient ingest markers and obtaining an X-ray at day 5.↗
▶Ep 41 · 3:48
clinicalSitz marker study is used as a screening test; if markers are scattered throughout the colon or predominantly on the right side, colonic manometry may be indicated.↗
▶Ep 41 · 4:13
clinicalIf all Sitz markers have disappeared on day-5 X-ray, the patient has stooled, even if they report not having done so; the markers do not dissolve.↗
clinicalSome patients have a true outlet issue with a normal colon on manometry.↗
▶Ep 41 · 8:40
quoteThere are some patients who they have, they truly have an outlet issue, and their colon is actually normal.↗
▶Ep 41 · 8:47
clinicalColonic manometry can characterize whether contractions are well coordinated (neuropathic problem) or low amplitude (myopathic problem).↗
▶Ep 41 · 8:57
quoteSo is there a more of a neuropathic problem, or is there a low amplitude issue and there's Actually a myopathic problem.↗
▶Ep 41 · 9:03
clinicalContractions should propagate from the right colon to the rectum; the rectum does not have the same contractions as the colon.↗
▶Ep 41 · 9:09
quoteYour rectum does not have those same contractions.↗
▶Ep 41 · 9:12
clinicalIn Hirschsprung patients status post pull-through, the rectosigmoid brake is removed, and contractions may be seen extending from the right colon all the way to the sphincters.↗
▶Ep 41 · 9:19
quoteThey no longer have that rectal sigmoid break, and you actually might see contractions going all the way from, uh, the, the, the right side of the colon all the way down to the sphincters.↗
Kahleb's statements about Motility / Pseudo-obstruction25 statements
The Colorectal Quiz Episode 8: Motility Disorders Part 1
▶Ep 2 · 2:51
clinicalFailure of medical management is defined as appropriate treatment with no appropriate response↗
▶Ep 2 · 2:51
quoteThat's an excellent question, Mark, because defining failure of medical management is multifolded.↗
▶Ep 2 · 3:04
clinicalPatients with persistent symptoms or pain with treatment, or failure to grow, are considered to have failed medical management↗
▶Ep 2 · 3:04
clinicalPatients who cannot take treatment (e.g., kids with autism or other cognitive problems) are considered to have failed medical management↗
▶Ep 2 · 3:21
clinicalFailure of retrograde enemas is considered failure of medical management↗
▶Ep 2 · 5:27
clinicalIn patients with long-standing constipation where appropriate treatments have been tried and failed, the first step is diagnostic studies including contrast enema to assess colonic dilation, redundancy, and ensure normal ratio↗
The Colorectal Quiz Episode 9: Motility Disorders Part 2
▶Ep 3 · 2:24
clinicalA Sitz marker study is recommended to assess colonic transit.↗
▶Ep 3 · 2:35
clinicalAnorectal manometry should assess resting pressure; high resting pressure may indicate a patient amenable to anal Botox.↗
▶Ep 3 · 2:49
clinicalConscious rectal sensitivity threshold is tested by gradually inflating a balloon to determine when the patient has a sensation to defecate.↗
▶Ep 3 · 2:53
quoteGradually blowing up the balloon and getting a sense when the patient actually has a sensation to go to the bathroom.↗
▶Ep 3 · 3:00
clinicalNormal defecation physiology involves pushing from the belly (increasing intraabdominal pressure) and relaxing the anal sphincter, creating a positive pressure gradient.↗
▶Ep 3 · 3:02
quoteIs you're supposed to push from your belly, increasing your intraabdominal pressure, and also relaxing your bottom, creating a positive pressure.↗
▶Ep 3 · 3:09
clinicalMotility disorder patients may have a negative pressure gradient during defecation, termed dyssynergia, and may benefit from pelvic floor physical therapy or biofeedback.↗
▶Ep 3 · 3:39
clinicalSitz marker study is performed by having the patient ingest markers and obtaining an X-ray at day 5.↗
▶Ep 3 · 3:48
clinicalSitz marker study is used as a screening test; if markers are scattered throughout the colon or predominantly on the right side, colonic manometry may be indicated.↗
▶Ep 3 · 4:13
clinicalIf all Sitz markers have disappeared on day-5 X-ray, the patient has stooled, even if they report not having done so; the markers do not dissolve.↗
clinicalSome patients have a true outlet issue with a normal colon on manometry.↗
▶Ep 3 · 8:40
quoteThere are some patients who they have, they truly have an outlet issue, and their colon is actually normal.↗
▶Ep 3 · 8:47
clinicalColonic manometry can characterize whether contractions are well coordinated (neuropathic problem) or low amplitude (myopathic problem).↗
▶Ep 3 · 8:57
quoteSo is there a more of a neuropathic problem, or is there a low amplitude issue and there's Actually a myopathic problem.↗
▶Ep 3 · 9:03
clinicalContractions should propagate from the right colon to the rectum; the rectum does not have the same contractions as the colon.↗
▶Ep 3 · 9:09
quoteYour rectum does not have those same contractions.↗
▶Ep 3 · 9:12
clinicalIn Hirschsprung patients status post pull-through, the rectosigmoid brake is removed, and contractions may be seen extending from the right colon all the way to the sphincters.↗
▶Ep 3 · 9:19
quoteThey no longer have that rectal sigmoid break, and you actually might see contractions going all the way from, uh, the, the, the right side of the colon all the way down to the sphincters.↗
