Wikipedia research article discussing causes of rectal Malodor at length
Posted 28 June 2012 - 08:22 AM
Posted 30 June 2012 - 01:24 PM
http://en.wikipedia.org/wiki/Rectal_malodorThis article has been the result of a lot of research on my part. However I am not a GI doc/colorectal surgeon, co my understanding of these topics is perhaps limited.I will continue to add to this article in the future, but it is essentially finished now.
Posted 30 June 2012 - 11:43 PM
Posted 01 July 2012 - 09:23 AM
Ty, took me 2 days.
That's a really impressive wikipedia page. If you did this, it's a top job. It must have taken a while.Thanks for all the hard work if this is the case.
I haven't gone through the lit with a fine tooth comb yet, but not come across a paper investigating this possible link. I assume this is because it is such an unglamorous research topic. Pimmentel in his book references a study which showed increased volume of flatus produced by IBS patients over a certain time, that is closest. Another researcher (Levitt http://www.ncbi.nlm....[Author] flatus ) has done some papers of this kind:http://www.ncbi.nlm.nih.gov/pubmed/10998670
Why hasn't there ever been a proper test to determine the link between incomplete evacuation and flatus?
The closest they do is the colonic transit time test, where the patient swallows radiopaque markers and then x rays are taken each day to see how they are moving through the colon
How difficult is it to intermittently xray/scan the colon,
abulatory anorectal manometry? Or maybe they could use electrodes to monitor muscular activity of the sphincters over a particular time.
test the sphincter,
v difficult to collect flatus i would imagine. One paper used the "bathtub sampling method" where the subject imersed the lower half of their body in a tub of water to release flatus, and the researchers tried to catch the bubbles before they were exposed to the air. Not v scientific...
and collect flatus, say over 24 hours?
It makes sense. However, i recently had the solesta treatment. For about 1 week after the op the seal was v tight from swelling. It was painful to have a bowel movement, causing constipation and really bad incomplete evac in this time. Normally if I had this bad incomplete evac my odor would be horrendous. But because there was temporarily such a tight seal, people around me could not detect any odor. I therefore now suspect it takes incomplete evac + some kind of already compromised sphincter for incomplete evac to cause rectal malodor, but this is opinion only based on my own case.
if there is a direct link the flatus would gradually decrease with more complete emptying. Eventually after the 2 hours say, there should be little to no gas.
Thats interesting thing to say, but makes perfect sense. People generally have more volume and malodorous gas when they need a bowel movement?
If gas remains, then its constituents would be examined to see if it's predominantly "stool" gas or the usual digestion gas. I'm guessing the 2 gases would have a completely different composition.
Posted 01 July 2012 - 06:17 PM
Posted 02 July 2012 - 04:59 AM
lg is not psychosomatic. complete evacuation is not the only thing that works for lg, i heard it only stops it for a few hours whereas ive almost completely eliminated it through other means. the resistance is probably down to the other symptoms that come with it. why would incomplete evacuation cause sour mouth, stools with undigested food in, hardened mucus coming out following an enema, feelings of anxiety, stomach gurgling, hard stool followed by mushy stool? if there are studies which indicate gas is caused by swallowing air it has a lot more grounding than any theory you or i come out with on an internet forum.
I don't think the solesta treatment is a good idea for leaky gas, maybe for actual fecal incontinence. The 2 problems are quite different. Leaky gas is partly psychosomatic because of physiological feed-back issues. I'm not sure there's an actual physical weakness in the sphincter, and it could be just more "sensitive" to gas. I know this because I have heard people expel gas for what seemed to be a full minute in the loo. There's no way I could hold this amount of gas in, whether due to sphincter weakness or over-sensitivity is hard to say and really doesn't matter. The point is, as a leaky gasser ANY gas will be difficult for me to hold in. I've never found anything online that links incomplete evacuation with flatus. The problem could also be due to IBS sufferers being vague with their symptoms and so the doctors are just completely baffled as to what's causing it. There's a fair bit of resistance on the boards here about incomplete evacuation causing their LG. I think deep down people don't want to accept having to spend such a large part of their life on the toilet. Complete evacuation is the only thing that works for leaky gas. Unfortunately it takes a lot of time, for me maybe one or two hours.They can collect flatus through a rectal tube connected to a gas impermeable bag. Would an ultrasound show up stool? The point of all this was to demonstrate the link between stool in the colon, sphincter activity and flatus. It's so frustrating. If we could take this to ONE IBS researcher then maybe someone could set up a test. I wouldn't know how to contact anyone high enough who could make these types of decisions.I try not to laugh at the "studies" that claim excess gas is caused by swallowing air. How the doctors can be so clueless I don't know. But again, IBS sufferers need to be honest with themselves as well as their GI and this just isn't happening.
Posted 03 July 2012 - 10:11 AM
Involuntary passage of gas IS fecal incontinence, by definition, in its mildest form. My rectal odor symptom was eliminated from swelling caused by solesta (for 1 week only). This to me suggests that my symptom could be eliminated by improving the seal alone, without addressing anismus and mucus production issues (although I am researching these and waiting for tests).
I don't think the solesta treatment is a good idea for leaky gas, maybe for actual fecal incontinence. The 2 problems are quite different. Leaky gas is partly psychosomatic because of physiological feed-back issues. I'm not sure there's an actual physical weakness in the sphincter, and it could be just more "sensitive" to gas.
Posted 03 July 2012 - 05:36 PM
Posted 04 July 2012 - 05:03 AM
Enteric nervous system, or as Pimmentel calls it, "little brain".I don't really care about ease of evacuation, it is stinking of ###### that concerns me more. I grew up with pain and bloating on a daily basis, but my quality of life was relatively much higher than it is with this odor problem. I would do anything to go back to that state.I don't forsee evac ever being a problem as long as you take bulking agents and can always use a water enema if needed.I had incomplete evacuation before the solesta procedure, it hurt a while to pass stool in the days after it, but i can say now that evacuation is no different from before in terms of effort. See also, new wiki page on "Fecal leakage", and revisions to main fecal incontinence page:http://en.wikipedia.org/wiki/Fecal_leakagehttp://en.wikipedia.org/wiki/Fecal_incontinence
The mind works with the colon, it's like the whole system has its own brain. A solesta procedure doesn't take into account the mental side of things. It's an over-simplification just to say, OK we'll make the seal tighter so gas can't escape. What about ease of evacuation? How would the mind adapt if this was suddenly more difficult and how in turn will this affect long-term sphincter behaviour?
Posted 04 July 2012 - 09:08 AM
Posted 04 July 2012 - 03:41 PM
My problem about sitting for hours in the morning is about embarrasment more than anything (house share). Plus I usually manage to go within a few mins. The normal range of bowel movements per day is 3 per week to 3 per day (something like that). If it is normal for so many people to have more than one BM per day, why do they not smell? This gets me again thinking about sphincter problems may explain a proportion of rectal malodor cases.
Patients who have gas incontinence should be differentiated from those who are continent and have abnormal flatulence (either in terms of increased volume or increased malodor). Patients will frequently not think of themselves as incontinent if they lose control over gas only. In internet communities of patients who sufferer from rectal malodor-type symptoms, the term "leaky gas" has emerged. This term lacks any fixed definition, and consequently is used by different patients to mean different symptom sets. Some use the term to describe an increase in volume and/or odor of flatus with no reduction of continence, others to describe what would medically be termed gas incontinence, and others use to describe a liquid sensation perianally or rectal discharge. The abbreviation LG should not be confused with the more medically recognized concept of leaky gut, a state of increased intestinal permeability purported to be linked to various medical conditions.
Posted 04 July 2012 - 06:53 PM
Posted 04 July 2012 - 08:14 PM
thats absolute rubbish. Why would we be "naturally primed" to have a BM once per day. We don't urinate once per day, and the peristaltic movement in the colon is continuous, but more active after eating. GI docs say that 3per week to 3 per day is the normal range. I am going to have to quote from my colorectal surgery textbook. Everyone is different. I think ppl should go only when they feel the need. For me 2 times per day is normal when i behave on my diet. For me, going once a day I would consider mild constipation.Stop using word Leaky gas, or at least define what you mean by it. I take it to mean involuntary passage of gas, which is a type of fecal incontinence.I don't really have a problem with gas, for me its more of a mucous discharge issue. When there is no mucus, the odor is usually not present. When I have C there is more mucus, and odor is worse. When there is D odor is worse, but i rarely get D. Odor is gone after a bowel movement, for a variable amount of time
Unfortunately if you have Leaky Gas you can’t house share. This is a drastic condition and so is the cure. The best thing to do is live on your own or with understanding parents. You do need to sit for quite a while in the morning and this is the only thing that works. You need to be completely relaxed as it’s a mind/gut thing and there has to be that confidence there that you will completely evacuate, given enough time. We are naturually primed to go once a day, usually in the morning after some hot drinks, and there’s only a certain amount of stool in there, it’s not like it’s never-ending.I know other people, even here on the IBS boards, can go several times or not at all for days at a time and not have flatulence problems. But we’re Leaky Gassers and we’re different. Maybe we’re more “nervous” than other IBS sufferers, I really don’t know. But our sphincter seems to operate more “sympathetically” to constipation, and Leaky Gas is really a form of constipation.You have to experience this to know what I’m talking about and you only need to do this once. Any chance of staying somewhere overnight where you can completely relax and where you have a bit of time, say over a week-end?
Posted 04 July 2012 - 08:23 PM
*high-amplitude propagated contraction (HAPC)
HAPCs* have also been referred to in the past as large bowel peristalsis, giant migrating contractions, and migrating long spike bursts.50 HAPC is thought to be the equivalent of mass movement.42,51,52 The main function of HAPCs is to move large amounts of colonic contents toward the anus.49,53 They occur approximately five times daily. More than 95% of HAPCs propagate toward the anus (not retrograde).50 They usually occur upon awakening, during the day, and after meals.50 They are usually associated with abdominal sensation and defecatory stimulation (or defecation).50
Using 24-hour manometry, it has been found that the colon is continually active. There is a well-established circadian 26 rhythm with marked diminution of pressure activity at night.41,61 Immediately after waking, there is a threefold increase in colonic pressure activity. This may account for bowel patterns in some individuals who move their bowels after awakening in the morning. Colonic pressure activity also increases after meals, which in one study lasted for up to 2 hours after a meal.41 Propagating pressure waves (probably HAPCs) were seen intermittently throughout the day and especially after meals or after waking.
Even though several studies have shown that caudally propagating HAPCs occur in close temporal association with defecation,72,73 not all HAPCs end in defecation and defecation is not always preceded by HAPCs.49 However, it does appear that usually at least one very high amplitude HAPC occurs with the sensation of the urge to defecate.68
1. Abnormal stool frequency (>3 stools per day or <3 stools per week)
Posted 05 July 2012 - 06:20 AM
Posted 05 July 2012 - 09:22 AM
OK, thanks. So you use "leaky gas" to mean incontinence of gas, a type of fecal incontinence. I am happy to discuss recognized diagnoses/symptoms that have papers written about them, but its almost a waste of time to use this term (which I still feel most here define differently to each other). e.g. we could talk about anismus, fecal leakage (aka soiling/seepage), rectal discharge, increased malodor of flatus, increased volume of flatus, fecal incontinence, whatever severity, gas, liquid etc.Involuntary release of gas is very likely to be down to sphincter problems. Increased volume and/or malodor of gas in the presence of normally functioning sphincters is a separate cause, because here the patient retains ability to release the gas voluntarily. If you can't release gas voluntarily, I would reccomend seeing a specialist in fecal incontinence and getting a anorectal manometry/endoanal ultrasound scan to fully assess the anatomy and physiology of the seal. It will also detect if you have anismus or other causes of obstructed defecation like rectocele.
I define Leaky Gas as involuntary release of gas. This is what most people who post in this section have.
Please read the above quotes? 1 bowel movement per day is not standard.I feel that having to sit for a few hours is a symptom of the condition rather than the cure. Normal people can go perhaps a few times per day and not stink. Normal people can even hold things in for a while without stinking. This makes me think that something else is going on besides incomplete evacuation. Probably gut dysbiosis that increases the VSC content of flatus and feces, or simply increased volume of physiologically malodorous flatus, or sphincter weakness leading to incontinence of gas/fecal leakage etc
A bowel movement a day is the standard but this is beside the point.
Not quite true. The colon has its own "pacemaker" just like the heart, But this pace can be altered by hormones, drugs, inflammation, exercise, etc etc just like the heart rate. But I think it does have a "baseline" rate at which it operates naturally (without any other factors), and there will be a spectrum of variation of this rate between individuals.
We have the ability to change our bowel habits. There’s nothing written in stone that says 3 times a day is right for you.
*interstitial cells of CajalAnd, from Pimmentel's book:
ICC* are the pacemaker cells of the gut that have a central role in regulation of intestinal motility.56
I agree this "baseline" rate can be upregulated or downregulated fairly easily, through lifestyle changes like exercise (look at constipation syndrome in long distance runners, or constipation that comes with sedentary lifestyle), drugs (caffeine, serotonin, stress hormones), and the nature of the gut microbiota (how much methane/hydrogen is produced by fermentation), linked to this will be the diet, what the bacteria are being fed, and the amount of dietary fiber that determines the ease at which the stool can be propelled.What you are saying is that if you sit for long enough, the next HAPC will be more likely to result in another bowel movement. I do get this, but for me I would have to sit for about 5-10 mins longer (first BM happens pretty much straight away), usually have to read and completely forget I am on the toilet or text, and then suddenly I can get more out. This will not really affect the timing of the next BM for me though. However, I do not believe you empty the entire colon like this. I think you empty out enough to be socially acceptable for the day, whether this is eliminating stool which has increased malodor, or eliminating normal stool (and therefore flatus) from threatening mildly compromised sphincters.I think incomplete evacuation needs to be in conjunction with some other factor to cause rectal malodor. when I was growing up, I had incomplete evac all the time. I can remembering needing to go in school, and if it wasn't "convenient" to go, holding it in for a short time, then the urge would disappear and I would not feel the urge to go again until after school and I was at home. Despite this incomplete evac, where I must have had a fecal mass in the rectum, there was no odor. Something changed. Maybe I had anismus all my life? It has been shown to present in healthy subjects with no symptomsAlso, encopresis was shown to persist despite resolution of anismus (i.e. a cause of incomplete evac) with biofeedback (although study is in children) http://www.ncbi.nlm....bmed/8813983And, I am realizing that there are many, many causes of malodorous rectal discharge that are not related to incomplete evacuation. It is oversimplification to say that complete evacuation will work for all. If you have a internal hemorrhoid, or rectal ulcer, or whatever producing mucus, or a lesion mechanically preventing the normal closure of the anal canal, this mucus (whether pathologically produced or normal physiological mucus) can leak out, independent of whether there is incomplete evacuation of stool or not. I get pain on the left wall of the rectum, above the level of puborectalis, and I get pain on the posterior aspect of the anorectal ring (i.e. level of puborectalis). I also remember recurrent bleeding from the posterior midline, and large stool would feel like it was splitting something open with pain. Now, I can guess this was a anal fissure that perhaps has healed with scarring or a defect in the internal anal sphincter, causing mucus to leak out. Or, this pain in the rectal walls could be ulceration (solitary rectal ulcer syndrome?) or internal hemorrhoids... both of which might be causes of this clear mucus
...by comparison, the gastrointestinal tract is the oldest and most evolved, as well as possibly the most complex, organ system; it has its own extensive nerve network, which can function independently. In fact, if all nerve connections to the brain were removed, the gastrointestinal tract would continue to function on its own.
Posted 05 July 2012 - 04:22 PM
Posted 09 July 2012 - 04:30 AM
the condition would be called gas incontinence/incontinence of gas, the only place you will find mention of it is in the fecal incontinence literature.
I’ve been on this board for 7 years and everyone here refers to the involuntary passing of gas as “Leaky Gas”. I think it’s a good term. Some people are aware of the gas, others aren’t - but most of us agree that the odour is caused by gas. No-one seems to agree on what exactly is causing the gas but we mostly agree it leaks out. If you are only going to discuss recognised symptoms that have papers written about them you’ll in be strife. I can’t find my condition anywhere.
yes agreed doesn't sound like it is present for you, however this would require anorectal manometry to be sure (or defacography)
Anismus doesn’t accurately describe my symptoms as I don’t experience a feeling of blockage or resistance. It’s simply that the contraction dies off.
I'm not talking about IBS, I'm talking about causes of the rectal malodor. I am sorry if i am sounding rude, but I am not really focussed on "airy fairy" discussions. I still don't understand the wide range of physical causes of rectal malodor. I will try to research these before moving on to more esoteric & complicated subjects.
IBS problems are not all centred around the sphincter. The sphincter is simply part of the problem. My IBS problem concerns the mind, colon & sphincter and it’s impossible to isolate any of those things from each other. They all work in concert and there seems to be a feedback system between all 3.
if you have involuntary passage of gas, this certainly represents a diagnosis, (or rather a symptom). i.e. I would not call this a sesitivity, this is a problem and would need investigation, anorectal manometry and endoanal ultrasound to assess the structure and functioning of the sphincter.
Involuntary gas may not necessarily be caused by sphincter “problems”. As I have said before there is a mental element to all this as well. There is a huge difference between a clinically diagnosed problem and a “sensitivity”. I have a sensitive, irritable bowel which is probably why I post to the Irritable Bowel Syndrome boards.
yeah i would tend to think that incomplete evacuation is a significant contributor to rectal malodor in a proportion of cases, but it is not based on any evidence, it is opinion. I have no idea of the proportions of different causes of this symptom.
I am saying that I believe complete evacuation will work for most people with leaky gas.
agreed, but see point above about IBS not being the only cause of rectal malodor (not by a long way).
People with internal hemorroids or rectal ulcers or other clinical conditions will not necessarily have IBS.
Posted 09 July 2012 - 04:40 AM
Posted 09 July 2012 - 08:49 AM