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Section
1 Coloproctology and Flow Equation
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To
Section 2
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- According
to the flow equation constipation can be defined as a low flow
state during defecation while Anal Incontinence can be defined
as abnormal flow of bowel contents through the anal canal during
rest or squeeze.
Flow = Pressure/Resistance.
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According the rectoanal interaction is a pressure -resistance
interaction rather than Pressure – pressure interaction.
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The anal canal resistance is directly proportionate to Dynamic
viscosity (consistency) of stools and A.C. length and inversely
proportionate to (anal canal resistance) 4.
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Accordingly normal flow during defecation and abnormal flow
during incontinence increases as the intra-rectal pressure and
anal canal diameter increase and as the dynamic viscosity (consistency)
of the stools and anal canal length decreases. Being modified
by sensory and reflex factors.
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Sensory factors principally affects Intrarectal pressure due
to delayed sensations.
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Reflex factors works mainly by determining which anal canal
dimensions (and hence resistance) challenged by intra rectal
pressure during rest or squeeze for incontinent patients or
during defecation for constipated patients.
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The mathematically calculated flow was taken as a flow index
rather than an accurate measurement of flow in order to avoid
too- much corrections on the native equation.
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Norm grams representing the flow equation during defecation
and continence had been plotted in order to facilitate understanding
the flow equation and allocation of individual patients as a
rough though rapid substitute for suggested mathematical calculations.
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Click here for Flow index calculator
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Section
2: How to use the integrated
approach?
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To
Section 1
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- The
integrated Coloproctology can give a frame work to the puzzle
made of hundreds of scattered pieces of the puzzle called the
functional Coloproctology by providing the final imagination
on how this puzzle will look like when those pieces are fitted
together.
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It can be used equally for incontinence and constipation
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it can be used to understand normal anorectal physiology and
accordingly explains the controversies experienced due conflicting
research data.
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it determines mechanical factors marinating continence and defecation
and can quantities the roles played by each mechanical factor
as well as sensory and reflex components in each individual
patient.
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It helps in better planning of treatment and expecting outcome
based on the above- mentioned data.
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Helps in objective evaluation of different modalities of treatment
in comparison to each other e.g. the effect of biofeedback training
vs. different types of surgery by mathematically calculating
anal canal resistance before and after treatment.
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