ABSTRACT
OBJECTIVE: Faecal incontinence (FI) is a devastating condition which is well recognised in the elderly and those with certain conditions such as inflammatory bowel disease. However, there is surprisingly little information on its prevalence in irritable bowel syndrome (IBS), especially in relation to bowel habit subtype, and this study aimed to answer this question. DESIGN: 500 consecutive new and follow-up secondary care IBS outpatients (399 female, 101 male, age range 15-87, mean age 46) fulfilling Rome III criteria without any significant concomitant disease were studied. They completed a series of questionnaires documenting FI, IBS severity, IBS subtype, non-colonic symptoms, quality of life, anxiety, depression and any other factors that might be associated with FI. RESULTS: 285 patients (57%) reported FI, which was mild in 68 (23.9%), moderate in 99 (34.7%) and severe in 91 (31.9%) and in response to laxatives in 27 (9.5%) with an equal prevalence in males and females. The prevalence of FI in patients classified as having mild, moderate or severe IBS was 62%, 49.5% and 61%, respectively. The prevalence of incontinence was 65.2% in diarrhoea IBS, 63.7% in alternating IBS and, surprisingly, 37.9% in constipation IBS, where it was in response to laxatives in 35.8%. Compared to continent patients, those with FI had a significantly higher prevalence of urinary incontinence, previous abdominal surgery, pregnancy and vaginal as opposed to caesarean delivery. 23.3% had not disclosed their incontinence to anyone and only 50.6% had told their general practitioner. 66% always carried a change of clothes and 30% used incontinence pads on a regular basis. CONCLUSIONS: The prevalence of FI in these relatively young patients approached that observed in elderly care homes. Hopefully, recognition of this problem will lead to improved management and reduce the trivialisation that unfortunately still continues to surround this condition.
ABSTRACT
Angiogenic therapy is one of the new treatments of ischaemic heart disease. Oestrogen has angiogenic properties under hypoxic condition, and if oestrogen also induces angiogenesis under normoxic condition, it could be used in combination with other angiogenic therapies in the treatment of ischaemic heart disease. In this study, we evaluated the angiogenic effect of high-dose oestrogen treatment in normoxic rat heart tissue. Fifty-two ovariectomized rats were randomized in oestrogen-treated and control groups. 17beta-oestradiol (1 mg/week) and normal saline (1 mg/week) were administered intramuscularly in the treatment and control groups for 2 months. After that, coronary capillary density and coronary vessel permeability were measured. The serum vascular endothelial growth factor (VEGF) level was also measured before and after the treatment. The results indicate that coronary capillary density (number of capillary per square millimetre) and coronary vessel permeability (fluorescence intensity) were significantly higher in the oestrogen-treated group than in the control group (628 +/- 26 per mm(2) versus 540 +/- 26 per mm(2); P < 0.05 and 207 +/- 10 versus 147 +/- 19 per gram tissue; P < 0.05). Oestrogen treatment increased serum VEGF level in the oestrogen-treated group compared to the control group (52 +/- 3 versus 33 +/- 6 pg/ml; P < 0.05), but interestingly VEGF was also increased in the control group after placebo treatment. It seems that high-dose oestrogen administration has angiogenic properties even in normoxic conditions. These angiogenic properties may result from oestrogen's direct effect on VEGF or other mechanisms, such as endothelial progenitor cell mobilization. Because of the broad effect of oestrogen on angiogenic growth factors and endothelial cells, more studies are required to clarify angiogenic properties of high-dose oestrogen.
