The effect ofispaghula husk on colonic motility of the right and left side was examined in 10 patients with left sided diverticular disease using an untethered pressure sensitive radiotelemetry capsule. After treatment, ispaghula husk reduced mouth to rectum transit by a median of 8*8 hours and the time to midtransverse colon by five hours. In the right colon there was an increase in the median percentage activity of 7% and the median number of pressure waves >5 mm Hg/hour rose by 35-3. Motility changes in the left colon were less pronounced. Five of the seven patients with abdominal pain and six of the nine patients with altered bowel habit responded to treatment. These results suggest that it is ispaghula husk's action on the right unaffected colon which alleviates the symptoms of left sided diverticular disease.
This study was performed with an in vitro model to assess the relative importance of sphincter pressure and anorectal angulation in maintaining faecal continence. Water and semisolid material were infused separately into porcine intestine compressed by an inflatable cuff until leakage was observed. Angulation of the bowel with respect to the cuff was 180 degrees and then 90 degrees. With water, holdback pressure was independent of angulation. In contrast, when semisolid material was used, angling the bowel to 90 degrees increased holdback pressure by at least 100 per cent. Measurements taken in solid tubes demonstrated that both a restriction in the tube and an unconstricted 90 degrees bend produced a resistance to flow of the semisolid material which was dependent on flow rate. These data suggest that liquid is retained in the rectum by occlusion pressure alone, whereas the retention of semisolid material is enhanced by angulation.
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