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• W2149849503 abstract "Thirty-three years ago I suggested that all eases of constipation could be separated into two groups: (1) colonic constipation, in which the passage through the colon is delayed, and (2) dyschezia (δυς) difficult; χέζω, I go to stool), in which the faeces reach the rectum at the normal rate but their final evacuation is delayed owing to inefficient defaecation. Since that time the concept of dyschezia has become almost universally accepted, so that it was something of a surprise to read in the December 1941 issue of Radiology a paper by Delano, Ronayne, and Boland entitled “Rectal Dyschezia: A Misnomer for Megarectum.” Although they regard the term dyschezia as “inept” and “obsolescent” and add that they have probed for diagnostic criteria or notes on etiology, it would appear that they have not read a single one of the numerous papers which have been written on the subject since the original publication of my monograph on Constipation in 1909. There had, in fact, never been any confusion between dyschezia and megacolon until the paper by Delano and his colleagues appeared.2 In 1919 I pointed out the similarity between megacolon and megaesophagus and suggested that the former is a result of achalasia (absence of relaxation) of the anal sphincter secondary to disease of Auerbach's (myenteric) plexus (Hurst, 1936), a view which has been confirmed by all recent writers on the subject. I propose here to give a short account of “both dyschezia and megacolon. Dyschezia Normal defaecation depends on a conditioned reflex. An infant is trained to open his bowels when he is put on a chamber, no mental process being concerned in the act. In the course of time an elaborate conditioned reflex develops, in which getting up, a bath, dressing, breakfast, and finally sitting down with a newspaper and a pipe in the familiar w.c. take part. As a result of this, a strong mass peristaltic wave passes along the colon, and the feces which have collected in the pelvic colon enter the rectum, which has been empty since the last act of defaecation. The consequent distention of the rectum gives rise to the perineal sensation which constitutes the “call to defaecate.” The diaphragm and abdominal wall are then voluntarily contracted, and the rise in pressure within the rectum calls forth the final reflex, which results in contraction of the rectum and relaxation of the anal sphincter, through which the faeces are evacuated. Many cases of constipation formerly regarded as colonic are caused by inefficiency of the conditioned reflex, which should result in the partial evacuation of the contents of the proximal part of the colon into the pelvic colon as well as of the contents of the pelvic colon into the rectum." @default.
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• W2149849503 date "1944-02-01" @default.
• W2149849503 modified "2023-10-18" @default.
• W2149849503 title "Dyschezia and Megacolon" @default.
• W2149849503 doi "https://doi.org/10.1148/42.2.128" @default.
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