Severe circumferential rectal ulcer associated with electric bidet toilet use

A 66-year-old man presented to the gastroenterology department with anal pain. For >10 years, he had used an electric bidet toilet while defecating for >5 min at a time, because of constipation. Two weeks prior to his visit, he became aware of discomfort in his anal area and had used an enema 1 week previously. He had persistent diarrhea and began to use the electric bidet toilet at the highest water pressure for long periods. As a result, his anal pain worsened. A colonoscopy revealed circumferential inflammation and ulceration extending from the anal canal to the lower rectum. Approximately half of the Japanese population washes their anuses before and after defecation. Cleaning the anus after defecation using a bidet contributes to hand hygiene and local comfort, and may be effective against constipation. However, excessive bidet use may cause rectal disorders, such as rectal mucosal prolapse syndrome and solitary rectal ulcers. Herein, we report a rare case of a patient with advanced rectal ulceration caused by electric bidet toilet usage.

Colonoscopic finding in children with lower gastrointestinal complaints

Background and Aim

Colonoscopy is an important tool for the diagnosis and treatment of lower gastrointestinal (LGI) diseases in both children and adults. This study describes an endoscopic profile of children at the Shinnwari Gastroenterology Diagnostic Clinic in Jalalabad, Afghanistan.

Methods

This is a cross-sectional descriptive study conducted in children ≤16 years, taken from recorded colonoscopy reports from 1 January 2021 to 30 December 2022.

Results

Of the 672 colonoscopy procedures, 250 were diagnostic in children (7.41 years median age; 2.5:1 male/female ratio) without serious complications. Abnormal findings were recorded in 201 (81.2%) procedures; the most common presentation was hematochezia, which was higher in 5-8-year-olds. More frequent findings were colorectal polyps (50%), infection (16.4%), internal hemorrhoid (IH; 10%), and inflammatory bowel disease (IBD; 1.2%). Incidences of colorectal polyps were higher in those aged <9 years (37.2% vs 12.8%; P < 0.001). Conversely, internal IH and IBD tended to be higher in older children (aged ≥9 years) (IH: 6.8% vs 3.2%; P < 0.005; IBD: 1.2% vs 0%; P < 0.02). Colonoscopy procedures were completed without major complications.

Conclusion

Colonoscopy is an important and safe procedure for the diagnosis of LGI compliants, especially hematochezia, which is frequently accompanied by colorectal polyps.