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PubMedDate not supplied

Electrorectography in chronic constipation.

The rectal electrical activity recorded by electrorectogram (ERG) was studied in 22 chronically constipated subjects and 16 healthy volunteers. The latter had a mean (+/- SD) age of 42.6 +/- 8.5 years; 10 were men and 6 women. Of the 22 constipated patients, 14 had inertia-type constipation (IC; age 44.6 +/- 10.2 years) and 8 the obstructive type (OC; age 38.4 +/- 12.2 years). The rectal electrical activity was recorded by a silver-silver chloride electrode situated 1 cm from the tip of a 6 F catheter, which was applied to the rectal mucosa by suction. At least four recording sessions of 120 minutes each were performed for each individual. In normal volunteers, regular and reproducible pacesetter potentials (PPs) were recorded with a mean frequency of 2.8 +/- 0.7 cycles/min (cpm), amplitude 2.1 +/- 0.8 mV, and velocity 4.6 +/- 0.8 cm/sec. They were followed randomly by action potentials (APs). In IC patients the PPs were so infrequent that in most cases half an hour would have elapsed without recording a PP; the mean frequency was 2.4 +/- 0.2 cycle/60 min, amplitude 0.92 +/- 0.02 mV, and velocity 4.1 +/- 0.6 cm/sec. APs were not recorded in 10 patients during the recording time; in two patients they were occasional. In OC subjects regular and reproducible PPs were recorded with a higher frequency (p < 0.01) and velocity (p < 0.05) than normal. Two ERG patterns were identified in those with chronic constipation: bradyrectia and tachyrectia. The former was recorded in the IC subjects and the latter in OC subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Oral [111In]DTPA scintigraphic assessment of colonic transit in constipated subjects.

Patterns of colonic transit were assessed by a simple radioisotopic technique using 3.7 MBq of orally administered [111In]DTPA in 16 control subjects and 37 patients with intractable constipation. Normal subjects showed rapid diffuse spread of isotope through the colon resulting in low activity in all regions of interest (ROI). Activity was lost to feces at 24 hr and was virtually complete by 72 hr (median 94%, range 71-100%). Five constipated patients showed normal transit. Those with colonic inertia (N = 26) showed a significantly slowed geometric center of isotope compared to controls (P < 0.001), falling below the normal range at 48 hr. Percentage activity curves showed the major site of isotope hold-up to be in the transverse colon and splenic flexure. Other constipated patients (N = 6) showed late delay of the geometric center of isotope and accumulation of activity in the descending and rectosigmoid colon, compared to controls, at 96 hr. Oral [111In]DTPA colonic scintigraphy is a useful clinical test in the investigation of constipation.

Administration, Oral↗
PubMed1993

Impaired colonic motor response to cholinergic stimulation in patients with severe chronic idiopathic (slow transit type) constipation.

Chronic idiopathic constipation, especially the slow transit type, is a troubling problem often afflicting young women. The pathophysiological basis for this entity is unknown, although a defective cholinergic innervation has been postulated. We tested the hypothesis that cholinergic colonic innervation is deranged in this condition by studying colonic motor activity after strong cholinergic stimulation with edrophonium chloride in 14 women complaining of slow transit constipation. Unlike healthy subjects, constipated patients showed minimal or no response to edrophonium injection. It is concluded that in slow transit constipation there is an important alteration of colonic cholinergic activity and that edrophonium chloride may represent a useful test drug for colonic pathophysiological investigations.

Adult↗
PubMed1991

Persistence of chronic constipation in children after biofeedback treatment.

We investigated the efficacy of biofeedback treatment and evaluated anorectal factors that might be responsible for persistence of chronic constipation with or without encopresis in a group of 38 children with abnormal contraction of the pelvic floor during straining and persistence of chronic constipation with encopresis after conventional treatment. Nine children were unsuccessful in learning to relax the pelvic floor during straining with biofeedback treatment, and one patient had contraction of the pelvic floor on follow-up despite successful biofeedback treatment; none recovered. Twenty-eight children were able to relax the pelvic floor on follow-up; 14 recovered and 14 did not recover from chronic constipation. Nonrecovered patients who learned to relax the pelvic floor had significantly decreased rectal and anal responsiveness to rectal distension as compared to recovered patients during the initial and follow-up anorectal manometric study. Psychological factors such as social competence and behavior problems did not appear to be responsible for recovery or nonrecovery from chronic constipation and encopresis.

Adolescent↗
PubMed1985

Anismus in chronic constipation.

Among patients complaining of constipation, a group can be defined in which there is slow whole gut transit shown by retention of radiopaque markers but a rectum and colon of normal width judged by measurements of barium enema radiographs compared with control observations. It is not known whether their symptoms are due to an abnormality of colonic motility or to a failure of the defecatory mechanism. Defecation was simulated experimentally in a group of these patients by asking them to expel a water-filled rectal balloon. The constipated patients were not able to expel the balloon, whereas normal subjects could do so. Electromyography of the striated pelvic floor muscles during attempts at expulsion of the balloon in the constipated patients showed failure of the normal inhibition of resting activity. Failure of external and sphincter relaxation on attempted defecation may contribute to the symptoms of some patients who complain of constipation.

Adolescent↗
PubMed1989

Physician visits in the United States for constipation: 1958 to 1986.

Since 1958, the National Disease and Therapeutic Index (NDTI) has provided annual statistics summarizing the frequency physicians throughout the United States are visited for different disease conditions. In our present study, these data were used to examine the epidemiology of constipation. Since NDTI statistics are available for a longer time period than other U.S. statistics, they might confirm or disprove the relevance of recent environmental changes on the occurrence of this disorder. The average number of physician visits for constipation in the United States was 2.5 million per year, corresponding to a prevalence of 1.2%. The largest number of these patients (31%) was seen by general and family practitioners, followed in declining order by internists (20%) and pediatricians (15%). Only 4% of all these patients was seen by gastroenterologists. Eight-five percent of these patients received a prescription for medication, with laxatives and cathartics being the most frequently prescribed drugs. Among physician visits for constipation, female prevalence was 1.6% compared with 0.8% for males (P less than 0.001). In both sexes, there was a significant age-related increase in the rate of physician visits, with the steepest rise from 1.3% to 4.1% occurring between the age groups 60-64 and over 65. From 1958 to 1986, the rate of all physician visits for constipation remained unchanged. However, during this time period, there was a twofold rise in physician visits for those patients ages 0-9 years, while a smooth decline occurred in all of the older age groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Constipation↗
PubMed1990

Contributions of evacuation proctography and anorectal manometry to evaluation of adults with constipation and defecatory difficulty.

We prospectively evaluated 36 patients who complained of chronic constipation and/or defecatory difficulties to determine the role of anorectal manometry and evacuation proctography in delineating the pathogenesis of these complaints. Twenty patients with constipation also underwent a colonic transit study with radioopaque markers, which identified one group with normal transit (N = 10) and another with slow transit (N = 10). Nine of 36 patients (25%) had inappropriate puborectalis muscle contraction or exhibited weak expulsion efforts during evacuation proctography, and these correlated highly with poor rectal emptying of barium paste (20 +/- 6% vs 61 +/- 5% in patients with normal relaxation; P less than 0.01). However, poor rectal emptying did not correlate with the presence of high-grade intussusceptions, large rectoceles, anorectal angles at rest or with straining, rectal diameter, clinical features, or colonic transit. Moreover, abnormal expulsion patterns as seen with anorectal manometry correlated poorly with the presence of inappropriate puborectalis contraction and decreased rectal emptying by proctography. Although anatomic abnormalities occurred frequently in patients with constipation and/or defecatory difficulties, they were also prevalent in asymptomatic controls. In view of these findings, surgical intervention to correct anatomic abnormalities in patients with constipation and/or defecatory difficulties should be considered only with great caution.

Administration, Oral↗
PubMed1989

Rectal sensitivity in chronic constipation.

Rectal sensitivity is often reduced in patients affected by chronic constipation, but it is not known whether this alteration differs according to the severity and the site(s) of the slowing of gastrointestinal transit. Moreover, it is not known whether alteration precedes or follows bowel complaints. In this study, perception of intrarectal distension was evaluated in 28 healthy controls, in 20 patients complaining of constipation and with a normal gastrointestinal transit time (less than 96 hr), and in 44 patients complaining of constipation and with a prolonged gastrointestinal transit time (greater than 96 hr). Within the latter group, perception to intrarectal distension was analyzed in patients with slowing of transit in the rectum only, in the colon only, and in both the rectum and the colon. In a subgroup of 22 patients, rectal sensitivity was evaluated before and after treatment. Rectal sensitivity was found to be reduced significantly in constipated patients; it was more severely reduced in patients with objective evidence of prolonged gastrointestinal transit time and with slow transit in the rectum. Rectal sensitivity improved in patients who responded to treatment and did not vary significantly in nonresponders.

Adolescent↗
PubMed1988

Function of the striated anal sphincter during straining in control subjects and constipated patients with a radiologically normal rectum or idiopathic megacolon.

The function of the striated anal sphincter during defaecation straining was recorded by manometry and electromyography (E.M.G.) in 31 constipated patients who were unable to expel a water-filled rectal balloon with effort. This group was divided on the basis of measurement of colonic diameter into those with megacolon and those with a normal sized colon. The latter group was further divided into those with normal transit and those with slow transit. The results were compared with those recorded from 15 control subjects with normal bowel function. With straining, anal pressure fell in 12 of 15 controls while in 3 it increased. In 30 of 31 constipated patients, anal pressure rose paradoxically with straining. Electromyographic recording in controls during straining demonstrated decreased activity in 5, in 4 no change and in 5 an increase in activity. In 28 of 31 constipated patients E.M.G. activity increased with straining. These results suggest that external sphincter contraction during straining occurs in some normal subjects but more frequently among patients with constipation of different types.

Adolescent↗
PubMed1993

Defecographic findings in patients with anal incontinence and constipation and their relation to rectal emptying.

PURPOSE: The aim of this study was to examine defecographic findings in patients with anal incontinence and constipation and to compare these findings with rectal emptying. METHODS: One hundred seventy-five preoperative defecographies documented on videotape in patients with either anal incontinence or constipation were retrospectively reviewed. The examinations were evaluated with respect to anatomic abnormalities of the rectum or anal canal. The results were compared with a semi-quantitative assessment of rectal emptying as it appeared on the video sequence after one minute of strain. RESULTS: Anatomic abnormalities were found equally in incontinent and constipated patients, except for failure to open the anal canal, which was found only in constipated patients. Rectal intussusception was the most frequent finding. Abnormal defecograms were found in both sexes. Enteroceles, sigmoidoceles, and large rectoceles were found only in women. The presence of intussusception, lacking relaxation of the puborectalis muscle, and rectocele did not correlate with poor rectal emptying. Poor rectal emptying was also found in 19 of 58 patients with normal defecograms. CONCLUSIONS: Anatomic abnormalities of the rectum may be demonstrated independently of the clinical symptoms and are not always correlated to impaired rectal emptying. Since they may also be found in healthy controls, surgical correction of these abnormalities should be considered only with great caution.

Adult↗
PubMed1996

Results of colectomy for severe slow transit constipation.

PURPOSE: This study assesses the outcome of a standardized operation performed by two surgeons for severe idiopathic slow transit constipation that was resistant to laxative treatment. METHODS: Fifty-nine consecutive patients, 4 men and 55 women, with a mean age of 42.3 years, underwent colectomy with ileorectal anastomosis. Slow colonic transit was demonstrated in each case. Fifty-two patients were available for follow-up, with median time to follow-up being 42 (range, 3-81) months. RESULTS: Median bowel frequency was 4 per 24 hours. Sixty-nine percent had four or less bowel movements daily. Ten percent used antidiarrheal medication regularly. One patient had a stoma for recurrent severe constipation. Mean continence score was 1.8 (on a scale of 0-20); six patients were incontinent, and four of these six had normal preoperative anal manometry. Fourteen patients (27 percent) had difficulty with rectal evacuation. Preoperative defecating proctography was a poor predictor of postoperative evacuation difficulties. Twenty-seven patients (52 percent) had persisting abdominal pain, but there was a significant improvement in the degree of pain (P <0.00001). Forty-seven patients (90 percent) were satisfied with the outcome of the operation (and would elect to have it done again). Dissatisfied patients had recurrent constipation or diarrhea and incontinence. CONCLUSION: Colectomy with ileorectal anastomosis produces a satisfactory functional outcome in the majority of patients undergoing surgery for severe constipation with proven slow colonic transit.

Adolescent↗
PubMed1993

Fecoflowmetry: a new parameter assessing rectal function in normal and constipated subjects.

Fecoflowmetry is a new technique by which the fecal flow rate is studied through recorded curves representing the changes that occur in the flow against time. Fecal flow rate is the product of rectal detrusor action against outlet resistance. The technique was performed on 36 normal volunteers and 88 chronically constipated patients. Simultaneous recording of the fecal flow rate and intra-abdominal and rectal neck pressures were performed. A water or paste enema was given to the individual. Upon feeling the desire to defecate, he or she was placed on a fecoflowmeter commode and was asked to defecate. Evaluation of the obtained defecation flow curve comprises the reporting on the defecated volume, flow time, mean and maximum flow rates, time to maximum flow, and shape of the curve. In the 88 constipated patients, two fecoflowmetric patterns were recognized: nonobstructive (inertia) and obstructive. They differ from each other in parameters and curve configuration. The defecated volume as well as mean and maximum flow rates were lower in outlet obstruction than in the inertia type, whereas flow time and time to maximum flow were longer. The ascending limb in the obstructive-type curve rose less steeply than in inertia; the curve had a long plateau, and the descending limb sloped more gradually. To conclude, fecoflowmetric studies could differentiate between defecation of normal and constipated subjects, and in the latter between the obstructive and inertia types of constipation. The technique was developed to simulate natural defecation. It provides quantitative and qualitative data concerning the defecation act. The technique is simple, easy, noninvasive, and nonradiologic. It can be used as a screening tool in defecation disorders.

Abdomen↗
PubMed1997

Electromyographic assessment of biofeedback training for fecal incontinence and chronic constipation.

INTRODUCTION: Biofeedback training is an effective modality for the treatment of chronic constipation and fecal incontinence. In general, patients express satisfaction and perceive functional improvement following biofeedback therapy; however, quantifying these observations has been difficult. AIM: This study was undertaken to evaluate the physiologic benefits of biofeedback therapy as reflected by noninvasive electromyography parameters. METHODS: Fifty-five patients who underwent computerized electromyography-based biofeedback treatment at our institution between July 1993 and July 1995 were identified. Noninvasive electromyographic testing was performed before, during (weekly), and at completion of training. Mean number of weekly sessions was seven (range, 5-11). Short-term and ten-second contractions (amplitude/microV), sustained contractions (endurance, in seconds), and net strength (microV) of the external anal sphincter before and after biofeedback were compared for differences. RESULTS: There were 30 patients with chronic constipation, mean age, 65.3 (range, 33-86) years, composed of 24 women, and 25 patients with fecal incontinence, mean age 66 (range, 34-85) years, composed of 12 males. Statistically significant improvement in endurance and net strength following biofeedback training was noted in both the constipated and the fecal incontinence groups. Fifty-three of 55 (96.4 percent) patients expressed 50 to 100 percent subjective satisfaction after biofeedback therapy. Forty-six of 55 (83.6 percent) patients demonstrated individually improved endurance. CONCLUSIONS: Sphincter endurance and net strength, as measured by noninvasive electromyography, significantly improve following biofeedback therapy in both constipated and fecal incontinence patients. These data suggest that endurance and net strength may be useful tools in assessing a benefit from biofeedback training in these patients.

Adult↗
PubMed1990

Application of the colorectal laboratory in diagnosis and treatment of functional constipation.

Defecography, pelvic floor electromyography, and segmental colonic transit times were performed in 74 patients with functional constipation. Signs of functional outlet obstruction occurred in 74 percent. Transit times were normal in 33 percent. Measurement of colonic transit time in patients with disordered evacuation studies is useless from a clinical point of view, because abnormal segmental transit time is the result of outlet obstruction in most cases and will return to normal after adequate treatment. Only when evacuation studies are normal, or have become normal after treatment and constipation persists, are segmental transit studies indicated because they may demonstrate primary slow transit constipation. Primary slow transit constipation probably is caused by impaired motility of the whole gastrointestinal tract. As small-bowel transit time increases, defecation frequency decreases, laxatives are taken again, and abdominal pain persists. Surgery should be performed with restraint.

Adult↗
PubMed1996

Surgery for constipation: a review.

PURPOSE: Constipation is related to intestinal motility disorders (colonic inertia (CI)), pelvic floor disturbances (pelvic outlet obstruction), or a combination of both problems. This review summarizes the physiologic and pathophysiologic changes in patients with intractable constipation and gives an overview of surgical treatment options. RESULTS: Although subtotal colectomy with ileorectal anastomosis is the best surgery for CI, there are still approximately 10 percent of patients who will complain of pain and constipation. A completion proctectomy and an ileoanal pouch procedure may be a viable option in a highly select group of patients. In patients with megabowel, reported results are mixed. Subtotal colectomy, partial colectomy for megacolon, and the Duhamel procedure for megarectum have all been reported with variable results. In patients with an isolated distended sigmoid colon, sigmoid colectomy has achieved good results. Anorectal myectomy has not been proven to be successful in the long term. However, in patients with adult short segment Hirschsprung's disease, myectomy can be successful. Patients with pelvic outlet obstruction can be successfully treated with biofeedback. In a small group of patients with a rectocele or a third degree sigmoidocele, surgical intervention yields a high success rate. Division or resection of the puborectalis muscle is not recommended. In patients with a mixed pattern of CI and pelvic outlet obstruction, surgical intervention alone is often not successful. These patients achieve better results by conservative treatment of pelvic outlet obstruction, followed by a colectomy. CONCLUSION: Surgical intervention for patients with intractable constipation is rarely necessary. However, thorough preoperative physiologic testing is mandatory for a successful outcome.

Adult↗
PubMed1997

Prospective study of biofeedback for treatment of constipation.

PURPOSE: This study was designed to evaluate prospectively the results of pelvic floor physiotherapy with the aid of biofeedback in a heterogeneous group of patients with intractable constipation. METHODS: Biofeedback was used to treat 19 patients (age range, 16-78 (median, 63) years) with intractable constipation. Assessment, using visual linear analog scales of symptoms, was performed prospectively by an independent researcher. Biofeedback was performed by a physiotherapist, and patients were required to attend six sessions on an outpatient basis. The cause of constipation was heterogeneous, with no specific disorder being implicated on testing with anal manometry, defecating proctography, and colonic transit time. RESULTS: At six weeks, there was a median 27 percent (range, -8-93 percent) improvement in symptom scores. At six months, there was a median 23 percent (range, -54-64 percent) improvement in symptom scores. These were statistically significant compared with the scores at outset, six weeks (P = 0.0006), and six months (P = 0.012). However, only two (12.5 percent) patients at the six-month follow-up had an improvement of greater than 50 percent in their symptoms. CONCLUSION: Biofeedback is not recommended in the management of constipation.

Adolescent↗
PubMed1995

Nitric oxide synthase and VIP distribution in enteric nervous system in idiopathic chronic constipation.

Idiopathic chronic constipation has been correlated to neural abnormalities that consist of a reduced number of myenteric plexus neurons and a decreased concentration of VIP-positive nerve fibers within the circular muscle. Recent studies hypothesized the involvement of nitric oxide in motility disorders of the human gut. To date, no information is available on nitric oxide involvement in idiopathic chronic constipation. The density of VIP- and nitric oxide-producing neurons was evaluated by immunocytochemistry using anti-VIP and anti-nitric oxide synthase antibodies in five patients with idiopathic chronic constipation. A low total neuron density was found at the myenteric plexus. The density of VIP-positive neurons was low while that of nitric oxide synthase-positive neurons was high at both plexuses. Our data confirm that idiopathic slow-transit chronic constipation is due to abnormal neurogenic factors. The presence of numerous nitric oxide synthase-positive neurons, all along the colon and at both plexuses, supports the hypothesis that an excessive production of nitric oxide may cause the persistent inhibition of contractions.

Adult↗
PubMed1990

Role of proctography in severe constipation.

As referred to in the literature, patients complaining of constipation may have a spastic or, in the case of chronic staining, weak pelvic floor. Twenty-two severely constipated patients who did not improve after a high fiber diet were submitted to whole gut transit time (TT), proctographic, and anorectal manometric studies. A control group consisting of five subjects for TT, five subjects for proctogram, and ten subjects for manometry was also studied. Transit time was delayed (P less than 0.001) in all patients. Manometry in the constipated group showed a high rectal threshold (64.1 vs. 17.1 ml of air, P less than 0.01), but no other significant difference. Proctograms in 10 of 22 patients (Group A) showed no differences in the anorectal angle (ARA) and in its distance from the pubococcygeal line (DLPC) in respect to the control group; 12 of 22 patients (Group B) had a paradoxical closure of the ARA at straining in respect to resting position (101.2 degrees vs. 120.1 degrees), and a higher DLPC than Group A and the control group in all positions studied. There was no difference in TT for rectal stasis of radiopaque markers between the two pathologic groups. Patients in Group B were older than patients in Group A (55.3 vs. 42.9 years, P less than 0.05). In conclusion, proctograms showed alterations of the pelvic floor, but there was no correlation between protographic data and rectal or colonic stasis of the radiopaque markers, or clinic severity of constipation, but a correlation between ages did exist.

Adolescent↗