Functional Anorectal Disorders

Bharucha, Adil E.; Wald, Arnold; Enck, Paul; Rao, Satish S.C.

doi:10.1053/j.gastro.2005.11.064

Cited by 554 publications

(379 citation statements)

References 55 publications

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“…42 Defecography is particularly useful for identifying anatomical abnormalities, such as paradoxical contraction of the puborectalis muscle, a rectocele, rectoanal intussusception, and complete external rectal prolapse that may be amenable to surgical intervention. 23,[52][53][54][55][56] Barium defecography is commonly used, although the test or technique is incompletely standardized and it has limited reproducibility in terms of anorectal angle measurements. 54 Internal consistency of defecographic parameters has been reported to be good (α = 0.78), but agreements between each defecographic parameter and each test of ARM and electromyography have all been shown to be poor.…”

Section: Statement: Anorectal Manometry Is Useful For Diagnosing Defementioning

confidence: 99%

“…The criteria for primary functional constipation was developed by an international group of experts. 23 With respect to pathophysiology, primary functional constipation may be classified into defecatory disorders, slow transit constipation (STC), and normal transit constipation (NTC), a classification that facilitates its management. 19,22 Defecatory disorders are characterized by impaired rectal evacuation because of inadequate rectal propulsion and/or increased resistance to evacuation.…”

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confidence: 99%

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Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition

Shin

Jung

Lee

et al. 2016

J Neurogastroenterol Motil

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The Korean Society of Neurogastroenterology and Motility first published guidelines for chronic constipation in 2005 and was updated in 2011. Although the guidelines were updated using evidence-based process, they lacked multidisciplinary participation and did not include a diagnostic approach for chronic constipation. This article includes guidelines for diagnosis and treatment of chronic constipation to realistically fit the situation in Korea and to be applicable to clinical practice. The guideline development was based upon the adaptation method because research evidence was limited in Korea, and an organized multidisciplinary group carried out systematical literature review and series of evidence-based evaluations. Six guidelines were selected using the Appraisal of Guidelines for Research & Evaluation (AGREE) II process. A total 37 recommendations were adopted, including 4 concerning the definition and risk factors of chronic constipation, 8 regarding diagnoses, and 25 regarding treatments. The guidelines are intended to help primary physicians and general health professionals in clinical practice in Korea, to provide the principles of medical treatment to medical students, residents, and other healthcare professionals, and to help patients for choosing medical services based on the information. These guidelines will be updated and revised periodically to reflect new diagnostic and therapeutic methods.

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Section: Statement: Anorectal Manometry Is Useful For Diagnosing Defementioning

confidence: 99%

mentioning

confidence: 99%

Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition

Shin

Jung

Lee

et al. 2016

J Neurogastroenterol Motil

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“…two or more of six symptoms present for at least 12 weeks of the preceding 12 months: straining, lumpy or hard stools, sensation of incomplete evacuation, sensation of anorectal obstruction/blockage, or manual maneuvers to facilitate defecation on more than one fourth of bowel movements, or less than three evacuations per week; and b) paradoxical contraction or failure to relax pelvic floor muscles during attempts to defecate, as shown by anorectal manometry and defecography. It is worth noting that according to these criteria patients also met the recently published Rome III criteria for functional defecation disorder (17). Secondary causes of constipation were excluded by clinical and drug history taking, physical examination, blood chemistry, and colonoscopy or barium enema.…”

Section: Patientsmentioning

confidence: 99%

Prevalence of sexual and physical abuse in patients with obstructed defecation: impact on biofeedback treatment

Solé¹,

Bolino²,

Lueso³

et al. 2009

Rev. esp. enferm. dig.

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Background: obstructed defecation is one of the most common subtypes of constipation, and it is frequently responsive to biofeedback treatment.Aims: since a history of sexual and physical abuse may be present in patients with obstructed defecation, we assessed the incidence of abuse history in patients with obstructed defecation referred to a general gastroenterology practice, and whether such a history may lead to a different outcome of biofeedback training in these patients.Patients and methods: one hundred and twenty-one patients (17 men, 104 women, age 53 ± 15 years) with obstructed defecation were studied by retrospective chart review. Their history of sexual, physical and psychological abuse was obtained by a standard interview, and biofeedback training was carried out by means of a three-balloon technique.Results: a history of sexual/physical or psychological abuse was present in 12.4% patients. Biofeedback training yielded a successful improvement of obstructed defecation in 93% patients without abuse and in 100% of patients with abuse; this difference was not statistically different (p = 0.53).Conclusions: the prevalence of sexual/physical or psychological abuse in a population of patients with obstructed defecation referred to a general gastroenterology practice is relatively low; such a history seems not to affect the outcome of biofeedback training in these patients.Key words: Abuse. Biofeedback. Constipation. Obstructed defecation. INTRODUCTIONChronic constipation is a frequent complaint in clinical practice, and affects 3 to 30% of the general population in Western countries, particularly women (1). However, recent studies have shown that similar figures are also present in other countries, such as Latin America (2).The pathophysiological basis of chronic idiopathic constipation may basically be reconducted to two main subtypes, slow-transit constipation (STC) and constipation due to obstructed defecation (OD) (3). The latter, after excluding anatomical or mechanical causes, may be often due to paradoxical contraction or failure to relax of the pelvic floor muscles during attempts to defecate, which impedes the outflow of feces (4,5).The prevalence of OD in different series varies between 25 and 70% (6,7). This probably reflects different population samples, with a prevalence of 7% in the general population (8). In many of these patients biofeedback treatment is very effective (9,10).Even though behavioral or psychological disturbances are frequently encountered in OD, it is still controversial whether these abnormalities are the cause or the consequence of this often disabling symptom (11).Physical and/or psychical abuse are described with relative frequency in some functional gastrointestinal disorders, particularly in patients with irritable bowel syndrome (IBS) (12,13); less data are available for constipated, non-IBS patients. Two recent studies reported that more than 32% of patients with OD had a history of physical and/or psychical abuse (14,15). However, no data on the treatment of such pa...

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“…3 Furthermore, the prevalence of constipation was 26% in women and 16% in men 65 years of age or older in a study on self-reported constipation. 4 Age-related changes in the lower gastrointestinal tract include delayed colon transit time and reduction of the moisture content of stools. 5 These changes can result from intestinal atrophy, reduced blood supply, and alterations in the enteric nervous system.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Changes in the Interstitial Cells of Cajal and Neuronal Nitric Oxide Synthase-positive Neuronal Cells With Aging Between the Ascending and Descending Colon of F344 Rats

Lee

Kim

et al. 2017

J Neurogastroenterol Motil

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Background/AimsNeuronal degeneration and changes in interstitial cells of Cajal (ICCs) are important mechanisms of age-related constipation. This study aims to compare the distribution of ICCs and neuronal nitric oxide synthase (nNOS) with regard to age-related changes between the ascending colon (AC) and descending colon (DC) in 6-, 31-, and 74-week old and 2-year old male Fischer-344 rats. MethodsThe amount of fecal pellet and the bead expulsion times were measured. Fat proportion in the muscle layer of the colon was analyzed by hematoxylin and eosin staining. Proto-oncogene receptor tyrosine kinase (KIT) and neuronal nitric oxide synthase (nNOS) expression were analyzed with Western blotting and immunohistochemistry. Isovolumetric contractile measurements and electrical field stimulation were used to assess smooth muscle contractility. ResultsColon transit and bead expulsion slowed with senescence. Fat in the muscle layer accumulated with age in the AC, but not in the DC. The proportion of KIT-immunoreactive ICCs in the submucosal and myenteric plexus was higher in the DC than in the AC, and it declined with age, especially in the AC. In contrast, the proportion of NOS-immunoreactive neurons in the myenteric plexus was higher in the AC than in the DC, and both decreased in older rats. Nitric oxide levels declined with age in the DC. Muscle strip experiments showed that the inhibitory response mediated by nitric oxide in the circular direction of the DC was reduced in 2-year old rats. ConclusionThe AC and DC differ in their distribution of ICCs and nNOS, and age-related loss of nitrergic neurons more severely affects the DC than the AC.

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Functional Anorectal Disorders

Cited by 554 publications

References 55 publications

Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition

Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition

Prevalence of sexual and physical abuse in patients with obstructed defecation: impact on biofeedback treatment

Comparison of Changes in the Interstitial Cells of Cajal and Neuronal Nitric Oxide Synthase-positive Neuronal Cells With Aging Between the Ascending and Descending Colon of F344 Rats

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