Is constipation a disorder of defecation or impaired motility?: distinction based on defecography and colonic transit studies.

Karasick, Stephen; Ehrlich, Saundra M.

doi:10.2214/ajr.166.1.8571906

Cited by 40 publications

(19 citation statements)

References 9 publications

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“…As in prior studies, 58% of constipated patients exhibited normal transit (21,25). Motor activity increased from the early phase of colon transit to the time before capsule expulsion in healthy individuals and constipated subjects with normal transit and moderate STC with inconsistent increases in severe STC.…”

Section: Discussionsupporting

confidence: 76%

Heightened colon motor activity measured by a wireless capsule in patients with constipation: relation to colon transit and IBS

Hasler

Saad

Rao

et al. 2009

American Journal of Physiology-Gastrointestinal and Liver Physi

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Relationships of regional colonic motility to transit in health, constipation, and constipation-predominant irritable bowel syndrome (C-IBS) are poorly characterized. This study aimed to 1) characterize regional differences in colon pressure, 2) relate motor differences in constipation to colon transit, and 3) quantify the role of IBS in altered contractility with constipation. Colon pH and pressure were measured by wireless capsules in 53 healthy and 36 constipated subjects. Numbers of contractions >25 mmHg and areas under curves (AUC) were calculated for colon transit quartiles by time. Constipation was classified as normal transit (<59 h), moderate slow transit (STC) (59-100 h), and severe STC (>100 h). Twelve out of 36 constipated subjects had C-IBS; 24 had functional constipation. Numbers of contractions and AUCs increased from the first to the fourth quartile in health (P < 0.0001). Mean numbers of contractions in constipated subjects were similar to controls. Mean AUCs with normal transit (P = 0.01) and moderate STC (P = 0.004) but not severe STC (P = NS) were higher than healthy subjects. IBS was associated with greater mean numbers of contractions (P = 0.05) and AUCs (P = 0.0006) vs. controls independent of transit. Numbers of contractions increased from the first to fourth quartiles in moderate STC, C-IBS, and functional constipation; AUCs increased from the first to fourth quartiles in all groups (all P < 0.05). In conclusion, colon pressure activity is greater distally than proximally in health. Constipated patients with normal or moderately delayed transit show increased motor activity that is partly explained by IBS. These findings emphasize differential effects on transit and motility in different constipation subtypes.

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Section: Discussionsupporting

confidence: 76%

Heightened colon motor activity measured by a wireless capsule in patients with constipation: relation to colon transit and IBS

Hasler

Saad

Rao

et al. 2009

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…Retention of 10 or more markers in the right colon, left colon or rectosigmoid were de®ned as colonic inertia, hindgut dysfunction and outlet obstruction respectively. 8,20,22 The ®nding of 10 or more markers gathered in more than one sector was considered a mixed pattern. Xrays taken every 5 days categorized the abnormal CTTs as follows: moderate, when more than 10 markers were seen until the tenth day; severe, when more than 10 markers were seen until the ®fteenth day; and very severe when 10 or more markers were noted at 20 or more days.…”

Section: Methodsmentioning

confidence: 99%

Clinical evaluation and management of neurogenic bowel after spinal cord injury

Correa

Rotter

2000

Spinal Cord

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Objectives: To assess the state of the neurological bowel in spinal cord injured (SCI) patients, design and apply a program for the comprehensive management of neurogenic bowel and evaluate outcome. Setting: Out-patient in a Rehabilitation Service. Subjects: Thirty-eight SCI patients, 12 (32%) with complete lesions of more than 5 years duration. Design: Observational, longitudinal and prospective. Pre and post intervention. Method: Pre and post SCI intestinal function was evaluated clinically prior to beginning program. The presence of GI symptoms were studied. Laboratory work-up included colonic transit time (CTT), anorectal manometry and recto-colonoscopy. An intestinal program was designed, in order to achieve an eective and ecient evacuation in a predictable and socially acceptable time, to avoid short and long term complications and eliminate inadequate intestinal evacuation habits. Outcome measures: Pre and post SCI diculty in intestinal evacuation (DIE) was increased (from 2.6% to 26.3%). The most frequent GI symptom was abdominal distention (53%). Colonic inertia was present in 49% of CTT, internal anal sphincter pressure was normal or increased in 77% and rectoanal inhibitory re¯ex was present in 88%. With the intestinal program, the incidence of DIE was reduced to 8.8%, manual extraction (ME) was reduced from 53% to 37%. Excellent and good results were obtained in 56% of the patients. Conclusion: The proposed intestinal program is eective in the rehabilitation of SCI patients with neurogenic bowel. It is essential to initiate these physiological and safe procedures as soon as possible after sustaining the injury; this will lead to better results and to the elimination of inadequate intestinal maneuvering in the future. Spinal Cord (2000) 38, 301 ± 308

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“…Accordingly, both removal and alteration of constipation based on 10 different symptoms can be detected in these patients. The broad definition of constipation made possible by this score also seemed more adequate than more restricted interpretations based on disturbed colonic motor activity or outlet obstruction [12, 13, 19, 20]. Thus, both the symptoms most prevalent (feeling incomplete evacuation, bloating, minutes in lavatory per attempt, and abdominal pain) and the symptoms with the strongest improvement (enemas/digitation, unsuccessful evacuatory attempts, and painful evacuation effort) can be identified (Table 3).…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcome after Resection Rectopexy for Internal Rectal Intussusception

Johnson

Kjellevold

Johannessen

et al. 2012

ISRN Gastroenterology

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Background and Aims. The optimal treatment of patients with internal rectal intussusception (IRI) is unresolved. The aim was to study the short- and long-term outcome of resection rectopexy in these patients. Methods. An observational and mainly prospective study of 48 patients (44 women) with IRI who had ligament-preserving suture rectopexy by laparoscopic (n = 25) or open (n = 23) technique. Outcome measures were morbidity, scores for constipation and anal incontinence, patients' report, and health-related quality of life (HRQoL). Results. From preoperatively to a median of 6 months and 76 months postoperatively, constipation scores were reduced from a mean of (95% CI) 13.20 (11.41 to 15.00) to 6.91 (5.29 to 8.54) and 6.35 (4.94 to 7.76) (P < 0.0001). The number of constipated patients was reduced from 35 to eleven and eight, respectively, and none became constipated. Nine of ten symptoms of constipation improved. Corresponding scores for anal incontinence were 4.7 (2.4–7.0), 4.0 (2.4–5.7), and 4.1 (2.3–5.8), respectively. HRQoL at long-term followup compared to the general Norwegian population was reduced in four out of eight dimensions concerning physical factors. The patient-reported outcome at short- and long-term followup was improved by 85.4% and 75.0%, respectively. Conclusions. Resection rectopexy for IRI improved the outcome. HRQoL was reduced compared with the general population.

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Is constipation a disorder of defecation or impaired motility?: distinction based on defecography and colonic transit studies.

Cited by 40 publications

References 9 publications

Heightened colon motor activity measured by a wireless capsule in patients with constipation: relation to colon transit and IBS

Heightened colon motor activity measured by a wireless capsule in patients with constipation: relation to colon transit and IBS

Clinical evaluation and management of neurogenic bowel after spinal cord injury

Long-Term Outcome after Resection Rectopexy for Internal Rectal Intussusception

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