Motor activity of the sigmoid colon in chronic constipation: comparative study with normal subjects.

Abstract

SUMMARY Manometric studies of the sigmoid colon were performed on 17 healthy volunteers and on 49 constipated patients, after a long period of fasting (18-20 hours). Motility was recorded using perfused catheters at basal level during 45 minutes, then 30 minutes after a 0 5 mg intravenous injection of neostigmine, and, finally, 30 minutes during and after a meal. Motor activity was assessed by a motility index (per cent of activity x mean amplitude of waves). In both normal and constipated patients, the basal motility index was very low (respectively 82 +16 and 110 + 113). This low level of activity was due to the long fasting period imposed on all the subjects. After neostigmine the motility index increased in both controls (347±256) and constipated patients (311±323); this test, however was found to be unreliable. The meal increased the motility index to significantly higher values than after neostigmine in controls (538±215). In constipated patients the mean meal motility index was comparable with that of controls (577 ±549) with a large distribution of individual values. Using the mean meal motility index ±2 SD of the control group as a term of comparison, the patients were segregated into three groups: 'hypomotor' patients (eight cases), 'normomotor' patients (33 cases), and 'hypermotor' patients (eight cases). From the evidence of this series of clinically well-defined constipated patients, it was concluded that only the meal test is able to segregate three significant patterns of sigmoid activity and that a large number (68%) of constipated patients exhibit normal sigmoid motor activity.Abnormal motor activity of the sigmoid colon has been described in various disorders, including the irritable colon syndrome, diverticulosis of the colon, diarrhoeal states, and constipation (Connel, 1962;Wangel and Deller, 1965;Kirwan and Smith, 1977). It has been shown that, in constipation, the colonic motor disorder consists mainly in over-segmentation: regardless of the underlying disorder, an over-active sigmoid colon inhibits the transit of stools (Chowdury et al., 1976). However, in previous studies of colonic motility (Meunier et al., 1978), it was observed that such over-segmentation was not always present in chronic constipation. The present study is an attempt further to investigate sigmoid motor abnormalities in chronic constipation. On the other "Address for correspondence and reprints requests: Dr P. Meunier,

Sigmoidal and Rectal Motility in Healthy Elderly

“…Eating a 900‐kcal meal significantly increased motility 20 cm, 15 cm, and 10 cm above the anal verge, but motility returned to fasting levels immediately after the consumption of the meal. This has been also observed in a previous study by us of 12 healthy young adults, 9 and by others 11–13 . On the other hand, measuring 20 cm above the anal verge, Kerlin et al did not find an increase in the motility index after several different test meals containing approximately 600 kcal in six healthy men 14 …”

Mild dehydration: a risk factor of constipation?

“…In a study performed on 49 constipated adult patients (15-72 y) and compared with 17 healthy volunteers (19-33 y), it was shown that the meal increased the motility when compared to fasting subjects (Meunier et al, 1979b). In constipated patients, the mean meal motility index (5777549) was comparable with that of controls (5387215) with a large distribution of individual values.…”

“…The patients were segregated into three groups: hypomotor, normomotor and hypermotor patients. Only the meal test is able to identify three significant patterns of sigmoid activity and a large number (68%) of constipated patients were hypermotor (Meunier et al, 1979b). Adequate intake of fibres, carbohydrates and fluid are known to prevent constipation.…”

Prolonged (24-Hour) Manometric Recording of Rectal Contractile Activity in Patients with Slow Transit Constipation

“…Despite widespread interest in the patho physiological mechanisms of chronic consti pation [15, [29][30][31][32][33][34], there is still scarce infor mation on the subject. Most studies have focused on anorectal parameters and only recorded tracings for brief periods.…”