Parameters of anorectal and colonic motility in health and in severe constipation (original) (raw)

Abstract

Anorectal function and colonic transit was assessed in 17 severely constipated patients and 15 age-matched controls. The constipated patients were divided into those who had “immobile perineum” (perineal descent ≤1.0 cm during attempted defecation) and those who had a normal descent (>1.0 cm) of the perineum. When constipation was accompanied by an immobile perineum, patients had impaired balloon expulsion, impaired and delayed artificial stool expulsion, decreased straightening of the anorectal angle, decreased descent of the pelvic floor with defecation, and prolonged rectosigmoid colon transit compared with the patients with constipation who had a mobile perineum and with normal controls. The mobile-perineum group differed from controls only in colon transit times, having prolonged total colon transit. Anal sphincter resting pressures, immediate artificial stool expulsion, resting anorectal angles, and electromyography of the external anal sphincter and puborectalis did not differentiate the constipated patients from the controls. We concluded that descent of the perineum of <1 cm was associated with impaired expulsion, an adynamic anorectal angle, and slowed distal colon transit. This simple sign of pelvic floor function distinguished constipated patients with disordered expulsion from constipated patients with normal pelvic floor function. These patients may respond poorly to surgery and conventional management and would therefore be candidates instead for pelvic floor retraining. Accurate characterization and appreciation of pelvic floor dysfunction in patients with severe chronic constipation may improve the selection for and results of surgical and nonsurgical intervention.

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Author notes

  1. Michael E. Pezim M.D.
    Present address: , 750 West Broadway, Suite 510, V52 1H4, Vancouver, British Columbia, Canada
  2. Kenneth E. Levin M.D.
    Present address: Dean Medical Center, 1313, Fish Hatchery Road, 53715, Madison, Wisconsin

Authors and Affiliations

  1. The Section of Colon and Rectal Surgery, Gastroenterology Research Unit, USA
    Michael E. Pezim M.D., John H. Pemberton M.D., Kenneth E. Levin M.D., William J. Litchy M.D. & Sidney F. Phillips M.D.
  2. Department of Neurology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
    Michael E. Pezim M.D., John H. Pemberton M.D., Kenneth E. Levin M.D., William J. Litchy M.D. & Sidney F. Phillips M.D.

Authors

  1. Michael E. Pezim M.D.
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  2. John H. Pemberton M.D.
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  3. Kenneth E. Levin M.D.
    You can also search for this author inPubMed Google Scholar
  4. William J. Litchy M.D.
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  5. Sidney F. Phillips M.D.
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Additional information

Supported in part by Research Grants DK37990, RR585, and DK34988 from the National Institutes of Health and by the Mayo Foundation, Rochester, Minnesota.

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Pezim, M.E., Pemberton, J.H., Levin, K.E. et al. Parameters of anorectal and colonic motility in health and in severe constipation.Dis Colon Rectum 36, 484–491 (1993). https://doi.org/10.1007/BF02050015

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