Abstract
Manometric, radiological and neurophysiological investigations were performed on 34 women, aged between 14 and 53, who suffered with chronic constipation refractory to treatment, and on 27 agematched normal female control subjects. The constipated patients had more difficulty in evacuating simulated stools than control subjects and 13 out of 19 patients tested obstructed defaecation by contracting the external sphincter during straining. The constipated group required a greater degree of rectal distension than control subjects to induce rectal contractions, anal relaxation and a desire to defaecate. Other modalities of rectal sensation were normal in the constipated subjects. Compared with controls, constipated patients had significantly lower anal pressures, an abnormal degree of perineal descent on straining and an obtuse anorectal angulation at rest. These results were compatible with weakness of the pelvic floor and neuropathic damage to the external sphincter. Mouth to anus transit time was abnormally prolonged in 60% of constipated patients, but was within the normal range in the remainder. Anorectal function in patients with slow transit was not significantly different from that in patients with a normal transit time. The mouth to caecum transit time of a standard meal was prolonged in constipated patients irrespective of the duration of the whole gut transit. Gastric emptying was not significantly prolonged.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Martelli H, Devroede G, Arhan P, Duguay C (1978) Mechanisms of idiopathic constipation: outlet obstruction. Gastroenterology 75:623–631
Meunier P, Marechal JM, de Beaujeu MJ (1979) Rectoanal pressures and rectal sensitivity studies in chronic childhood constipation. Gastroenterology 77:330–336
Behar J, Biancani P (1984) Rectal function in patients with idiopathic chronic constipation. In: Roman C (ed) Gastrointestinal motility. MTP Press, Lancaster, pp 459–466
Lanfranchi GA, Bazzocchi G, Brignola C, Campieri M, Labo G (1984) Different patterns of intestinal transit time and anorectal motility in painful and painless chronic constipation. Gut 25:1352–1357
Ducrotte P, Denis P, Galmiche J-P, Hellot M-F, Desechalliers J-P, Colin R, Pasquis P, Hecketsweiler P (1985) Motricite anorectale dans la constipation idiopathique. Etude de 200 patients consecutifs. Gastroenterol Clin Biol 9:10–15
Read NW, Timms JM, Barfield LJ, Donnelly TC, Bannister JJ (1986) Impairment of defecation in young women with severe constipation. Gastroenterology 90:53–60
Read NW, Harford MV, Schmulen AC, Read MG, Santa Ana C, Fordtran JS (1979) A clinical study of patients with fecal incontinence and diarrhea. Gastroenterology 76:747–756
Schuster MM, Hookman P, Hendrix TR, Mendeloff AI (1965) Simultaneous manometric recording of internal and external anal sphincteric reflexes. Bull John Hopkins Hosp 116:79–88
Read M, Read NW, Barber DC, Duthie HL (1982) Effects of loperamide on anal sphincter function in patients complaining of chronic diarrhea with fecal incontinence and urgency. Dig Dis Sci 27:807–814
Basmajian JV, Stecko G (1962) A new bipolar electrode for electromyography. J Appl Physiol 17:849
Bartolo DCC, Read NW, Jarratt JA, Read MG, Donnelly TC, Johnson AG (1983) Differences in anal sphincter function and clinical presentation in patients with pelvic floor descent. Gastroenterology 85:68–75
Wald A, Van Thiel DH, Hoechstetter L, Gavaler JS, Egler KM, Verm R, Scott L, Lester R (1981) Gastrointestinal transit: the effect of the menstrual cycle. Gastroenterology 80:1497–1500
Read NW, Miles CA, Fisher D, Holgate AM, Kime ND, Mitchell MA, Reeves AM, Roche TB, Walker M (1980) Transit of a meal through the stomach, small intestine and colon in normal subjects and its role in the pathogenesis of diarrhea. Gastroenterology 79:1276–1282
Cann PA, Read NW, Brown C, Hobson N, Holdsworth CD (1983) Irritable bowel syndrome: relationship of disorders in the transit of a single solid meal to symptom patterns. Gut 24:405–411
Ostick DG, Green G, Howe K, Dymock IW, Cowley DJ (1976) Simple clinical method of measuring gastric emptying of solid meals. Gut 17:189–191
Read NW, Al-Janabi MN, Bates TE, Holgate AM, Cann PA, Kinsman RI, McFarlane A, Brown C (1985) Interpretation of the breath hydrogen profile obtained after ingesting a solid meal containing unabsorbable carbohydrate. Gut 26:834–842
Diem K, Lentner C (1970) Scientific tables, 7th edn. Geigy Pharmaceuticals, Macclesfield
Armitage P (1971) Statistical methods in medical research, 1st edn. Blackwell Scientific, Oxford
Ihre T (1974) Studies on anal function in continent and incontinent patients. Scand J Gastroenterology 9 [Suppl 25] 1–64
Parks AG, Swash M, Urich H (1977) Sphincter denervation in anorectal incontinence and rectal prolapse. Gut 18:656–665
Snooks SJ, Barnes PRH, Swash M, Henry MM (1985) Damage to the innervation of the pelvic floor musculature in chronic constipation. Gastroenterology 89:977–981
Snooks SJ, Swash M, Setchell M, Henry MM (1984) Injury to the innervation of pelvic floor sphincter musculature in childbirth. Lancet 2:546–550
Preston DM, Lennard-Jones JE (1985) Anismus in chronic constipation. Dig Dis Sci 30:413–418
Preston DM, Lennard-Jones JE (1985) Pelvic motility and response to intraluminal bisacodyl in slow transit constipation. Dig Dis Sci 30:289–294
Schang J-C, Devroede G, Duguay C, Hemond M, Hebert M (1985) Constipation par inertie colique et obstruction distale; etude electromyographique. Gastroenterol Clin Biol 9:480–485
Preston DM, Butler MG, Smith B, Lennard-Jones JE (1983) Neuropathology of slow transit constipation. Gut 24:A997
Krishnamurthy S, Schuffler MD, Rohrmann CA, Pope CE (1985) Severe, idiopathic constipation is associated with a distinct abnormality of the colonic myenteric plexus. Gastroenterology 88:26–34
Smith B (1968) Effect of irritant purgatives on the myenteric plexus in man and the mouse. Gut 9:139–143
Parks AG, Porter NH, Melzak J (1962) Experimental study of the reflex mechanism controlling the muscles of the pelvic floor. Dis Col Rect 5:407–414
Hinton JM, Lennard-Jones JE (1968) Constipation: definition and classification. Postgrad Med J 44:720–723
Manning AP, Wyman JB, Heaton KW (1976) How trustworthy are bowel histories? Comparison of recalled and recorded information. Br Med J 2:213–214
Read NW, Krejs GJ, Read MG, Santa Ana CA, Morawski SG, Fordtran JS (1980) Chronic diarrhea of unknown origin. Gastroenterology 78:264–271
Holgate AM, Read NW (1983) Relationship between small bowel transit time and absorption of a solid meal. Dig Dis Sci 28:812–819
Chauve A, Devroede G, Bastin E (1976) Intraluminal pressures during perfusion of the human colon in situ. Gastroenterology 70:336–340
Youle MS, Read NW (1984) Effect of painless rectal distension on gastrointestinal transit of solid meal. Dig Dis Sci 29:902–906
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bannister, J.J., Timms, J.M., Barfield, L.J. et al. Physiological studies in young women with chronic constipation. Int J Colorect Dis 1, 175–182 (1986). https://doi.org/10.1007/BF01648446
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01648446