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Evidence for pelvic floor dyssynergia in patients with irritable bowel syndrome.

Abstract

PURPOSE

Although functional constipation is known to often manifest concomitant features of pelvic floor dyssynergia, the nature of pelvic floor symptoms and anorectal dysfunction in non-diarrhea predominant irritable bowel syndrome is less clear. This study aims to compare anorectal sensorimotor function and symptoms of patients who have non-diarrhea predominant irritable bowel syndrome with those who have functional constipation.

METHODS

We studied 50 consecutive female patients referred with constipation and 2 or more symptoms of pelvic floor dyssynergia, who also satisfied Rome II criteria for either non-diarrhea predominant irritable bowel syndrome (n = 25; mean age, 47 +/- 3 y) or functional constipation (n = 25; 49 +/- 3 y). Assessments included the Rome II Integrative Questionnaire, a validated constipation questionnaire, Hospital Anxiety and Depression scale, visual analog scores for satisfaction with bowel habit and for impact on quality of life, and a comprehensive anorectal physiology study.

RESULTS

Both groups displayed physiological evidence of pelvic floor dyssynergia; but patients with non-diarrhea predominant irritable bowel syndrome exhibited a higher prevalence of abnormal balloon expulsion (P < .01) and less paradoxical anal contraction with strain (P = .045) than patients with functional constipation. These patients with irritable bowel syndrome also reported more straining to defecate (P = .04), a higher total constipation score (P = .02), lower stool frequency (P = .02), a trend toward harder stools (P = .06), and less satisfaction with bowel habit (P = .03) than patients with functional constipation.

CONCLUSION

Patients with non-diarrhea predominant irritable bowel syndrome with symptoms of pelvic floor dyssynergia exhibit overall pelvic floor dyssynergia physiology similar to that of patients with functional constipation. Certain features, however, such as abnormal balloon expulsion, may be more prominent in the patients with irritable bowel syndrome. Therapeutic modalities, such as biofeedback, that are effective in patients with functional constipation with pelvic floor dyssynergia should therefore be considered in selected patients with irritable bowel syndrome with pelvic floor dyssynergia.

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  • Authors+Show Affiliations

    ,

    GI Investigation Unit, Royal North Shore Hospital, University of Sydney, Australia.

    , , ,

    Source

    Diseases of the colon and rectum 53:2 2010 Feb pg 156-60

    MeSH

    Anal Canal
    Constipation
    Defecation
    Female
    Follow-Up Studies
    Humans
    Irritable Bowel Syndrome
    Manometry
    Middle Aged
    Pelvic Floor
    Pressure
    Prognosis
    Quality of Life
    Surveys and Questionnaires

    Pub Type(s)

    Comparative Study
    Journal Article

    Language

    eng

    PubMed ID

    20087090

    Citation

    Suttor, V P., et al. "Evidence for Pelvic Floor Dyssynergia in Patients With Irritable Bowel Syndrome." Diseases of the Colon and Rectum, vol. 53, no. 2, 2010, pp. 156-60.
    Suttor VP, Prott GM, Hansen RD, et al. Evidence for pelvic floor dyssynergia in patients with irritable bowel syndrome. Dis Colon Rectum. 2010;53(2):156-60.
    Suttor, V. P., Prott, G. M., Hansen, R. D., Kellow, J. E., & Malcolm, A. (2010). Evidence for pelvic floor dyssynergia in patients with irritable bowel syndrome. Diseases of the Colon and Rectum, 53(2), pp. 156-60. doi:10.1007/DCR.0b013e3181c188e8.
    Suttor VP, et al. Evidence for Pelvic Floor Dyssynergia in Patients With Irritable Bowel Syndrome. Dis Colon Rectum. 2010;53(2):156-60. PubMed PMID: 20087090.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Evidence for pelvic floor dyssynergia in patients with irritable bowel syndrome. AU - Suttor,V P, AU - Prott,G M, AU - Hansen,R D, AU - Kellow,J E, AU - Malcolm,A, PY - 2010/1/21/entrez PY - 2010/1/21/pubmed PY - 2010/2/19/medline SP - 156 EP - 60 JF - Diseases of the colon and rectum JO - Dis. Colon Rectum VL - 53 IS - 2 N2 - PURPOSE: Although functional constipation is known to often manifest concomitant features of pelvic floor dyssynergia, the nature of pelvic floor symptoms and anorectal dysfunction in non-diarrhea predominant irritable bowel syndrome is less clear. This study aims to compare anorectal sensorimotor function and symptoms of patients who have non-diarrhea predominant irritable bowel syndrome with those who have functional constipation. METHODS: We studied 50 consecutive female patients referred with constipation and 2 or more symptoms of pelvic floor dyssynergia, who also satisfied Rome II criteria for either non-diarrhea predominant irritable bowel syndrome (n = 25; mean age, 47 +/- 3 y) or functional constipation (n = 25; 49 +/- 3 y). Assessments included the Rome II Integrative Questionnaire, a validated constipation questionnaire, Hospital Anxiety and Depression scale, visual analog scores for satisfaction with bowel habit and for impact on quality of life, and a comprehensive anorectal physiology study. RESULTS: Both groups displayed physiological evidence of pelvic floor dyssynergia; but patients with non-diarrhea predominant irritable bowel syndrome exhibited a higher prevalence of abnormal balloon expulsion (P < .01) and less paradoxical anal contraction with strain (P = .045) than patients with functional constipation. These patients with irritable bowel syndrome also reported more straining to defecate (P = .04), a higher total constipation score (P = .02), lower stool frequency (P = .02), a trend toward harder stools (P = .06), and less satisfaction with bowel habit (P = .03) than patients with functional constipation. CONCLUSION: Patients with non-diarrhea predominant irritable bowel syndrome with symptoms of pelvic floor dyssynergia exhibit overall pelvic floor dyssynergia physiology similar to that of patients with functional constipation. Certain features, however, such as abnormal balloon expulsion, may be more prominent in the patients with irritable bowel syndrome. Therapeutic modalities, such as biofeedback, that are effective in patients with functional constipation with pelvic floor dyssynergia should therefore be considered in selected patients with irritable bowel syndrome with pelvic floor dyssynergia. SN - 1530-0358 UR - https://www.unboundmedicine.com/medline/citation/20087090/Evidence_for_pelvic_floor_dyssynergia_in_patients_with_irritable_bowel_syndrome_ L2 - http://Insights.ovid.com/pubmed?pmid=20087090 DB - PRIME DP - Unbound Medicine ER -