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Frequency, spectrum, and factors associated with fecal evacuation disorders among patients with chronic constipation referred to a tertiary care center in northern India.
Indian J Gastroenterol 2016; 35(2):83-90IJ

Abstract

BACKGROUND

Data on fecal evacuation disorder (FED) causing chronic constipation (CC) is scanty in India.

METHODS

Prospectively maintained data of 249 consecutive patients with CC (Rome III) referred for investigations were retrospectively analyzed.

RESULTS

Of 249 patients (43.7 ± 16.2 years, 174 males), 135/242 (55.8 %), 57/249 (22.9 %), and 83/136 (61.0 %) had abnormal balloon expulsion test (>200 g), anorectal manometry [>100 mmHg resting pressure (n = 4), >167 mmHg squeeze pressure (n = 46), and both (n = 7)], and defecography (anorectal angle not opening by >15° during defecation, perineal descent ≥4 cm, and/or rectocele), respectively. Though 181/249 (72.6 %) had one test abnormality, 86/249 (34 %) had FED (greater than or equal to two abnormalities), 44/65 (67.6 %) of whom had a defecation index ≤1.4. Rome III criteria for irritable bowel syndrome were equally fulfilled by patients with and without FED [74/83 (89 %) vs. 117/144 (81.2 %); p = ns]. On univariate analysis, straining duration, prolonged straining [≥30 min; 21/39 (53.8 %) vs. 15/65 (23.1 %); p = 0.002], incomplete evacuation [75/77 (97.4 %) vs. 95/114 (83.3 %); p = 0.004], and >3 stools/week [60/75 (80 %) vs. 76/128 (60 %); p = 0.004] were commoner among the FED patients though age, gender, symptom duration, mucus, manual evacuation, and stool forms were comparable. Resting and squeeze pressures and balloon volume at maximum tolerable limit were higher, and the sphincter tended to be shorter in FED. Prolonged straining, incomplete evacuation, and squeeze pressure were significant on multivariate analysis. Manometry and defecography abnormalities were commoner among the female FED patients.

CONCLUSION

FED is not uncommon, which fulfills the Rome III criteria for IBS, and prolonged straining may be suggestive; abnormal defecography and manometry are commoner in female.

Authors+Show Affiliations

Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India. udayghoshal@yahoo.co.in.Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India.Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27041380

Citation

Ghoshal, Uday C., et al. "Frequency, Spectrum, and Factors Associated With Fecal Evacuation Disorders Among Patients With Chronic Constipation Referred to a Tertiary Care Center in Northern India." Indian Journal of Gastroenterology : Official Journal of the Indian Society of Gastroenterology, vol. 35, no. 2, 2016, pp. 83-90.
Ghoshal UC, Verma A, Misra A. Frequency, spectrum, and factors associated with fecal evacuation disorders among patients with chronic constipation referred to a tertiary care center in northern India. Indian J Gastroenterol. 2016;35(2):83-90.
Ghoshal, U. C., Verma, A., & Misra, A. (2016). Frequency, spectrum, and factors associated with fecal evacuation disorders among patients with chronic constipation referred to a tertiary care center in northern India. Indian Journal of Gastroenterology : Official Journal of the Indian Society of Gastroenterology, 35(2), pp. 83-90. doi:10.1007/s12664-016-0631-6.
Ghoshal UC, Verma A, Misra A. Frequency, Spectrum, and Factors Associated With Fecal Evacuation Disorders Among Patients With Chronic Constipation Referred to a Tertiary Care Center in Northern India. Indian J Gastroenterol. 2016;35(2):83-90. PubMed PMID: 27041380.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Frequency, spectrum, and factors associated with fecal evacuation disorders among patients with chronic constipation referred to a tertiary care center in northern India. AU - Ghoshal,Uday C, AU - Verma,Abhai, AU - Misra,Asha, Y1 - 2016/04/04/ PY - 2015/07/05/received PY - 2016/03/01/accepted PY - 2016/4/5/entrez PY - 2016/4/5/pubmed PY - 2017/3/10/medline KW - Anorectal manometry KW - Chronic constipation KW - Functional gastrointestinal disorders KW - Irritable bowel syndrome SP - 83 EP - 90 JF - Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology JO - Indian J Gastroenterol VL - 35 IS - 2 N2 - BACKGROUND: Data on fecal evacuation disorder (FED) causing chronic constipation (CC) is scanty in India. METHODS: Prospectively maintained data of 249 consecutive patients with CC (Rome III) referred for investigations were retrospectively analyzed. RESULTS: Of 249 patients (43.7 ± 16.2 years, 174 males), 135/242 (55.8 %), 57/249 (22.9 %), and 83/136 (61.0 %) had abnormal balloon expulsion test (>200 g), anorectal manometry [>100 mmHg resting pressure (n = 4), >167 mmHg squeeze pressure (n = 46), and both (n = 7)], and defecography (anorectal angle not opening by >15° during defecation, perineal descent ≥4 cm, and/or rectocele), respectively. Though 181/249 (72.6 %) had one test abnormality, 86/249 (34 %) had FED (greater than or equal to two abnormalities), 44/65 (67.6 %) of whom had a defecation index ≤1.4. Rome III criteria for irritable bowel syndrome were equally fulfilled by patients with and without FED [74/83 (89 %) vs. 117/144 (81.2 %); p = ns]. On univariate analysis, straining duration, prolonged straining [≥30 min; 21/39 (53.8 %) vs. 15/65 (23.1 %); p = 0.002], incomplete evacuation [75/77 (97.4 %) vs. 95/114 (83.3 %); p = 0.004], and >3 stools/week [60/75 (80 %) vs. 76/128 (60 %); p = 0.004] were commoner among the FED patients though age, gender, symptom duration, mucus, manual evacuation, and stool forms were comparable. Resting and squeeze pressures and balloon volume at maximum tolerable limit were higher, and the sphincter tended to be shorter in FED. Prolonged straining, incomplete evacuation, and squeeze pressure were significant on multivariate analysis. Manometry and defecography abnormalities were commoner among the female FED patients. CONCLUSION: FED is not uncommon, which fulfills the Rome III criteria for IBS, and prolonged straining may be suggestive; abnormal defecography and manometry are commoner in female. SN - 0975-0711 UR - https://www.unboundmedicine.com/medline/citation/27041380/Frequency_spectrum_and_factors_associated_with_fecal_evacuation_disorders_among_patients_with_chronic_constipation_referred_to_a_tertiary_care_center_in_northern_India_ L2 - https://dx.doi.org/10.1007/s12664-016-0631-6 DB - PRIME DP - Unbound Medicine ER -