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Symptoms and physiology in severe chronic constipation.
Am J Gastroenterol 1999; 94(1):131-8AJ

Abstract

OBJECTIVE

Symptoms of constipation have been attributed to slow colon transit, irritable bowel syndrome (IBS), or pelvic floor dysfunction (PFD). Our aim was to determine the existence of symptom-based constipation subgroups and whether these correspond to differences in colonic transit and anorectal sensorimotor function.

METHODS

Constipated patients (n = 108) completed questionnaires, and underwent colon transit studies, anorectal manometry, and rectal sensory testing. Factor analysis of symptoms was performed. Factor-based symptom scores were correlated with physiological findings.

RESULTS

Three symptom factors were identified as compatible with slow colonic transit, IBS, and PFD. There was a significant correlation between the symptoms of slow transit and total and rectosigmoid colon transit. There were also significant correlations between both the IBS symptom score and the number of Manning criteria with measures of rectal hypersensitivity typical of IBS. Neither PFD symptom scores nor symptoms of straining correlated with any electromyographic or manometric measure of anal defecatory function or with rectosigmoid colon transit. Based on physiological testing patients were classified as slow transit, visceral hypersensitivity (typical of IBS), PFD, or no abnormalities found. As expected, slow-transit patients had symptoms of infrequent stools and patients with visceral hypersensitivity had an increased number of Manning criteria for IBS. Patients with PFD physiology and those with no detectable abnormalities had no specific symptoms.

CONCLUSIONS

Three symptom-based subgroups for constipation were confirmed: slow transit, IBS, and PFD. Slow transit and IBS symptoms correlated with expected physiology. Conversely, PFD symptoms and physiology did not correlate.

Authors+Show Affiliations

Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

9934743

Citation

Mertz, H, et al. "Symptoms and Physiology in Severe Chronic Constipation." The American Journal of Gastroenterology, vol. 94, no. 1, 1999, pp. 131-8.
Mertz H, Naliboff B, Mayer EA. Symptoms and physiology in severe chronic constipation. Am J Gastroenterol. 1999;94(1):131-8.
Mertz, H., Naliboff, B., & Mayer, E. A. (1999). Symptoms and physiology in severe chronic constipation. The American Journal of Gastroenterology, 94(1), pp. 131-8.
Mertz H, Naliboff B, Mayer EA. Symptoms and Physiology in Severe Chronic Constipation. Am J Gastroenterol. 1999;94(1):131-8. PubMed PMID: 9934743.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Symptoms and physiology in severe chronic constipation. AU - Mertz,H, AU - Naliboff,B, AU - Mayer,E A, PY - 1999/2/6/pubmed PY - 1999/2/6/medline PY - 1999/2/6/entrez SP - 131 EP - 8 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 94 IS - 1 N2 - OBJECTIVE: Symptoms of constipation have been attributed to slow colon transit, irritable bowel syndrome (IBS), or pelvic floor dysfunction (PFD). Our aim was to determine the existence of symptom-based constipation subgroups and whether these correspond to differences in colonic transit and anorectal sensorimotor function. METHODS: Constipated patients (n = 108) completed questionnaires, and underwent colon transit studies, anorectal manometry, and rectal sensory testing. Factor analysis of symptoms was performed. Factor-based symptom scores were correlated with physiological findings. RESULTS: Three symptom factors were identified as compatible with slow colonic transit, IBS, and PFD. There was a significant correlation between the symptoms of slow transit and total and rectosigmoid colon transit. There were also significant correlations between both the IBS symptom score and the number of Manning criteria with measures of rectal hypersensitivity typical of IBS. Neither PFD symptom scores nor symptoms of straining correlated with any electromyographic or manometric measure of anal defecatory function or with rectosigmoid colon transit. Based on physiological testing patients were classified as slow transit, visceral hypersensitivity (typical of IBS), PFD, or no abnormalities found. As expected, slow-transit patients had symptoms of infrequent stools and patients with visceral hypersensitivity had an increased number of Manning criteria for IBS. Patients with PFD physiology and those with no detectable abnormalities had no specific symptoms. CONCLUSIONS: Three symptom-based subgroups for constipation were confirmed: slow transit, IBS, and PFD. Slow transit and IBS symptoms correlated with expected physiology. Conversely, PFD symptoms and physiology did not correlate. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/9934743/Symptoms_and_physiology_in_severe_chronic_constipation_ L2 - http://Insights.ovid.com/pubmed?pmid=9934743 DB - PRIME DP - Unbound Medicine ER -