Symptoms in chronic constipation

被引:125
作者
Koch, A [1 ]
Voderholzer, WA [1 ]
Klauser, AG [1 ]
MullerLissner, S [1 ]
机构
[1] UNIV MUNICH,KLINIKUM INNENSTADT,MED KLIN,D-8000 MUNICH,GERMANY
关键词
chronic constipation; slow-transit stool; functional outlet obstruction; anismus; rectal prolapse; rectocele; defecation;
D O I
10.1007/BF02051196
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
OBJECTIVES: This study was designed to evaluate whether detailed symptom analysis would help to identify pathophysiologic subgroups in chronic constipation. METHODS: In 190 patients with chronic constipation (age, 53 (range, 18-88) years; 85 percent of whom were women), symptom evaluation, transit time measurement (radiopaque markers), and functional rectoanal evaluation (proctoscopy, anorectal manometry, defecography) were performed. Patients were classified on the basis of objective data from all tests in four different groups (''disordered defecation,'' ''slow gastrointestinal transit,'' ''disordered defecation combined with slow-transit stool,'' and ''no pathologic finding''). RESULTS: In 59 percent of patients, disordered defecation was found, and 27 percent had slow-transit stool. In 6 percent of patients, a combination of both was found; in only 8 percent of patients, there were no pathologic findings. Straining was reported by the vast majority in all groups (82-94 percent). Infrequent bowel movements and abdominal bloating were more common in slow-transit stool (87 and 82 percent vs. 69 and 55 percent, respectively; both P < 0.01). Feeling of incomplete evacuation was more common in disordered defecation (84 vs. 46 percent; P < 0.0001). However, specificity of these symptoms was discouraging (for slow-transit stool: infrequent bowel movements had a sensitivity of 87 percent and a specificity of 32 percent and abdominal bloating had a sensitivity of 82 percent and specificity of 45 percent; for disordered defecation: feeling of incomplete evacuation had a sensitivity of 84 percent and a specificity of 54 percent). Only the sense of obstruction and digital maneuvers were acceptably specific (79 and 85 percent, respectively) for disordered defecation, but sensitivity was low. CONCLUSIONS: Definition of chronic constipation by infrequent bowel movements alone is of little value; the symptom ''necessity to strain'' is much better suited (94 percent sensitivity). Specificity of infrequent bowel movements for slow-transit stool was discouraging. Sense of obstruction and digital manipulation for evacuation are relatively specific for disordered defecation but insensitive. Therefore, symptoms of chronically constipated patients are not well suited to differentiate between the pathophysiologic subgroups suffering chronic constipation.
引用
收藏
页码:902 / 906
页数:5
相关论文
共 15 条
[1]  
Ashraf W, 1996, AM J GASTROENTEROL, V91, P26
[2]   EFFECT OF STOOL SIZE AND CONSISTENCY ON DEFECATION [J].
BANNISTER, JJ ;
DAVISON, P ;
TIMMS, JM ;
GIBBONS, C ;
READ, NW .
GUT, 1987, 28 (10) :1246-1250
[3]  
DEVROEDE G, 1993, GASTROINTESTINAL DIS, P837
[4]  
DROSSMAN DA, 1982, GASTROENTEROLOGY, V83, P529
[5]   ANISMUS - THE CAUSE OF CONSTIPATION - RESULTS OF INVESTIGATION AND TREATMENT [J].
DUTHIE, GS ;
BARTOLO, DCC .
WORLD JOURNAL OF SURGERY, 1992, 16 (05) :831-835
[6]   Is constipation a disorder of defecation or impaired motility?: Distinction based on defecography and colonic transit studies [J].
Karasick, S ;
Ehrlich, SM .
AMERICAN JOURNAL OF ROENTGENOLOGY, 1996, 166 (01) :63-66
[7]   BEHAVIORAL-MODIFICATION OF COLONIC FUNCTION - CAN CONSTIPATION BE LEARNED [J].
KLAUSER, AG ;
VODERHOLZER, WA ;
HEINRICH, CA ;
SCHINDLBECK, NE ;
MULLERLISSNER, SA .
DIGESTIVE DISEASES AND SCIENCES, 1990, 35 (10) :1271-1275
[8]   APPLICATION OF THE COLORECTAL LABORATORY IN DIAGNOSIS AND TREATMENT OF FUNCTIONAL CONSTIPATION [J].
KUIJPERS, HC .
DISEASES OF THE COLON & RECTUM, 1990, 33 (01) :35-39
[9]   DIFFERENT PATTERNS OF INTESTINAL TRANSIT-TIME AND ANORECTAL MOTILITY IN PAINFUL AND PAINLESS CHRONIC CONSTIPATION [J].
LANFRANCHI, GA ;
BAZZOCCHI, G ;
BRIGNOLA, C ;
CAMPIERI, M ;
LABO, G .
GUT, 1984, 25 (12) :1352-1357
[10]   CHRONIC SEVERE CONSTIPATION - PROSPECTIVE MOTILITY STUDIES IN 25 CONSECUTIVE PATIENTS [J].
REYNOLDS, JC ;
OUYANG, A ;
LEE, CA ;
BAKER, L ;
SUNSHINE, AG ;
COHEN, S .
GASTROENTEROLOGY, 1987, 92 (02) :414-420