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Related Experiment Videos

Physiology of refractory chronic constipation.

H Mertz1, B Naliboff, E Mayer

  • 1Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA.

The American Journal of Gastroenterology
|March 23, 1999
PubMed
Summary

Constipation involves three main issues: slow colon transit, irritable bowel syndrome (IBS), and pelvic floor dysfunction (PFD). These conditions frequently overlap, and PFD doesn't correlate with transit speed.

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Area of Science:

  • Gastroenterology
  • Colorectal Surgery
  • Physiology

Background:

  • Constipation is a common condition with several proposed underlying pathophysiologies.
  • These include slow colon transit, irritable bowel syndrome (IBS), and pelvic floor dysfunction (PFD).
  • Understanding the prevalence and overlap of these pathophysiologies is crucial for effective management.

Purpose of the Study:

  • To determine the prevalence of slow colon transit, IBS (visceral hypersensitivity), and PFD in patients with chronic constipation.
  • To investigate the degree of overlap between these pathophysiologies.
  • To examine potential interactions between different constipation mechanisms.

Main Methods:

  • 131 constipated patients refractory to fiber were studied.

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  • Methods included regional colon transit studies, anorectal manometry/EMG, rectal compliance, and sensory testing.
  • Correlations were performed to analyze interactions between physiological measures.

    • Main Results:

    • Visceral hypersensitivity (IBS) was present in 58%, slow colonic transit in 47%, and PFD in 59% of patients.
    • Significant overlap was observed between slow transit and visceral hypersensitivity, and PFD was common across subgroups.
    • No correlation was found between PFD and colon transit, or between slow transit and visceral hypersensitivity.

    Conclusions:

    • Slow transit and IBS-related visceral hypersensitivity are equally prevalent and significantly overlap in constipated patients.
    • PFD physiology is common but does not correlate with slower colon transit.
    • Four distinct patient subgroups emerge: IBS, slow transit, both, or neither, guiding personalized treatment.