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[Pathophysiology of chronic constipation and new therapy recommendation]
1Chirurgisches Zentrum, Universität Bonn.
Zentralblatt Fur Chirurgie
|November 2, 1999
Summary
Chronic idiopathic constipation, common in females, may stem from distal colon and anorectal dysfunction. Rectal resection significantly improved bowel function in patients, suggesting a new treatment approach for this condition.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Physiology
Background:
- Idiopathic chronic constipation (ICC) is prevalent, particularly in females, with potential links to laxative abuse.
- Rare causes include Chagas' disease, Hirschsprung's disease, and continent obstipation, treatable by medication, surgery, or psychotherapy.
- The absence of constipation in colostomy patients suggests a localized issue within the distal colon and anorectum in ICC.
Observation:
- A potential cause of defecation malfunction in ICC is a caliber discrepancy between the narrow pelvic colon and the wide rectum.
- The rectum's polar fibrous configuration contrasts with the large bowel's apolar structure, possibly contributing to functional disorders.
- Disruptions in the continence-defecation feedback mechanism may impede bowel passage in patients with ICC.
Findings:
- Deep rectal resection, rather than colon resection, was performed on 18 patients with ICC.
- All patients who underwent rectal resection experienced significant improvements in bowel function.
- Postoperative outcomes included regular and normal bowel movements, indicating treatment efficacy.
Implications:
- Rectal resection may be a viable surgical option for treating chronic idiopathic constipation.
- Understanding anorectal physiology and structural differences is crucial for addressing defecation disorders.
- This approach offers a promising alternative for patients with severe ICC unresponsive to conservative treatments.