[Motility disorders of the colon].

Area of Science:

• Gastroenterology
• Neurogastroenterology
• Colorectal Surgery

Context:

• Colon motility is regulated by the complex enteric nervous system, influencing fecal movement.
• Clinical presentations of megacolon and megarectum vary, requiring distinct management strategies.
• Acute colonic pseudo-obstruction can arise from systemic illness, electrolyte imbalances, or medical interventions.

Purpose:

• To differentiate between various motility disorders of the colon, including slow transit constipation and pelvic floor dyssynergia.
• To outline appropriate treatment pathways for conditions such as megarectum and refractory megacolon.
• To clarify the pathophysiology and management of acute colonic pseudo-obstruction.

Summary:

• Slow transit constipation involves impaired propulsive colonic motility, reduced response to dietary fiber and bisacodyl.
• Pelvic floor dyssynergia is marked by simultaneous contraction of the anal sphincter and abdominal muscles during attempted defecation.
• Effective management includes avoiding straining and implementing sphincter training for pelvic floor dyssynergia.

Impact:

• Provides a framework for diagnosing and managing complex colonic motility disorders.
• Guides therapeutic decisions, distinguishing between surgical intervention for megacolon and conservative laxation for megarectum.
• Enhances understanding of functional bowel disorders, potentially improving patient outcomes.