Physiological studies in young women with chronic constipation

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Neurogastroenterology

Background:

• Chronic constipation affects a significant number of women, often proving refractory to standard treatments.
• Understanding the underlying pathophysiology is crucial for developing effective therapeutic strategies.

Purpose of the Study:

• To investigate the anorectal and colonic function in women with chronic constipation.
• To identify potential contributing factors to treatment-resistant constipation.

Main Methods:

• Manometric, radiological, and neurophysiological assessments were conducted on 34 women with chronic constipation and 27 healthy controls.
• Evaluation included simulated stool evacuation, rectal distension response, anal pressures, perineal descent, and anorectal angulation.
• Mouth-to-anus and mouth-to-caecum transit times were measured.

Main Results:

• Constipated patients exhibited difficulty in stool evacuation, often with external sphincter contraction during straining.
• Lower anal pressures, abnormal perineal descent, and obtuse anorectal angulation were observed in the constipated group.
• Sixty percent of constipated patients had prolonged mouth-to-anus transit time; mouth-to-caecum transit was prolonged irrespective of whole gut transit duration.

Conclusions:

• Findings suggest pelvic floor weakness and potential neuropathic damage to the external sphincter in women with chronic constipation.
• Anorectal manometry and imaging can reveal functional abnormalities contributing to refractory constipation.
• Abnormal colonic transit, particularly prolonged mouth-to-caecum transit, is a common feature in this patient population.