[Anorectal motility in idiopathic constipation. Study of 200 consecutive patients]

The aim of our work was to study anorectal motility and tension of the rectal wall in 200 constipated adult patients. Anorectal manometry was normal in 88 patients (group A), showed abnormal amplitude of the anorectal inhibitory reflex in 33 patients (group B) and hypertonia and ultraslow waves in 70 patients (group C). These anomalies were: a) reproducible in the 20 patients studied twice; b) observed in patients with enterocolitis, thus not specific of constipation; c) associated with an increased frequency of fecal evacuation difficulties. Despite normal values of tension of the rectal wall: a) the threshold of conscious perception of distension was increased in 14 p. 100 of patients; b) a paradoxical relationship between the anorectal inhibitory reflex and rectal tension was observed in group B patients. Our results support the concept of outlet obstruction due to anorectal dysfunction and suggest the possibility of neurologic and or ischemic mechanisms in group B patients.