Rome Constipation Symptoms Augmented by Painful Defecation Predicts Specific Subtypes of Refractory Constipation.

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Physiology

Background:

• Functional defecation disorders (FDD) are a common cause of severe constipation.
• Diagnosing FDD typically requires physiological tests like anorectal manometry (ARM) and balloon expulsion test (BET).
• Differentiating FDD subtypes is crucial for effective treatment.

Purpose of the Study:

• To assess if adding the symptom of painful defecation to the Rome III questionnaire can help differentiate refractory chronic constipation subtypes.
• To correlate patient-reported symptoms with objective physiological findings.

Main Methods:

• 198 patients with chronic constipation, unresponsive to initial treatment, were enrolled.
• Patients underwent digital rectal examination (DRE) for tenderness and reported painful defecation frequency.
• Physiological testing included DRE, ARM, BET, and in some cases, barium defecography and colonic transit time evaluation.

Main Results:

• 40.9% of patients reported weekly painful defecation, and 43.3% had DRE-tenderness.
• 48.5% of patients were diagnosed with FDD, primarily dyssynergic defecation (DD) or inadequate defecatory propulsion (IDP).
• No specific predictors were identified for IDP.

Conclusions:

• The symptom of painful defecation is a critical addition to the Rome III criteria for identifying specific subtypes of refractory chronic constipation.
• This symptom-based approach can enhance diagnostic accuracy and potentially reduce reliance on costly physiological testing.
• Improved identification of constipation subtypes can lead to more targeted and effective patient care.