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Obstructive defaecation and slow transit constipation: the proctographic parameters

M Papachrysostomou1, A N Smith, M V Merrick

  • 1Department of Gastroenterology, University of Edinburgh, Western General Hospital, UK.

International Journal of Colorectal Disease
|August 1, 1994
PubMed
Summary
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Functional obstructive defecation involves prolonged defecation time and reduced evacuation rates compared to slow transit constipation. Patients with obstructive defecation exhibit abnormal pelvic floor descent and anorectal angles.

Area of Science:

  • Gastroenterology
  • Colorectal Surgery
  • Physiology

Background:

  • Obstructive defecation and slow transit constipation are distinct functional bowel disorders.
  • Differentiating these conditions is crucial for effective treatment.
  • Isotope proctography offers a quantitative method to assess rectal evacuation dynamics.

Purpose of the Study:

  • To compare the defecation dynamics and anorectal parameters between patients with functional obstructive defecation and slow transit constipation.
  • To identify key differences using isotope proctography.

Main Methods:

  • Isotope proctography was utilized to assess rectal evacuation in 22 patients with functional obstructive defecation and 7 with slow transit constipation.
  • Key parameters measured included percentage of activity evacuated, defecation time, defecation rate, anorectal angle (ARA) on straining, and pelvic floor (PF) descent.

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Main Results:

  • Obstructive defecation patients showed incomplete rectal evacuation (54%), prolonged defecation time (120 s), and a lower defecation rate (0.5%/s) compared to slow transit constipation patients.
  • The anorectal angle remained unchanged in obstructive defecation patients during straining, whereas it became more obtuse in slow transit constipation patients (P < 0.02).
  • Pelvic floor descent was significantly greater in obstructive defecation patients during straining and evacuation (P < 0.01).

Conclusions:

  • Functional obstructive defecation is characterized by prolonged defecation and reduced defecation rates, distinguishing it from slow transit constipation.
  • Obstructive defecation patients present with acute anorectal angles on straining and abnormal perineal descent, unlike those with slow transit constipation.