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Symptoms in chronic constipation

A Koch1, W A Voderholzer, A G Klauser

  • 1Department of Internal Medicine, Park-Klinik Weissensee, Berlin, Germany.

Diseases of the Colon and Rectum
|August 1, 1997
PubMed
Summary
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Detailed symptom analysis is insufficient for classifying chronic constipation subgroups. While straining is common, specific symptoms like infrequent bowel movements lack diagnostic value for identifying slow-transit stool or disordered defecation.

Area of Science:

  • Gastroenterology
  • Clinical Medicine
  • Digestive Health

Background:

  • Chronic constipation affects a significant portion of the population, impacting quality of life.
  • Accurate diagnosis of underlying pathophysiologic mechanisms is crucial for effective treatment.
  • Current diagnostic approaches may not fully differentiate between subtypes of chronic constipation.

Purpose of the Study:

  • To investigate if detailed symptom analysis can identify distinct pathophysiologic subgroups in patients with chronic constipation.
  • To evaluate the diagnostic utility of specific symptoms in differentiating between disordered defecation and slow gastrointestinal transit.

Main Methods:

  • A cohort of 190 patients with chronic constipation underwent comprehensive evaluation.
  • Methods included symptom assessment, radiopaque marker transit time measurements, and functional rectoanal evaluations (proctoscopy, manometry, defecography).

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  • Patients were categorized into four groups based on objective test results: disordered defecation, slow gastrointestinal transit, combined, or no pathology.

    • Main Results:

    • The majority of patients (59%) exhibited disordered defecation, while 27% had slow-transit stool; 6% had both, and 8% had no findings.
    • Straining was a near-universal symptom (82-94%) across all groups.
    • While infrequent bowel movements and bloating were more common in slow-transit stool, and incomplete evacuation in disordered defecation, the specificity of these symptoms was low. Sense of obstruction and digital maneuvers showed higher specificity for disordered defecation but low sensitivity.

    Conclusions:

    • Defining chronic constipation solely by infrequent bowel movements is of limited value; the necessity to strain is a more sensitive indicator.
    • The specificity of common symptoms for differentiating between slow-transit stool and disordered defecation is poor.
    • Symptoms alone are not sufficiently reliable for distinguishing between the pathophysiologic subgroups of chronic constipation, necessitating objective testing.