Constipation

Current Opinion in Gastroenterology

Volumn 13, Issue 1, 1997, Pages 28-33

  Mertz, Howard R ^a  

^a VANDERBILT UNIVERSITY MEDICAL CENTER   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

NITRIC OXIDE;

COLON RESECTION; CONSTIPATION; FECES INCONTINENCE; IRRITABLE COLON; PATHOGENESIS; PELVIS FLOOR; SENSORY NERVE; SHORT SURVEY;

EID: 0031001915     PISSN: 02671379     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001574-199701000-00006     Document Type: Short Survey

References (30)

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3. Fleshman JW, Dreznik Z, Cohen E, Fry RD, Kodner IJ: Balloon expulsion test facilitates diagnosis of pelvic floor outlet obstruction due to nonrelaxing puborectalis muscle. Dis Colon Rectum 1992, 35:1019-1025.
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6. Pluta H, Bowes KL, Jewell LD: Long-term results of total abdominal colectomy for chronic idiopathic constipation: value of preoperative assessment Dis Colon Rectum 1996, 39:160-166. Twenty-four patients with severe constipation underwent colectomy. Four subjects had myenteric ganglion morphologic abnormalities, and all had rectal hypersensitivity on preoperative testing. This group of four did not do as well, which raises the question whether sensory testing could be used to diagnose visceral neuropathic processes. In addition, as expected, patients with psychiatric distress did not do well.
7. Cortesini C, Cianchi F, Infantino A, Lise M: Nitric oxide synthase and VIP distribution in enteric nervous system in idiopathic chronic constipation. Dig Dis Sci 1995, 40:2450-2455. Five colons from patients with severe colonic inertia were evaluated on histologic examination. Although the myenteric and submucosal nerves appeared normal, immunohistologic analysis revealed a marked increase in NO synthase and a decrease in VIP staining. This abnormality supports the hypothesis that imbalance of the motility-controlling neurotransmitters may have profound effects.
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10. Karlbom U, Pahlman L, Nilsson S, Graf W: Relationships between defecographic findings, rectal emptying, and colonic transit time in constipated patients. Gut 1995, 36:907-912. A study of 80 constipated patients shows that proctographic abnormalities do not correlate with obstructed defecation symptoms or slow transit. Only rate of rectal emptying correlates with rectosigmoid transit.
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17. Hull TL, Fazio VW, Schroeder T: Paradoxic puborectalis contraction in patients after pelvic pouch construction. Dis Colon Rectum 1995, 38:1144-1146. Straining developed in 13 patients after ileal pouch construction. Twelve cases occurred after an episode of pouchitis or pouch trauma. Paradoxic anal contraction may be induced by inflammation or pain.
18. Koutsomanis D, Lennard-Jones JE, Roy AJ, Kamm MA: Controlled randomized trial of visual biofeedback versus muscle training without a visual display for intractable constipation. Gut 1995, 37:95-99.
19. Park UC, Choi SK, Piccirillo MF, Verzaro R, Wexner SD: Patterns of anismus and the relation to biofeedback therapy. Dis Colon Rectum 1996, 39:768-773. Not all their data are reported; however, good and poor responses to biofeed-back for pelvic floor dysfunction in constipation are described. Resting anal canal pressures greater than one standard deviation above normal appear to be a predictor of worse outcome in this limited retrospective study.
20. Loening-Baucke V, Yamada T: Is the afferent pathway from the rectum impaired in children with chronic constipation and encopresis? Gastroenterology 1995, 109:397-403. Encopretic children with constipation had hyposensitivity to slow rectal distention but not to rapid (phasic) distention. With use of phasic distending stimuli, cerebral evoked potentials showed increased latencies consistent with afferent (sensory) nerve dysfunction. This may play a role in developing pediatric constipation or encopresis or in perpetuating it.
21. Borowitz SM, Sutphen J, Ling W, Cox DJ: Lack of correlation of anorectal manometry with symptoms of chronic childhood constipation and empresis. Dis Colon Rectum 1996, 39:400-405. In forty-four children with constipation and encopresis, anal contraction during defecation did not correlate with bowel frequency. Balloon expulsion problems also did not relate to bowel function. These results suggest that pelvic floor dysfunction does not play a large role in pediatric constipation with encopresis.
22. Loening-Baucke V: Biofeedback treatment for chronic constipation and encopresis in childhood: long-term outcome. Pediatrics 1995, 96:105-110. A large (n=129) long-term (4-year) study by one of biofeedback's main proponents did not show a benefit for biofeedback in constipation with encopresis.
23. Loening-Baucke V: Biofeedback training in children with functional constipation: a critical review. Dig Dis Sci 1996, 41:65-71.
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25. Muller-Lissner SA and The Bavarian Constipation Study Group: Treatment of chronic constipation with cisapride and placebo. Gut 1987, 28:1033-1038.
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27. Staiano A, Giudice ED, Simeone D, Miele E, Marino A: Cisapride in neurologically impaired children with chronic constipation. Dig Dis Sci 1996, 41:870-874. In cerebral palsy patients with constipation, cisapride increased bowel movement frequency greater than placebo did. The differences are not due to faster transit but to reduced rectal (and perhaps left colonic) compliance. however. This corroborates the findings of earlier studies suggesting that cisapride is not particularly effective in severe constipation and that its effects are most notable in the rectosigmoid colon. This small study was in a unique population, so conclusions may not be generalizable.
28. Pemberton JH, Rath DM, Ilstrup DM: Evaluation and surgical treatment of severe chronic constipation. Ann Surg 1991, 214:403-411
29. Piccirillo MF, Reissman P, Wexner SD: Colectomy as treatment for constipation in selected patients. Br J Surg 1995, 82:898-901.
30. Pfeifer J, Agachan F, Wexner SD: Surgery for constipation: a review. Dis Colon Rectum 1996, 39:444-460. This complete review summarizes the state of the art in colectomy for severe constipation. Experience with this procedure argues against anything but a subtotal colectomy. The need to exclude patients with pelvic floor disorders is unclear, but preoperative biofeedback is prudent if PFD is present. Small bowel obstruction after surgery is frequent (17%) and is a reminder that this surgery is not innocuous.