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Constipation caused by functional outlet obstruction

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Abstract

Functional constipation is a very common problem in Western societies. Functional outlet obstruction, part of the spectrum of functional constipation, is suspected when patients present with select symptoms. Diagnosis is commonly made with anorectal manometry, electromyography, and rectal evacuation tests. Abnormal test patterns include poor relaxation and contraction of the anal sphincter in response to attempted defecation and difficult rectal evacuation. Several treatment approaches have been tested in these patients. Biofeedback training is considered the most specific therapeutic modality, and it is particularly attractive because of its safety. This review provides an assessment of the diagnostic tests for functional outlet obstruction and summarizes current options for therapy.

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References and Recommended Reading

  1. Sonnenberg A, Koch TR: Physician visits in the United States for constipation: 1958–1986. Dig Dis Sci 1989, 34:606–611.

    Article  PubMed  CAS  Google Scholar 

  2. Stewart WF, Liberman JN, Sandler RS, et al.: Epidemiology of constipation (EPOC) study in the United States: relation of clinical subtypes to socioeconomic features. Am J Gastroenterol 1999, 94:3540–3539. A comprehensive study on the epidemiology of constipation.

    Article  Google Scholar 

  3. Thompson WG, Longstreth GF, Drossman DA, et al.: Functional bowel disorders and functional abdominal pain. Gut 1999, 45(suppl II):43–47.

    Google Scholar 

  4. Whitehead WE, Wald A, Diamant NE: Functional disorders of the anus and rectum. Gut 1999, 45(suppl II):55–59.

    Google Scholar 

  5. Rao SSC, Welcher KD, Leistikow JS: Obstructive defecation: failure of rectoanal coordination. Am J Gastroenterol 1998, 93:1042–1050. This study determined different patterns of rectoanal dyssynergia.

    Article  PubMed  CAS  Google Scholar 

  6. Rao SSC, Hatfield R, Soffer E, et al.: Manometric tests of anorectal function in healthy adults. Am J Gastroenterol 1999, 94:773–783.

    Article  PubMed  CAS  Google Scholar 

  7. Savoye G, Leroi AM, Bertot-Sasigneux P, et al.: Does water-perfused catheter overdiagnose anismus compared to balloon probe? Scand J Gastroenterol 2002, 37:1411–1416.

    Article  PubMed  CAS  Google Scholar 

  8. Duthie GS, Bartolo DCC: Anismus: the cause of constipation? Results of investigation and treatment. World J Surg 1992, 16:831–835.

    Article  PubMed  CAS  Google Scholar 

  9. Pinho M, Yoshioka K, Keighley MRB: Long term results of anorectal myectomy for chronic constipation. Br J Surg 1989, 76:1163–1164.

    Article  PubMed  CAS  Google Scholar 

  10. Joo JS, Agachan F, Wolff B, et al.: Initial North American experience with botulinum toxin type A for treatment of anismus. Dis Colon Rectum 1996, 39:1107–1111.

    Article  PubMed  CAS  Google Scholar 

  11. Hallan RI, Williams NS, Melling J, et al.: Treatment of anismus in intractable constipation with botulinum A toxin. Lancet 1988, 2:714–717.

    Article  PubMed  CAS  Google Scholar 

  12. Wald A, Hinds JP, Caruanna BJ: Psychological and physiological characteristics of patients with severe idiopathic constipation. Gastroenterology 1989, 81:879–883.

    Google Scholar 

  13. Nehra V, Bruce BK, Rath-Harvey DM, et al.: Psychological disorders in patients with evacuation disorders and constipation in a tertiary practice. Am J Gastroenterol 2000, 95:1755–1758.

    Article  PubMed  CAS  Google Scholar 

  14. Glia A, Lindberg G: Quality of life in patients with different types of functional constipation. Scan J Gastroenterol 1997, 32:1083–89.

    Article  CAS  Google Scholar 

  15. Irvine EJ, Ferrazzi S, Pare P, et al.: Health-related quality of life in functional GI disorders: focus on constipation and resource utilization. Am J Gastroenterol 2002, 97:1986–1993.

    Article  PubMed  CAS  Google Scholar 

  16. Rao SSC, Wellema T, Kempf J, et al.: Symptoms, stool patterns and quality of life in patients with dyssynergic defecation [abstract]. Gastroenterology 2000, 118:A782.

    Google Scholar 

  17. Glia A, Lindberg G, Nilsson LH, et al.: Clinical value of symptom assessment in patients with constipation. Dis Colon Rectum 1999, 42:1401–1410. arge study that examined the correlation between symptoms and abnormalities in physiologic tests in patients with severe constipation. Most patients in this prospective study completed all tests.

    Article  PubMed  CAS  Google Scholar 

  18. Mertz H, Naliboff B, Mayer EA: Symptoms and physiology in severe chronic constipation. Am J Gastroenterol 1999, 94:131–138.

    Article  PubMed  CAS  Google Scholar 

  19. Koch A, Woderholzer WA, Klauser AG, et al.: Symptoms in chronic constipation. Dis Colon Rectum 1997, 40:902–906.

    Article  PubMed  CAS  Google Scholar 

  20. Azpiroz F, Enck P, Whitehead WE: Anorectal functional testing: review of collective experience. Am J Gastroenterol 2002, 97:232–240. This study provides critical assessment of anorectal function tests. The authors review the indications, techniques, and interpretation of various tests in clinical use.

    PubMed  Google Scholar 

  21. Schouten WR, Briel JW, Auwerda JJA, et al.: Anismus: fact or fiction? Dis Colon Rectum 1997, 40:1033–1041.

    Article  PubMed  CAS  Google Scholar 

  22. Mertz H, Naliboff B, Mayer E: Physiology of refractory chronic constipation. Am J Gastroenterol 1999, 94:609–615.

    Article  PubMed  CAS  Google Scholar 

  23. Glia A, Lindberg G, Nilsson LH, et al.: Constipation assessed on the basis of colorectal physiology. Scand J Gastroenterol 1998, 33:1273–1279.

    Article  PubMed  CAS  Google Scholar 

  24. Rao SSC, Welcher KD, Pelsang RE: Effects of biofeedback therapy on anorectal function in obstructive defecation. Dig Dis Sci 1997, 42:2197–2205.

    Article  PubMed  CAS  Google Scholar 

  25. Emmanuel AB, Kamm MA: Response to a behavioral treatment, biofeedback in constipated patients is associated with improved gut transit and autonomic innervation. Gut 2001, 49:214–219.

    Article  PubMed  CAS  Google Scholar 

  26. Wiesel PH, Cuypers P, Herranz M, et al.: Patient satisfaction after biofeedback for constipation and pelvic floor dyssinergia. Swiss Med Wkly 2001, 131:152–156. Long follow-up of large study in patients undergoing biofeedback therapy. The study highlights the dissociation between symptomatic response and normalization of anorectal function tests.

    PubMed  CAS  Google Scholar 

  27. Van der Plas RN, Benninga MA, Buller HA, et al.: Biofeedback training in treatment of childhood constipation: a randomised controlled study. Lancet 1996, 348:776–780. A controlled study of biofeedback in children. It shows that clinical improvement with conventional therapy for constipation is comparable with conventional therapy plus biofeedback, regardless of the impact on anorectal tests.

    Article  PubMed  Google Scholar 

  28. Glia A, Gylin M, Gullberg K, et al.: Biofeedback retraining in patients with functional constipation and paradoxical puborectalis contraction: comparison of anal manometry and sphincter electromyography for feedback. Dis Colon Rectum 1997, 40:998–995.

    Article  Google Scholar 

  29. Heymen S, Wexner S, Vickers D, et al.: Prospective, randomized trial comparing four biofeedback techniques for patients with constipation. Dis Colon Rectum 1999, 42:1388–1393.

    Article  PubMed  CAS  Google Scholar 

  30. McKee RF, McEnroe L, Anderson JH, et al.: Identification of patients likely to benefit from biofeedback for outlet obstruction constipation. Br J Surgery 1999, 86:355–359.

    Article  CAS  Google Scholar 

  31. Lau CW, Heymen S, Alabaz O, et al.: Prognostic significance of rectocele, intussusception, and abnormal perineal descent in biofeedback treatment for constipated patients with paradoxical puborectalis contraction. Dis Colon Rectum 2000, 43:478–482.

    Article  PubMed  CAS  Google Scholar 

  32. Rhee PL, Choi MS, Jun YH, et al.: An increased rectal maximum tolerable volume and long anal canal are associated with poor short-term response to biofeedback therapy for patients with anismus with decreased bowel frequency and normal colonic transit time. Dis Colon Rectum 2000, 43:1405–1411.

    Article  PubMed  CAS  Google Scholar 

  33. Karlbom U, Hallden M, Eeg-Olofsson KE, et al.: Results of biofeedback in constipated patients: a prospective study. Dis Colon Rectum 1997, 40:1149–1155.

    Article  PubMed  CAS  Google Scholar 

  34. Park UC, Choi SK, Piccirillo MF, et al.: Patterns of anismus and the relation to biofeedback therapy. Dis Colon Rectum 1996, 39:768–773.

    Article  PubMed  CAS  Google Scholar 

  35. Mason HJ, Serrano-Ikkos, Kamm MA: Psychological state and quality of life in patients having behavioral treatment (biofeedback) for intractable constipation. Am J Gastroenterol 2002, 97:3154–3159.

    Article  PubMed  Google Scholar 

  36. Maria G, Brisinda G, Bentivoglio AR, et al.: Botulinum toxin in the treatment of outlet obstruction constipation caused by puborectalis syndrome. Dis Colon Rectum 2000, 43:376–380.

    Article  PubMed  CAS  Google Scholar 

  37. Ron Y, Avni Y, Lukovetski A, et al.: Botulinum toxin type A in therapy of patients with anismus. Dis Colon Rectum 2001, 44:1821–1826.

    Article  PubMed  CAS  Google Scholar 

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Sanmiguel, C.P., Soffer, E.E. Constipation caused by functional outlet obstruction. Curr Gastroenterol Rep 5, 414–418 (2003). https://doi.org/10.1007/s11894-003-0055-1

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