Digestive Diseases and Sciences

, Volume 39, Issue 7, pp 1558–1564 | Cite as

Anorectal manometric abnormalities and colonic propulsive impairment in patients with severe chronic idiopathic constipation

  • Gabrio Bassotti
  • Giuseppe Chiarioni
  • Italo Vantini
  • Cesare Betti
  • Carla Fusaro
  • Maria Antonietta Pelli
  • Antonio Morelli
Original Articles


Idiopathic chronic constipation is a frequent and disabling symptom, but its pathophysiological grounds are still poorly understood. In particular, there is little knowledge about the relationships between distal (anorectal area) and proximal (colonic area) motor abnormalities in this condition, especially concerning high-amplitude propagated colonic activity. For this purpose, we studied 25 patients complaining of severe idiopathic constipation and categorized them as normal- or slow-transit constipation according to colonic transit time. Twenty-five age-matched controls were also studied. Investigations included standard anorectal motility testing and prolonged (24-hr) colonic motility studies. Analysis of results showed that both groups of constipated patients displayed significantly different (P<0.05) minimum relaxation volumes of the internal anal sphincter, defecatory sensation thresholds, and maximum rectal tolerable volumes with respect to controls. Patients with normal-transit constipation also showed lower internal anal sphincter pressure with respect to slow-transit constipation and controls (P<0.001 andP<0.02, respectively). The daily number of high-amplitude propagated contractions (mass movements) as well as their amplitude and duration, was significantly reduced in both subgroups of constipated patients (P<0.02 vs controls). We conclude that (1) in normal-transit constipation, motor abnormalities are not limited to the anorectal area; (2) patients with slow-transit constipation probably have a severe neuropathic rectal defect; (3) prolonged colonic motility studies may highlight further the functional abnormalities in constipated subjects; and (4) an approach taking into account proximal and distal colon motor abnormalities might be useful to understand pathophysiological grounds of chronic constipation and lead to better therapeutic approaches.

Key words

anorectal colon constipation manometry 


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Copyright information

© Plenum Publishing Corporation 1994

Authors and Affiliations

  • Gabrio Bassotti
    • 1
    • 2
    • 3
  • Giuseppe Chiarioni
    • 1
    • 2
    • 3
  • Italo Vantini
    • 1
    • 2
    • 3
  • Cesare Betti
    • 1
    • 2
    • 3
  • Carla Fusaro
    • 1
    • 2
    • 3
  • Maria Antonietta Pelli
    • 1
    • 2
    • 3
  • Antonio Morelli
    • 1
    • 2
    • 3
  1. 1.From the Laboratorio di Motilità Intestinale, Clinica di Gastroenterologia et Endoscopia Digestiva, Dipartimento di Medicina Clinica, Patologia e FarmacologiaUniversità di PerugiaItaly
  2. 2.Divisione di Riabilitazione Gastroenterologica, Ospedale Clinicizzato di Valeggio sul MincioUniversità di VeronaItaly
  3. 3.Center for Study of Functional and Motility Disorders of the Gut, Departments of Psychiatry and MedicineThe Johns Hopkins University School of Medicine and Francis Scott Key Medical CenterBaltimore

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