Diseases of the Colon & Rectum

, Volume 39, Issue 6, pp 681–685 | Cite as

A constipation scoring system to simplify evaluation and management of constipated patients

  • Feran Agachan
  • Teng Chen
  • Johann Pfeifer
  • Petachia Reissman
  • Steven D. Wexner
Original Contributions
  • 584 Downloads

Abstract

PURPOSE: Constipation is a common complaint; however, clinical presentation varies with each individual. The aim of this study was to assess a standard scoring system for evaluation of constipated patients. MATERIALS AND METHODS: All consecutive patients with idiopathic constipation who were referred for anorectal physiologic testing were assessed. A subjective constipation score was calculated based on a detailed questionnaire that included over 100 constipation-related symptoms. Based on the questionnaire, scores ranged from 0 to 30, with 0 indicating normal and 30 indicating severe constipation. The constipation score was then compared with the objective findings of the physiology tests, which include colonic transit time (CTT), anal manometry (AM), cinedefecography (CD), and electromyography (EMG). Colonic inertia was defined as diffuse marker delay on CTT without evidence of paradoxical contraction on AM, CD, or EMG. Pelvic outlet obstruction was defined as paradoxical puborectalis contraction, rectal prolapse or rectoanal intussusception, rectocele, or sigmoidocele. RESULTS: A total of 232 patients (185 females and 47 males) of a mean age of 64.9 (range, 14–92) years were evaluated. All patients had a score of more than 15; on evaluation of the significance of different symptoms in the constipation score with the Pearson's linear correlation test, 8 of 18 factors were identified as significant (P<0.05). These factors included frequency of bowel movements, painful evacuation, incomplete evacuation, abdominal pain, length of time per attempt, assistance for evacuation, unsuccessful attempts for evacuation per 24 hours, and duration of constipation. All 232 patients had objective obstruction attributable to one or more of the following causes: paradoxical puborectalis contraction (81), significant rectocele or sigmoidocele (48), rectoanal intussusception (64), and rectal prolapse (9). CONCLUSION: The proposed constipation scoring system correlated well with objective physiologic findings in constipated patients to allow uniformity in assessment of the severity of constipation.

Key words

Constipation Colonic inertia Sigmoidocele Rectocele Rectal prolapse Rectoanal intussusception Anismus Paradoxical puborectalis contraction 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Wexner SD, Jagelman DG. Constipation. Postgrad Adv Colorectal Surg 1989;1:1–22.Google Scholar
  2. 2.
    Whitehead WE, Chaussade S, Corazziari E, Kumar D. Report of an international workshop on management of constipation. Int J Gastroenterol 1991;4:99–113.Google Scholar
  3. 3.
    Sonnenberg A, Koch TR. Epidemiology of constipation in the United States. Dis Colon Rectum 1989;32:1–8.PubMedGoogle Scholar
  4. 4.
    Manning AP, Thompson AG, Heaton KW, Morris AF. Toward positive diagnosis of the irritable bowel. BMJ 1978;2:653–4.PubMedGoogle Scholar
  5. 5.
    Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum 1993;36:77–97.PubMedGoogle Scholar
  6. 6.
    Wexner SD, Marchetti F, Salanga VD, Corredor C, Jagelman DG. Neurophysiologic assessment of the anal sphincters. Dis Colon Rectum 1991;34:606–12.PubMedGoogle Scholar
  7. 7.
    Wexner SD, Marchetti F, Jagelman DG. The role of sphincteroplasty for fecal incontinence reevaluated: a prospective physiologic and functional review. Dis Colon Rectum 1991;34:22–30.PubMedGoogle Scholar
  8. 8.
    Hinton JM, Lennard-Jones JE, Young AC. A new method for studying gut transit times using radioopaque markers. Gut 1969;10:842–7.PubMedGoogle Scholar
  9. 9.
    Kuijpers JH, Bleijenberg G. The spastic pelvic floor syndrome: a cause of constipation. Dis Colon Rectum 1985;28:669–72.PubMedGoogle Scholar
  10. 10.
    van Tets WF, Kuijpers JH. Internal rectal intussusception—fact or fancy? Dis Colon Rectum 1995;38:1080–3.PubMedGoogle Scholar
  11. 11.
    Hoffman MJ, Kodner IJ, Fry RD. Internal intussusception of the rectum: diagnosis and surgical management. Dis Colon Rectum 1984;27:435–41.PubMedGoogle Scholar
  12. 12.
    Johansson C, Nilsson BY, Holström B, Dolk A, Mellgren A. Association between rectocele and paradoxical sphincter response. Dis Colon Rectum 1992;35:503–9.PubMedGoogle Scholar
  13. 13.
    Frykman HM, Goldberg SM. The surigal treatment of rectal procidentia. Surg Gynecol Obstet 1969;129:1225–30.PubMedGoogle Scholar
  14. 14.
    Jorge JM, Wexner SD, Marchetti F, Rosato GO, Sullivan M, Jagelman DG. How reliable are currently available methods of measuring the anorectal angle? Dis Colon Rectum 1992;35:332–8.PubMedGoogle Scholar
  15. 15.
    Jorge JM, Yang Y-K, Wexner SD. Incidence and clinical significance of sigmoidoceles as determined by a new classification system. Dis Colon Rectum 1994;37:1112–7.PubMedGoogle Scholar
  16. 16.
    Moore-Gillon V. Constipation: what does the patient mean? J R Soc Med 1984;77:108–10.PubMedGoogle Scholar
  17. 17.
    MacDonald A, Baxter JN, Finlay IG. Idiopathic slow transit constipation. Br J Surg 1993;80:1107–11.PubMedGoogle Scholar
  18. 18.
    Drossman DA, Sandler RS, McKee DC, Lovitz AJ. Bowel patterns among subjects not seeking health care. Gastroenterology 1982;83:529–34.PubMedGoogle Scholar
  19. 19.
    Thompson WG, Heaton KW. Functional bowel disorders in apparently healthy people. Gastroenterology 1980;79:283–8.PubMedGoogle Scholar
  20. 20.
    Devroede G, Roy T, Bouchoucha M,et al. Idiopathic constipation by colonic dysfunction: relationship with personality and anxiety. Dig Dis Sci 1989;34:1428–33.PubMedGoogle Scholar
  21. 21.
    Heymen S, Wexner SD, Gulledge AD. MMPI assessment of patients with functional bowel disorders. Dis Colon Rectum 1993;36:593–6.PubMedGoogle Scholar
  22. 22.
    Wald A, Burgio K, Holeva K, Locher J. Psychological evaluation of patients with severe idiopathic constipation: which instrument to use. Am J Gastroenterol 1992;87:977–80.PubMedGoogle Scholar
  23. 23.
    Wald A, Hinds JP, Caruana BJ. Psychological and physiological characteristics of patients with severe idiopathic constipation. Gastroenterology 1989;97:932–7.PubMedGoogle Scholar
  24. 24.
    Grotz RL, Pemberton JH, Talley NJ, Rath DM, Zinsmeister AR. Discriminant values of psychological distress, symptom profiles, and segmentai colonic dysfunction in out patients with severe idiopathic constipation. Gut 1994;35:798–802.PubMedGoogle Scholar
  25. 25.
    Pemberton JH, Rath DM, Ilstrup DM. Evaluation and surgical treatment of severe constipation. Ann Surg 1991;214:403–11.PubMedGoogle Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1996

Authors and Affiliations

  • Feran Agachan
    • 1
  • Teng Chen
    • 1
  • Johann Pfeifer
    • 1
  • Petachia Reissman
    • 1
  • Steven D. Wexner
    • 1
  1. 1.Department of Colorectal SurgeryCleveland Clinic FloridaFort Lauderdale

Personalised recommendations