Diseases of the Colon & Rectum

, Volume 41, Issue 6, pp 735–739 | Cite as

Which physiologic tests are useful in patients with constipation?

  • Amy L. Halverson
  • Bruce A. Orkin
Original Contributions
  • 39 Downloads

Abstract

PURPOSE: Physiologic tests such as manometry, colonic transit times, balloon compliance, defecography, pudendal nerve latency, and electromyography are used to evaluate patients with severe constipation. Patients referred because of severe constipation between 1991 and 1996 were studied to examine the role that physiologic testing played in making a diagnosis and directing treatment. METHODS: Of 139 patients referred for severe idiopathic constipation, physiologic testing was recommended in 127, and 104 patients underwent the studies. The pretesting impression was noted, and test results were evaluated to determine diagnostic accuracy. If a specific initial impression was documented, tests were classified as refuting it, confirming it or confirming and adding significant information. If there was no clear pretest impression, tests were evaluated for their ability to indicate a diagnosis. The patient's history also was evaluated to determine what information was most useful in making a diagnosis. Historical features including duration of constipation, symptoms consistent with outlet obstruction or dysmotility, age, associated urinary incontinence, and prior hysterectomy were analyzed. Data were collected prospectively, then reviewed by an independent observer. RESULTS: Ninety-eight study patients remained after 29 were excluded who did not undergo the recommended studies (19) or because no initial impression was documented (10). In 43 patients (44 percent), testing did not provide additional useful information. In 8 patients, testing confirmed the initial impression and added information impacting the treatment plan. Test results clearly refuted the initial impression in only one patient. In 46 (47 percent) patients the initial impression was uncertain, and in 43 (94 percent) of these, testing aided in making the diagnosis. In three cases, the diagnosis remained uncertain after testing. Prior hysterectomy (P=0.003), urinary incontinence (P<0.001), and symptoms of pelvic outlet obstruction (P=0.03) were associated with a high incidence of rectocele. Defecography and transit times were the most useful tests. Surprisingly, symptoms of outlet obstruction or dysmotility did not show an overall correlation with transit times. CONCLUSIONS: In one-half of these patients with severe constipation, physiologic testing added significant information, leading to a specific diagnosis. Pretesting history and symptoms did not predict which patients were most likely to benefit from these studies.

Key words

Constipation Diagnosis Physiologic testing Defecography Manometry Transit time 

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References

  1. 1.
    Borowitz SM, Sutphen J, Ling W, Cox DJ. Lack of correlation of anorectal manometry with symptoms of chronic childhood constipation and encoperesis. Dis Colon Rectum 1996;39:400–5.Google Scholar
  2. 2.
    Grotz RL, Pemberton JH, Talley NJ, Rath DM, Zinsmeister AR. Discriminant values of physiological distress, symptom profiles and segmental colonic dysfunction in outpatients with severe idiopathic constipation. Gut 1994;35:798–802.Google Scholar
  3. 3.
    Merkel IS, Locher J, Burgio K, Towers A, Wald A. Physiologic and psychological characteristics of an elderly population with chronic constipation. Am J Gastreoenterol 1993;88:1854–7.Google Scholar
  4. 4.
    Dean AG, Dean JA, Coulombier D,et al. Epi Info Version 6: a word-processing, database and statistics program for public health on IBM-compatible microcomputer. Atlanta: Centers for Disease Control and Prevention, 1995.Google Scholar
  5. 5.
    Metcalf AM, Phillips SF, Zinsmeister AR, MacCarty RL, Beart RW, Wolff BG. Simplified assessment of segmental colonic transit. Gastroenterology 1987;92:40–7.Google Scholar
  6. 6.
    Smith LE. An algorithm for constipation. In: Smith LE, ed. Practical guide to anorectal testing. 2nd ed. New York: Igaku-shoin, 1995:289–99.Google Scholar
  7. 7.
    Kamm MA, Lennard-Jones JE, Pemberton JH. Constipation: pathophysiology and management. In: Henry MM, Swash M, eds. Coloproctology and the pelvic floor. 2nd ed. London: Butterworth-Heineman, 1992:403–29.Google Scholar
  8. 8.
    Pemberton JH, Rath DM, Ilstrup DM. Evaluation and surgical treatment of severe constipation. Ann Surg 1991;214:403–11.Google Scholar
  9. 9.
    Altringer WE, Saclarides TJ, Dominguez JM, Brubaker LT, Smith CS. Four-contrast defecography: pelvic “flooroscopy.” Dis Colon Rectum 1995;38:695–9.Google Scholar
  10. 10.
    Rao SS, Patel RS. How useful are manometric tests of anorectal function in the management of defecation disorders? Am J Gastroenterol 1997;92:469–75.Google Scholar
  11. 11.
    Wexner SD, Daniel N, Jagelman DG. Colectomy for constipation: physiologic investigation is the key to success. Dis Colon Rectum 1991;34:851–6.Google Scholar
  12. 12.
    Piccirillo MF, Wexner SD. Diagnosis and management approach of chronic constipation. In: Wexner SD, Vernava AM, eds. Clinical decision-making in colorectal surgery. New York: Igaku-Shoin, 1995:91–9.Google Scholar

Copyright information

© The American Society of Colon and Rectal Surgeons 1998

Authors and Affiliations

  • Amy L. Halverson
    • 1
  • Bruce A. Orkin
    • 1
  1. 1.Division of Colon and Rectal SurgeryThe George Washington UniversityWashington, D.C.

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