Abstract
Purpose
This study was undertaken to assess the clinical significance of anismus in patients who complain of constipation.
Patients and methods
Thirty control subjects and 93 consecutive patients complaining of functional constipation took part in the study. Colonic transit time study and anorectal manometry were performed. Questions about depression and urinary and sexual diseases were added to a questionnaire based on the Rome II criteria, and visual analog scales about four items (constipation, diarrhoea, abdominal bloating and abdominal pain).
Results
Constipated patients have lower threshold sensation volume, lower constant sensation volume, and lower maximum tolerable volume than controls. Thirty-seven patients (40%) were found to have anismus, based on anorectal manometry. No significant difference was found between constipated patients with anismus and constipated patients without anismus, using anorectal manometry. Constipated patients had longer colorectal transit time than controls, but neither total nor segmental colonic transit time was correlated with the presence or absence of anismus. In patients with anismus, a higher frequency of oesophageal symptoms, dysmotility-like dyspepsia, aerophagia, functional bowel disorders, functional abdominal pain, soiling, and dyschezia was found. In addition, a higher frequency of urinary complaints, sexual complaints, and depression was found. Anismus was associated with increased awareness of constipation, abdominal bloating, and abdominal pain, but not with diarrhoea.
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References
Drossman DA, Thompson WG, Talley NJ, et al (1990) Identification of subgroups of functional bowel disorders. Gastroenterol Internat 3:159–72
Drossman DA (2000) In: Drossman DA, Corazziari E, Talley NJ, Thompson WG, Whitehead WE (eds) The functional gastrointestinal disorders. Diagnosis, pathophysiology, and treatment. A multinational consensus, 2nd edn. Degnon Associates, McLean, VA, pp 1–764
Drossman DA (1999) The functional gastrointestinal disorders and the Rome II process. Gut 45[Suppl 2]:II1–5
Koch A, Voderholzer WA, Klauser AG, Muller-Lissner S (1997) Symptoms in chronic constipation. Dis Colon Rectum 40:902–906
Preston DM, Lennard-Jones JE (1985) Anismus in chronic constipation. Dig Dis Sci 30:413–418
Kuijpers HC, Bleijenberg G (1985) The spastic pelvic floor syndrome. A cause of constipation. Dis Colon Rectum 28:669–672
Devroede G (1999) Front and rear: the pelvic floor is an integrated functional structure. Med Hypotheses 52:147–153
Hémond M, Bédard G, Bouchard H, Arhan P, Watier A, Devroede G (1995) Step by step anorectal motility: small balloon tube. In: Lee E (ed) Practical guide to anorectal testing, 2nd edn. Igaku-Shoin, New York, Tokyo, pp 101–141
Jones PN, Lubowski DZ, Swash M, Henry MM (1987) Is paradoxical contraction of puborectalis muscle of functional importance? Dis Colon Rectum 30:667–670
Schouten WR, Briel JW, Auwerda JJ, et al (1997) Anismus: fact or fiction? Dis Colon Rectum 40:1033–1041
Kuijpers HC, Bleijenberg G, de Morree H (1986) The spastic pelvic floor syndrome. Large bowel outlet obstruction caused by pelvic floor dysfunction: a radiological study. Int J Colorectal Dis 1:44–48
Karlbom U, Edebol Eeg-Olofsson K, Graf W, Nilsson S, Pahlman L (1998) Paradoxical puborectalis contraction is associated with impaired rectal evacuation. Int J Colorectal Dis 13:141–147
Lestar B, Penninckx FM, Kerremans RP (1989) Defecometry. A new method for determining the parameters of rectal evacuation. Dis Colon Rectum 32:197–201
Surrenti E, Rath DM, Pemberton JH, Camilleri M (1995) Audit of constipation in a tertiary referral gastroenterology practice. Am J Gastroenterol 90:1471–1475
Martelli H, Devroede G, Arhan P, Duguay C, Dornic C, Faverdin C (1978) Some parameters of large bowel motility in normal man. Gastroenterology 75:612–618
Bouchoucha M, Devroede G, Arhan P, et al (1992) What is the meaning of colorectal transit time measurement? Dis Colon Rectum 35:773–782
Bouchoucha M, Thomas SR (2000) Error analysis of classic colonic transit time estimates. Am J Physiol Gastrointest Liver Physiol 279:G520–G527
Whooley MA, Avins AL, Miranda J, Browner WS (1997) Case-finding instruments for depression. Two questions are as good as many. J Gen Intern Med 12:439–445
Voderholzer WA, Neuhaus DA, Klauser AG, Tzavella K, Muller-Lissner SA, Schindlbeck NE (1997) Paradoxical sphincter contraction is rarely indicative of anismus. Gut 41:258–262
Leroi AM, Berkelmans I, Denis P, Hemond M, Devroede G (1995) Anismus as a marker of sexual abuse. Consequences of abuse on anorectal motility. Dig Dis Sci 40:1411–1416
Leroi AM, Bernier C, Watier A, et al (1995) Prevalence of sexual abuse among patients with functional disorders of the lower gastrointestinal tract. Int J Colorectal Dis 10:200–206
Kuijpers JH (1991) Functional constipation: results of application of the colorectal laboratory. Neth J Surg 43:213–217
Duthie GS, Bartolo DC (1992) Anismus: the cause of constipation? Results of investigation and treatment. World J Surg 16:831–835
Watier A, Devroede G, Duranceau A, et al (1983) Constipation with colonic inertia. A manifestation of systemic disease? Dig Dis Sci 28:1025–1033
Reynolds JC, Ouyang A, Lee CA, Baker L, Sunshine AG, Cohen S (1987) Chronic severe constipation. Prospective motility studies in 25 consecutive patients. Gastroenterology 92:414–420
Aggarwal A, Cutts TF, Abell TL, et al (1994) Predominant symptoms in irritable bowel syndrome correlate with specific autonomic nervous system abnormalities. Gastroenterology 106:945–950
Altomare DF, Portincasa P, Rinaldi M, et al (1999) Slow-transit constipation: solitary symptom of a systemic gastrointestinal disease. Dis Colon Rectum 42:231–240
Krishnamurthy S, Schuffler MD, Rohrmann CA, Pope CEd (1985) Severe idiopathic constipation is associated with a distinctive abnormality of the colonic myenteric plexus. Gastroenterology 88:26–34
Shafik A (1993) Esophago-rectal reflex. Description and clinical significance. Int Surg 78:83–85
Abrahamsson H (1987) Gastrointestinal motility in patients with the irritable bowel syndrome. Scand J Gastroenterol Suppl 130:21–26
Hemingway D, Neilly JB, Finlay IG (1996) Biliary dyskinesia in idiopathic slow-transit constipation. Dis Colon Rectum 39:1303–1307
Kamath PS, Gaisano HY, Phillips SF, et al (1991) Abnormal gallbladder motility in irritable bowel syndrome: evidence for target-organ defect. Am J Physiol 260:G815–G819
Whitehead WE (1996) Psychosocial aspects of functional gastrointestinal disorders. Gastroenterol Clin North Am 25:21–34
Bouchoucha M, Odinot JM, Devroede G, Landi B, Cugnenc PH, Barbier JP (1998) Simple clinical assessment of colonic response to food. Int J Colorectal Dis 13:217–222
Wald A, Hinds JP, Caruana BJ (1989) Psychological and physiological characteristics of patients with severe idiopathic constipation. Gastroenterology 97:932–937
Grotz RL, Pemberton JH, Talley NJ, Rath DM, Zinsmeister AR (1994) Discriminant value of psychological distress, symptom profiles, and segmental colonic dysfunction in outpatients with severe idiopathic constipation. Gut 35:798–802
Ashraf W, Park F, Lof J, Quigley EM (1996) An examination of the reliability of reported stool frequency in the diagnosis of idiopathic constipation. Am J Gastroenterol 91:26–32
Devroede G, Girard G, Bouchoucha M, et al (1989) Idiopathic constipation by colonic dysfunction. Relationship with personality and anxiety. Dig Dis Sci 34:1428–1433
Devroede G (2000) Early life abuses in the past history of patients with gastrointestinal tract and pelvic floor dysfunctions. Prog Brain Res 122:131–155
Longstreth GF, Preskill DB, Youkeles L (1990) Irritable bowel syndrome in women having diagnostic laparoscopy or hysterectomy. Relation to gynecologic features and outcome. Dig Dis Sci 35:1285–1290
Drossman DA, Leserman J, Nachman G, et al (1990) Sexual and physical abuse in women with functional or organic gastrointestinal disorders. Ann Intern Med 113:828–833
Drossman DA, Talley NJ, Leserman J, Olden KW, Barreiro MA (1995) Sexual and physical abuse and gastrointestinal illness. Review and recommendations. Ann Intern Med 123:782–794
Yazbeck S, Schick E, O’Regan S (1987) Relevance of constipation to enuresis, urinary tract infection and reflux. A review. Eur Urol 13:318–321
Devroede G (1992) Constipation—a sign of a disease to be treated surgically, or a symptom to be deciphered as nonverbal communication? J Clin Gastroenterol 15:189–191
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Bouchoucha, M., Devroede, G. & Arsac, M. Anismus: a marker of multi-site functional disorders?. Int J Colorectal Dis 19, 374–379 (2004). https://doi.org/10.1007/s00384-003-0574-0
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DOI: https://doi.org/10.1007/s00384-003-0574-0