Abstract
Purpose
The aims of this study were to evaluate several clinical and instrumental parameters in a large number of patients with constipation and incontinence as well as in healthy controls and discuss their potential implications in the functional aspects of these disorders.
Methods
Eighty-four constipated and 38 incontinent patients and 45 healthy controls were submitted to a protocol based on proctologic examination, clinico-physiatric assessment, and instrumental evaluation.
Results
Constipated and incontinent patients had significantly worse lumbar lordosis as well as lower rate in the presence of perineal defense reflex than controls. Constipated but not incontinent patients had a lower rate of puborectalis relaxation than controls. Furthermore, worse pubococcygeal tests and a higher rate of muscle synergies presence, either agonist or antagonist, were observed in both constipated and incontinent patients compared to controls.
Conclusions
This study has demonstrated strong correlations between physiatric disorders and the symptoms of constipation and incontinence. Further studies designed to demonstrate a causal relationship between these parameters and the success of a specific treatment of the physiatric disorders on the proctology symptoms are warranted.
Similar content being viewed by others
Abbreviations
- PC:
-
Pubococcygeal
References
Higgins PD, Johanson JF (2004) Epidemiology of constipation in North America: a systematic review. Am J Gastroenterol 99:750–759
Whitehead WE, Wald A, Diamant NE, Enck P, Pemberton JH, Rao SSC (1999) Functional disorders of the anus and rectum. Gut 45(Suppl 2):II55–II59
Rao S, Tuteja AK, Vellema T et al (2004) Dyssynergic defecation: demographics, symptoms, stool patterns, and quality of life. J Clin Gastroenterol 38:1–6
Whitehead WE, Wald A, Norton NJ (2001) Treatment options for faecal incontinence. Dis Colon Rectum 44:131–142
Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97
Agachan F, Chen T, Pfeifer J, Reissman P, Wexner SD (1996) A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum 39:681–685
Rentsch M, Paetzel C, Lenhart M, Feuerbach S, Jauch KW, Furst A (2001) Dynamic magnetic resonance imaging defecography: a diagnostic alternative in the assessment of pelvic floor disorders in proctology. Dis Colon Rectum 44:999–1007
Beer-Gabel M, Teshler M, Schechtman E, Zbar AP (2004) Dynamic transperineal ultrasound vs. defecography in patients with evacuatory difficulty: a pilot study. Int J Colorectal Dis 19:60–67
Zbar AP, Beer-Gabel M (2003) Manometric variables in rectocele patients with symptomatic constipation. Tech Coloproctol 7:65
Brusciano L, Limongelli P, Pescatori M, Napolitano V, Gagliardi G, Maffettone V, Rossetti G, del Genio G, Russo G, Pizza F, del Genio A (2007) Ultrasonographic patterns in patients with obstructed defaecation. Int J Colorectal Dis 22:969–977
Brusciano L, Limongelli P, del Genio G, Sansone S, Rossetti G, Maffettone V, Napolitano V, Sagnelli C, Pizza F, del Genio A (2007) Useful parameters helping proctologists to identify patients with defaecatory disorders that may be treated with pelvic floor rehabilitation. Tech Coloproctol 11:45–50
Farup PG, Vandvik PO, Aabakken L (2005) How useful are the Rome II criteria for identification of upper gastrointestinal disorders in general practice? Scand J Gastroenterol 40:1284–1289
Gilliland R, Altomare DF, Moreira H Jr, Oliveira L, Gilliland JE, Wexner SD (1998) Pudendal neuropathy is predictive of failure following anterior overlapping sphincteroplasty. Dis Colon Rectum 41:1516–1522
De Troyer A (1983) Mechanical role of the abdominal muscles in relation to posture. Respir Physiol 53:341–353
Kera T, Maruyama H (2005) The effect of posture on respiratory activity of the abdominal muscles. J Physiol Anthropol Appl Human Sci 24:259–265
Messelink B, Benson T, Berghmans B, Bo K, Corcos J, Fowler C, Laycock J, Lim PH, van Lunsen R, a Nijeholt GL, Pemberton J, Wang A, Watier A, Van Kerrebroeck P (2005) Standardization of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the International Continence Society. Neurourol Urodyn 24:374–380
Di Benedetto P. La valutazione neuro-fisiatrica perineale. In Riabilitazione uro-ginecologica. Di Benedetto P. Edizioni Minerva Medica 2004;99–103.
Fabiani C, lana LG, Masè N et al (1991) Pelvic floor muscles assessment in continent and incontinent women. Urodinamica 1:95–96
Morin M, Dumoulin C, Bourbonnais D, Gravel D, Lemieux MC (2004) Pelvic floor maximal strength using vaginal digital assessment compared to dynamometric measurements. Neurourol Urodyn 23:336–341
Herbison P, Plevnik S, Mantle J. Weighted vaginal cones for urinary incontinence. Cochrane Database Syst Rev. 2002;(1):CD002114.
Pezim ME, Pemberton JH, Levin KE, Litchy WJ, Phillips SF (1993) Parameters of anorectal and colonic motility in health and in severe constipation. Dis Colon Rectum 36(5):484–491
Piloni V, Pomerri F, Platania E, Pieri L, Pinto F, Gasparini G, Genovesi N, Di Giandomenico E, Grassi R, Salzano A et al (1994) The National Workshop on Defaecography: anorectal deformities with a functional origin (prolapse, intussusception, rectocele). Radiol Med (Torino) 87:789–795
Bartram CI (1992) Anal endosonography. Ann Gastroenterol Hepatol 28:185–189
Pucciani F, Rottoli ML, Bologna A, Cianchi F, Forconi S, Cutellè M, Cortesini C (1998) Pelvic floor dyssynergia and bimodal rehabilitation: results of combined pelviperineal kinesithrapy and biofeedback training. Int J Colorect Dis 13:124–130
Pucciani F, Iozzi L, Masi A, Cianchi F, Cortesini C (2003) Multimodal rehabilitation for faecal incontinence: experience of an Italian centre devoted to faecal disorder rehabilitation. Tech Coloproctol 7:139–147
Chiarioni G, Whitehead WE, Pezza V, Morelli A, Bassotti G (2006) Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology 130:657–664
Battaglia E, Serra AM, Buonafede G, Dughera L, Chistolini F, Morelli A et al (2004) Long-term study on the effects of visual biofeedback and muscle training as a therapeutic modality in pelvic floor dyssynergia and slow transit constipation. Dis Colon Rectum 47:90–95
Pages IH, Jahr S, Schaufele MK, Conradi E (2001) Comparative analysis of biofeedback and physical therapy for treatment of urinary stress incontinence in women. Am J Phys Med Rehabil 80:494–502
Dumoulin C, Seaborne DE, Quirion-DeGirardi C, Sullivan SJ (1995) Pelvic-floor rehabilitation, part 2: pelvic-floor reeducation with interferential currents and exercise in the treatment of genuine stress incontinence in postpartum women—a cohort study. Phys Ther 75:1075–1081
Bourcier AP (1994) Physical therapy for female pelvic floor disorders. Curr Opin Obstet Gynecol 6:331–335
Galeri S, Sottini C (2001) Physiotherapy of pelvic floor for incontinence. Arch Ital Urol Androl 73:143–146
Voderholzer WA, Neuhaus DA, Klauser AG, Tzavella K, Muller-Lissner SA et al (1997) Paradoxical sphincter contraction is rarely indicative of anismus. Gut 41:258–262
Hay-Smith EJ, Dumoulin C. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2006;(1):CD005654.
Whitehead WE, Orr WE, Engel BT, Schuster MM (1982) External anal sphincter response to rectal distension: learned response or reflex. Psychophysiology 19:57–62
Sangwan YP, Coller JA, Schoetz DJ, Murray JJ, Roberts PL (1995) Latency measurements of rectoanal reflexes. Dis Colon Rectum 38:1281–1285
Boccasanta P, Venturi M, Stuto A, Bottini C, Caviglia A, Carriero A et al (2004) Stapled transanal rectal resection for outlet obstruction: a prospective, multicenter trial. Dis Colon Rectum 47:1285–1297
Fang DT, Nivatvongs S, Vermeulen FD, Herman FN, Goldberg SM, Rothenberger DA (1984) Overlapping sphincteroplasty for acquired anal incontinence. Dis Colon Rectum 27:720–722
van Laarhoven CJ, Kamm MA, Bartram CI, Halligan S, Hawley PR, Phillips RK (1999) Relationship between anatomic and symptomatic long-term results after rectocele repair for impaired defecation. Dis Colon Rectum 42:204–211
Pescatori M, Boffi F, Russo A, Zbar AP (2006) Complications and recurrence after excision of rectal internal mucosal prolapse for obstructed defecation. Int J Colorectal Dis 21:160–165
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Brusciano, L., Limongelli, P., del Genio, G. et al. Clinical and instrumental parameters in patients with constipation and incontinence: their potential implications in the functional aspects of these disorders. Int J Colorectal Dis 24, 961–967 (2009). https://doi.org/10.1007/s00384-009-0678-2
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-009-0678-2