Skip to main content

Advertisement

Log in

Clinical and instrumental parameters in patients with constipation and incontinence: their potential implications in the functional aspects of these disorders

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Abbreviations

PC:

Pubococcygeal

References

  1. Higgins PD, Johanson JF (2004) Epidemiology of constipation in North America: a systematic review. Am J Gastroenterol 99:750–759

    Article  PubMed  Google Scholar 

  2. 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

    PubMed  Google Scholar 

  3. 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

    Article  Google Scholar 

  4. Whitehead WE, Wald A, Norton NJ (2001) Treatment options for faecal incontinence. Dis Colon Rectum 44:131–142

    Article  PubMed  CAS  Google Scholar 

  5. Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97

    Article  PubMed  CAS  Google Scholar 

  6. 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

    Article  PubMed  CAS  Google Scholar 

  7. 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

    Article  PubMed  CAS  Google Scholar 

  8. 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

    Article  PubMed  CAS  Google Scholar 

  9. Zbar AP, Beer-Gabel M (2003) Manometric variables in rectocele patients with symptomatic constipation. Tech Coloproctol 7:65

    Article  PubMed  CAS  Google Scholar 

  10. 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

    Article  PubMed  CAS  Google Scholar 

  11. 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

    Article  PubMed  CAS  Google Scholar 

  12. 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

    Article  PubMed  Google Scholar 

  13. 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

    Article  PubMed  CAS  Google Scholar 

  14. De Troyer A (1983) Mechanical role of the abdominal muscles in relation to posture. Respir Physiol 53:341–353

    Article  PubMed  Google Scholar 

  15. 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

    Article  PubMed  Google Scholar 

  16. 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

    Article  PubMed  Google Scholar 

  17. Di Benedetto P. La valutazione neuro-fisiatrica perineale. In Riabilitazione uro-ginecologica. Di Benedetto P. Edizioni Minerva Medica 2004;99–103.

  18. Fabiani C, lana LG, Masè N et al (1991) Pelvic floor muscles assessment in continent and incontinent women. Urodinamica 1:95–96

    Google Scholar 

  19. 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

    Article  PubMed  CAS  Google Scholar 

  20. Herbison P, Plevnik S, Mantle J. Weighted vaginal cones for urinary incontinence. Cochrane Database Syst Rev. 2002;(1):CD002114.

  21. 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

    Article  PubMed  CAS  Google Scholar 

  22. 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

    CAS  Google Scholar 

  23. Bartram CI (1992) Anal endosonography. Ann Gastroenterol Hepatol 28:185–189

    CAS  Google Scholar 

  24. 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

    Article  CAS  Google Scholar 

  25. 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

    Article  PubMed  CAS  Google Scholar 

  26. 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

    Article  PubMed  Google Scholar 

  27. 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

    Article  PubMed  Google Scholar 

  28. 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

    Article  PubMed  CAS  Google Scholar 

  29. 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

    PubMed  CAS  Google Scholar 

  30. Bourcier AP (1994) Physical therapy for female pelvic floor disorders. Curr Opin Obstet Gynecol 6:331–335

    PubMed  CAS  Google Scholar 

  31. Galeri S, Sottini C (2001) Physiotherapy of pelvic floor for incontinence. Arch Ital Urol Androl 73:143–146

    PubMed  CAS  Google Scholar 

  32. 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

    Article  PubMed  CAS  Google Scholar 

  33. 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.

  34. Whitehead WE, Orr WE, Engel BT, Schuster MM (1982) External anal sphincter response to rectal distension: learned response or reflex. Psychophysiology 19:57–62

    Article  PubMed  CAS  Google Scholar 

  35. Sangwan YP, Coller JA, Schoetz DJ, Murray JJ, Roberts PL (1995) Latency measurements of rectoanal reflexes. Dis Colon Rectum 38:1281–1285

    Article  PubMed  CAS  Google Scholar 

  36. 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

    Article  PubMed  Google Scholar 

  37. 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

    Article  PubMed  CAS  Google Scholar 

  38. 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

    Article  PubMed  Google Scholar 

  39. 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

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to L. Brusciano.

Rights and permissions

Reprints 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

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-009-0678-2

Keywords

Navigation