Severe, Idiopathic Constipation is Caused by a Distinct Abnormality of the Colonic Myenteric Plexus (Abstract)
We analyzed 26 patients, all women with severe constipation without obvious organic cause. Clinical: 24/26 were between 19–39 yrs. The duration of constipation was from 1/2–30 yrs. 7 had constipation from childhood and 7 from adolescence. Stool frequency was once every 5–30 days; 16/26 had stools once in 10–30 days. 25/26 had abdominal pain, bloating and distention; 22/26 had nausea and 4/26 occasional vomiting. 4 patients previously had anorexia nervosa and 3 had psychiatric problems. All 26 were on multiple laxatives. Radiography: One patient had gaseous distension of the stomach; but no patient had gaseous distention of small bowel or colon; 13/13 had normal UGI and small bowel series. Barium enemas were normal in 16/26; 10/26 had long redundant colons and 6/10 had increased colonic widths (8–15 cm). None had a narrowed rectal segment. Esophageal manometry: 12/22 were normal. 10/22 had high amplitude (180–240 mm) peristalsis, 3/22 had long duration waves. Solid meal gastric emptying studies were normal in 23/23. Pathology: Mucosal rectal biopsies showed normal submucosal neurons in 26/26 and melanosis coli in 6/26. 12 had subtotal colectomies because of severe constipation. H&E stains of the resected colons showed normal circular and longitudinal muscles in 11/12, and thin muscle layers in 1/12. By this technique we saw no definite abnormalities of the myenteric plexus (MP); quantitative neuron counts were normal in 12/12.