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Clinical value of symptom assessment in patients with constipation

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Diseases of the Colon & Rectum

Abstract

PURPOSE: This study was designed to evaluate symptoms and clinical findings in a prospective series of patients with chronic constipation. METHODS: A total of 155 consecutive patients with intractable constipation underwent detailed symptom registration, anorectal manometry, electromyography, colonic transit time measurement, and defecography. RESULTS: All investigations were completed by 134 patients (112 females) with a median age of 52 (range, 17–79) years. Whole-gut transit time was delayed in 55 patients (41 percent), pelvic floor dysfunction was diagnosed in 59 patients (44 percent), but in 35 percent of patients both transit time and pelvic floor function were found to be normal. Three symptoms were shown to have an independent value for the diagnosis of slow-transit constipation. Patients with slow transit more often reported two or fewer stools per week (84vs. 46 percent), laxative dependence (87vs. 44 percent), and a history of constipation since childhood (58vs. 22 percent) than did those with normal transit. Pelvic floor dysfunction was associated with a higher prevalence of backache (53vs. 33 percent) and a lower prevalence of normal stool frequency (19vs. 36 percent), heartburn (12vs. 27 percent), and a history of anorectal surgery (7vs. 21 percent) compared with those with normal pelvic floor function. All four symptoms retained an independent value in the logistic regression analysis for pelvic floor dysfunction. Two symptoms characterized the group with normal transit and normal pelvic floor function: normal stool frequency and alternating diarrhea and constipation. CONCLUSIONS: Symptoms are good predictors of transit time but poorer predictors of pelvic floor function in patients with constipation.

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Authors and Affiliations

  1. the Department of Medicine, Karolinska Institutet, Huddinge University Hospital, Huddinge, Sweden

    Greger Lindberg M.D., Ph.D. & Lars H. Nilsson M.D., Ph.D.

  2. the Department of Radiology, Karolinska Institutet, Huddinge University Hospital, Huddinge, Sweden

    Laszlo Mihocsa M.D.

  3. Karolinska Institutet, Department of Surgery, Huddinge University Hospital, K63, SE-141 86, Huddinge, Sweden

    Abdulhakim Glia M.D. & Jan Erik Åkerlund M.D., Ph.D.

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  1. Abdulhakim Glia M.D.
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  2. Greger Lindberg M.D., Ph.D.
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  3. Lars H. Nilsson M.D., Ph.D.
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  4. Laszlo Mihocsa M.D.
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  5. Jan Erik Åkerlund M.D., Ph.D.
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Glia, A., Lindberg, G., Nilsson, L.H. et al. Clinical value of symptom assessment in patients with constipation. Dis Colon Rectum 42, 1401–1408 (1999). https://doi.org/10.1007/BF02235036

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