Advertisement

Indian Journal of Gastroenterology

, Volume 37, Issue 3, pp 255–260 | Cite as

Clinical predictors and gender-wise variations in dyssynergic defecation disorders

  • Mayank Jain
  • Rajiv Baijal
  • Melpakkam Srinivas
  • Jayanthi Venkataraman
Original Article

Abstract

Background

There is insufficient data from India regarding clinical predictors of dyssynergic defecation.

Aim

To identify demography, symptom, and colonoscopic parameters that can predict dyssynergic defecation (DD) among patients with chronic constipation (CC) and to compare the profile among male and female patients with DD.

Methods

Data collected from three centers during June 2014 to May 2017 included age, gender, symptom duration, form and consistency of stools, digital examination, colonoscopy, and anorectal manometry (ARM). Patients were grouped based on ARM diagnosis: group I (normal study) and group II (DD). The two groups were compared for demography, symptom profile, and colonoscopy findings. Gender-wise subset analysis was done for those with the normal and abnormal ARM using chi-square and unpaired t tests.

Results

Of 236 patients with CC evaluated, 130 (55%) had normal ARM and 106 (45%) had DD. Male sex, straining during defecation, bleeding per rectum, and abnormal colonoscopic diagnosis were significantly more common in group II. While bleeding per rectum and absence of urge to defecate were more common in males (p < 0.02), straining, digital evacuation, and hard stools were commoner in females with DD.

Conclusion

Straining during defecation, bleeding per rectum, and abnormal colonoscopy findings were more common in patients with DD. Symptoms of bleeding per rectum and absence of urge to defecate in men and straining during defecation in female patients were significantly associated with DD. Symptoms differ in males and females with DD.

Keywords

Anorectal manometry Chronic constipation Dyssynergic defecation 

Notes

Compliance with ethical standards

Conflict of interest

MJ, RB, MS, and JV declare that they have no conflict of interest.

Ethics statement

The study was performed in a manner to conform with the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com. The study protocol was approved by the institutional review board and ethics committee.

References

  1. 1.
    Ghoshal UC. Chronic constipation in Rome IV era: the Indian perspective. Indian J Gastroenterol. 2017;36:163–73.CrossRefPubMedGoogle Scholar
  2. 2.
    Rao SS, Patcharatrakul T. Diagnosis and treatment of dyssynergic defecation. J Neurogastroenterol Motil. 2016;22:423–35.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Shah N, Baijal R, Kumar P, et al. Clinical and investigative assessment of constipation: a study from a referral center in western India. Indian J Gastroenterol. 2014;33:530–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Ratuapli S, Bharucha AE, Harvey D, Zinsmeister AR. Comparison of rectal balloon expulsion test in seated and left lateral positions. Neurogastroenterol Motil. 2013;25:e813–20.CrossRefPubMedGoogle Scholar
  5. 5.
    Rao SS, Hatfield R, Soffer E, et al. Manometric tests of anorectal function in healthy adults. Am J Gastroenterol. 1999;94:773–83.CrossRefPubMedGoogle Scholar
  6. 6.
    Rao SS. Dyssynergic defecation and biofeedback therapy. Gastroenterol Clin N Am. 2008;37:569–86.CrossRefGoogle Scholar
  7. 7.
    Videlock EJ, Lembo A, Cremonini F. Diagnostic testing for dyssynergic defecation in chronic constipation: meta-analysis. Neurogastroenterol Motil. 2013;25:509–20.CrossRefPubMedGoogle Scholar
  8. 8.
    Ghoshal UC, Abraham P, Bhatt C, et al. Epidemiological and clinical profile of irritable bowel syndrome in India: report of the Indian Society of Gastroenterology Task Force. Indian J Gastroenterol. 2008;27:22–8.PubMedGoogle Scholar
  9. 9.
    Zhao YF, Ma XQ, Wang R, et al. Epidemiology of functional constipation and comparison with constipation-predominant irritable bowel syndrome: the Systematic Investigation of Gastrointestinal Diseases in China (SILC). Aliment Pharmacol Ther. 2011;34:1020–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Park JM, Choi MG, Cho YK, et al. Functional gastrointestinal disorders diagnosed by Rome III questionnaire in Korea. J Neurogastroenterol Motil. 2011;17:279–86.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Jain M, Baijal R. Dyssynergic defecation: demographics, symptoms, colonoscopic findings in north Indian patients. Indian J Gastroenterol. 2017;36:435–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Rao SS, Tuteja AK, Vellema T, Kempf J, Stessman M. Dyssynergic defecation: demographics, symptoms, stool patterns, and quality of life. J Clin Gastroenterol. 2004;38:680–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Ghoshal UC, Verma A, Misra A. Frequency, spectrum, and factors associated with fecal evacuation disorders among patients with chronic constipation referred to a tertiary care center in northern India. Indian J Gastroenterol. 2016;35:83–90.CrossRefPubMedGoogle Scholar
  14. 14.
    Panigrahi MK, Kar SK, Singh SP, Ghoshal UC. Defecation frequency and stool form in a coastal eastern Indian population. J Neurogastroenterol Motil. 2013;19:374–80.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Shin A, Camilleri M, Nadeau A, et al. Interpretation of overall colonic transit in defecation disorders in males and females. Neurogastroenterol Motil. 2013;25:502–8.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Jain M. Digital rectal examination—a reliable screening tool for dyssynergic defecation. Indian J Gastroenterol. 2018; 37:176–7.Google Scholar
  17. 17.
    Tantiphlachiva K, Rao P, Attaluri A, Rao SS. Digital rectal examination is a useful tool for identifying patients with dyssynergia. Clin Gastroenterol Hepatol. 2010;8:955–60.CrossRefPubMedGoogle Scholar

Copyright information

© Indian Society of Gastroenterology 2018

Authors and Affiliations

  1. 1.Choithram Hospital and Research CentreIndoreIndia
  2. 2.Gleneagles Global Health CityChennaiIndia
  3. 3.Pushpavati Singhania Hospital and Research CentreNew DelhiIndia

Personalised recommendations