Advertisement

Benign Colorectal Disease

Chapter

Abstract

The incidence of benign medical and surgical diseases of the colon and rectum increases with age. Although constipation, fecal incontinence, and several other associated benign ­conditions increase in frequency with aging, a paucity of information exists regarding the normal aging effect on gastrointestinal pathophysiology. Studies documenting anatomic, physiologic, and pathologic changes that occur in the aging colon have not been definitive, and many studies have reported conflicting results. Mucosal atrophy, atrophy of ­circular muscles, thickening of longitudinal muscles (taeniae coli), increased elastin deposition, and atherosclerosis are several of the changes seen in the aging bowel [1]. These changes may factor into the development of several disease states (i.e., diverticular disease and angiodysplasia). Medications affect gastrointestinal function and many have constipation as a side effect. Preexisting diseases (cardiac, pulmonary, renal, neurologic, psychiatric) may affect colonic motility directly or secondarily. In addition, these comorbidities affect medical and surgical therapy, making geriatric operative risks higher. Early diagnosis and treatment is crucial even for seemingly benign diseases or symptoms. In this chapter, we address benign colorectal diseases frequently encountered in the elderly patient and which may increase as the population ages. Diseases common to both young and old persons, such as hemorrhoids and fissures, are not discussed.

Keywords

Pelvic Organ Prolapse Fecal Incontinence Anal Sphincter Rectal Prolapse Pudendal Nerve 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Whiteway J, Morson B (1985) Pathology of the aging: diverticular disease. Clin Gastroenterol 14:829–846PubMedGoogle Scholar
  2. 2.
    Everhart JE, Go VL, Johannes RS et al (1989) A longitudinal survey of self-reported bowel habits in the United States. Dig Dis Sci 34:1153–1162PubMedCrossRefGoogle Scholar
  3. 3.
    Stewart WF, Liberman JN, Sandler RS et al (1999) Epidemiology of constipation (EPOC) study in the United States: relation of clinical subtypes to sociodemographic features. Am J Gastroenterol 94:3530–3540PubMedCrossRefGoogle Scholar
  4. 4.
    Read NW, Celik AF, Katsinelos P (1995) Constipation and incontinence in the elderly. J Clin Gastroenterol 20:61–70PubMedCrossRefGoogle Scholar
  5. 5.
    Stewart RB, Moore MT, Marks RG, Hale WE (1992) Correlates of constipation in an ambulatory elderly population. Am J Gastroenterol 87:859–864PubMedGoogle Scholar
  6. 6.
    Connell AM, Hilton C, Irvine G et al (1965) Variation of bowel habit in two population samples. Br Med J 2:1095–1099PubMedCrossRefGoogle Scholar
  7. 7.
    Milne JS, Williamson J (1972) Bowel habit in older people. Gerontol Clin 14:56–60CrossRefGoogle Scholar
  8. 8.
    Donald IP, Smith RG, Cruikshank JG et al (1985) A study of constipation in the elderly living at home. Gerontology 31:112–118PubMedCrossRefGoogle Scholar
  9. 9.
    Harari D, Gurwitz JH, Minaker KL (1993) Constipation in the elderly. J Am Geriatr Soc 41:1130–1140PubMedGoogle Scholar
  10. 10.
    Moore-Gillon V (1984) Constipation: what does the patient mean? J R Soc Med 77:108–110PubMedGoogle Scholar
  11. 11.
    Merkel IS, Locher J, Burgio K et al (1993) Physiologic and psychologic characteristics of an elderly population with chronic constipation. Am J Gastroenterol 88:1854–1859PubMedGoogle Scholar
  12. 12.
    Johanson JF, Sonnenberg A, Koch TR (1989) Clinical epidemiology of chronic constipation. J Clin Gastroenterol 11:525–536PubMedCrossRefGoogle Scholar
  13. 13.
    Thompson WG, Longstreth GF, Drossman DA et al (1999) Functional bowel disorders and functional abdominal pain. Gut 45(suppl 2):1143–1147Google Scholar
  14. 14.
    Muller-Lissner SA (1988) Effect of wheat bran on weight of stool and gastrointestinal transit time: a meta-analysis. Br Med J 296:615–617CrossRefGoogle Scholar
  15. 15.
    Campbell AJ, Busby WJ, Horwath CC (1993) Factors associated with constipation in a community based sample of people aged 70 years and over. J Epidemiol Community Health 47:23–26PubMedCrossRefGoogle Scholar
  16. 16.
    Smith B (1968) Effect of irritant purgatives on the myenteric plexus in man and the mouse. Gut 9:139–143PubMedCrossRefGoogle Scholar
  17. 17.
    Locke GR III, Pemberton JH, Phillips SF (2000) American Gastroenterological Association Medical Position Statement: guidelines on constipation. Gastroenterology 119:1791–1796CrossRefGoogle Scholar
  18. 18.
    Tjandra JJ, Fazio VW, Church JM et al (1992) Clinical conundrum of solitary rectal ulcer. Dis Colon Rectum 35:227–234PubMedCrossRefGoogle Scholar
  19. 19.
    Metcalf A, Phillips S, Zinsmeister A et al (1987) Simplified ­assessment of segmental colonic transit. Gastroenterology 92:40–47PubMedGoogle Scholar
  20. 20.
    Melkersson M, Andersson H, Bosaeus I, Falkheden T (1983) Intestinal transit time in constipated and nonconstipated geriatric patients. Scand J Gastroenterol 18:593–597PubMedCrossRefGoogle Scholar
  21. 21.
    Kelvin FM, Hale DX, Maglinte DD et al (1999) Female pelvic organ prolapse: diagnostic contribution of dynamic cystoproctography and comparison with physical examination. AJR Am J Roentgenol 173:31–37PubMedGoogle Scholar
  22. 22.
    Lienemann A, Anthuber C, Baron A et al (1997) Dynamic MR colpocystorectography assessing pelvic floor descent. Eur Radiol 7:1309–1317PubMedCrossRefGoogle Scholar
  23. 23.
    Hecht EM, Lee VS, Tanpitukpongse TP et al (2008) MRI of pelvic floor dysfunction: dynamic true fast imaging with steady state precision versus HASTE. AJR Am J Roentgenol 191:352–358PubMedCrossRefGoogle Scholar
  24. 24.
    Maglinte DD, Kelvin FM, Fitzgerald K et al (1999) Association of compartment defects in pelvic floor dysfunction. AJR Am J Roentgenol 172:439–444PubMedGoogle Scholar
  25. 25.
    Stoker J, Halligan S, Bartram CI (2001) Pelvic floor imaging. Radiology 218:621–641PubMedGoogle Scholar
  26. 26.
    Modot L, Movellas S, Senni M et al (2007) Pelvic prolapse: static and dynamic MRI. Abdom Imaging 32:775–783CrossRefGoogle Scholar
  27. 27.
    Thomas DR, Forrester L, Gloth MF et al (2003) Clinical consensus: the constipation crisis in long-term care. Ann Longterm Care 11(suppl):3–14Google Scholar
  28. 28.
    Shariati A, Maceda JS, Hale DS (2008) High-fiber diet for treatment of constipation in women with pelvic floor disorders. Obstet Gynecol 111:908–913PubMedCrossRefGoogle Scholar
  29. 29.
    Fleshman J, Dreznik Z, Meyer K et al (1992) Outpatient protocol for biofeedback therapy of pelvic floor outlet obstruction. Dis Colon Rectum 35:1–7PubMedCrossRefGoogle Scholar
  30. 30.
    Harrington KL, Haskvitz EM (2006) Managing a patient’s constipation with physical therapy. Phys Ther 86:1511–1519PubMedCrossRefGoogle Scholar
  31. 31.
    Kuijpers HC, Schreve RH, ten Cate Hoedemakers H (1986) Diagnosis of functional disorders of defecation causing the solitary rectal ulcer syndrome. Dis Colon Rectum 29:126–129PubMedCrossRefGoogle Scholar
  32. 32.
    Gerten KA, Markland AD, Lloyd LK et al (2008) Prolapse and incontinence surgery in older women. J Urol 179:2111–2118PubMedCrossRefGoogle Scholar
  33. 33.
    Altemeier WA, Culbertson WR, Schowengerdt C, Hunt J (1971) Nineteen years’ experience with the one-stage perineal repair of rectal prolapse. Ann Surg 173:993–1006PubMedCrossRefGoogle Scholar
  34. 34.
    Williams JG, Rothenberger DA, Madoff RD, Goldberg SM (1992) Treatment of rectal prolapse in the elderly by perineal rectosigmoidectomy. Dis Colon Rectum 35:830–834PubMedCrossRefGoogle Scholar
  35. 35.
    Lieberth M, Kondyllis LA, Reilly JC et al (2009) The Delorme repair for full thickness rectal prolapse: a retrospective review. Am J Surg 197:418–423PubMedCrossRefGoogle Scholar
  36. 36.
    Watts JD, Rothenberger DA, Bulls JG et al (1985) The management of procidentia: 30 years’ experience. Dis Colon Rectum 28:96–102PubMedCrossRefGoogle Scholar
  37. 37.
    Kuijpers HC (1992) Treatment of complete rectal prolapse: to narrow, to wrap, to suspend, to fix, to encircle, to plicate or to resect? World J Surg 16:826–830PubMedCrossRefGoogle Scholar
  38. 38.
    McKee RF, Lauder JC, Poon FW et al (1992) A prospective ­randomized study of abdominal rectopexy with and without sigmoidectomy in rectal prolapse. Surg Gynecol Obstet 174:145–148PubMedGoogle Scholar
  39. 39.
    Ripstein CB (1952) Treatment of massive rectal prolapse. Am J Surg 83:68–71PubMedCrossRefGoogle Scholar
  40. 40.
    Kuijpers JHC, DeMorree H (1988) Toward a selection of the most appropriate procedure in the treatment of complete rectal prolapse. Dis Colon Rectum 31:355–357PubMedCrossRefGoogle Scholar
  41. 41.
    Berman IR (1992) Sutureless laparoscopic rectopexy for procidentia: technique and implications. Dis Colon Rectum 35:689–693PubMedCrossRefGoogle Scholar
  42. 42.
    Kariv Y, Delaney CP, Casillas S et al (2006) Long term outcome after laparoscopic and open surgery for rectal prolapse: a case control study. Surg Endosc 20:35–42PubMedCrossRefGoogle Scholar
  43. 43.
    Carpelan-Holmstrom M, Kruuna O, Scheinin T (2006) Laparoscopic rectal prolapse surgery combined with short hospital stay is safe in elderly and debilitated patients. Surg Endosc 20:1353–1359PubMedCrossRefGoogle Scholar
  44. 44.
    Madiba TE, Baig MK, Wexner SD (2005) Surgical management of rectal prolapse. Arch Surg 140:63–73PubMedCrossRefGoogle Scholar
  45. 45.
    Raftopoulous Y, Senagore AJ, DiGiuroetal G (2005) Recurrence rates after abdominal surgery for complete rectal prolapse: a multicenter pooled analysis of 643 individual patient data. Dis Colon Rectum 48:1200–1206CrossRefGoogle Scholar
  46. 46.
    Mikulicz J (1889) Zur operativen behandlung des prolapsus recti et coli invaginati. Arch Klin Chir 38:74–97Google Scholar
  47. 47.
    Prasad ML, Pearl RK, Abcarian H et al (1986) Perineal proctectomy, posterior rectopexy, and postanal levator repair for the treatment of rectal prolapse. Dis Colon Rectum 29:547–552PubMedCrossRefGoogle Scholar
  48. 48.
    Delorme E (1985) On the treatment of total rectal prolapse of the rectum by excision of the rectal mucous membranes or recto-colic. Dis Colon Rectum 28:544–553CrossRefGoogle Scholar
  49. 49.
    Watkins BP, Landercasper J, Belzer GE et al (2003) Long-term follow-up of the modified Delorme procedure for rectal prolapse. Arch Surg 138:498–503PubMedCrossRefGoogle Scholar
  50. 50.
    Serpell JW, Nicholls RJ (1990) Stercoral perforation of the colon. Br J Surg 77:1325–1329PubMedCrossRefGoogle Scholar
  51. 51.
    Heffernan C, Pachter HL, Megbow AJ et al (2005) Stercoral colitis leading to patal peritonitis: CT findings. AJR Am J Roentgenol 184:1189–1193PubMedGoogle Scholar
  52. 52.
    Guyton DP, Evans D, Schreiber H (1985) Stercoral perforation of the colon: concepts of operative management. Am Surg 51:520–522PubMedGoogle Scholar
  53. 53.
    Ballantyne GH, Brandner MD, Beart RW, Ilstrup DM (1985) Volvulus of the colon; incidence and mortality. Ann Surg 202:83–92PubMedCrossRefGoogle Scholar
  54. 54.
    Habr Gama A, Haddad J, Simonsen O, Warde P et al (1976) Volvulus of the sigmoid colon in Brazil: a report of 230 cases. Dis Colon Rectum 19:314–320CrossRefGoogle Scholar
  55. 55.
    Ballantyne GH (1982) Review of sigmoid volvulus: history and results of treatments. Dis Colon Rectum 25:494–501PubMedCrossRefGoogle Scholar
  56. 56.
    Bak MP, Boley SJ (1986) Sigmoid volvulus in elderly patients. Am J Surg 151:71–75PubMedCrossRefGoogle Scholar
  57. 57.
    Hines JR, Geurkink RE, Bass RT (1967) Recurrence and mortality rates in sigmoid volvulus. Surg Gynecol Obstet 124:567–570PubMedGoogle Scholar
  58. 58.
    Arnold GJ, Nance FC (1973) Volvulus of the sigmoid colon. Ann Surg 177:527–533PubMedCrossRefGoogle Scholar
  59. 59.
    Wolfer JA, Beaton LE, Anson BJ (1942) Volvulus of the cecum: anatomical factors in its etiology; report of a case. Surg Gynecol Obstet 74:882–894Google Scholar
  60. 60.
    Rabinovici R, Simansky DA, Kaplan O et al (1990) Cecal volvulus. Dis Colon Rectum 55:765–769CrossRefGoogle Scholar
  61. 61.
    Todd GJ, Forde KA (1979) Volvulus of the cecum: choice of operation. Am J Surg 138:632–634PubMedCrossRefGoogle Scholar
  62. 62.
    Barrett JA, Brocklehurst JC, Kiff ES et al (1989) Anal function in geriatric patients with faecal incontinence. Gut 30:1244–1251PubMedCrossRefGoogle Scholar
  63. 63.
    Nelson R, Norton N, Cautley E, Furner S (1995) Community-based prevalence of anal incontinence. JAMA 274:559–561PubMedCrossRefGoogle Scholar
  64. 64.
    Norton C, Whitehead WE, Bliss DZ et al (2005) Conservative and pharmacologic management of fecal incontinence in adults. In: Abrams P, Cardozo L, Khoury S, Wein A (eds) Incontinence, 3rd international consultation on incontinence. Health Publications, Paris, pp 1521–1564Google Scholar
  65. 65.
    Oberwalder M, Dinnewitzer A, Baig MK et al (2004) The association between late-onset fecal incontinence and obstetric anal sphincter defects. Arch Surg 139:429–432PubMedCrossRefGoogle Scholar
  66. 66.
    McHugh SM, Diamant NE (1987) Effect of age, gender, and parity on anal canal pressures; contribution of impaired anal sphincter function to fecal incontinence. Dig Dis Sci 32:726–736PubMedCrossRefGoogle Scholar
  67. 67.
    Bannister JJ, Abouzekry I, Read NW (1987) Effect of aging on anorectal function. Gut 28:353–357PubMedCrossRefGoogle Scholar
  68. 68.
    Roach M, Christie JA (2008) Fecal incontinence in the elderly. Geriatrics 63:13–22PubMedGoogle Scholar
  69. 69.
    Whitehead WE, Burgio KL, Engel BT (1985) Biofeedback treatment of fecal incontinence in geriatric patients. J Am Geriatr Soc 33:320–324PubMedGoogle Scholar
  70. 70.
    Markland AD, Richter HE, Burgio KL et al (2008) Outcomes of combination treatment of fecal incontinence in women. Am J Obstet Gynecol 199:699.el–699.e7CrossRefGoogle Scholar
  71. 71.
    Simmang C, Birnbaum EH, Kodner IJ et al (1994) Anal sphincter reconstruction in the elderly: does advancing age affect outcome? Dis Colon Rectum 37:1065–1069PubMedCrossRefGoogle Scholar
  72. 72.
    Nyhus LM (ed) (1992) Surgery annual, vol 24. McGraw-Hill, New YorkGoogle Scholar
  73. 73.
    Schwartz SI (ed) (1998) Principles of surgery, 6th edn. McGraw-Hill, New YorkGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of SurgeryBarnes Jewish Hospital, Washington University School of MedicineSt. LouisUSA

Personalised recommendations