Advertisement

Motility Disorders of the Colon and Rectum

  • Uday C. Ghoshal
Chapter
Part of the GI Surgery Annual book series (GISA, volume 22)

Abstract

A large proportion of patients with constipation presenting in tertiary care practice have refractory constipation in whom the primary treatment such as lifestyle modification, osmotic laxative and fibre has failed. A considerable number of these patients may be suffering from colonic and anorectal motility disorders such as slow colonic transit, faecal evacuation disorder or a combination of these. In a study from a tertiary care centre in Thailand, of 103 patients with chronic constipation, 30, 14, 11 and 48 patients were diagnosed to have anorectal dysfunction, colonic inertia, anorectal dysfunction with colonic inertia, and normal transit constipation, respectively [1]. In a retrospective study from our centre, of 130 patients with chronic constipation referred for anorectal physiological testing, 46 % had abnormal anorectal manometry and 35 % abnormal balloon expulsion test, and 17 % of 48 patients undergoing defaecography had abnormal results suggesting faecal evacuation disorder (unpublished data). In another recent Indian study, of 99 patients with primary chronic constipation, 46, 15 and 40 had normal transit, slow transit constipation, and faecal evacuation disorder, respectively [2]. It is important to understand these pathophysiological mechanisms to treat these patients effectively. Faecal incontinence, another motility abnormality of the anorectum, is not reviewed here.

Keywords

Botulinum Toxin Rectal Prolapse Chronic Constipation Anorectal Manometry Colonic Motility 
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.
    Gonlachanvit S, Patcharatrakul T. Causes of idiopathic constipation in Thai patients: Associations between the causes and constipation symptoms as defined in the Rome II criteria. J Med Assoc Thai 2004;87 Suppl 2:S22–8.PubMedGoogle Scholar
  2. 2.
    Shah N, Baijal R, Kumar P, Gupta D, Kulkarni S, Doshi S, 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
  3. 3.
    Heaton KW, Radvan J, Cripps H, Mountford RA, Braddon FE, Hughes AO. Defecation frequency and timing, and stool form in the general population: A prospective study. Gut 1992;33:818–24.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Shih DQ, Kwan LY. All Roads Lead to Rome: Update on Rome III criteria and new treatment options. Gastroenterol Rep 2007; 1: 56–65. PubMedPubMedCentralGoogle Scholar
  5. 5.
    Drossman DA. Rome III: The new criteria. Chin J Dig Dis 2006;7:181–5.Google Scholar
  6. 6.
    Dinning PG, Jones M, Hunt L, Fuentealba SE, Kalanter J, King DW, et al. Factor analysis identifies subgroups of constipation. World J Gastroenterol 2011;17:1468–74.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Park SK, Myung SJ, Jung KW, Chun YH, Yang DH, Seo SY, et al. Biofeedback therapy for female patients with constipation caused by radical hysterectomy or vaginal delivery. J Gastroenterol Hepatol 2013;28:1133–40.CrossRefPubMedGoogle Scholar
  8. 8.
    Chan AO, Lam KF, Hui WM, Hu WH, Li J, Lai KC, et al. Validated questionnaire on diagnosis and symptom severity for functional constipation in the Chinese population. Aliment Pharmacol Ther 2005;22:483–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Varma MG, Wang JY, Berian JR, Patterson TR, McCrea GL, Hart SL. The constipation severity instrument: A validated measure. Dis Colon Rectum 2008;51:162–72.CrossRefPubMedGoogle Scholar
  10. 10.
    Schey R, Cromwell J, Rao SS. Medical and surgical management of pelvic floor disorders affecting defecation. Am J Gastroenterol 2012;107:1624–33; quiz p.1634.Google Scholar
  11. 11.
    Wong RK, Drossman DA, Bharucha AE, Rao SS, Wald A, Morris CB, et al. The digital rectal examination: A multicenter survey of physicians’ and students’ perceptions and practice patterns. Am J Gastroenterol 2012;107:1157–63.CrossRefPubMedGoogle Scholar
  12. 12.
    Ghoshal UC. Review of pathogenesis and management of constipation. Trop Gastroenterol 2007;28:91–5.PubMedGoogle Scholar
  13. 13.
    Ghoshal UC, Sengar V, Srivastava D. Colonic transit study technique and interpretation: Can these be uniform globally in different populations with non-uniform colon transit time? J Neurogastroenterol Motil 2012;18:227–8.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Hinton JM, Lennard-Jones JE, Young AC. A new method for studying gut transit times using radioopaque markers. Gut 1969;10:842–7.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Nabar AA, Bhatia SJ, Abraham P, Ravi P, Mistry FP. Total and segmental colonic transit time in non ulcer dyspepsia. Indian J Gastroenterol 1995;14:131–3.PubMedGoogle Scholar
  16. 16.
    Ghoshal UC, Gupta D, Kumar A, Misra A. Colonic transit study by radio-opaque markers to investigate constipation: Validation of a new protocol for a population with rapid gut transit. Natl Med J India 2007;20:225–9.PubMedGoogle Scholar
  17. 17.
    Bove A, Pucciani F, Bellini M, Battaglia E, Bocchini R, Altomare DF, et al. Consensus statement AIGO/SICCR: Diagnosis and treatment of chronic constipation and obstructed defecation (Part I: Diagnosis). World J Gastroenterol 2012;18:1555–64.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Feyen BJ, Rao SS. Functional disorders of defecation: Evaluation and treatment. Curr Treat Options Gastroenterol 2007;10:221–30.CrossRefPubMedGoogle Scholar
  19. 19.
    Lee HJ, Jung KW, Han S, Kim JW, Park SK, Yoon IJ, et al. Normal values for high-resolution anorectal manometry/topography in a healthy Korean population and the effects of gender and body mass index. Neurogastroenterol Motil 2014; 26:52937.CrossRefPubMedGoogle Scholar
  20. 20.
    Pezim ME, Pemberton JH, Levin KE, Litchy WJ, Phillips SF. Parameters of anorectal and colonic motility in health and in severe constipation. Dis Colon Rectum 1993;36:484–91.CrossRefPubMedGoogle Scholar
  21. 21.
    Rao SS, Kavlock R, Rao S. Influence of body position and stool characteristics on defecation in humans. Am J Gastroenterol 2006;101:2790–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Rao SS, Hatfield R, Soffer E, Rao S, Beaty J, Conklin JL. Manometric tests of anorectal function in healthy adults. Am J Gastroenterol 1999;94:773–83.CrossRefPubMedGoogle Scholar
  23. 23.
    Lee BE, Kim GH. How to perform and interpret balloon expulsion test. J Neurogastroenterol Motil 2014;20:407–9.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Minguez M, Herreros B, Sanchiz V, Hernandez V, Almela P, Añon R, et al. Predictive value of the balloon expulsion test for excluding the diagnosis of pelvic floor dyssynergia in constipation. Gastroenterology 2004;126:57–62.CrossRefPubMedGoogle Scholar
  25. 25.
    Kim AY. How to interpret a functional or motility test—defecography. J Neurogastroenterol Motil 2011;17:416–20.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Sharma A, Misra A, Ghoshal UC. Fecal evacuation disorder among patients with solitary rectal ulcer syndrome: A case–control study. J Neurogastroenterol Motil 2014;20:531–8.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Emmanuel AV, Kamm MA. Response to a behavioural treatment, biofeedback, in constipated patients is associated with improved gut transit and autonomic innervation. Gut 2001;49:214–19.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Schmulson M, Corazziari E, Ghoshal UC, Myung SJ, Gerson CD, Quigley EM, et al. A four-country comparison of healthcare systems, implementation of diagnostic criteria, and treatment availability for functional gastrointestinal disorders: A report of the Rome Foundation working team on crosscultural, multinational research. Neurogastroenterol Motil 2014;26:1368–85.CrossRefPubMedGoogle Scholar
  29. 29.
    Camilleri M, Tack JF. Current medical treatments of dyspepsia and irritable bowel syndrome. Gastroenterol Clin North Am 2010;39:481–93.CrossRefPubMedGoogle Scholar
  30. 30.
    Gwee KA, Ghoshal UC, Gonlachanvit S, Chua AS, Myung SJ, Rajindrajith S, et al. Primary care management of chronic constipation in Asia: The ANMA chronic constipation tool. J Neurogastroenterol Motil 2013;19:149–60.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Gwee KA, Bak YT, Ghoshal UC, Gonlachanvit S, Lee OY, Fock KM, et al; Asian Neurogastroenterology and Motility Association. Asian consensus on irritable bowel syndrome. J Gastroenterol Hepatol 2010;25:1189–205.Google Scholar
  32. 32.
    Müller-Lissner SA, Kamm MA, Scarpignato C, Wald A. Myths and misconceptions about chronic constipation. Am J Gastroenterol 2005;100:232–42.CrossRefPubMedGoogle Scholar
  33. 33.
    Kamm MA, Mueller-Lissner S, Wald A, Richter E, Swallow R, Gessner U. Oral bisacodyl is effective and well-tolerated in patients with chronic constipation. Clin Gastroenterol Hepatol 2011;9:577–83.CrossRefPubMedGoogle Scholar
  34. 34.
    Ke M, Zou D, Yuan Y, Li Y, Lin L, Hao J, et al. Prucalopride in the treatment of chronic constipation in patients from the Asia-Pacific region: A randomized, double-blind, placebo-controlled study. Neurogastroenterol Motil 2012;24:999–e541.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Atluri DK, Chandar AK, Bharucha AE, Falck-Ytter Y. Effect of linaclotide in irritable bowel syndrome with constipation (IBS-C): A systematic review and meta-analysis. Neurogastroenterol Motil 2014;26:499–509.CrossRefPubMedGoogle Scholar
  36. 36.
    Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology 2014;146:67–75.e5.Google Scholar
  37. 37.
    Bassotti G, Chistolini F, Sietchiping-Nzepa F, de Roberto G, Morelli A, Chiarioni G. Biofeedback for pelvic floor dysfunction in constipation. BMJ 2004;328:393–6.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Battaglia E, Serra AM, Buonafede G, Dughera L, Chistolini F, Morelli A, et al. 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 2004;47:90–5.CrossRefPubMedGoogle Scholar
  39. 39.
    Bleijenberg G, Kuijpers HC. Biofeedback treatment of constipation: A comparison of two methods. Am J Gastroenterol 1994;89:1021–6.PubMedGoogle Scholar
  40. 40.
    Chiarioni G, Whitehead WE, Pezza V, Morelli A, Bassotti G. Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology 2006;130:657–64.CrossRefPubMedGoogle Scholar
  41. 41.
    Chiarioni G, Heymen S, Whitehead WE. Biofeedback therapy for dyssynergic defecation. World J Gastroenterol 2006;12:7069–74.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Chiotakakou-Faliakou E, Kamm MA, Roy AJ, Storrie JB, Turner IC. Biofeedback provides long-term benefit for patients with intractable, slow and normal transit constipation. Gut 1998;42:517–21.CrossRefPubMedGoogle Scholar
  43. 43.
    Heymen S, Scarlett Y, Jones K, Ringel Y, Drossman D, Whitehead WE. Randomized, controlled trial shows biofeedback to be superior to alternative treatments for patients with pelvic floor dyssynergia-type constipation. Dis Colon Rectum 2007;50:428–41.CrossRefPubMedGoogle Scholar
  44. 44.
    McKee RF, McEnroe L, Anderson JH, Finlay IG. Identification of patients likely to benefit from biofeedback for outlet obstruction constipation. Br J Surg 1999;86:355–9.CrossRefPubMedGoogle Scholar
  45. 45.
    Nehra V, Bruce BK, Rath-Harvey DM, Pemberton JH, Camilleri M. Psychological disorders in patients with evacuation disorders and constipation in a tertiary practice. Am J Gastroenterol 2000;95:1755–8.CrossRefPubMedGoogle Scholar
  46. 46.
    Farid M, El Monem HA, Omar W, El Nakeeb A, Fikry A, Youssef T, et al. Comparative study between biofeedback retraining and botulinum neurotoxin in the treatment of anismus patients. Int J Colorectal Dis 2009;24:115–20.CrossRefPubMedGoogle Scholar
  47. 47.
    Farid M, Youssef T, Mahdy T, Omar W, Moneim HA, El Nakeeb A, et al. Comparative study between botulinum toxin injection and partial division of puborectalis for treating anismus. Int J Colorectal Dis 2009;24:327–34.CrossRefPubMedGoogle Scholar
  48. 48.
    Jung KW, Yang DH, Yoon IJ, Seo SY, Koo HS, Lee HJ, et al. Electrical stimulation therapy in chronic functional constipation: Five years’ experience in patients refractory to biofeedback therapy and with rectal hyposensitivity. J Neurogastroenterol Motil 2013;19:366–73.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Pfeifer J, Agachan F, Wexner SD. Surgery for constipation: A review. Dis Colon Rectum 1996;39:444–60.CrossRefPubMedGoogle Scholar
  50. 50.
    Kumar A, Lokesh H, Ghoshal UC. Successful outcome of refractory chronic constipation by surgical treatment: A series of 34 patients. J Neurogastroenterol Motil 2013;19:78–84.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Pfeifer J. Surgery for constipation. Acta Chir Iugosl 2006;53:71–9.CrossRefPubMedGoogle Scholar

Copyright information

© T.K. Chattopadhyay 2015

Authors and Affiliations

  • Uday C. Ghoshal
    • 1
  1. 1.Department of GastroenterologySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia

Personalised recommendations