Download PDF
CC BY-NC-ND 4.0 · Journal of Coloproctology 2022; 42(03): 210-216
DOI: 10.1055/s-0042-1750761
Original Article

Prevalence and Predictors of Functional Evacuation Disorder in Patients with Chronic Constipation

Manas Kumar Behera
1   Department of Hepatology, SCB Medical College and Hospital, Cuttack, Odisha, India
,
Debakanta Mishra
2   Department of Gastroenterology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
,
Manoj Kumar Sahu
2   Department of Gastroenterology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
,
Ayaskanta Singh
2   Department of Gastroenterology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
,
Girish Kumar Pati
2   Department of Gastroenterology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
,
Shobhit Agarwal
2   Department of Gastroenterology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
,
Jimmy Narayan 
2   Department of Gastroenterology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
› Author Affiliations Financial Support The authors have no sources of funding to declare
› Further Information
   Permissions and Reprints

Abstract

Background Functional evacuation disorder (FED) is the second most common cause of functional constipation (FC) after constipation-predominant irritable bowel syndrome. However, the data on FED is relatively scanty in our region. Hence, the present study was performed to evaluate the demographics of FED and to find out the predictors of FED in patients with chronic constipation.

Methods A total of 134 patients with chronic constipation diagnosed according to the Rome IV criteria who were referred for high-resolution anorectal manometry (HRAM) were retrospectively enrolled in the present study. All FC patients who underwent HRAM were asked to fill a questionnaire and underwent anorectal manometry and were submitted to the balloon expulsion test (BET).

Results The mean age of patients was 43.09 ± 9.32 years old, with a total of 76 (54%) males. The most common symptom was straining during defecation (87%) followed by incomplete evacuation (86%). The prevalence of FED, diagnosed by HRAM and by the BET was 39%. Patients with FED had a significantly higher percentage of straining and sensation of anorectal blockade compared with those without FED (96 versus 82%; p < 0.01; 81 versus 44%; p < 0.001, respectively). On the multivariate regression analysis, straining > 30 minutes (odds ratio [OR] = 3.63; p = 0.03), maximum squeeze pressure (OR = 1.05; p < 0.001), and balloon volume at maximal sensation (OR = 1.06; p < 0.001) were found to be significant independent predictors of FED.

Conclusion Prolonged straining and sensation of anorectal blockade were significant indicators of FED in patients with chronic constipation.

Keywords

chronic constipation - functional evacuation disorder - anorectal manometry - gender

Data Availability Statement

All data are reported in the present manuscript.


Contribution of the Authors

Behera M. K.: Preparation and presentation of the published work through the creation of the initial draft, data collection, review of the literature, and development of the finalized manuscript; Mishra D.: Data collection, critical review, commentary, and revision of the manuscript; Sahu M. K.: Critical review, commentary, and revision of the manuscript; Singh A.: Data collection, critical review, and final revision of the manuscript; Pati G. K.: Data collection and final revision of the manuscript; Agarwal S.: Data collection, revision of the manuscript; Narayan J.: Design of the study, revision of the final draft, critical review, and commentary.




Publication History

Received: 23 January 2022

Accepted: 06 May 2022

Article published online:
20 September 2022

© 2022. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Chang FY, Chen PH, Wu TC. et al. Prevalence of functional gastrointestinal disorders in Taiwan: questionnaire-based survey for adults based on the Rome III criteria. Asia Pac J Clin Nutr 2012; 21 (04) 594-600
    PubMedGoogle Scholar
  • 2 Sobrado CW, Neto IJ, Pinto RA, Sobrado LF, Nahas SC, Cecconello I. Diagnosis and treatment of constipation: a clinical update based on the Rome IV criteria. J Coloproctol (Rio J) 2018; 38: 137-144
    Article in Thieme ConnectGoogle Scholar
  • 3 Tse Y, Armstrong D, Andrews CN. et al. Treatment algorithm for chronic idiopathic constipation and constipation-predominant irritable bowel syndrome derived from a Canadian national survey and needs assessment on choices of therapeutic agents. Can J Gastroenterol Hepatol 2017; 2017: 8612189
    PubMedGoogle Scholar
  • 4 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 (07) 1755-1758
    CrossrefPubMedGoogle Scholar
  • 5 Shin JE, Jung HK, Lee TH. et al. Guidelines for the diagnosis and treatment of chronic functional constipation in Korea, 2015 revised edition. J Neuro gastroenterol Motil 2016; 22: 383-411
    CrossrefPubMedGoogle Scholar
  • 6 Forootan M, Bagheri N, Darvishi M. Chronic constipation: A review of literature. Medicine (Baltimore) 2018; 97 (20) e10631
    CrossrefPubMedGoogle Scholar
  • 7 Rao SS, Welcher KD, Leistikow JS. Obstructive defecation: a failure of rectoanal coordination. Am J Gastroenterol 1998; 93 (07) 1042-1050
    CrossrefPubMedGoogle Scholar
  • 8 Rao SS, Patcharatrakul T. Diagnosis and treatment of dyssynergic defecation. J Neurogastroenterol Motil 2016; 22 (03) 423-435
    CrossrefPubMedGoogle Scholar
  • 9 Rao SS, Bharucha AE, Chiarioni G. et al. Functional anorectal disorders. Gastroenterology 2016; 150: 1430-1442.e4
    CrossrefPubMedGoogle Scholar
  • 10 Ghoshal UC. Review of pathogenesis and management of constipation. Trop Gastroenterol 2007; 28 (03) 91-95
    PubMedGoogle Scholar
  • 11 Andromanakos N, Skandalakis P, Troupis T, Filippou D. Constipation of anorectal outlet obstruction: pathophysiology, evaluation and management. J Gastroenterol Hepatol 2006; 21 (04) 638-646
    CrossrefPubMedGoogle Scholar
  • 12 Schmulson M, Corazziari E, Ghoshal UC. 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 cross-cultural, multinational research. Neurogastroenterol Motil 2014; 26 (10) 1368-1385
    CrossrefPubMedGoogle Scholar
  • 13 Higgins PD, Johanson JF. Epidemiology of constipation in North America: a systematic review. Am J Gastroenterol 2004; 99 (04) 750-759
    CrossrefPubMedGoogle Scholar
  • 14 Adeyemo MA, Spiegel BM, Chang L. Meta-analysis: do irritable bowel syndrome symptoms vary between men and women?. Aliment Pharmacol Ther 2010; 32 (06) 738-755
    CrossrefPubMedGoogle Scholar
  • 15 Mearin F, Lacy BE, Chang L. et al. Bowel Disorders. Gastroenterology 2016; 150: 1393-1407
    CrossrefPubMedGoogle Scholar
  • 16 Korah AT, Misra A, Kumar S, Ghoshal UC. Manometric spectrum of fecal incontinence in a tertiary care center in northern India. Trop Gastroenterol 2010; 31 (03) 165-168
    PubMedGoogle Scholar
  • 17 Behera MK, Dixit VK, Shukla SK. et al. Solitary rectal ulcer syndrome: clinical, endoscopic, histological and anorectal manometry findings in north Indian patients. Trop Gastroenterol 2015; 36 (04) 244-250
    CrossrefPubMedGoogle Scholar
  • 18 Goyal O, Bansal M, Sood A. Clinical and anorectal manometry profile of patients with functional constipation and constipation-predominant irritable bowel syndrome. Indian J Gastroenterol 2019; 38 (03) 211-219
    CrossrefPubMedGoogle Scholar
  • 19 Zhao Y, Ren X, Qiao W, Dong L, He S, Yin Y. High-resolution Anorectal Manometry in the Diagnosis of Functional Defecation Disorder in Patients With Functional Constipation: A Retrospective Cohort Study. J Neurogastroenterol Motil 2019; 25 (02) 250-257
    CrossrefPubMedGoogle Scholar
  • 20 Öncü K, Özel AM, Demırtürk L, Gürbüz AK, Yazgan Y, Kizilkaya E. Determination of the frequency of dyssynergic defecation and patient characteristics in patients with functional constipation. Turk J Gastroenterol 2010; 21 (04) 372-380
    CrossrefPubMedGoogle Scholar
  • 21 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. 02) S22-S28
    PubMedGoogle Scholar
  • 22 Lunniss PJ, Gladman MA, Benninga MA, Rao SS. Pathophysiology of evacuation disorders. Neurogastroenterol Motil 2009; 21 (Suppl. 02) 31-40
    CrossrefPubMedGoogle Scholar
  • 23 Whitehead WE, Wald A, Diamant NE, Enck P, Pemberton JH, Rao SS. Functional disorders of the anus and rectum. Gut 1999; 45 (Suppl. 02) II55-II59
    PubMedGoogle Scholar
  • 24 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 (03) 657-664
    CrossrefPubMedGoogle Scholar
  • 25 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 (02) 83-90
    CrossrefPubMedGoogle Scholar
  • 26 Grotz RL, Pemberton JH, Talley NJ, Rath DM, Zinsmeister AR. Discriminant value of psychological distress, symptom profiles, and segmental colonic dysfunction in outpatients with severe idiopathic constipation. Gut 1994; 35 (06) 798-802
    CrossrefPubMedGoogle Scholar
  • 27 Chitkara DK, Bredenoord AJ, Cremonini F. et al. The role of pelvic floor dysfunction and slow colonic transit in adolescents with refractory constipation. Am J Gastroenterol 2004; 99 (08) 1579-1584
    CrossrefPubMedGoogle Scholar
  • 28 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 (01) 22-28
    PubMedGoogle Scholar
  • 29 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 (06) 530-536
    CrossrefPubMedGoogle Scholar