| Phenotypic variation in functional disorders of defecation. | |
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MedLine Citation:
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PMID: 15887104 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND & AIMS: Although obstructed defecation is generally attributed to pelvic floor dyssynergia, clinical observations suggest a wider spectrum of anorectal disturbances. Our aim was to characterize phenotypic variability in constipated patients by anorectal assessments. METHODS: Anal pressures, rectal balloon expulsion, rectal sensation, and pelvic floor structure (by endoanal magnetic resonance imaging) and motion (by dynamic magnetic resonance imaging) were assessed in 52 constipated women and 41 age-matched asymptomatic women. Phenotypes were characterized in patients by principal components analysis of these measurements. RESULTS: Among patients, 16 had a hypertensive anal sphincter, 41 had an abnormal rectal balloon expulsion test, and 20 had abnormal rectal sensation. Forty-nine patients (94%) had abnormal pelvic floor motion during evacuation and/or squeeze. After correcting for age and body mass index, 3 principal components explained 71% of variance between patients. These factors were weighted most strongly by perineal descent during evacuation (factor 1), anorectal location at rest (factor 2), and anal resting pressure (factor 3). Factors 1 and 3 discriminated between controls and patients. Compared with patients with normal (n = 23) or reduced (n = 18) perineal descent, patients with increased (n = 11) descent were more likely (P < or = .01) to be obese, have an anal resting pressure >90 mm Hg, and have a normal rectal balloon expulsion test result. CONCLUSIONS: These observations demonstrate that functional defecation disorders comprise a heterogeneous entity that can be subcharacterized by perineal descent during defecation, perineal location at rest, and anal resting pressure. Further studies are needed to ascertain if the phenotypes reflect differences in the natural history of these disorders. |
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Authors:
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Adil E Bharucha; Joel G Fletcher; Barb Seide; Stephen J Riederer; Alan R Zinsmeister |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Gastroenterology Volume: 128 ISSN: 0016-5085 ISO Abbreviation: Gastroenterology Publication Date: 2005 May |
Date Detail:
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Created Date: 2005-05-11 Completed Date: 2005-07-05 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 0374630 Medline TA: Gastroenterology Country: United States |
Other Details:
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Languages: eng Pagination: 1199-210 Citation Subset: AIM; IM |
Affiliation:
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Division of Gastroenterology and Hepatology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA. bharucha.adil@mayo.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Anal Canal / physiology Balloon Dilatation Constipation / pathology*, physiopathology* Defecation* Fecal Incontinence / pathology*, physiopathology* Female Humans Magnetic Resonance Imaging / standards, statistics & numerical data Magnetics Manometry Middle Aged Observer Variation Perineum / physiology Phenotype Reproducibility of Results Sensation |
| Grant Support | |
ID/Acronym/Agency:
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R01 HD38666/HD/NICHD NIH HHS; R01 HD41129/HD/NICHD NIH HHS; RR00585/RR/NCRR NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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