Skip to main content
PMC home page
Gut logoLink to Gut
. 1990 Nov;31(11):1284–1288. doi: 10.1136/gut.31.11.1284

Evidence for motor neuropathy and reduced filling of the rectum in chronic intractable constipation.

D J Waldron 1, D Kumar 1, R I Hallan 1, D L Wingate 1, N S Williams 1
PMCID: PMC1378700  PMID: 2253913

Abstract

Subtotal colectomy with ileorectal anastomosis is now frequently offered to patients with slow transit constipation who have severe symptoms and no response to more conventional medical treatment. If this operation is to be successful, the underlying problem should be delay in the progress of contents through the colon but no mechanical or functional obstruction in the small bowel or rectum. We have used a recently described technique of prolonged ambulant manometry and electromyography to investigate anorectal function in these patients. Pressure data were collected using a 2 mm diameter intrarectal probe carrying microtransducers, and external anal sphincter activity was assessed by a pair of silver-silver chloride surface electrodes. Fourteen control subjects and eight patients with colonic inertia were studied. Sampling reflexes, indicative of rectal filling, occurred at mean (SEM) rates of 7.4 (2.0)/hour in controls but were significantly reduced in patients (2.4 (0.3)/hour (p less than 0.01]. Recurrent rectal motor complexes were seen to occur in both groups at intervals of 76 (1.8) minutes in controls and 64.9 (7.2) minutes in patients (p less than 0.1), and with amplitudes of 42.4 (2.1) mmHg and 9.2 (0.7) mmHg (p less than 0.001), respectively. External sphincter electromyographic spike activity did not differ between groups. Our results support the concept of reduced transit of faeces to the rectum from the colon over a 24 hour period in slow transit constipation and suggest that a motor neuropathy may also be present in the rectum.

Full text

PDF
1284

Images in this article

1285Figure 2
on p.1285

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Akervall S., Fasth S., Nordgren S., Oresland T., Hultén L. The functional results after colectomy and ileorectal anastomosis for severe constipation (Arbuthnot Lane's disease) as related to rectal sensory function. Int J Colorectal Dis. 1988 Jun;3(2):96–101. doi: 10.1007/BF01645313. [DOI] [PubMed] [Google Scholar]
  2. Barnes P. R., Hawley P. R., Preston D. M., Lennard-Jones J. E. Experience of posterior division of the puborectalis muscle in the management of chronic constipation. Br J Surg. 1985 Jun;72(6):475–477. doi: 10.1002/bjs.1800720623. [DOI] [PubMed] [Google Scholar]
  3. Bleijenberg G., Kuijpers H. C. Treatment of the spastic pelvic floor syndrome with biofeedback. Dis Colon Rectum. 1987 Feb;30(2):108–111. doi: 10.1007/BF02554946. [DOI] [PubMed] [Google Scholar]
  4. Duthie H. L., Bennett R. C. The relation of sensation in the anal canal to the functional anal sphincter: a possible factor in anal continence. Gut. 1963 Jun;4(2):179–182. doi: 10.1136/gut.4.2.179. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Hallan R. I., Williams N. S., Melling J., Waldron D. J., Womack N. R., Morrison J. F. Treatment of anismus in intractable constipation with botulinum A toxin. Lancet. 1988 Sep 24;2(8613):714–717. doi: 10.1016/s0140-6736(88)90188-2. [DOI] [PubMed] [Google Scholar]
  6. Hinton J. M., Lennard-Jones J. E., Young A. C. A ne method for studying gut transit times using radioopaque markers. Gut. 1969 Oct;10(10):842–847. doi: 10.1136/gut.10.10.842. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Kamm M. A., Hawley P. R., Lennard-Jones J. E. Outcome of colectomy for severe idiopathic constipation. Gut. 1988 Jul;29(7):969–973. doi: 10.1136/gut.29.7.969. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Keighley M. R., Shouler P. Outlet syndrome: is there a surgical option? J R Soc Med. 1984 Jul;77(7):559–563. doi: 10.1177/014107688407700707. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Klatt G. R. Role of subtotal colectomy in the treatment of incapacitating constipation. Am J Surg. 1983 May;145(5):623–625. doi: 10.1016/0002-9610(83)90107-1. [DOI] [PubMed] [Google Scholar]
  10. Krishnamurthy S., Schuffler M. D., Rohrmann C. A., Pope C. E., 2nd Severe idiopathic constipation is associated with a distinctive abnormality of the colonic myenteric plexus. Gastroenterology. 1985 Jan;88(1 Pt 1):26–34. doi: 10.1016/s0016-5085(85)80128-1. [DOI] [PubMed] [Google Scholar]
  11. Kuijpers H. C., Bleijenberg G., de Morree H. The spastic pelvic floor syndrome. Large bowel outlet obstruction caused by pelvic floor dysfunction: a radiological study. Int J Colorectal Dis. 1986 Jan;1(1):44–48. doi: 10.1007/BF01648836. [DOI] [PubMed] [Google Scholar]
  12. Leon S. H., Krishnamurthy S., Schuffler M. D. Subtotal colectomy for severe idiopathic constipation. A follow-up study of 13 patients. Dig Dis Sci. 1987 Nov;32(11):1249–1254. doi: 10.1007/BF01296374. [DOI] [PubMed] [Google Scholar]
  13. Martelli H., Devroede G., Arhan P., Duguay C. Mechanisms of idiopathic constipation: outlet obstruction. Gastroenterology. 1978 Oct;75(4):623–631. [PubMed] [Google Scholar]
  14. Nicholls R. J., Kamm M. A. Proctocolectomy with restorative ileoanal reservoir for severe idiopathic constipation. Report of two cases. Dis Colon Rectum. 1988 Dec;31(12):968–969. doi: 10.1007/BF02554897. [DOI] [PubMed] [Google Scholar]
  15. Nicholls R. J., Lubowski D. Z. Restorative proctocolectomy: the four loop (W) reservoir. Br J Surg. 1987 Jul;74(7):564–566. doi: 10.1002/bjs.1800740705. [DOI] [PubMed] [Google Scholar]
  16. Pescatori M., Mattana C., Castagneto M. Clinical and functional results after restorative proctocolectomy. Br J Surg. 1988 Apr;75(4):321–324. doi: 10.1002/bjs.1800750410. [DOI] [PubMed] [Google Scholar]
  17. Preston D. M., Hawley P. R., Lennard-Jones J. E., Todd I. P. Results of colectomy for severe idiopathic constipation in women (Arbuthnot Lane's disease). Br J Surg. 1984 Jul;71(7):547–552. doi: 10.1002/bjs.1800710726. [DOI] [PubMed] [Google Scholar]
  18. Preston D. M., Lennard-Jones J. E. Pelvic motility and response to intraluminal bisacodyl in slow-transit constipation. Dig Dis Sci. 1985 Apr;30(4):289–294. doi: 10.1007/BF01403835. [DOI] [PubMed] [Google Scholar]
  19. Preston D. M., Lennard-Jones J. E. Severe chronic constipation of young women: 'idiopathic slow transit constipation'. Gut. 1986 Jan;27(1):41–48. doi: 10.1136/gut.27.1.41. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Read N. W., Timms J. M., Barfield L. J., Donnelly T. C., Bannister J. J. Impairment of defecation in young women with severe constipation. Gastroenterology. 1986 Jan;90(1):53–60. doi: 10.1016/0016-5085(86)90074-0. [DOI] [PubMed] [Google Scholar]
  21. Reynolds J. C., Ouyang A., Lee C. A., Baker L., Sunshine A. G., Cohen S. Chronic severe constipation. Prospective motility studies in 25 consecutive patients. Gastroenterology. 1987 Feb;92(2):414–420. [PubMed] [Google Scholar]
  22. Roe A. M., Bartolo D. C., Mortensen N. J. Diagnosis and surgical management of intractable constipation. Br J Surg. 1986 Oct;73(10):854–861. doi: 10.1002/bjs.1800731031. [DOI] [PubMed] [Google Scholar]
  23. Smith B. Pathologic changes in the colon produced by anthraquinone purgatives. Dis Colon Rectum. 1973 Nov-Dec;16(6):455–458. doi: 10.1007/BF02588868. [DOI] [PubMed] [Google Scholar]
  24. Stanghellini V., Camilleri M., Malagelada J. R. Chronic idiopathic intestinal pseudo-obstruction: clinical and intestinal manometric findings. Gut. 1987 Jan;28(1):5–12. doi: 10.1136/gut.28.1.5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Waldron D., Bowes K. L., Kingma Y. J., Cote K. R. Colonic and anorectal motility in young women with severe idiopathic constipation. Gastroenterology. 1988 Nov;95(5):1388–1394. doi: 10.1016/0016-5085(88)90377-0. [DOI] [PubMed] [Google Scholar]
  26. Watier A., Devroede G., Duranceau A., Abdel-Rahman M., Duguay C., Forand M. D., Tétreault L., Arhan P., Lamarche J., Elhilali M. Constipation with colonic inertia. A manifestation of systemic disease? Dig Dis Sci. 1983 Nov;28(11):1025–1033. doi: 10.1007/BF01311732. [DOI] [PubMed] [Google Scholar]
  27. Womack N. R., Williams N. S., Holmfield J. H., Morrison J. F., Simpkins K. C. New method for the dynamic assessment of anorectal function in constipation. Br J Surg. 1985 Dec;72(12):994–998. doi: 10.1002/bjs.1800721221. [DOI] [PubMed] [Google Scholar]
  28. Yoshioka K., Keighley M. R. Anorectal myectomy for outlet obstruction. Br J Surg. 1987 May;74(5):373–376. doi: 10.1002/bjs.1800740516. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES