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Obstructive defaecation and slow transit constipation: the proctographic parameters

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Abstract

Twenty-two patients with functional obstructive defaecation were compared with seven patients with slow transit constipation using isotope proctography. The obstructive defaecation patients were unable to perform a complete rectal evacuation (% of the activity evacuated: 54%). The defaecation time in this group was prolonged (120 s) with a lower defaecation rate (0.5%/s) compared with the slow transit constipation subjects (32 s and 1.8%/s). The anorectal angle (ARA) on straining did not change in the obstructive defaecation patients but became more obtuse in the slow transit constipation subjects (P<0.02). The pelvic floor (PF) descent on straining and evacuation was greater in obstructive defaecation patients compared with the slow transit constipation ones (P<0.01). Obstructive defaecation is characterised by prolonged defaecation and reduced defaecation rate compared with slow transit constipation. Obstructive defaecation patients present with more acute ARAs on straining, and abnormal perineal descent in contrast to the slow transit constipation ones.

Résumé

Vingt-deux patients souffrant de dyschésie ont été comparés avec 7 patients souffrant d'une constipation par relentissement du transit au moyen d'une proctographie isotopique. Les patients souffrant de dyschésie sont incapables d'évacuer complètement leur ampoule rectale (54%). Le temps d'exonération de ce collectif était prolongé (120 s) avec une vitesse d'exonération inférieure (0,5%/s) comparativement aux sujets avec un ralentissement du transit (32 s et 1,8%/s). L'angle ano-rectal, lors de l'effort d'exonération, ne change pas chez les patients souffrant de dyschésie mais devient plus obtus dans le collectif de patients souffrant d'une constipation à transit lent (P<0,02). L'abaissement du périnée lors de l'exonération et de l'évacuation était plus important chez des patients souffrant de dyschésie que chez ceux souffrant de constipation avec ralentissement du transit (P<0,01). La dyschésie est caractérisée par un allongement du temps d'exonération et une diminution de la vitesse de l'évacuation de l'ampoule rectale comparativement à la stonstipation avec ralentissement du transit. La dyschésie s'accompagne d'un angle ano-rectal plus aigu lors de l'exonération et d'une descente anormale du périnée comparativement à la constipation à transit lent.

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This study has been presented and published as an abstract in the Proceedings of the II. European Gastroenterology Week in Barcelona 1993

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Papachrysostomou, M., Smith, A.N. & Merrick, M.V. Obstructive defaecation and slow transit constipation: the proctographic parameters. Int J Colorect Dis 9, 115–120 (1994). https://doi.org/10.1007/BF00290185

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