GI Investigation Unit, Royal North Shore Hospital, University of Sydney, Australia.
Dis Colon Rectum. 2010 Feb;53(2):156-60. doi: 10.1007/DCR.0b013e3181c188e8.
Although functional constipation is known to often manifest concomitant features of pelvic floor dyssynergia, the nature of pelvic floor symptoms and anorectal dysfunction in non-diarrhea predominant irritable bowel syndrome is less clear. This study aims to compare anorectal sensorimotor function and symptoms of patients who have non-diarrhea predominant irritable bowel syndrome with those who have functional constipation.
We studied 50 consecutive female patients referred with constipation and 2 or more symptoms of pelvic floor dyssynergia, who also satisfied Rome II criteria for either non-diarrhea predominant irritable bowel syndrome (n = 25; mean age, 47 +/- 3 y) or functional constipation (n = 25; 49 +/- 3 y). Assessments included the Rome II Integrative Questionnaire, a validated constipation questionnaire, Hospital Anxiety and Depression scale, visual analog scores for satisfaction with bowel habit and for impact on quality of life, and a comprehensive anorectal physiology study.
Both groups displayed physiological evidence of pelvic floor dyssynergia; but patients with non-diarrhea predominant irritable bowel syndrome exhibited a higher prevalence of abnormal balloon expulsion (P < .01) and less paradoxical anal contraction with strain (P = .045) than patients with functional constipation. These patients with irritable bowel syndrome also reported more straining to defecate (P = .04), a higher total constipation score (P = .02), lower stool frequency (P = .02), a trend toward harder stools (P = .06), and less satisfaction with bowel habit (P = .03) than patients with functional constipation.
Patients with non-diarrhea predominant irritable bowel syndrome with symptoms of pelvic floor dyssynergia exhibit overall pelvic floor dyssynergia physiology similar to that of patients with functional constipation. Certain features, however, such as abnormal balloon expulsion, may be more prominent in the patients with irritable bowel syndrome. Therapeutic modalities, such as biofeedback, that are effective in patients with functional constipation with pelvic floor dyssynergia should therefore be considered in selected patients with irritable bowel syndrome with pelvic floor dyssynergia.
虽然已知功能性便秘常表现出盆底功能障碍的伴随特征，但非腹泻型肠易激综合征中盆底症状和肛肠功能障碍的性质尚不清楚。本研究旨在比较非腹泻型肠易激综合征（IBS）伴盆底功能障碍和功能性便秘患者的肛肠感觉运动功能和症状。
我们研究了 50 例因便秘和 2 种或以上盆底功能障碍相关症状而就诊的连续女性患者，她们也符合罗马 II 标准的非腹泻型 IBS（n = 25；平均年龄 47 +/- 3 岁）或功能性便秘（n = 25；49 +/- 3 岁）。评估包括罗马 II 整合问卷、经验证的便秘问卷、医院焦虑和抑郁量表、对排便习惯满意度和对生活质量影响的视觉模拟评分，以及全面的肛肠生理学研究。
两组均表现出盆底功能障碍的生理证据；但非腹泻型 IBS 患者异常气囊排出的发生率更高（P <.01），排便时反常肛收缩的发生率更低（P =.045），而功能性便秘患者则更低。这些 IBS 患者还报告排便时更费力（P =.04），便秘总评分更高（P =.02），排便频率更低（P =.02），粪便硬度趋势更高（P =.06），对排便习惯的满意度更低（P =.03），而功能性便秘患者则更低。
伴有盆底功能障碍的非腹泻型 IBS 患者表现出与功能性便秘患者相似的整体盆底功能障碍生理学。然而，某些特征，如异常气囊排出，在 IBS 患者中可能更为突出。因此，对于伴有盆底功能障碍的功能性便秘患者有效的治疗方式，如生物反馈，应在伴有盆底功能障碍的 IBS 患者中考虑。
