Gastrointestinal Investigation Unit, Royal North Shore Hospital and University of Sydney, Sydney, NSW, Australia.
Neurogastroenterol Motil. 2010 Jul;22(7):764-9. doi: 10.1111/j.1365-2982.2010.01503.x. Epub 2010 May 6.
Pelvic floor dyssynergia (PFD) within irritable bowel syndrome (IBS) is often overlooked and the relationship between symptoms and physiology is relatively unexplored. Our aims were to determine relationships between clinical features and anorectal function in non-diarrhea predominant IBS (non-D IBS) patients and whether certain clinical or physiological features predict PFD in IBS.
Two groups of patients were evaluated. Group I: 32 female non-D IBS patients with >or=2 symptoms suggesting PFD underwent comprehensive symptom and anorectal function assessment. Group II: 32 female non-D IBS patients recruited from the community underwent symptom assessment.
Prevalence of PFD symptoms was similar in both groups. In group I patients, increased frequency of digitation was associated with a longer balloon expulsion time (P = 0.03). Higher scores for anal pain were associated with both a low resting anal pressure (P = 0.04) and a shorter duration of maximum squeeze (P = 0.03). Reduced perineal descent was associated with anxiety (P = 0.03) and depression (P = 0.01). A shorter duration of maximum squeeze was associated with higher parity (P = 0.02) and previous hysterectomy (P = 0.047). Duration of PFD symptoms was higher (P = 0.02) and maximum tolerated volume was lower (P = 0.05) in 22 patients with a physiological diagnosis of PFD compared to 10 without PFD. No symptoms independently predicted a physiological diagnosis of PFD.
CONCLUSIONS & INFERENCES: Important relationships between certain PFD symptoms and disordered anorectal physiology have been demonstrated in these non-D IBS patients. However, symptoms alone could not predict PFD, and certain clinical features should therefore highlight the need for comprehensive anorectal function tests.
盆底功能障碍（PFD）在肠易激综合征（IBS）中经常被忽视，其症状与生理之间的关系尚未得到充分探索。我们的目的是确定非腹泻型 IBS（非 D IBS）患者的临床特征与肛肠功能之间的关系，以及某些临床或生理特征是否可预测 IBS 中的 PFD。
评估了两组患者。第 I 组：32 名女性非 D IBS 患者，有> 2 种提示 PFD 的症状，接受了全面的症状和肛肠功能评估。第 II 组：从社区招募的 32 名女性非 D IBS 患者，接受了症状评估。
两组患者 PFD 症状的发生率相似。在第 I 组患者中，频繁出现的肛门指诊与更长的气囊排出时间相关（P = 0.03）。肛门疼痛评分较高与静息时肛压较低（P = 0.04）和最大收缩持续时间较短（P = 0.03）有关。会阴下降减少与焦虑（P = 0.03）和抑郁（P = 0.01）有关。最大收缩持续时间较短与较高的产次（P = 0.02）和既往子宫切除术（P = 0.047）相关。22 例存在 PFD 生理诊断的患者 PFD 症状持续时间较长（P = 0.02），最大耐受容量较低（P = 0.05），而 10 例无 PFD 的患者无此差异。没有任何症状可以独立预测 PFD 的生理诊断。
在这些非 D IBS 患者中，已经证明了某些 PFD 症状与肛肠功能障碍之间存在重要关系。然而，症状本身不能预测 PFD，因此某些临床特征应强调需要进行全面的肛肠功能检查。
