Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.
Colorectal Dis. 2013 Mar;15(3):e130-7. doi: 10.1111/codi.12105.
Slow colonic transit time (CTT) and pelvic floor dyssynergia (PFD) are major contributors to constipation in patients with Parkinson's disease (PD). However, no symptom survey yet exists that effectively differentiates the contributing aetiologies. The significance of individual pelvic floor musculature behaviours and their relationship with colorectal dysmotility in constipated patients with PD are still controversial and need further clarification. We aimed to investigate how differentiated constipation-related symptoms of PD patients with constipation may identify constipation groupings and to register the pathophysiological features of the pelvic musculature.
Our subjects undertook CTT, defaecography and the Knowles-Eccersley-Scott Symptom questionnaire. The pathological aetiologies were categorized as group 1 (slow CTT) and/or group 2 (puborectalis syndrome) and/or group 3 (pubococcygeus syndrome), in accordance with the CTT and defaecography results.
Constipation-related symptoms such as incomplete evacuation and defaecation difficulty yielded high post-test probabilities (81% and 88%, respectively) in groups 3 and 2, but a low post-test probability in group 1 (58%). Changes in the anorectal angle and perineum descent during straining were significantly correlated with CTT (r = 0.57 and r = 0.61, respectively) and with each other (r = 0.82).
Our findings that neural control of the puborectalis and pubococcygeus, along with colorectal peristalsis, were in a similar state of degeneration is key information that should assist physicians to instigate more effective management for colonic dysmotility or PFD.
结肠传输时间（CTT）缓慢和盆底功能障碍（PFD）是导致帕金森病（PD）患者便秘的主要原因。然而，目前还没有一种症状调查能够有效地区分导致便秘的病因。盆底肌肉行为的个体差异及其与 PD 便秘患者结直肠蠕动功能障碍的关系仍存在争议，需要进一步阐明。我们旨在研究 PD 便秘患者的便秘相关症状如何区分便秘分组，并记录盆底肌肉的病理生理学特征。
我们的研究对象接受了 CTT、排粪造影和 Knowles-Eccersley-Scott 症状问卷检查。根据 CTT 和排粪造影结果，将病理病因分为 1 组（CTT 缓慢）和/或 2 组（耻骨直肠肌综合征）和/或 3 组（耻骨尾骨肌综合征）。
不完全排空和排便困难等便秘相关症状在第 3 组和第 2 组中的阳性预测值较高（分别为 81%和 88%），而在第 1 组中的阳性预测值较低（58%）。在用力排便时，肛直肠角和会阴下降的变化与 CTT 显著相关（r 分别为 0.57 和 0.61），且彼此之间也显著相关（r 为 0.82）。
我们发现，耻骨直肠肌和耻骨尾骨肌的神经控制以及结直肠蠕动功能处于相似的退化状态，这是一个重要的信息，应该有助于医生为结肠动力障碍或 PFD 患者实施更有效的治疗管理。
