Petryszyn Paweł W, Paradowski Leszek
Department of Clinical Pharmacology, Faculty of Pharmacy with Division of Laboratory Diagnostics, Wroclaw Medical University, Poland.
Department of Gastroenterology and Hepatology, Faculty of Postgraduate Medical Training, Wroclaw Medical University, Poland.
Adv Clin Exp Med. 2018 Jun;27(6):813-818. doi: 10.17219/acem/68986.
BACKGROUND: Crohn's disease (CD) and ulcerative colitis (UC) typically clinically manifest with symptoms like chronic diarrhea, cramps, abdominal pain, and rectal bleeding. However, symptoms of abnormal anorectal function seem to be of equal importance, regardless of the presence or absence of perianal disease. OBJECTIVES: The aim of this study was to assess stool patterns and the prevalence of symptoms of disordered anorectal function, particularly urgency and fecal incontinence, and their severity in patients with inflammatory bowel diseases (IBDs). MATERIAL AND METHODS: Thirty-three patients with CD and 38 patients with UC completed a questionnaire. A push/strain maneuver was performed on all patients and 20 controls. RESULTS: Thirty-three patients had more than 3 bowel movements a day; 44 had loose/watery stools. Two patients had fewer than 3 bowel movements a week, 8 had hard/lumpy stools, and 3 used laxatives. Excessive straining and incomplete evacuation were reported by 17 and 38 patients, respectively. Fifty-two patients complained of urgency and 32 of tenesmus. Significantly, more UC patients than CD patients had urgency at least once a day (p < 0.04). The following symptoms were reported by patients in the following numbers: fecal incontinence (31), passive (20) and urge incontinence (16), incontinence to gas (24), as well as liquid (33) and solid stool (7). Stool/gas discrimination was defective in 28 patients. Eleven patients had to wear pads. Everyday functioning was worsened because of urgency/tenesmus in 39 patients and because of fecal incontinence in 28 patients. The push/strain maneuver was abnormal in 12 patients with CD, 15 patients with UC and 1 control subject. The differences between the 2 study groups and the controls were significant (p < 0.03 and p < 0.01). CONCLUSIONS: A majority of patients with IBD complain of urgency. Fecal incontinence is reported by over 50% of patients. Both worsen patients' everyday functioning. A relevant proportion of patients have symptoms consistent with constipation, which is in connection with an abnormal push/strain maneuver in more than 1/3 of them.
背景：克罗恩病（CD）和溃疡性结肠炎（UC）通常临床表现为慢性腹泻、痉挛、腹痛和直肠出血等症状。然而，无论是否存在肛周疾病，肛门直肠功能异常的症状似乎同样重要。 目的：本研究旨在评估炎症性肠病（IBD）患者的排便模式、肛门直肠功能紊乱症状（尤其是便急和大便失禁）的患病率及其严重程度。 材料与方法：33例CD患者和38例UC患者完成了一份问卷。对所有患者及20名对照者进行了推/用力排便动作检查。 结果：33例患者每天排便超过3次；44例有稀便/水样便。2例患者每周排便少于3次，8例有硬便/块状便，3例使用泻药。分别有17例和38例患者报告有过度用力排便和排便不尽。52例患者主诉便急，32例主诉里急后重。值得注意的是，UC患者中每天至少出现一次便急的人数明显多于CD患者（p < 0.04）。患者报告的以下症状的人数如下：大便失禁（31例）、被动性（20例）和紧迫性失禁（16例）、气体失禁（24例），以及液体（33例）和固体粪便失禁（7例）。28例患者存在大便/气体辨别障碍。11例患者不得不使用护垫。39例患者因便急/里急后重、28例患者因大便失禁导致日常功能恶化。12例CD患者、15例UC患者和1名对照者的推/用力排便动作异常。两个研究组与对照组之间的差异具有统计学意义（p < 0.03和p < 0.01）。 结论：大多数IBD患者主诉便急。超过50%的患者报告有大便失禁。两者均会使患者的日常功能恶化。相当一部分患者有与便秘相符的症状，其中超过1/3的患者存在异常的推/用力排便动作。
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