Singh Prashant, Seo Yoonjin, Ballou Sarah, Ludwig Andrew, Hirsch William, Rangan Vikram, Iturrino Johanna, Lembo Anthony, Nee Judy W
Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, USA.
J Neurogastroenterol Motil. 2019 Jan 31;25(1):129-136. doi: 10.5056/jnm17139.
BACKGROUND/AIMS: Although symptoms related to the pelvic floor, such as pelvic organ prolapse (POP) and lower urinary tract symptoms (LUTS), are common in patients with chronic constipation (CC), its impact is not clear. Our aims were to investigate the following (1) compare pelvic floor symptom related dysfunction in irritable bowel syndrome with constipation (IBS-C) and functional constipation (FC), and (2) symptom correlation with findings on anorectal manometry (ARM) and balloon expulsion test.
This was a retrospective analysis of patients with CC undergoing ARM. IBS-C and FC were diagnosed by Rome III criteria. Pelvic Floor Distress Inventory (PFDI-20) was used to measure pelvic floor symptom distress. Constipation Severity Scale was used to assess constipation severity.
A total of 107 patients underwent ARM (64 FC, 43 IBS-C). The overall PFDI-20 score in IBS-C was higher compared with FC patients (118.0 vs 79.2, = 0.001). In those with IBS-C, POP, LUTS, and colorectal symptoms subscales were all higher compared with FC patients ( ＜ 0.05 for each). On multivariable regression, IBS-C ( = 0.001) and higher constipation severity ( = 0.001) were both independently associated with higher PFDI scores. ARM parameters and abnormal balloon expulsion test did not correlate with PFDI scores.
Compared with FC patients, those with IBS-C have significantly higher distress from pelvic floor specific symptoms including POP and LUTS. Higher abdominal pain among IBS-C patients did not entirely explain these findings. A diagnosis of IBS-C and higher constipation severity correlated with PFDI-20 scores, but dyssynergia did not.
背景/目的：尽管慢性便秘（CC）患者中盆底相关症状很常见，如盆腔器官脱垂（POP）和下尿路症状（LUTS），但其影响尚不清楚。我们的目的是研究以下内容：（1）比较便秘型肠易激综合征（IBS-C）和功能性便秘（FC）患者盆底症状相关功能障碍，以及（2）症状与肛门直肠测压（ARM）和气囊排出试验结果的相关性。
这是一项对接受ARM检查的CC患者的回顾性分析。IBS-C和FC根据罗马III标准进行诊断。盆底困扰量表（PFDI-20）用于测量盆底症状困扰程度。便秘严重程度量表用于评估便秘严重程度。
共有107例患者接受了ARM检查（64例FC，43例IBS-C）。IBS-C患者的总体PFDI-20评分高于FC患者（118.0对79.2，P = 0.001）。在IBS-C患者中，POP、LUTS和结直肠症状子量表均高于FC患者（每项P＜0.05）。多变量回归分析显示，IBS-C（P = 0.001）和更高的便秘严重程度（P = 0.001）均与更高的PFDI评分独立相关。ARM参数和异常气囊排出试验与PFDI评分无关。
与FC患者相比，IBS-C患者因包括POP和LUTS在内的盆底特异性症状而产生的困扰明显更高。IBS-C患者较高的腹痛并不能完全解释这些结果。IBS-C诊断和更高的便秘严重程度与PFDI-20评分相关，但不协调排便与之无关。
