Prevalence and Clinical Characteristics of Dyssynergic Defecation and Slow Transit Constipation in Patients with Chronic Constipation.
Level 4 - case-series / case-control
Cross-sectional diagnostic case series of consecutive patients at a referral motility center
PubMed 34065116 · doi:10.3390/jcm10092027
What was done
The authors reviewed records from 230 consecutive chronic constipation patients evaluated at a tertiary motility center who completed high-resolution anorectal manometry (HR-ARM), balloon expulsion testing (BET), and whole gut transit scintigraphy (WGTS). Patients also completed questionnaires regarding their medical history and symptoms to determine the prevalence and clinical characteristics of dyssynergic defecation (DD) and slow transit constipation (STC).
What was found
Of the 230 patients, 55% (n = 127) had STC, 22% (n = 50) had DD, and 13% (n = 30) had overlapping DD and STC. No specific symptoms differentiated STC from DD; however, patients with both STC and DD reported more severe constipation than patients with normal transit and anorectal function.
Why it matters
Because symptoms cannot reliably discriminate between pelvic floor dyssynergia and slow transit, patients with refractory chronic constipation require objective physiological testing to identify the underlying mechanism and guide appropriate management.
Limits
The study is a single-center study at a specialized referral motility center, creating substantial selection bias toward treatment-refractory patients. Symptom characterization was based on subjective questionnaires, and the abstract does not report effect sizes, confidence intervals, or p-values.
Cited by
- supports About one in three people with treatment-resistant constipation have pelvic floor dysfunction as the primary cause.