Details

Autor(en) / Beteiligte

• Vollebregt, Paul F
• Wiklendt, Lukasz
• Burgell, Rebecca E
• Chaichanavichkij, Pam
• Dinning, Phil G
• Knowles, Charles H
• Scott, S Mark

Titel

Abnormal perception of urge to defecate: an important pathophysiological mechanism in women with chronic constipation

Ist Teil von

• The American journal of gastroenterology, 2022-07, Vol.117 (7), p.1125-1136

Ort / Verlag

United States: Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins

Erscheinungsjahr

2022

Beschreibungen/Notizen

• Though the association of absent or attenuated "call to stool" with constipation is well-recognized, no studies have systematically evaluated the perception of urge to defecate in a well-defined cohort of patients with chronic constipation (CC). Prospective study of 43 healthy adult women and 140 consecutive adult women attending a tertiary center for investigation of CC. All participants completed a 5-day viscerosensory questionnaire and all women with CC also underwent anorectal physiologic investigations. Normal and abnormal urge perception were defined using a Naive Bayes model trained in healthy women (95% having normal urge). In total, 181 toilet visits in healthy women and 595 in women with CC were analyzed. Abnormal urge perception occurred in 70 (50.0%) women with CC. In this group, the urge to defecate was more often experienced as abdominal sensation (69.3% vs 41.4%; p<0.0001) and the viscerosensory referral area was 81% larger (median pixels anterior: 1,849 vs 1,022; p<0.0001) compared to women with CC and normal urge perception. Abnormal (vs normal) urge in women with CC was associated with more severe constipation (Cleveland Clinic constipation score: 19 vs 15 p<0.0001), IBS (45.7% vs 22.9% p<0.0001) and a functional evacuation disorder on defecography (31.3% vs 14.3% p=0.023). A distinct pattern of abnormal urge was found in women with CC and rectal hyposensitivity. Abnormal urge perception was observed in 50% of women with CC, and was frequently described as abdominal sensation, supporting the concept that sensory dysfunction makes an important contribution to the pathophysiology of constipation.