Rectal Hyposensitivity Is Associated With a Defecatory Disorder But Not Delayed Colon Transit Time in a Functional Constipation Population

Yu, Ting; Qian, Dong; Zheng, Yongping; Jiang, Ya; Wu, Ping; Lin, Lin

doi:10.1097/md.0000000000003667

Cited by 15 publications

(18 citation statements)

References 30 publications

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“…Rectal sensory dysfunction involves in the development of functional bowel diseases ( 22 ), and rectal hyposensitivity was reported in patients with functional constipation ( 38 , 39 ). In addition, diminished awareness of rectal distension has been shown in metabolic diseases, neurological diseases, and postanorectal surgery.…”

Section: Discussionmentioning

confidence: 99%

Transcutaneous Electrical Acustimulation Improves Constipation by Enhancing Rectal Sensation in Patients With Functional Constipation and Lack of Rectal Sensation

Xiao

Lin

et al. 2022

Clin Transl Gastroenterol

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INTRODUCTION: Reduced rectal sensation is involved in the pathophysiology of constipation. The aim of this study was to investigate the effects of transcutaneous electrical acustimulation (TEA) at acupuncture point ST36 on constipation and rectal sensation as well as autonomic functions in patients with constipation and reduced rectal sensation. METHODS:In an acute study, anorectal motility and sensation tests were performed in constipation patients (N 5 53) who were treated with TEA at ST36 or sham points. In a chronic study, patients (N 5 18) underwent 2 weeks of TEA or sham-TEA in a crossover design. RESULTS:Chronic TEA increased spontaneous bowel movements (3.72 vs 2.00 per week with sham-TEA, P < 0.0001) and significantly reduced constipation symptoms and increased quality of life in comparison with sham-TEA (P < 0.05). Acute TEA reduced the sensation threshold in response to rectal distention for the urge of defecation and maximum tolerable volume (P < 0.05, vs baseline); chronic TEA reduced the sensation thresholds for first sensation and desire of defecation, and decreased the threshold volume to an elicit rectal anal inhibitory reflex (P < 0.05). Both acute and chronic TEA increased parasympathetic activity (P < 0.05).DISCUSSION:TEA at ST36 improves chronic constipation by enhancing rectal sensation possibly mediated by the reinforcement of parasympathetic activity in patients with functional constipation and reported lack/ absence of rectal sensation.

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Section: Discussionmentioning

confidence: 99%

Transcutaneous Electrical Acustimulation Improves Constipation by Enhancing Rectal Sensation in Patients With Functional Constipation and Lack of Rectal Sensation

Xiao

Lin

et al. 2022

Clin Transl Gastroenterol

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“…Therefore, STC may cause LODD. However, recent rectal balloon expulsion and manometry study proved an association with DeD and RH, but not with delayed colonic transit and RH ( 13 ). Other balloon study showed the relationship between RH and higher thresholds for inducing recto-anal reflexes and abnormal characteristics of sensorimotor response ( 10 ).…”

Section: Discussionmentioning

confidence: 99%

Difference in Defecation Desire Between Patients With and Without Chronic Constipation: A Large-Scale Internet Survey

Ohkubo

Takatsu

Yoshihara

et al. 2020

Clin Transl Gastroenterol

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INTRODUCTION: Defecation desire (DD) is an important physiological component of normal defecation. However, knowledge of DD in the general population and in individuals with chronic constipation (CC) is lacking. We aimed to assess the prevalence of DD in the general population and individuals with CC and to understand the impact of treatment on DD among individuals with CC. METHODS: We conducted an online questionnaire survey targeting the Japanese general population in 2019. DD was reported as never, rarely, usually, or always. Individuals who self-reported constipation and met the Rome IV criteria for functional constipation but did not for irritable bowel syndrome were included in the CC group, while the same number of age-/sex-matched controls who met neither functional constipation nor irritable bowel syndrome criteria was included in the non-CC group. Individuals who reported DD as rarely or never were defined as having loss of DD (LODD). RESULTS: Of the 20,986 participants, 2,587 were included in the CC group (12.3%). LODD was significantly higher in the CC individuals than in the non-CC controls (57.4% vs 8.3%, respectively, P < 0.001, odds ratio 14.84 [95% confidence interval 12.65–17.42]). Satisfaction with treatment for constipation was lower in individuals with persistent LODD (25.9%) compared with those with improved LODD (56.5%) on treatment ( P < 0.001, odds ratio 2.48 [1.39–4.43]). DISCUSSION: LODD is common in CC and is associated with decreased satisfaction to treatment. Greater attention should be paid to DD when treating patients with CC.

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“…131,133,134 Functional EDs (or FDDs), first described in the mid-1980s, [135][136][137] are characterized by recto-anal incoordination, manifest as paradoxical involuntary contraction or failure of relaxation of the anal sphincter and pelvic floor musculature (principally puborectalis), and/or inadequate abdomino-rectal propulsive forces. 4,32,132 Functional EDs are often associated with blunted rectal sensation (hyposensitivity) 12,32,138 and also anal hypertonia in a small proportion. 139,140 On testing, >80% of chronically constipated patients may be diagnosed with pathophysiological features compatible with an ED.…”

Section: Evacuation Disordersmentioning

confidence: 99%

“…145 RH appears to be linked primarily to ED 138 and particularly with "functional" rather than a mechanical (anatomical) obstruction to defecation. 12,32,70,138,158 RH impacts CC via two key mechanisms: (a) through its association with functional ED either directly, due to co-incident/ corresponding efferent dysfunction (ie, concurrent reduced rectal contractility), 154,159 or indirectly via the development of large, hard, and difficult to evacuate stools due to fecal retention and desiccation secondary to reduced awareness; and (b) due to colonic transit delay via inhibitory feedback loops triggered by chronic rectal distension. 160,161…”

Section: Sensory Dysfunctionmentioning

confidence: 99%

“…Symptomatically, RH is associated with “no urge constipation” 156,157 and is more common in individuals meeting the Rome IV criteria for FC (60%) rather than IBS‐C (2%) 145 . RH appears to be linked primarily to ED 138 and particularly with “functional” rather than a mechanical (anatomical) obstruction to defecation 12,32,70,138,158 …”

Section: Pathophysiologymentioning

confidence: 99%

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Chronic constipation in adults: Contemporary perspectives and clinical challenges. 1: Epidemiology, diagnosis, clinical associations, pathophysiology and investigation

Scott

Simrén

Farmer

et al. 2020

Neurogastroenterology Motil

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BACKGROUND: Chronic constipation is a prevalent disorder that affects patients' quality of life and consumes resources in healthcare systems worldwide. In clinical practice, it is still considered a challenge as clinicians frequently are unsure as to which treatments to use and when. Over a decade ago, a Neurogastroenterology & Motility journal supplement devoted to the investigation and management of constipation was published Listen to the podcast for this article 2 of 21 | SCOTT eT al. | INTRODUC TI ONChronic constipation (CC) remains a clinical challenge, with frequent suboptimal outcomes to a variety of conservative, behavioral, medical, and surgical interventions. Over a decade ago, a Neurogastroenterology & Motility journal supplement was devoted to the investigation and management of constipation (2009:21 [Suppl. 2]). This included seven articles, 1-7 disseminating all themes covered during a preceding 2-day meeting held in London, entitled "Current perspectives in chronic constipation: a scientific and clinical symposium." In October 2018, the 3rd London Masterclass, entitled "Contemporary management of constipation" was held, again over 2 days, and again boasting a world-renowned faculty. By way of dissemination, two side-by-side review articles have been produced that represent a collective synthesis of talks presented and discussions held during this meeting. Authorship includes all invited faculty members. These reviews provide not only an update on topics addressed in the previous journal supplement, but also a stateof-the-art overview of the clinical management of constipation. Areas for future research are additionally highlighted. The first of these reviews addresses epidemiology, diagnosis, clinical associations, pathophysiology, and investigation. Clearly, not all aspects of the condition can be covered in adequate detail; hence, there is a focus on particular "hot topics" and themes that are of contemporary interest. The second, "sister" review, addresses management of chronic constipation, encompassing behavioral, conservative, medical, and surgical therapies. | EPIDEMI OLOGY AND D IAG NOS IS | DefinitionsConstipation is most simplistically defined as unsatisfactory defecation resulting from infrequent stools, difficult stool passage, or both. 8 Alternatively, it is a term that embraces a (limited) spectrum of symptoms related to an individuals' personal dissatisfaction with their evacuatory ability. 4 Symptoms include, though are not restricted to, hard stools, excessive straining, infrequent bowel movements, bloating, and abdominal pain, 9 and if such symptoms last >1 month, constipation is labeled as chronic. CC can be viewed as an umbrella term encompassing all disorders and conditions with long-standing constipation, and can be primary or secondary. Multiple conditions may cause secondary CC, for example, drugs (opioids, calcium channel blockers, NSAIDs), neurological disorders (Parkinson's disease), or metabolic diseases (diabetes). 10 Primary CC (which is the main focus of these review...

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Rectal Hyposensitivity Is Associated With a Defecatory Disorder But Not Delayed Colon Transit Time in a Functional Constipation Population

Cited by 15 publications

References 30 publications

Transcutaneous Electrical Acustimulation Improves Constipation by Enhancing Rectal Sensation in Patients With Functional Constipation and Lack of Rectal Sensation

Transcutaneous Electrical Acustimulation Improves Constipation by Enhancing Rectal Sensation in Patients With Functional Constipation and Lack of Rectal Sensation

Difference in Defecation Desire Between Patients With and Without Chronic Constipation: A Large-Scale Internet Survey

Chronic constipation in adults: Contemporary perspectives and clinical challenges. 1: Epidemiology, diagnosis, clinical associations, pathophysiology and investigation

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