Defecographic Findings in Patients with Severe Idiopathic Chronic Constipation

Rahmatollah Rafiei; Azadeh Bayat; Masoud Taheri; Zahra Torabi; Lotfollah Fooladi; Saideh Husaini

doi:10.4166/kjg.2017.70.1.39

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Rafiei, Bayat, Taheri, Torabi, Fooladi, and Husaini: Defecographic Findings in Patients with Severe Idiopathic Chronic Constipation

Original Article

Korean J Gastroenterol 2017;70(1):39-43.

Published online: 4 October 2017

DOI: https://doi.org/10.4166/kjg.2017.70.1.39

Defecographic Findings in Patients with Severe Idiopathic Chronic Constipation

Rahmatollah Rafiei¹, Azadeh Bayat², Masoud Taheri³, Zahra Torabi², Lotfollah Fooladi⁴, Saideh Husaini¹

¹Department of Medicine, Islamic Azad University, Najafabad Branch, Najafabad, Korea

²Isfahan University of Medical Sciences, Isfahan, Iran

³Department of Radiology, Shariati Hospital, Isfahan, Iran

⁴Dr. Fooladi Laboratory, Amadegah St, Isfahan, Iran

Correspondence to: Masoud Taheri, Department of Radiology, Shariati Hospital, Shariati Street, Isfahan 81746, Iran. Tel: +98-31-3629-0178, Fax: +98-31-3629-0178, E-mail: msd.taheri.gp@gmail.com

Received 6 December 2016 Revised 16 February 2017 Accepted 21 March 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Chronic constipation is a common gastrointestinal disorder diagnosed using Rome III criteria. Defecography is a radiographic method used to identify anatomic abnormalities of anorectum. The present study aimed to evaluate the defecographic findings in patients with severe idiopathic chronic constipation.

Methods

One hundred patients, who complained of severe idiopathic chronic constipation with abnormal balloon expulsion test, underwent defecography after injection of barium. An analysis of radiographs was performed by an expert radiologist for the diagnosis of descending perineum syndrome, rectocele, enterocele, rectal ulcer, rectal prolapse, fecal residue of post defecation, and etc. Then, they were compared between the two sexes.

Results

Normal defecography was only observed in two participants. Descending perineum syndrome was the most common abnormality (73.3%). The results showed that rectocele (80.8%) and descending perineum syndrome (69.2%) were most frequent in women. In males, descending perineum syndrome and rectal prolapse were more prevalent (87% and 43.5%, respectively). Compared with men, rectocele and rectal ulcer were more frequently observed in women (p<0.001, and p=0.04, respectively), while men were more affected by descending perineum syndrome (p=0.04). In total, women had a greater incidence of abnormal defecographic findings compared with men (p=0.02).

Conclusions

Defecography can be performed to detect anatomic abnormalities in patients with severe idiopathic chronic constipation and abnormal balloon expulsion test. This technique can assist physicians in making the most suitable decision for surgical procedure.

Keywords: Constipation, Defecography, Rectocele, Rectal prolapse

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Fig. 1.

Frequency of abnormal defecographic findings in all patients.

Table 1.

Demographic Characteristics of Patients

	Males (n=23)	Females (n=77)
Age, year	39.0±17.1	41.4±14.7
Constipation duration, year	5.6±5.5	5.8±4.4

Values are presented as mean±standard deviation.

Table 2.

Frequency of the ROME III Criteria in Participants

Straining	94
Lumpy or hard stools	83
Sensation of incomplete evacuation	85
Sensation of anorectal obstruction/blockage	64
Manual maneuvers to facilitate defecation	42
Fewer than three defecations per week	56

Values are presented as n (%).

Table 3.

Frequency of the Abnormal Defecographic Findings in Patients according to Sex

	Women (n=77)	Men (n=23)	p-value
Perineal descending syndrome	54 (69.2)	20 (87)	0.04
Rectocele	63 (80.8)	7 (30.4)	<0.001
Enterocele	2 (2.6)	0 (0)	>0.05
Rectal ulcer	24 (30.8)	3 (13)	0.04
Rectal prolapse	23 (29.5)	10 (43.5)	>0.05
Fecal residue of post defecation	1 (1.3)	1 (4.3)	>0.05
Other	23 (29.5)	3 (13)	0.046

Values are presented as n (%).

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