The importance of defecography in the assessment of the etiology of chronic constipation: An analysis of 630 patients

The Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colonproctologia) guidelines for the management of acute and chronic hemorrhoidal disease

The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colon-Proctologia, SIUCP) on the diagnosis and management of hemorrhoidal disease, with the goal of guiding physicians in the choice of the best treatment option. A panel of experts was charged by the Board of the SIUCP to develop key questions on the main topics related to the management of hemorrhoidal disease and to perform an accurate and comprehensive literature search on each topic, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in multiple rounds through the Delphi approach and, for each statement, a consensus among the experts was reached. The questions were created according to PICO (patients, intervention, comparison, and outcomes) criteria, and the statements were developed adopting the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology. In cases of grade 1 hemorrhoidal prolapse, outpatient procedures including hemorrhoidal laser procedure and sclerotherapy may be considered the preferred surgical options. For grade 2 prolapse, nonexcisional procedures including outpatient treatments, hemorrhoidal artery ligation and mucopexy, laser hemorrhoidoplasty, the Rafaelo procedure, and stapled hemorrhoidopexy may represent the first-line treatment options, whereas excisional surgery may be considered in selected cases. In cases of grades 3 and 4, stapled hemorrhoidopexy and hemorrhoidectomy may represent the most effective procedures, even if, in the expert panel opinion, stapled hemorrhoidopexy represents the gold-standard treatment for grade 3 hemorrhoidal prolapse.

Application of dynamic MRI defecography in diagnosis of outlet obstructive constipation

AIM

To assess the application value of dynamic magnetic resonance imaging (MRI) defecography in the diagnosis of outlet obstructive constipation (OCC).

METHODS

Forty-eight patients with suspected OOC at Third Affiliated Hospital of Nanchang University from March 2016 to February 2018 were selected, and they underwent dynamic MRI defecography and X-ray defecography. The situations of dynamic MRI defecography and X-ray defecography were recorded. Using X-ray defecography as the standard, the specificity, sensitivity, negative predictive value, and positive predictive value of dynamic MRI defecography were calculated.

RESULTS

There was no statistical difference in the diagnosis of intersigmoid hernia, puborectalis spasm, hernia, or internal hemorrhoid between dynamic MRI defecography and X-ray defecography (P > 0.05). The detection rates of dynamic MRI defecography in the diagnosis of rectocele, rectal mucosal prolapse, perinaeum descent, intrarectal invaginate, and sigmoid colon zigzagging were lower than those of X-ray defecography (P < 0.05). Dynamic MRI defecography could find lesions that cannot be displayed by X-ray defecography, including muscular rupture, uterine fibroid, cervical accepts cyst, sacral cyst, and mullerian duct cyst. Using X-ray defecography as the gold standard, the specificity and positive predictive value of dynamic MRI defecography in the diagnosis of rectal mucosal prolapse, rectocele, puborectalis spasm, intrarectal invaginate, intersigmoid hernia, hernia, sigmoid colon zigzagging, and perinaeum descent were all 100.00%; the sensitivity and positive predictive value for different diseases had a significant difference, the positive predictive value was generally higher, and the sensitivity was usually lower.

CONCLUSION

MRI and X-ray defecography have their own advantages in the diagnosis of OOC. Dynamic MRI defecography can provide information on the pelvic organ and pelvic wall, pelvic floor function, and morphological structure, and it is a good supplement to X-ray defecography. Dynamic MRI defecography can provide guidance for overall evaluation and comprehensive diagnosis of OOC with pelvic multiple-organ lesions.

Relationship between functional constipation and anal-retentive behavior features

Objectives

Constipation is the most commonly seen defecation problem related to several environmental factors. Defecation is learned in the childhood anal period in which anal characteristic features appear. Problems in the childhood anal period may affect not only characters but also defecation function. This study aimed to evaluate the relationship between constipation and anal characteristic features of participants with functional constipation.

Material and Methods

Patients with functional constipation were included into the study according to the ROME III criteria. Patients with irritable bowel disease, slow transit constipation, outlet obstruction constipation, malignancy, and psychiatric diseases were excluded from the study. Patients filled out Personality Belief Questionnaire, Hospital Anxiety and Depression Scale, and Obsessive Belief Questionnaire. The results were compared with healthy individuals.

Results

A total of 47 patients with functional constipation were included in the study. Avoidant, obsessive-compulsive, antisocial, narcissistic, and paranoid personality traits were found to be higher in patients with constipation than in the control group. Perfectionism/certainty, importance and control, and hospital anxiety scores were found to be higher in patients with constipation than in the control group.

Conclusion

Constipation may be related to several factors, such as socioeconomic environment, emotional stress, age, and diet, among others. Here, it was found that anal-retentive behavior features are prominent in functional constipation. Biofeedback, which can be regarded as psychotherapy of defecation control, can be used for treatment.