Dawn E. Vickers
Constipation, with its associated symptoms, is the most common chronic gastrointestinal complaint, accounting for 2.5 million physician visits per year1 with a prevalence of 2% in the United States population.2 Rome II diagnostic criteria for a diagnosis of constipation are specified in Table 13.1.3 After identification and exclusion of extracolonic or anatomic causes, many patients respond favorably to medical and dietary management. However, patients unresponsive to simple treatment may require further physiologic investigation to evaluate the patho-physiologic process underlying the symptoms. Physiologic investigation generally includes colonic transit time study, cinedefecography, anorectal manometry, and electromyography (EMG),4 which allows for definitive diagnosis of treatable conditions including anismus, colonic inertia, rectocele, and sigmoidocele.5
Anismus, also termed pelvic floor dyssyner-gia, spastic pelvic floor syndrome, paradoxical puborectalis contraction, and nonrelaxing pub-orectalis syndrome, accounts for an estimated 50% of patients with symptoms of chronic constipation.6 Rome II diagnostic criteria for a diagnosis of pelvic floor dyssynergia are specified in Table 13.2.3 This disorder of unknown etiology is characterized by failure of the puborectalis muscle to relax during defecation. Invasive surgical therapy or injection of botulinum neurotoxin7 are associated with an unacceptable incidence of incontinence. In 1993, Enck's8 critical review found that biofeedback has become widely accepted as the treatment of choice for anismus.
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Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.