Eltringham, M.T.; McCauley, E.; Mackie, A.; Bain, I.M.; Yiannakou, J.Y.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA96
Academic Journal
Introduction: There are a host of causes attributed to chronic constipation while some patients remain idiopathic. Labour, pelvic surgery, and consequent rectoceles have been seen as causes but this remains controversial and few studies have shown a definite link. Methods: 53 consecutive female patients with severe constipation (SC) were assessed using a proforma including a detailed history of the effect, on their symptoms of pelvic trauma (PT) including childbirth, and pelvic surgery. Patients with PT were asked whether it had; triggered symptoms of SC, worsened them if present previously, or had no effect. All of the patients had radionuclide proctograms and data were obtained on the presence and size of rectoceles. Results: 40/53 (75%) of patients with SC had experienced PT. Of these 12/40 (30%) felt their constipation was triggered by it, 10/40 (25%) had symptoms preceding PT but felt it worsened their symptoms, and 18/40 (45%) felt there was no relationship between PT and SC. Patients with a history of PT had a greater likelihood of having a rectocele (85%) compared with the group with no PT (52%). Rectocele size was significantly greater in the PT group, 3.1 cm versus 2.2 cm (p = 0.02). Rectocele size was no greater for patients in "triggered" (3.13 cm) or "worsened" (2.97 cm) groups than in those with "no effect" (2.95 cm)(p = 0.96). Conclusions: Pelvic trauma is a significant factor in the aetiology of SC. However, the mechanism of this is unclear. Rectoceles are a common Finding in women with SC, and are likely to be greater in size if the patient has experienced pelvic trauma. However, it seems unlikely that the presence or size of rectocoele is a major factor in the pathogenesis of SC.


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