Biomedical subjects
Publications and source records attributed to C Duguay.
In 4 patients, trauma to the lumbosacral area produced abnormalities similar to those seen after resection of the nervi erigentes. Mechanisms of the resulting constipation and fecal incontinence for liquid stools included a prolonged transit time through the entire colon, a low rectal pressure, spasticity of the anal canal, and abnormal anal reflexes. Previous trauma to the lower spine must be considered in the differential diagnosis of chronic constipation.
This study presents normal values of bowel habits, colonic transit times of radioopaque markers, and anorectal pressure obtained from 114 normal subjects. Their stool frequency ranged from 3 to 11 per 7 days, whereas their diet contained an average of 14.4 g of crude fibers. Radioopaque markers progressed regularly along the large bowel and a range of transit times was established for its different segments. Manometric studies included measurements of anal pressure at rest, amplitude and duration of the rectoanal inhibitory reflex, anal inflation reflex, and amplitude of rectal contraction in response to rectal distension. Normal ranges were established. Amplitude, duration and magnitude (as measured by planimetry) of anal relaxation elicited by rectal distensions were related to rectal distending volume (P less than 0.001). The incidence of spontaneous variations of anal pressure at rest and of overshoot of pressure after the inhibitory reflex was also established. These data obtained on normal subjects may be compared to those obtained in patients with constipation in order to define the symptoms and to understand pathophysiological mechanisms. This has been done in a companion study.
Anorectal myectomy was performed in 62 patients suffering from symptoms attributed to ineffective colonic motility. Indications for surgery rested on the presence of one or more of the following three criteria: abnormally reduced stool frequency, prolonged transit of radioopaque markers, and abnormal anorectal manometry. One year after myectomy in the 50 patients with less than three stools per week the average number of stools per week increased from 1.2 to 4.2 (P less than 0.001). The remaining 12 patients, who had more than three stools per week, were completely relieved of their symptoms. In all cases with improved symptoms, myectomy acclerated the transit of radioopaque markers through the large bowel. Organic constipation amenable to surgical treatment is more frequent than previously thought. Idiopathic constipation may result from colonic inertia or outlet (anorectal) obstruction.