| Objective:Functional constipation(FC),as apart of functional bowel disorder,is common in disease of the gastrointestinal system,and mainly characterized by low defecation frequency,defecation difficulty,and defecation.With its morbidity increasing greatly,more people are suffering from FC,which is seriously affecting the quality of people's lives,although not life-threatening,various therapies are surging into the clinical with uncertain treatment effects.And the role of psychological factors has gained more concern in mechanism of FC,after the introduction of bio-psycho-social medical model that means previous index such as syndromes and biochemical markers used to assess the condition of FC patients may be not enough,and the mental state and ever-changing living standard are supposed to be in consideration.High resolution anorectal manometry is widely used in clinical detection of anorectal dynamics,and serves an important role in the rectum and anal function assessment,constipation type,constipation treatment method and evaluation of treatment effect.This experiment aims at monitoring and analysing changes of anorectal motility and sensory function in patients with functional constipation meeting the criterion of the ROME IV through anorectal pressure detection to further explore the relationship between some symptoms of constipation and constipation score and anorectal manometry results,and hope to make benifits for clinical treatment of functional constipation.Methods:According to the diagnostic criteria of Rome IV of functional constipation,86 cases of functional constipation were recruited and classified as group FC,healthy volunteers were recruited as H group,which have received high resolution anorectal manometry,and the data of two groups of subjects were compared.Refering to the Rao SSC standard,on the basis of measured pressure tipping anorectal pressure.The cases which have incresing internal rectal pressure(>45mmHg),reducing anal pressure,and anal relaxation(relaxation rate of>20%compared with sphincter resting pressure)in FC group when do bowel movements,were ragarded as anorectal motility in normal group,namely the FC-N group.And the cases with abnormal changes of anorectal pressure in the FC group,were classified as anorectal motility in abnormal group,namely FC-D group.According to the results of pressure measurement on the reference of Rao SSC standard,the patients in group FC-D were divided into four types(?,?,?,?).All patients with functional constipation were required to fill in and complete questionnaire for constipation symptoms and the severity of constipation,and the questionnaires were scored and compared before examination.According to the normal distribution,the data are expressed as mean± standard deviation,and the independent samples t test is used to represent the data which do not conform to the normal distribution,and the mean value is represented by the Mann-Whitney two test of the nonparametric and independent samples of U.The percentage and the constituent ratio were expressed as percentage,and chi square test was used for comparison between groups.The data were analyzed by SPSS 17.0 software,and the results showed that P<0.05 which means differences and P<0.01,which means significant differences.Results:1.In this study,patients with functional constipation(FC group)are 86 cases(including 33 cases of male,53 females),whose mean age is(54.38 + 17.56)years old,and the average BMI is(23.37 + 3.21)cm/kg2;patients in healthy controls(H group)are 20 cases(including 7 cases of males,13 females),whose mean age is(54.63 + 4.53)years old,and the average BMI is(22.64 + 3.51)cm/kg2.Patients in FC-D group are 75 cases(including 28 cases of male,47 females),whose mean age is(63.20 ±13.90)years old,and the average BMI is(23.53 ±3.54)cm/kg2;patients in FC-N group are 11 cases(including 5 cases of males,6 females),whose mean age is(59.60 ± 11.37)years old,and the average BMI is(24.18 ± 1.93)cm/kg2.There were no significant differences between the two groups in gender,age and BMI.2.The initial sensory threshold of FC group was significantly higher than that of group H(P<0.01),but there was no significant difference between the initial defecation threshold,the threshold of defecation distress and the maximum volume sensation threshold(P>0.05).There were no differences of the rectal resting pressure,anal resting pressure,anal sphincter length,maximum systolic pressure,and the minimum volume measurement result of rectoanal inhibitoy reflex(P>0.05),compared with H group.3.In this study,the anal rectal pressure test for 86 patients of functional constipation showed that patients of FC-D group accounted for 87.2%(75 cases),patients of FC-N group accounted for 12.8%(11 cases).In group FC-D,type ? accounted for 72%(54 cases),type ? accounted for 5.3%(4 cases),type ? accounted for 8%(6cases),and type IV accounted for 14.7%(11cases).4.Scores assessing defecation frequency of patients in group FC-D was lower than that of group FC-N(P<0.05).Scores assessing defecate feeling,endless defecation,obstruction or feeling of obstruction,and sense of defecation time consuming in group FC-D were higher than those of group FC-N(P<0.01).And scores of the rest parts in the FC-D group had no statistical significance(P>0.05)compared with those of FC-N group.Conclusion:1.The FC patients tend to have decreased rectal sensitivity.2.Abnormal movement of the anus and rectum is the mainly type of FC in this study,of which mode I is most common.3.The incidence of decreased frequency defecation of patients with abnormal movement of the anus and rectum is lower than those with non-abnormal movement of the anus and rectum,but it is more likely for them to have defecate feeling,endless defecation,obstruction or feeling of obstruction,sense of defecation time consuming and worse life quality. |
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