| Purpose: Study the constipation symptoms and high-resolution anorectal manometry characteristics of patients with different types of idiopathic constipation,and provide clinical reference for the diagnosis and treatment of patients with idiopathic constipation.Methods: Seventy-four patients with idiopathic constipation who attended 967 th Hospital of the Chinese People’s Liberation Army(PLA)from January 2021 to January 2023 were selected for the study,and were divided into the functional constipation group(FC group),irritable bowel syndrome with predominant constipation group(IBS-C group)and the non-Roman constipation group(No Rome Constipation,NRC group)according to the Rome IV diagnostic criteria.The general information(age,gender composition and duration of disease),number of complete spontaneous bowel movements per week(CSBMs/week),frequency of constipation symptoms(straining to defecate,feeling of incomplete defecation and feeling of obstruction),stool properties,Constipation Severity Instrument(CSI),patient assessment of constipation quality of life(PAC-QOL)and anorectal kinetic indexes(anal sphincter resting pressure,anal maximal squeeze pressure,residual anal pressure,rectal push pressure,and anal relaxation rate)were compared among the three groups.Results:1.47(54.7%),20(36.0%),and 7(9.3%)of the 74 patients with idiopathic constipation had FC,IBS-C,and NRC,respectively,and there were no statistically significant differences in the age and gender composition of the three study groups(P > 0.05),and there were significant differences in the duration of disease in the FC,IBS-C,and NRC groups,with the duration of disease in the FC and IBS-C groups longer than that of the NRC group(P < 0.05).2.In this study,the frequency of straining to defecate,incomplete defecation and obstructive defecation(as a percentage of the number of bowel movements)was(75.27±22.47)%,(65.14±28.54)%,(41.76±16.83)%,respectively,in patients with idiopathic constipation,and the frequency of hard defecation(stool with dry ball or hard stool)was 72.97%(54/74).The frequency of straining to defecate,incomplete defecation and obstruction was statistically different in the FC,IBS-C and NRC groups(P < 0.05).The FC and IBS-C groups were more likely to have strained,incomplete,and obstructed bowel movements than the NRC group(P < 0.05).There was no statistical difference in the number of complete spontaneous bowel movements per week among the three groups(P > 0.05).3.There were 36(76.6%),14(70.0%)and 4(57.1%)patients with BSFS type 1 and type 2 stools in the FC,IBS-C and NRC groups,respectively,and there was no statistical difference in the frequency of type 1 and type 2 stools among the three groups(χ2 = 1.51,P > 0.05).4.The CSI obstructive bowel movement score,CSI defecation colonic fatigue score and total CSI score in the FC group were not significantly different from those in the IBSC group(P > 0.05).The CSI defecation pain score in the IBS-C group was higher than that in the FC group,and there was a statistical difference between them(P < 0.05).The total CSI score,obstructive bowel movement score,defecation colonic weakness score and defecation pain score were all higher in the FC group than in the NRC group(P <0.05).5.The PAC-QOL physiological score,PAC-QOL psychosocial score and PAC-QOL satisfaction score in the FC group were not significantly different from those in the IBSC group(P > 0.05).The PAC-QOL worry score and total PAC-QOL score in the IBS-C group were higher than those in the FC group,and there was a statistical difference between them(P < 0.05).The PAC-QOL total score and its physiological score and PACQOL satisfaction score in the FC group were statistically different from those in the IBSC group(P < 0.05).QOL total score and its physical score and psychosocial score were higher in the FC group than in the NRC group(P < 0.05).6.There was no statistical difference in the anal sphincter resting pressure,anal maximal squeeze pressure and rectal push pressure among the study subjects in the FC,IBSC and NRC groups(P > 0.05).The residual anal canal pressure and anal relaxation rate of the three study groups were statistically different(P < 0.05).The residual anal canal pressure in the NRC group was lower than that in the FC and IBS-C groups,and the anal relaxation rate in the NRC group was higher than that in the FC and IBS-C groups(P <0.05).There was a statistical difference in the frequency of anorectal synergistic disorders among the three study groups(χ2= 8.54,P < 0.05).There was no statistical difference in the frequency of anorectal synergistic disorders among the patients in the FC and IBS-C groups,and the frequency of anorectal synergistic disorders among the patients in the FC group was higher than that in the NRC group(P < 0.05).7.Patients with anorectal synergistic disorder had a higher frequency of straining to defecate and feeling of obstruction than patients with normal anorectal function(P < 0.05).There was no statistical difference between patients with anorectal synergistic disorder and patients with normal anorectal function in terms of age,disease duration,number of complete spontaneous bowel movements per week,frequency of feeling of incomplete defecation,total CSI score and total PAC-QOL score.The rate of anal relaxation was negatively correlated with the frequency of effortful defecation(r=-0.289,P<0.05);the rate of anal relaxation was negatively correlated with the frequency of obstructive defecation sensation(r=-0.357,P<0.05).Conclusions:1.NRC and Occasional Constipation are a group that should not be ignored,although their disease duration is shorter and the severity of constipation is less severe than that of FC and IBS-C,and clinical attention should be paid to the consultation and treatment complaints of this group of patients.2.Idiopathic constipation is most common in patients with reduced stool frequency,while other symptoms are,in order of frequency,straining to defecate,dry or hard stools,incomplete defecation and obstructive defecation.3.The main difference between IBS-C and FC is the difference in severity of abdominal pain and quality of life.Clinical treatment should focus on giving more psychological support to IBS-C patients.4.The pathogenesis of IBS-C and FC may be related to anorectal synergistic dysregulation,and HRAM is clinically important for assessing whether FC and IBS-C may be FDD.5.Patients with idiopathic constipation with high frequency of straining and obstructive defecation may be more likely to have anorectal dyskinesia,suggesting that the patients may have functional defecation disorder. |
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