| Objective: To investigate the characteristics and influencing factors of anorectal dynamics in elderly patients with chronic constipation along with different clinical symptoms and intestinal flora imbalance.Methods: Patients were enrolled from Department of Gastroenterology and Department of Healthcare in Qingdao Municipal Hospital during June 2014 to February 2016,including the elderly(more than 60years)with chronic constipation 58 cases,the oldest old with chronic constipation 35 cases,and patients with intestinal flora imbalance 130 cases.Water-perfused anorectal manometry was used to detect anal resting pressure,anal maximum squeeze pressure,paradoxical motility of anorectum,first sensation volume,defecation sensation volume and maximal tolerance volume.Anal pressure and rectal sensation,combined with the clinical data,were statistically analyzed.Results: 1.The anal resting pressure was(59.74±2.31)mm Hg in elderly patients with chronic constipation,which was significantly lower than(68.22 ± 2.37)mm Hg in non-elderly adults(t=2.43,P<0.05).The incidence of paradoxical motility of anal sphincter in elderly patients with incomplete defecation,stool of Bristol type 3-5 and straining at defecation was significantly higher than those in groups without above symptoms(c 2=8.88 、 11.54 、 6.07,P<0.05).Maximal tolerable volume in elderly patients with straining at defecation and abdominal pain was(139.17±7.38)ml and(131.00±3.60)ml respectively,which were significantly lower than those in groups without above symptoms(t=2.14、2.26,P<0.05).No correlation was observed between sex and anorectal motility in elderly patients with chronic constipation.2.The anal resting pressure and anal maximum squeeze pressure(MSP)in the oldest-old was(52.94±2.72)mm Hg and(136.57±9.01)mm Hgrespectively,which were significantly lowerthan that in old and non elderly adults(F=8.57 、 9.00,P<0.01).MSP was significantly lower in the female oldest-old than that in the female elderly(60-80 years old).MSP of the female and male in oldest-old patients was significantly lower than in subjects of the same sex in elderly(60-80 years old)patients.MSP of female was significantly lower than that of male in subjects of the same age.MSP of the oldest-old patients with or without straining at defecation,incomplete defecation and stool of Bristol type 3-5 was significantly lower than in subjects of the same symptom in elderly(60-80 years old)patients.The anal resting pressure of oldest-old patients without straining at defecation and stool of Bristol type 3-5 was significantly lower than that in elderly(60-80 years old)patients with same symptom.The incidence of paradoxical motility of anal sphincter in the elderly(60-80 years old)patients with stool of Bristol type 3-5 was significantly higher than control group.The incidence of paradoxical motility of anal sphincter in the oldest-old patients with incomplete defecation and straining at defecation was significantly higher than those in groups without above symptoms(c 2=4.65 、 4.27,P<0.05).3.The volume of first sensation was(40.54±19.78)ml in patients with dysbacteriosis,which was significantly lower than(50.97 ± 37.07)ml in those with normal intestinal microbiota(t=2.25,P<0.05).Maximal squeeze pressure(MSP)was(208.60 ± 51.46)mm Hg in non-elderly patients with dysbacteriosis,which was significantly higher than(162.08±45.54)mm Hg in subjects without dysbacteriosis of the same age(P<0.05)and(174.45±70.31)mm Hg)in elderly patients with intestinal flora imbalance(P<0.05).MSP of the female with or without intestinal flora imbalance was(141.32 + 54.03)mm Hg and(140.96 + 43.11)mm Hg respectively,which were significantly lower than those of men(both P<0.05).No correlation was observed between intestinal dysbacteriosis and anorectal motility in patients with constipation,diarrhea,abdominal pain,and bloating.MSP of female in elderly patients with chronic constipation and dysbacteriosis was significantly lower than that of male in elderly patients without dysbacteriosis.Conclusions: Anorectal motility in elderly patients with chronic constipation has its characteristics.The age,sex and intestinal dysbacteriosis may be influencing factors of anorectal motility.The dynamic abnormalities of anorectum were different in elderly patients with chronic constipation with specific symptoms. |
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