Clinical Parameters for Differentiating Pelvic Floor Dyssynergia (PFD) in Constipated Patients

Kim, Dae Hyun; Myung, Seung Jae; Yang, Suk Kyun; Jung, Sung Hee; Chang, Hye Sook; Park, IL Gwon; Jung, Hwoon Yong; Hong, Weon Seon; Kim, Jin Ho; Min, Young Il

Abstract

BACKGROUND AND AIMS: PFD is effectively treated by biofeedback therapy. For the definite diagnosis of PFD, defecography, colon transit time study, balloon expulsion testing, and anorectal manometry are needed. However, these methods are of high cost and cause discomfort to patients. Moreover, definite diagnosis cannot be made by a single test due to a high false positive rate. In general, several symptoms linked with problems in defecating, including excessive straining, the sensation of incomplete evacuation, and applying pressure around the anus or the vagina to facilitate defecation, are known to be frequently associated with PFD. The aim of this study was to evaluate whether specific clinical parameters could differentiate patients with PFD from other constipated patients.
METHODS
An organized questionnaire including 47 questions that contained subjective symptoms, past medical history, and eating habits was designed. The questionnaire was distributed to 132 patients who fulfilled Rome II criteria for functional constipation. Digital rectal examination was conducted by a single gastroenterologist.
RESULTS
Among 132 patients, 45 patients were categorized as PFD, 26 patients as slow transit constipation (STC) and 17 patients as normal transit constipation. Among specific questions about constipation, hard stool was more frequently noted in patients with STC than PFD (p<0.05), and the frequency of defecation was lower in patients with STC than PFD (p<0.05). However, the symptoms suggesting difficult defecation were not different between the two groups. The percentage of paradoxical contraction by digital rectal examination was not different between the two groups (PFD: 57.1% vs. STC: 48.0%).
CONCLUSION
The symptoms and signs suggesting difficult defecation could not differentiate PFD from STC and normal transit constipation, although several parameters were different among the three subgroups. Therefore, anorectal physiologic tests are needed for the diagnosis of PFD.