MECHANISMS OF IDIOPATHIC CONSTIPATION - OUTLET OBSTRUCTION

Abstract

Anorectal myectomy was performed in 62 patients suffering from symptoms attributed to ineffective colonic motility. Indications for surgery rested on the presence of 1 or more of the following 3 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 3 stools/wk, the average number of stools/wk increased from 1.2 to 4.2 (P < 0.001). The remaining 12 patients, who had more than 3 stools/wk, were completely relieved of their symptoms. In all cases with improved symptoms, myectomy accelerated 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.