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Abnormal Perception of Urge to Defecate: An Important Pathophysiological Mechanism in Women With Chronic Constipation.
The American Journal of Gastroenterology ( IF 9.8 ) Pub Date : 2022-04-15 , DOI: 10.14309/ajg.0000000000001794
Paul F Vollebregt 1 , Lukasz Wiklendt 2 , Rebecca E Burgell 1, 3 , Pam Chaichanavichkij 1 , Phil G Dinning 2, 4 , Charles H Knowles 1 , S Mark Scott 1
Affiliation  

INTRODUCTION Although the association of absent or attenuated "call to stool" with constipation is well-recognized, no studies have systematically evaluated the perception of urge to defecate in a well-defined cohort of patients with chronic constipation (CC). METHODS A prospective study of 43 healthy adult women and 140 consecutive adult women attending a tertiary center for investigation of CC. All participants completed a 5-day viscerosensory questionnaire, and all women with CC also underwent anorectal physiologic investigations. Normal urge perception and abnormal urge perception were defined using a Naive Bayes model trained in healthy women (95% having normal urge). RESULTS In total, 181 toilet visits in healthy women and 595 in women with CC were analyzed. Abnormal urge perception occurred in 70 (50.0%) women with CC. In this group, the urge to defecate was more often experienced as abdominal sensation (69.3% vs 41.4%; P < 0.0001), and the viscerosensory referral area was 81% larger (median pixels anterior: 1,849 vs 1,022; P < 0.0001) compared to women with CC and normal urge perception. Abnormal (vs normal) urge in women with CC was associated with more severe constipation (Cleveland Clinic constipation score: 19 vs 15 P < 0.0001), irritable bowel syndrome (45.7% vs 22.9% P < 0.0001), and a functional evacuation disorder on defecography (31.3% vs 14.3% P = 0.023). A distinct pattern of abnormal urge was found in women with CC and rectal hyposensitivity. DISCUSSION Abnormal urge perception was observed in 50% of women with CC and was frequently described as abdominal sensation, supporting the concept that sensory dysfunction makes an important contribution to the pathophysiology of constipation.

中文翻译:

排便冲动的异常感知:慢性便秘女性的重要病理生理机制。

引言 尽管“大便呼唤”缺失或减弱与便秘的关联已得到广泛认可,但尚无研究系统评估明确定义的慢性便秘 (CC) 患者队列中对排便冲动的感知。方法 对 43 名健康成年女性和 140 名连续成年女性在三级中心就诊进行 CC 调查的前瞻性研究。所有参与者都完成了为期 5 天的内脏感觉问卷调查,所有患有 CC 的女性也接受了肛门直肠生理检查。正常冲动感知和异常冲动感知是使用在健康女性中训练的朴素贝叶斯模型定义的(95% 具有正常冲动)。结果 总共分析了 181 次健康女性和 595 次 CC 女性上厕所。70 名 (50.0%) 患有 CC 的女性出现了异常的冲动知觉。在这组中,排便的冲动更多地表现为腹部感觉(69.3% vs 41.4%;P < 0.0001),内脏感觉转诊区域大 81%(前中位像素:1,849 vs 1,022;P < 0.0001)对于有 CC 和正常冲动知觉的女性。CC 女性的异常(与正常)冲动与更严重的便秘(克利夫兰诊所便秘评分:19 对 15 P < 0.0001)、肠易激综合征(45.7% 对 22.9% P < 0.0001)和功能性排空障碍相关排便图(31.3% 对 14.3% P = 0.023)。在患有 CC 和直肠敏感性低下的女性中发现了一种明显的异常冲动模式。讨论 在 50% 的 CC 女性中观察到异常的冲动知觉,经常被描述为腹部感觉、
更新日期:2022-04-15
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