Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 2.1
5-Year Impact Factor – 2.2
Scopus CiteScore – 3.4 (CiteScore Tracker 3.7)
Index Copernicus  – 161.11; MNiSW – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2018, vol. 27, nr 6, June, p. 813–818

doi: 10.17219/acem/68986

Publication type: original article

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Stool patterns and symptoms of disordered anorectal function in patients with inflammatory bowel diseases

Paweł W. Petryszyn1,A,B,C,D,E, Leszek Paradowski2,A,E,F

1 Department of Clinical Pharmacology, Faculty of Pharmacy with Division of Laboratory Diagnostics, Wroclaw Medical University, Poland

2 Department of Gastroenterology and Hepatology, Faculty of Postgraduate Medical Training, Wroclaw Medical University, Poland

Abstract

Background. Crohn’s disease (CD) and ulcerative colitis (UC) typically clinically manifest with symptoms like chronic diarrhea, cramps, abdominal pain, and rectal bleeding. However, symptoms of abnormal anorectal function seem to be of equal importance, regardless of the presence or absence of perianal disease.
Objectives. The aim of this study was to assess stool patterns and the prevalence of symptoms of disordered anorectal function, particularly urgency and fecal incontinence, and their severity in patients with inflammatory bowel diseases (IBDs).
Material and Methods. Thirty-three patients with CD and 38 patients with UC completed a questionnaire. A push/strain maneuver was performed on all patients and 20 controls.
Results. Thirty-three patients had more than 3 bowel movements a day; 44 had loose/watery stools. Two patients had fewer than 3 bowel movements a week, 8 had hard/lumpy stools, and 3 used laxatives. Excessive straining and incomplete evacuation were reported by 17 and 38 patients, respectively. Fifty-two patients complained of urgency and 32 of tenesmus. Significantly, more UC patients than CD patients had urgency at least once a day (p < 0.04). The following symptoms were reported by patients in the following numbers: fecal incontinence (31), passive (20) and urge incontinence (16), incontinence to gas (24), as well as liquid (33) and solid stool (7). Stool/gas discrimination was defective in 28 patients. Eleven patients had to wear pads. Everyday functioning was worsened because of urgency/tenesmus in 39 patients and because of fecal incontinence in 28 patients. The push/strain maneuver was abnormal in 12 patients with CD, 15 patients with UC and 1 control subject. The differences between the 2 study groups and the controls were significant (p < 0.03 and p < 0.01).
Conclusion. A majority of patients with IBD complain of urgency. Fecal incontinence is reported by over 50% of patients. Both worsen patients’ everyday functioning. A relevant proportion of patients have symptoms consistent with constipation, which is in connection with an abnormal push/strain maneuver in more than 1/3 of them.

Key words

high-resolution manometry, fecal incontinence, inflammatory bowel disease

References (17)

  1. Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol. 1997;32(9):920–924.
  2. Miller R, Bartolo DC, Locke-Edmunds JC, et al. Prospective study of conservative and operative treatment for fecal incontinence. Br J Surg. 1988;75(2):101–105.
  3. Rao SS, Holdsworth CD, Read NW. Symptoms and stool patterns in patients with ulcerative colitis. Gut. 1988;29(3):342–345.
  4. Rao SS, Read NW. Gastrointestinal motility in patients with ulcerative colitis. Scand J Gastroenterol Suppl. 1990;175:22–28.
  5. Crispino P, Habib FI, Badiali D, et al. Colorectal motor and sensitivity features in patients affected by ulcerative proctitis with constipation: A radiological and manometric controlled study. Inflamm Bowel Dis. 2006;12:712–718.
  6. Isgar B, Harman M, Kaye MD, et al. Symptoms of irritable bowel syndrome in ulcerative colitis in remission. Gut. 198;24:190–192.
  7. Bassotti G, de Roberto G, Chistolini F, et al. Twenty-four-hour manometric study of colonic propulsive activity in patients with diarrhea due to inflammatory (ulcerative colitis) and non-inflammatory (irritable bowel syndrome) conditions. Int J Colorectal Dis. 2004;19:493–497.
  8. Bassotti G, Villanacci V, Mazzocchi A, et al. Colonic propulsive and postprandial motor activity in patients with ulcerative colitis in remission. Eur J Gastroenterol Hepatol. 2006;18:507–510.
  9. Simren M, Axelsson J, Gillberg R, et al. Quality of life in inflammatory bowel disease in remission: The impact of IBS-like symptoms and associated psychological factors. Am J Gastroenterol. 2002;97(2):389–396.
  10. Loening-Baucke V, Metcalf AM, Shirazi S. Anorectal manometry in active and quiescent ulcerative colitis. Am J Gastroenterol. 1989;84(8):892–897.
  11. Rao SS, Hatfield R, Soffer E, et al. Manometric tests of anorectal function in healthy adults. Am J Gastroenterol. 1999;94(3):773–783.
  12. Mueller MH, Kreis ME, Gross ML, et al. Anorectal functional disorders in the absence of anorectal inflammation in patients with Crohn’s disease. Br J Surg. 2002;89:1027–1031.
  13. Buchmann P, Kolb E, Alexander-Williams J. Pathogenesis of urgency in defecation in Crohn’s disease. Digestion. 1981;22(6):310–316.
  14. Kangas E, Hiltunen KM, Matikainen M. Anorectal function in Crohn’s disease. Ann Chir Gynaecol. 1992;81(1):43–47.
  15. Daniel JM. Young adults’ perceptions of living with chronic inflammatory bowel disease. Gastroenterol Nurs. 2002;25(3):83–94.
  16. Porcelli P, Leandro G. Bowel obsession syndrome in a patient with ulcerative colitis. Psychosomatics. 2007;48(5):448–450.
  17. Moody G, Probert CS, Srivastava EM, et al. Sexual dysfunction amongst women with Crohn’s disease: A hidden problem. Digestion. 1992;52(3–4):179–183.
© Wroclaw Medical University