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KMID : 0978920120130020176
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Korean Journal of Clinical Geriatrics
2012 Volume.13 No. 2 p.176 ~ p.185
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Clinical Characteristics and Diagnosis of Idiopathic Chronic Constipation in Elderly Patients
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Shin Kyung-Soo
Hwang Yong-Hee
Jung Yong-Hwan
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Abstract
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Background: The aim of this investigation was to assess clinical characteristics and diagnostic tool of idiopathic chronic constipation in elderly patient.
Methods: A retrospective study of 32 constipated patients (9 male, 23 female) of mean age 71.2±5.4 (65∼83) years who had no abnormalities in colonoscopy, barium enema and rectal exam were done. 32 patients underwent defecography and cine-defecography, of which 21 patients underwent anal manometry, 20 patients underwent colonic transit time study (CTT), and 30 patients underwent anal plug electromyography (EMG).
Results: Nonrelaxing puborectalis syndrome (NRPR), rectocele, rectal intussusception, anal dyschezia and sigmoidocele were observed in 14 (44%), 15 (47%), 7 (22%), 1 (3.1%) and 3 (9%) of the patients, respectively. Normal cine-defecography finding was observed in 2 (6.3%) patients. More than one abnormal finding was found in 11 (34.4%) patients. Abnormal findings included colonic inertia in 3 (15%) patients. Normal colonic transit time was observed in 17 (85%) patients. Anal hypertonia was observed in 2 (9.5%) patients by manometry, of which 1 (4.8%) patient was diagnosed with anal dyschezia in cine-defecography. 13 (43.3%) patients were diagnosed with NRPR in anal plug EMG. The correlation rate between cine-defecography/EMG, defecography/CTT, and CTT/EMG were 73.3%, 55%, and 55.6% respectively in the diagnosis of NRPR.
Conclusion: Elderly patients with chronic constipation should be evaluated with physiological tests (defecography and cine-defecography, anal manometry, anal electromyography, colonic transit time test) after structural disorders and extracolonic causes have been excluded. Defecography and EMG were complements each of the other in diagnosis of pelvic outlet obstruction especially NRPR, but CTT has no role.
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KEYWORD
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Elderly, Constipation, Defecography
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