The role of pelvic floor dysfunction and slow colonic transit in adolescents with refractory constipation.
OBJECTIVE
Although pelvic floor dysfunction (PFD) is recognized as a cause of refractory constipation in adults, this diagnosis is not frequently considered in children and adolescents with refractory constipation. The purpose of this study was to examine the symptoms and colonic transit in adolescents with constipation evaluated for a disorder in pelvic floor function.


METHODS
Adolescents with refractory constipation who had undergone anorectal manometry (ARM) and balloon expulsion test (BET) were identified by retrospective review of records. Initial symptoms and the clinician's assessment were used to categorize patients by pediatric Rome II criteria, that is, functional constipation (FC), constipation-predominant irritable bowel syndrome (C-IBS) or functional fecal retention (FFR). Results of scintigraphic colonic transit studies were evaluated. A chi2 test was used to assess the association between individual clinical symptoms and Rome II criteria.


RESULTS
Sixty-seven adolescents underwent evaluation of pelvic floor function by tests for PFD: BET was abnormal in 42%. There was no underlying disease or alternative diagnosis to account for the constipation in these patients. Among the 41 patients who also underwent scintigraphic colonic transit, 30% had slow transit constipation and 12% had both slow colonic transit and abnormal BET. Patients classified as C-IBS were more likely to report weight loss (p = 0.03), bloating (p = 0.04), and incomplete rectal evacuation (p = 0.03).


CONCLUSIONS
Abnormal pelvic floor function and delayed colonic transit are demonstrable as single or combined problems in adolescents with refractory constipation.
Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.) Program and Department of Pediatrics, Mayo Clinic, Rochester, Minnesota, USA. denesh.chitkara@childrens.harvard.edu
Denesh K
DK
Chitkara
Albert J
AJ
Bredenoord
Filippo
F
Cremonini
Silvia
S
Delgado-Aros
Rory L
RL
Smoot
Mounif
M
El-Youssef
Deborah
D
Freese
Michael
M
Camilleri
D000293:Adolescent; D001003:Anal Canal / Q000503:physiopathology; D003106:Colon / Q000503:physiopathology; D003248:Constipation / Q000503:physiopathology*; D005260:Female; D005772:Gastrointestinal Transit; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008365:Manometry; D017773:Pelvic Floor / Q000503:physiopathology*