Bowel urgency in patients with irritable bowel syndrome.
OBJECTIVE
Bowel urgency is the most bothersome symptom in irritable bowel syndrome patients with diarrhea, but its pathophysiology is poorly understood. Our aim was to assess the relationships among reporting the symptom, the reservoir functions of the colon and rectum, and the patients' psychologic profile.


METHODS
The study involved 28 consecutive patients with irritable bowel syndrome and 17 healthy subjects. The presence or absence of bowel urgency was verified by means of a questionnaire during the 3 days required for the ingestion of radio-opaque markers. On the fourth day, an abdominal x-ray was taken to assess colonic transit time, and rectal sensory and motor responses were measured during rectal distention. The subjects' psychologic profiles were assessed using a psychologic symptoms checklist.


RESULTS
Forty-six percent of the patients reported urgency associated with at least 1 defecation. The multivariate logistic regression analysis showed that colonic transit was the only variable independently associated with reported bowel urgency, but the threshold for the sensation of urgency was not removed from the model since its borderline significance level. Rectal compliance was closely associated with the threshold for the sensation of urgency during rectal distention but was not an independent factor for reporting the sensation. The patients with and without urgency showed altered psychologic profiles.


CONCLUSIONS
The symptom of urgency is associated with objective alterations in the colonic and rectal reservoir of patients with irritable bowel syndrome.
Basilisco
Guido
G
Postgraduate School of Gastroenterology-IRCCS-Fondazione Policlinico, Mangiagalli e Regina Elena, University of Milano, Via F. Sforza 35, 20122 Milan, Italy. basilisc@policlinico.mi.it
De Marco
Elisabetta
E
Tomba
Carolina
C
Cesana
Bruno Mario
BM
D000328:Adult; D003106:Colon / Q000000981:diagnostic imaging / Q000502:physiology*; D003187:Compliance; D003672:Defecation / Q000502:physiology*; D005243:Feces; D005260:Female; D005769:Gastrointestinal Motility / Q000502:physiology*; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000523:psychology; D016015:Logistic Models; D008297:Male; D009119:Muscle Contraction / Q000502:physiology; D011859:Radiography; D012007:Rectum / Q000000981:diagnostic imaging / Q000502:physiology*; D012677:Sensation