title: Joint hypermobility and rectal evacuatory dysfunction: an etiological link in abnormal connective tissue?
abstract: BACKGROUND
  Previous studies report an association between joint hypermobility (JHM), as a clinical feature of underlying connective tissue (CT) disorder, and pelvic organ prolapse. However, its association with rectal evacuatory dysfunction (RED) has not been evaluated. To investigate the prevalence of JHM in the general population and in patients with symptoms of RED referred for anorectal physiological investigation.
  
  
  METHODS
  Bowel symptom and Rome III questionnaires to detect irritable bowel syndrome were sent to 273 patients with RED. Patients then underwent full investigation, including evacuation proctography. A validated 5-point self-reported questionnaire was used to assess JHM in both the patient group and 100 age- and sex-matched controls [87 female, median age 55 (range 28-87)].
  
  
  RESULTS
  Seventy-three patients were excluded from analysis (incomplete questionnaire or investigation). Of 200, 65 patients [32%: 63 female, median age 52 (range 15-80)] and 14% of controls (P = 0.0005 vs patients) had features satisfying criteria for JHM. Overall constipation score (P < 0.0001), abdominal pain (P = 0.003), need for manual assistance (P = 0.009), and use of laxatives (P = 0.03) were greater in the JHM group than the non-JHM group. On proctography, 56 of JHM patients (86%) were found to have significant morphological abnormalities (e.g. functional rectocoele), compared with 64% of the non-JHM group (P = 0.001).
  
  
  CONCLUSIONS
  The greater prevalence of JHM in patients with symptoms of RED, and the demonstration of significantly higher frequencies of morphological abnormalities than those without JHM, raises the possibility of an important pathoaetiology residing in either an enteric or supporting pelvic floor abnormality of CT.
authors.affiliation: GI Physiology Unit (Academic Surgical Unit) and Neurogastroenterology Group, Centre for Digestive Diseases, Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, London, UK. s.d.mohammed@qmul.ac.uk
authors.forename: S D
authors.initials: SD
authors.lastname: Mohammed
authors.forename: P J
authors.initials: PJ
authors.lastname: Lunniss
authors.forename: N
authors.initials: N
authors.lastname: Zarate
authors.forename: A D
authors.initials: AD
authors.lastname: Farmer
authors.forename: R
authors.initials: R
authors.lastname: Grahame
authors.forename: Q
authors.initials: Q
authors.lastname: Aziz
authors.forename: S M
authors.initials: SM
authors.lastname: Scott
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003238:Connective Tissue / Q000503:physiopathology*; D003240:Connective Tissue Diseases / Q000503:physiopathology*; D003248:Constipation / Q000209:etiology / Q000503:physiopathology; D003672:Defecation / Q000502:physiology; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012002:Rectal Diseases / Q000503:physiopathology*; D012007:Rectum / Q000503:physiopathology*; D011795:Surveys and Questionnaires; D055815:Young Adult