title: Frequency, spectrum, and factors associated with fecal evacuation disorders among patients with chronic constipation referred to a tertiary care center in northern India.
abstract: BACKGROUND
  Data on fecal evacuation disorder (FED) causing chronic constipation (CC) is scanty in India.
  
  
  METHODS
  Prospectively maintained data of 249 consecutive patients with CC (Rome III) referred for investigations were retrospectively analyzed.
  
  
  RESULTS
  Of 249 patients (43.7 ± 16.2 years, 174 males), 135/242 (55.8 %), 57/249 (22.9 %), and 83/136 (61.0 %) had abnormal balloon expulsion test (>200 g), anorectal manometry [>100 mmHg resting pressure (n = 4), >167 mmHg squeeze pressure (n = 46), and both (n = 7)], and defecography (anorectal angle not opening by >15° during defecation, perineal descent ≥4 cm, and/or rectocele), respectively. Though 181/249 (72.6 %) had one test abnormality, 86/249 (34 %) had FED (greater than or equal to two abnormalities), 44/65 (67.6 %) of whom had a defecation index ≤1.4. Rome III criteria for irritable bowel syndrome were equally fulfilled by patients with and without FED [74/83 (89 %) vs. 117/144 (81.2 %); p = ns]. On univariate analysis, straining duration, prolonged straining [≥30 min; 21/39 (53.8 %) vs. 15/65 (23.1 %); p = 0.002], incomplete evacuation [75/77 (97.4 %) vs. 95/114 (83.3 %); p = 0.004], and >3 stools/week [60/75 (80 %) vs. 76/128 (60 %); p = 0.004] were commoner among the FED patients though age, gender, symptom duration, mucus, manual evacuation, and stool forms were comparable. Resting and squeeze pressures and balloon volume at maximum tolerable limit were higher, and the sphincter tended to be shorter in FED. Prolonged straining, incomplete evacuation, and squeeze pressure were significant on multivariate analysis. Manometry and defecography abnormalities were commoner among the female FED patients.
  
  
  CONCLUSIONS
  FED is not uncommon, which fulfills the Rome III criteria for IBS, and prolonged straining may be suggestive; abnormal defecography and manometry are commoner in female.
authors.affiliation: Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India. udayghoshal@yahoo.co.in.
authors.forename: Uday C
authors.initials: UC
authors.lastname: Ghoshal
authors.affiliation: Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India.
authors.forename: Abhai
authors.initials: A
authors.lastname: Verma
authors.affiliation: Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India.
authors.forename: Asha
authors.initials: A
authors.lastname: Misra
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000503:physiopathology; D002908:Chronic Disease; D003248:Constipation / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology*; D003672:Defecation; D019841:Defecography; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D043183:Irritable Bowel Syndrome; D008297:Male; D008365:Manometry; D008875:Middle Aged; D012007:Rectum / Q000503:physiopathology; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*
keywords: Anorectal manometry; Chronic constipation; Functional gastrointestinal disorders; Irritable bowel syndrome