title: Gender differences in chronic constipation on anorectal motility.
abstract: BACKGROUND
  The epidemiology of chronic constipation (CC) skews toward female predominance, yet men make up an important component of those suffering from CC. We sought to determine whether there are sex-specific differences in symptoms and physiologic parameters on anorectal manometry (ARM).
  
  
  METHODS
  We performed a case-control analysis of sequential men and age-matched women (2:1 ratio) presenting for ARM as part of the evaluation of CC. We collected physiologic parameters derived from 3D high-resolution ARM in addition to the ROME III constipation module and the Pelvic Floor Distress Inventory 20 (PFDI-20) questionnaires. We analyzed univariate, sex-specific differences in ARM physiologic parameters and PFDI-20 parameters and adjusted for putative confounders using multivariate logistic regression.
  
  
  RESULTS
  Our study enrolled 80 men and 165 age-matched women. Men had a higher median sphincter resting pressure (81.2 vs 75.2 mm Hg, P=.01) and mean squeeze pressure (257.0 vs 170.5 mm Hg, P<.0001) than women. Although men reported significantly less severe straining and incomplete evacuation, they had greater mean rectoanal pressure differential (-106.7 vs -71.1 mm Hg, P<.0001), smaller mean defecation index (0.17 vs 0.27, P=.03) and higher volume threshold for urgency (115.2 v. 103.4 mL, P=.03). However, women were more likely to have abnormal balloon expulsion time (BET) than men (52.7% vs 35.0%, P=.01). After multivariate analysis, male gender was the only independent predictor of a normal BET (OR: 0.48, 95% CI: 0.27-0.86, P=.01).
  
  
  CONCLUSIONS
  Men and women with CC differ with regard to symptom severity and physiologic parameters derived from ARM suggesting differences in their pathophysiology.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Zakari
authors.affiliation: Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Nee
authors.affiliation: Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: W
authors.initials: W
authors.lastname: Hirsch
authors.affiliation: Center for Neurointestinal Health and Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: B
authors.initials: B
authors.lastname: Kuo
authors.affiliation: Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Lembo
authors.affiliation: Center for Neurointestinal Health and Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: K
authors.initials: K
authors.lastname: Staller
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000503:physiopathology*; D016022:Case-Control Studies; D002908:Chronic Disease; D003248:Constipation / Q000175:diagnosis* / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D005260:Female; D005769:Gastrointestinal Motility / Q000502:physiology*; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D012007:Rectum / Q000503:physiopathology*; D012727:Sex Characteristics
keywords: anal sphincter; anorectal disorders; anorectal manometry; chronic constipation; dyssynergic defecation; gender