TY - JOUR
T1 - Clinical presentation and characteristics of pelvic floor myofascial pain in patients presenting with constipation
AU - Liu, Andy
AU - Chedid, Victor
AU - Wang, Xiao J.
AU - Vijayvargiya, Priya
AU - Camilleri, Michael
N1 - Publisher Copyright:
© 2020 John Wiley & Sons Ltd.
PY - 2020/7/1
Y1 - 2020/7/1
N2 - Background: Patients with pelvic floor myofascial pain (PFMP) have puborectalis tenderness on digital rectal examination (DRE). Little is known about its significance to anorectal function in patients presenting with constipation. Aim: To characterize demographics, clinical characteristics, findings on anorectal manometry (ARM), diagnosis of rectal evacuation disorder (RED), colonic transit [normal (NTC) or slow (STC)], and imaging in constipated patients with PFMP and compare these features to constipation without PFMP. Methods: We performed an electronic medical records review of patients with constipation evaluated by a single gastroenterologist between January 2008 and February 2019. Patients with PFMP were compared to controls with constipation but without PFMP (1:2 ratio). Key Results: A total of 98 PFMP cases and 196 controls were identified. Constipated patients with PFMP were more likely to have RED [OR 7.59 (3.82-15.09), P <.01]; controls were more likely to have either NTC [OR 4.25 (1.45-12.42), P <.01] or STC [OR 3.57 (1.45-8.78), P <.01]. RED in patients with PFMP is supported by comparison to controls: On DRE, they had increased resting tone [OR 2.25 (1.33-3.83), P <.01] and paradoxical contraction of the puborectalis upon simulated evacuation [OR 3.41 (1.94-6.00), P <.01]; on ARM, they had higher maximum resting pressure (102.9 mmHg vs 90.7 mmHg, P <.01) and lower rectoanal pressure gradient (−39.4 mmHg vs −24.7 mmHg, P <.01). Conclusions/Inferences: In constipated patients, PFMP is highly associated with RED. Its presence provides a valuable clue regarding the etiology of a patient's constipation; it should be assessed in all patients with constipation and should also be an additional target for management.
AB - Background: Patients with pelvic floor myofascial pain (PFMP) have puborectalis tenderness on digital rectal examination (DRE). Little is known about its significance to anorectal function in patients presenting with constipation. Aim: To characterize demographics, clinical characteristics, findings on anorectal manometry (ARM), diagnosis of rectal evacuation disorder (RED), colonic transit [normal (NTC) or slow (STC)], and imaging in constipated patients with PFMP and compare these features to constipation without PFMP. Methods: We performed an electronic medical records review of patients with constipation evaluated by a single gastroenterologist between January 2008 and February 2019. Patients with PFMP were compared to controls with constipation but without PFMP (1:2 ratio). Key Results: A total of 98 PFMP cases and 196 controls were identified. Constipated patients with PFMP were more likely to have RED [OR 7.59 (3.82-15.09), P <.01]; controls were more likely to have either NTC [OR 4.25 (1.45-12.42), P <.01] or STC [OR 3.57 (1.45-8.78), P <.01]. RED in patients with PFMP is supported by comparison to controls: On DRE, they had increased resting tone [OR 2.25 (1.33-3.83), P <.01] and paradoxical contraction of the puborectalis upon simulated evacuation [OR 3.41 (1.94-6.00), P <.01]; on ARM, they had higher maximum resting pressure (102.9 mmHg vs 90.7 mmHg, P <.01) and lower rectoanal pressure gradient (−39.4 mmHg vs −24.7 mmHg, P <.01). Conclusions/Inferences: In constipated patients, PFMP is highly associated with RED. Its presence provides a valuable clue regarding the etiology of a patient's constipation; it should be assessed in all patients with constipation and should also be an additional target for management.
KW - chronic constipation
KW - digital rectal examination
KW - dyssynergic defecation
KW - pelvic floor dysfunction
KW - pelvic floor tension myalgia
KW - puborectalis tenderness
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U2 - 10.1111/nmo.13845
DO - 10.1111/nmo.13845
M3 - Article
C2 - 32281205
AN - SCOPUS:85083338162
SN - 1350-1925
VL - 32
JO - Neurogastroenterology and Motility
JF - Neurogastroenterology and Motility
IS - 7
M1 - e13845
ER -