Stool patterns and symptoms of disordered anorectal function in patients with inflammatory bowel diseases
Stool patterns and symptoms of disordered anorectal function in patients with inflammatory bowel diseases
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DOI：
10.17219/acem/68986
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发表时间：
2018-06-01
影响因子：
2.1
通讯作者：
Paradowski, Leszek
中科院分区：
文献类型：
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作者：
Petryszyn, Pawel W.;Paradowski, Leszek
背景。克罗恩病 (CD) 和溃疡性结肠炎 (UC) 临床上通常表现为慢性腹泻、痉挛、腹痛和直肠出血等症状。然而，无论是否存在肛周疾病，肛门直肠功能异常的症状似乎都同等重要。 目的。本研究的目的是评估炎症性肠病 (IBD) 患者的粪便模式和肛门直肠功能紊乱症状的患病率，特别是尿急和大便失禁，及其严重程度。材料和方法。 33 名 CD 患者和 38 名 UC 患者完成了问卷调查。对所有患者和 20 名对照者进行推/应变操作。结果。 33名患者每天排便次数超过3次； 44 人有稀便/水样便。两名患者每周排便次数少于 3 次，8 名患者出现硬/块状粪便，3 名患者使用泻药。分别有 17 名和 38 名患者报告过度用力和不完全排空。 52 名患者主诉尿急，32 名患者主诉里急后重。值得注意的是，每天至少有一次尿急的 UC 患者多于 CD 患者 (p < 0.04)。患者报告的症状如下：大便失禁（31 例）、被动失禁（20 例）和急迫性失禁（16 例）、气体失禁（24 例）以及液体粪便（33 例）和固体粪便（7 例）。 28 名患者的粪便/气体辨别存在缺陷。十一名患者必须佩戴护垫。 39 名患者因尿急/里急后重，28 名患者因大便失禁而导致日常功能恶化。 12 名 CD 患者、15 名 UC 患者和 1 名对照受试者的推/拉动作异常。 2 个研究组与对照组之间的差异显着（p < 0.03 和 p < 0.01）。结论。大多数 IBD 患者抱怨病情紧迫。超过 50% 的患者报告有大便失禁。两者都会使患者的日常功能恶化。相当比例的患者具有与便秘一致的症状，其中超过 1/3 的患者与异常的推/拉动作有关。
Background. Crohn's disease (CD) and ulcerative colitis (UC) typically clinically manifest with symptoms like chronic diarrhea, cramps, abdominal pain, and rectal bleeding. However, symptoms of abnormal anorectal function seem to be of equal importance, regardless of the presence or absence of perianal disease.Objectives. The aim of this study was to assess stool patterns and the prevalence of symptoms of disordered anorectal function, particularly urgency and fecal incontinence, and their severity in patients with inflammatory bowel diseases (IBDs).Material and methods. Thirty-three patients with CD and 38 patients with UC completed a questionnaire. A push/strain maneuver was performed on all patients and 20 controls.Results. Thirty-three patients had more than 3 bowel movements a day; 44 had loose/watery stools. Two patients had fewer than 3 bowel movements a week, 8 had hard/lumpy stools, and 3 used laxatives. Excessive straining and incomplete evacuation were reported by 17 and 38 patients, respectively. Fifty-two patients complained of urgency and 32 of tenesmus. Significantly, more UC patients than CD patients had urgency at least once a day (p < 0.04). The following symptoms were reported by patients in the following numbers: fecal incontinence (31), passive (20) and urge incontinence (16), incontinence to gas (24), as well as liquid (33) and solid stool (7). Stool/gas discrimination was defective in 28 patients. Eleven patients had to wear pads. Everyday functioning was worsened because of urgency/tenesmus in 39 patients and because of fecal incontinence in 28 patients. The push/strain maneuver was abnormal in 12 patients with CD, 15 patients with UC and 1 control subject. The differences between the 2 study groups and the controls were significant (p < 0.03 and p < 0.01).Conclusions. A majority of patients with IBD complain of urgency. Fecal incontinence is reported by over 50% of patients. Both worsen patients' everyday functioning. A relevant proportion of patients have symptoms consistent with constipation, which is in connection with an abnormal push/strain maneuver in more than 1/3 of them.