DEFECOGRAPHY IN PATIENTS WITH IRRITABLE-BOWEL-SYNDROME AND HEALTHY-VOLUNTEERS

Background: In patients with IBS, many symptoms have their origin in t he recto-anal segment, with motility changes in the rectum and in the internal anal sphincter, and alterations in rectal sensitivity. Howeve r, up to now, it is not known if these clinical and physiological chan ges are equated with morphological changes in the recto-anal segment. Methods: Sixteen consecutive patients with IBS (mean age 22, range 18- 33 years; 13 females) and 10 healthy volunteers (mean age 34.5, range 19-50 yr.; 6 males) were evaluated prospectively with defaecography. R esults: 1) Anorectal angle: No significant differences were observed i n the anorectal angle during rest (91.6+/-3.5 degrees vs 92.6+/-2.5 de grees) and during defaecation (92+/-5.5 degrees vs 98.7+/-2.6 degrees) between patients with IBS and healthy volunteers. However, patients w ih IBS were unable to widen the angle during defaecation, remaining th e same at rest (91.6+/-3.5 degrees) as during defaecation (92+/-5.5 de grees). IBS patients with constipation (n = 2) compared to those with normal frequency defaecation (n = 13) showed no significant difference s at rest (95+/-6 vs 89.8+/-4.1 degrees) and during defaecation (100+/ -8 vs 88.9+/-6.4 degrees). Healthy volunteers widened the angle by mor e than 5 degrees during defaecation. 2) Perineometry: although not sig nificant, patients with IBS had less perineal descent during the simul ated defaecation (1.98+/-0.37 cm) than healthy subjects (2.1+/-0.3 cm) . Nevertheless, during squeeze there was significantly less mobility o r perineal descent in patients with IBS than in control subjects (0.21 +/-0.17 vs 0.95+/-0.21 cm; P = 0.01). Conclusions: The findings of thi s study suggest that patients with IBS as a whole, whether constipatio n predominant or not, showed changes in pelvic-floor mobility.