Manometric investigation of anorectal function in early and late stage Parkinson's disease

Abnormal gastrointestinal function is relatively frequent in Parkinson's di sease, and constipation is a disturbing symptom in many patients. However, it remains to be established whether anorectal abnormalities are characteri stic of the late stages of the disease. Clinical and anorectal manometric f unction were investigated in groups of early and late stage parkinsonian pa tients. Thirty one patients (19 men, 12 women, age range 22 to 89 years) en tered the study. The disease severity was assessed by Hoehn and Yahr stagin g: there were four (12.9%) stage I, seven (22.6%) stage II, 10 (32.2%) stag e III, and 10 (32.2%) stage IV patients. Anorectal variables were measured by standard manometric equipment and techniques. Values obtained in early s tage patients (Hoehn and Yahr stage I and II) were compared with those obta ined in late stage patients (Hoehn and Yahr stage III and IV). Overall, mor e than 70% of patients complained of chronic constipation, with chronic lax ative use reported in more than 30%. Late stage patients were slightly olde r than their early stage counterparts. Pelvic floor dyssynergia was documen ted in more than 60% of patients. Manometric variables were not different i n the two groups. In conclusion, defecatory dysfunction is frequent in Park inson's disease, it is not confined to late stage patients, and it is found early in the course of the disease. This has potential implications for a targeted therapeutic approach.