Slow transit constipation - A disorder of pelvic autonomic nerves?

Slow transit constipation (STC) is a severe motility disorder, which in the majority of cases is of unknown etiology. In some, symptoms arise de novo in childhood, but a proportion of patients present in later life, including after pelvic surgery pr childbirth. Our aims were: (1) to describe our cur rent knowledge of the anatomy and function of the pelvic autonomic nerves w ith respect to colonic motility (experimental and observational studies); ( 2) to discuss evidence for pelvic nerve injury in STC arising after pelvic Surgery pr childbirth; and (3), on the basis that such patients are clinica lly indistinguishable from patients with chronic idiopathic STC, to evaluat e whether there is evidence that pelvic autonomic neuropathy has an etiolog ic role in patients with chronic idiopathic STC. The outcome was as follows : (1) The clear importance of the pelvic autonomic nerves in colonic motor function is documented. (2) While there is an association between pelvic su rgery and childbirth, and the onset of STC, there is little direct anatomic al evidence that pelvic denervation occurs in these patients. However the p henotype of these patients is similar to results of experimental and observ ational studies. (3) Clinical, physiological, and histological similarities exist between patients whose symptoms arose following pelvic intervention and those whose symptoms arise de novo (idiopathic). We further present evi dence for possible pathogenetic mechanisms underlying pelvic autonomic neur opathy in chronic idiopathic STC.