technetium-tc-99m-medronate and Constipation

Twenty-two patients with functional obstructive defaecation were compared with seven patients with slow transit constipation using isotope proctography. The obstructive defaecation patients were unable to perform a complete rectal evacuation (% of the activity evacuated: 54%). The defaecation time in this group was prolonged (120 s) with a lower defaecation rate (0.5%/s) compared with the slow transit constipation subjects (32 s and 1.8%/s). The anorectal angle (ARA) on straining did not change in the obstructive defaecation patients but became more obtuse in the slow transit constipation subjects (P < 0.02). The pelvic floor (PF) descent on straining and evacuation was greater in obstructive defaecation patients compared with the slow transit constipation ones (P < 0.01). Obstructive defaecation is characterised by prolonged defaecation and reduced defaecation rate compared with slow transit constipation. Obstructive defaecation patients present with more acute ARAs on straining, and abnormal perineal descent in contrast to the slow transit constipation ones.

Topics: Adult; Anal Canal; Constipation; Defecation; Female; Gastrointestinal Transit; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

Twelve patients with longstanding constipation were examined by isotope proctography. Radio-labelled potato mash was inserted rectally to provoke the urge to defaecate and expulsive manoeuvres were recorded using a Gamma-camera. The method illustrated dynamic alterations in the anorectal angles (ARA) which became more acute on 'squeezing', less so on coughing and more obtuse on straining, and maximally so on evacuation. The pelvic floor (PF) movements were consistently upwards on squeezing, less so on coughing, downwards on straining, and maximally so on evacuation. A useful addition was the measurement of the completeness of evacuation and the time involved. The results were comparable to radiological videoproctography (P < 0.01), but the isotope method gave greater discrimination for both ARA and PF movement changes. It also allowed correlations to be made between the pelvic floor descent (P < 0.05) and anorectal angle changes (P < 0.01) with rectal evacuation.

Topics: Adult; Anal Canal; Chronic Disease; Constipation; Defecation; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Radiography; Radionuclide Imaging; Rectum; Technetium Tc 99m Medronate

Patients with long-standing constipation were examined by radioisotope proctography. A radiolabelled synthetic potato mash was inserted intrarectally and the dynamic changes during simulated defaecation recorded using a gamma-camera. Computer images from the stored data illustrate changes in the anorectal angle and pelvic floor. The median (and 95% confidence intervals) of the anorectal angles were: at rest 105 degrees (101 degrees, 116 degrees), on voluntary contraction of the pelvic floor by 'squeezing' 91 degrees (81 degrees, 98 degrees), on straining 120 degrees (107 degrees, 137 degrees) and during evacuation 126 degrees (116 degrees, 153 degrees). The pelvic floor movements were: pelvic floor ascent on voluntary contraction 28 mm (9, 34 mm), pelvic floor descent on straining -8 mm (-14, -4 mm) and descent during evacuation -27 mm (-34, -11 mm). Useful additions to previous methods are measurement of the completeness of rectal evacuation 58% (42, 77%), the defaecation time 64 s (50, 138 s) and the defaecation rate 0.9%/s (0.4, 1.4%/s).

Topics: Anal Canal; Constipation; Defecation; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Rectum; Technetium Tc 99m Medronate