Early recognition of pelvic floor dyssynergia and colorectal assessment in Parkinson's disease associated with bowel dysfunction
Article first published online: 27 FEB 2013
© 2013 The Authors Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland
Volume 15, Issue 3, pages e130–e137, March 2013
How to Cite
Wang, C.-P., Sung, W.-H., Wang, C.-C. and Tsai, P.-Y. (2013), Early recognition of pelvic floor dyssynergia and colorectal assessment in Parkinson's disease associated with bowel dysfunction. Colorectal Disease, 15: e130–e137. doi: 10.1111/codi.12105
- Issue published online: 27 FEB 2013
- Article first published online: 27 FEB 2013
- Accepted manuscript online: 15 JAN 2013 12:35PM EST
- Manuscript Accepted: 14 OCT 2012
- Manuscript Received: 24 MAR 2012
- Parkinson's disease;
- pelvic floor dyssynergia;
- colorectal transit
Slow colonic transit time (CTT) and pelvic floor dyssynergia (PFD) are major contributors to constipation in patients with Parkinson's disease (PD). However, no symptom survey yet exists that effectively differentiates the contributing aetiologies. The significance of individual pelvic floor musculature behaviours and their relationship with colorectal dysmotility in constipated patients with PD are still controversial and need further clarification. We aimed to investigate how differentiated constipation-related symptoms of PD patients with constipation may identify constipation groupings and to register the pathophysiological features of the pelvic musculature.
Our subjects undertook CTT, defaecography and the Knowles–Eccersley–Scott Symptom questionnaire. The pathological aetiologies were categorized as group 1 (slow CTT) and/or group 2 (puborectalis syndrome) and/or group 3 (pubococcygeus syndrome), in accordance with the CTT and defaecography results.
Constipation-related symptoms such as incomplete evacuation and defaecation difficulty yielded high post-test probabilities (81% and 88%, respectively) in groups 3 and 2, but a low post-test probability in group 1 (58%). Changes in the anorectal angle and perineum descent during straining were significantly correlated with CTT (r = 0.57 and r = 0.61, respectively) and with each other (r = 0.82).
Our findings that neural control of the puborectalis and pubococcygeus, along with colorectal peristalsis, were in a similar state of degeneration is key information that should assist physicians to instigate more effective management for colonic dysmotility or PFD.