Meeting NewsPerspective

IBS-C linked to pelvic floor symptoms

WASHINGTON — Patients with constipation predominant irritable bowel syndrome are more likely to experience pelvic floor-related distress compared to others with chronic constipation, according to research presented at Digestive Disease Week.

Prashant Singh, MD, of Beth Israel Deaconess Medical Center said that pelvic floor symptoms such as urinary tract symptoms and pelvic organ prolapse often coexist with constipation.

“Patients with IBS-constipation have higher somatic and psychiatric comorbidities compared to functional constipation patients,” Singh said in a presentation. “It is also possible that patients with IBS-constipation subtype have higher pelvic floor symptom severity compared to functional constipation patients. However, no study has compared disfunction related to pelvic floor symptoms between IBS constipation and functional constipation.”

Singh and colleagues conducted a retrospective analysis of patients who underwent anorectal manometry (ARM) and balloon expulsion tests to determine if pelvic floor symptom-related distress is different between patients with IBS-C and functional constipation, which comprises the larger group of patients with chronic constipation.

Researchers determined chronic constipation symptoms through the ARM test and measured pelvic floor distress using the PFDI-20 questionnaire. They diagnosed patients with either IBS-C or FC using ROME-III criteria and measured constipation severity using a constipation severity scale (CSS).

Of 133 patients included in the study, 83 had FC and 50 had IBS-C.

Singh and colleagues found that the overall PFDI-20 score was higher in patients with IBS-C compared with patients with FC (116 vs. 77.4; P < .001). Using multivariate regression, they found that IBS-C (P < .001) and higher CSS scores (P = .001) were both independently associated with higher PFDI scores. Conversely, they did not find a link between higher PFDI scores and ARM measures or abnormal balloon expulsion tests.

“Pelvic floor-related distress correlated with diagnosis of IBS-C and higher constipation severity,” Singh said. “It did not correlate with findings on anorectal manometry or balloon expulsion time.” – by Alex Young

Reference:

Singh P, et al. Abstract 261. Presented at: Digestive Disease Week; June 2-5, 2018; Washington, D.C.

Disclosures: Singh reports no relevant financial disclosures. Please see the DDW faculty disclosure index for a list of all other authors’ relevant financial disclosures.

WASHINGTON — Patients with constipation predominant irritable bowel syndrome are more likely to experience pelvic floor-related distress compared to others with chronic constipation, according to research presented at Digestive Disease Week.

Prashant Singh, MD, of Beth Israel Deaconess Medical Center said that pelvic floor symptoms such as urinary tract symptoms and pelvic organ prolapse often coexist with constipation.

“Patients with IBS-constipation have higher somatic and psychiatric comorbidities compared to functional constipation patients,” Singh said in a presentation. “It is also possible that patients with IBS-constipation subtype have higher pelvic floor symptom severity compared to functional constipation patients. However, no study has compared disfunction related to pelvic floor symptoms between IBS constipation and functional constipation.”

Singh and colleagues conducted a retrospective analysis of patients who underwent anorectal manometry (ARM) and balloon expulsion tests to determine if pelvic floor symptom-related distress is different between patients with IBS-C and functional constipation, which comprises the larger group of patients with chronic constipation.

Researchers determined chronic constipation symptoms through the ARM test and measured pelvic floor distress using the PFDI-20 questionnaire. They diagnosed patients with either IBS-C or FC using ROME-III criteria and measured constipation severity using a constipation severity scale (CSS).

Of 133 patients included in the study, 83 had FC and 50 had IBS-C.

Singh and colleagues found that the overall PFDI-20 score was higher in patients with IBS-C compared with patients with FC (116 vs. 77.4; P < .001). Using multivariate regression, they found that IBS-C (P < .001) and higher CSS scores (P = .001) were both independently associated with higher PFDI scores. Conversely, they did not find a link between higher PFDI scores and ARM measures or abnormal balloon expulsion tests.

“Pelvic floor-related distress correlated with diagnosis of IBS-C and higher constipation severity,” Singh said. “It did not correlate with findings on anorectal manometry or balloon expulsion time.” – by Alex Young

Reference:

Singh P, et al. Abstract 261. Presented at: Digestive Disease Week; June 2-5, 2018; Washington, D.C.

Disclosures: Singh reports no relevant financial disclosures. Please see the DDW faculty disclosure index for a list of all other authors’ relevant financial disclosures.

    Perspective
    Mark Pimentel

    Mark Pimentel

    We have known for a long time that pelvic floor is associated with IBS. Managing pelvic floor symptoms and pelvic floor dysfunction are things we do in clinic every day. Still physicians must remember to ask the question: Is it due to a pelvic floor problem or is it due to your colon? Most time we can discern that, just historically, and then we know if we should do further testing on the pelvic floor. This is important to determine because if you have pelvic floor dysfunction, giving drugs is not the treatment. Doing pelvic floor therapy is the treatment. We need to maintain the philosophy that we are determining the root cause, not just giving our patients a laxative. This study stands to remind us, from a practical perspective, to include the pelvic floor in our work-up.

    Additionally, this study links pelvic floor dysfunction to higher somatic and psychiatric comorbidities. For example, pelvic floor symptoms are more likely related to previous sexual trauma and other events.  Especially in women with pelvic floor dysfunction, there is a higher likelihood to have those historical features in their history. Those are important questions to ask when you take a patient’s history so that you address all those important issues.

    • Mark Pimentel, MD
    • Executive director Medically Associated Science and Technology program Cedars Sinai Medical Center Los Angeles

    Disclosures: Pimentel reports financial relationships with Synthetic Biologics, Salix, Naia Pharmaceuticals, Commonwealth Diagnostics International and Valeant.

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