Surgical Treatment of Dysmotility Disorders of the Colon

Constipation is one of the most frequently experienced gastrointestinal complaints and one of the most common indications for medical consultation. It is estimated that more than 4 million patients in North America suffer from constipation, and laxatives are annually prescribed for 2 million individuals, at a cost of more than $800 million. In the United States, more than 90,000 patients are hospitalized each year for constipation-related problems. Constipation has been shown to be more prevalent in persons of a lower socioeconomic background, females, and the elderly.

The definition of constipation includes both subjective and objective aspects. In addition to decreased frequency of defecation, patients may present complaining of incomplete or difficult evacuation, abdominal or rectal pain, hard stools, decreased stool bulk or caliber, straining for evacuation, nausea, bloating, and tenesmus. Whitehead et al. proposed that at least two of the following criteria need to be met in a patient who has not used laxatives for at least 12 months: (1) straining during more than 25% of bowel movements; (2) feeling of incomplete evacuation after more than 25% of bowel movements; (3) hard stool on more than 25% of bowel movements; and (4) bowel movement frequency of less than two per week with or without symptoms of constipation. Agachan et al from Cleveland Clinic Florida proposed a scoring system (Cleveland Clinic Florida Constipation Score) that includes frequency of bowel movements, painful evacuation, incomplete evacuation, abdominal pain, length of time per attempts, assistance for defecation, unsuccessful attempts for evacuation per 24 hours, and duration of constipation. After evaluating more than 230 patients, the authors concluded that a score of 15 or greater represents constipation. The widely used Rome III criteria defines constipation as two or more of the following abnormalities occurring for 3 months (with onset of symptoms more than 6 months prior to diagnosis): (1) less than three bowel movements per week, (2) sensation of incomplete evacuation, (3) feeling of anorectal obstruction, (4) hard or lumpy stool, (5) need for straining, or (6) need of manual disimpaction or pelvic floor support.