Elsevier

Mayo Clinic Proceedings

Volume 75, Issue 10, October 2000, Pages 1015-1019
Mayo Clinic Proceedings

Original Article
Anorectal Dysfunction in Constipated Women With Anorexia Nervosa

https://doi.org/10.4065/75.10.1015Get rights and content

Objective

To evaluate anorectal and colonic function in a group of patients with anorexia nervosa complaining of chronic constipation.

Patients and Methods

Twelve women (age range, 19-29 years) meeting the criteria for anorexia nervosa and complaining of chronic constipation were recruited for the study. A group of 12 healthy women served as controls. Colonic transit time was measured by a radiopaque marker technique. Anorectal manometry and a test of rectal sensation were carried out with use of standard techniques to measure pelvic floor dysfunction. A subgroup of 8 patients was retested after an adequate refeeding program was completed.

Results

Eight (66.7%) of 12 patients with anorexia nervosa had slow colonic transit times, while 5 (41.7%) had pelvic floor dysfunction. Colonic transit time normalized in the 8 patients who completed the 4-week refeeding program. However, pelvic floor dysfunction did not normalize in these patients.

Conclusions

Patients with anorexia nervosa who complain of constipation have anorectal motor abnormali­ties. Delayed colonic transit time is probably due to abnor­mal eating behavior.

Section snippets

Patients and Controls

Twelve women with anorexia nervosa (age range, 19-29 years) were recruited for the study. The diagnosis of anorexia nervosa was made according to the criteria of the American Psychiatric Association.7 The patients were referred by psychiatrists for severe malnutrition, and all complained of chronic constipation, which they perceived as a disabling symptom. All patients also took at least 1 laxative dose per week. Constipation was defined as fewer than 2 bowel movements per week for at least 9

RESULTS

Table 1 shows overall demographic, clinical, and manometric data of the 12 anorexia nervosa patients who participated in the first part of the study. Comparison with manometric data obtained in controls revealed that significant differences were found concerning resting anal pressure (50.6±19.1 mm Hg in patients vs 83.1±24.4 mm Hg in controls; P=.003); threshold for urge to defecate (121±86.5 ±86.5 mL in patients vs 58.3±19.5 mL in controls; P=.01); and pelvic floor dyssynergia (41.7% in

DISCUSSION

Patients with anorexia nervosa may display motor abnormalities of the upper gut, including delayed gastric emptying.17, 18, 19 Many patients also complain of debilitating constipation, but it is unclear whether this complaint is due to a gastrointestinal pathophysiological process or represents a manifestation of distorted bodily perception. Unfortunately, the available data are few.

Kamal et al5 studied the overall delay in gastrointestinal transit time in 8 patients with anorexia nervosa

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