Additional faecal reservoirs or hidden constipation: a link between functional and organic bowel disease.

INTRODUCTION The study was undertaken to test a hypothesis of coexistence and causality between abdominal and recto-anal symptoms and physical signs. MATERIAL AND METHODS A random sample of 251 patients was drawn from 645 referred patients from 12th September 1988 to 19th January 1999. Nineteen selected symptoms were recorded; abdominal palpation and ano-rectoscopy were with special reference to identify faecal reservoirs. Barium enema was used to demonstrate colon pathology. After a combined prokinetic regimen, symptoms and signs were reassessed. The study was observational and factor analysis was used to explore the data together with testing after cross tabulations. RESULTS One hundred and fifty-nine patients were female (63%); neither bloating (64%), abdominal pressure (60%) and pain (26%) nor right iliac fossa tenderness (58%) and faecal mass (42%) and meteorism (33%) were related to age. Patients with additional diverticula and haemorrhoids were significantly older than patients without these lesions. Bloating was found together with a reservoir of faeces in ano-rectum in 62% of patients and 51% had haemorrhoids grade 2 or more and 50% had bloating, faeces in rectum and a right sided palpable abdominal mass (additional faecal reservoir). Among 17 factors explaining 68% of the variance in 45 variables, frequent abdominal and ano-rectal symptoms and physical signs showed substantial correlations to nine factors, indicating that they belong to the same underlying condition. A malignant tumour was found in four patients, polyps in 20 patients, and in 105 patients left sided diverticula were present. After a prokinetic regimen was conducted the dominant symptoms and signs were reduced significantly. CONCLUSIONS Collectively, the data showed significant correlations between abdominal and anorectal symptoms and signs. Additional faecal reservoirs were demonstrated in the right colon and the rectum, irrespective of defaecation daily. This hidden constipation (faecal retention) gives rise to bloating, pain and right iliac fossa tenderness and mass, and defaecation disorders (functional faecal retention) which was confirmed by a significant reduction in symptoms and physical signs after a propulsive regimen. Also, over the years, the state of hidden constipation seems to bear a cumulative risk of developing organic diseases like diverticula, polyps, haemorrhoids and malignancy.