Presumed IBS May Be Missed Pelvic Floor Dysfunction


CHICAGO — Many individuals diagnosed with irritable bowel syndrome could actually have pelvic floor dysfunction, a condition that can be much more remediable, according to a study conducted at the Mayo Clinic.

Considerable overlap exists in the symptoms of pelvic floor dysfunction and irritable bowel syndrome (IBS), particularly constipation-predominant irritable bowel syndrome, even though the Rome diagnostic criteria for functional bowel disorders considers the two distinctly separate entities, Christopher N. Andrews, M.D., the main investigator of the study, said in a poster presentation at the annual Digestive Disease Week.

The study showed that few patients who present with symptoms of straining, lumpy or hard stools, or a sensation of incomplete evacuation get a pelvic floor work-up as they should, because those with pelvic floor dysfunction probably could be helped by biofeedback training of the pelvic floor muscles, Dr. Andrews said in an interview.

The study included 450 patients being seen at the Mayo Clinic, Rochester, Minn.; 77% of participants were women. The patients either had diagnosed IBS or were undergoing a scintigraphic GI transit study. The patients filled out a symptom questionnaire to help the investigators determine whether they had symptoms the Rome criteria listed in conjunction with pelvic floor dysfunction. Study investigators reviewed the patients' medical records to see if the subjects had been given any anorectal defecation testing.

A total of 194 of the patients had at least two symptoms of pelvic floor dysfunction as outlined by the Rome criteria. But only 50 patients (11%) had undergone pelvic floor dysfunction testing, usually balloon-expulsion manometry. Of those 50 patients, 13 (26%) had an abnormal test result.

Patients with constipation-predominant IBS were more likely to get testing, but they were also more likely to have overlapping symptoms and an abnormal test result.

Of the 78 patients with constipation-predominant IBS, 76 had at least two symptoms of pelvic floor dysfunction. Of those patients, 24 (32%) underwent testing, and among those tested, 8 (33%) had an abnormal test result.

Anorectal defecation testing of patients with IBS-type symptoms is thought to have become more common at highly specialized centers in recent years, Dr. Andrews said in the interview. But if the rate of testing is so low at the Mayo Clinic, then it is probably not done often enough anywhere.

One problem that may discourage testing is that there are different tests but no real standards concerning which to use, he added.

The Rome criteria symptoms used to define pelvic floor dysfunction include: straining when defecating more than 25% of the time, lumpy or hard stools more than 25% of the time, incomplete evacuation more than 25% of the time, sensation of anorectal blocking more than 25% of the time, manual maneuvers to facilitate defecation more than 25% of the time, or one or fewer defecations per week.

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