Skip to main content
Log in

Abstract

Slow transit constipation (STC) is a severe motility disorder, which in the majority of cases is of unknown etiology. In some, symptoms arise de novo in childhood, but a proportion of patients present in later life, including after pelvic surgery or childbirth. Our aims were: (1) to describe our current knowledge of the anatomy and function of the pelvic autonomic nerves with respect to colonic motility (experimental and observational studies); (2) to discuss evidence for pelvic nerve injury in STC arising after pelvic surgery or childbirth; and (3), on the basis that such patients are clinically indistinguishable from patients with chronic idiopathic STC, to evaluate whether there is evidence that pelvic autonomic neuropathy has an etiologic role in patients with chronic idiopathic STC. The outcome was as follows: (1) The clear importance of the pelvic autonomic nerves in colonic motor function is documented. (2) While there is an association between pelvic surgery and childbirth, and the onset of STC, there is little direct anatomical evidence that pelvic denervation occurs in these patients. However the phenotype of these patients is similar to results of experimental and observational studies. (3) Clinical, physiological, and histological similarities exist between patients whose symptoms arose following pelvic intervention and those whose symptoms arise de novo (idiopathic). We further present evidence for possible pathogenetic mechanisms underlying pelvic autonomic neuropathy in chronic idiopathic STC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

REFRENCES

  1. Preston DM, Hawley PR, Lennard-Jones JE, Todd IP: Results of colectomy for severe idiopathic constipation in women (Arbuthnot Lane's disease). Br J Surg 71:547–552, 1984

    Google Scholar 

  2. Preston DM, Lennard-Jones JE: Severe chronic constipation of young women: “Idiopathic slow transit constipation.” Br J Surg 27:41–48, 1986

    Google Scholar 

  3. Roe AM, Bartolo DCC, Mortenson NJ McC: Slow transit constipation. Comparison between patients with or without previous hysterectomy. Dig Dis Sci 3:1159–1163, 1988

    Google Scholar 

  4. Waldron D, Bowes KL, Kingma YJ, Cote KR: Colonic and anorectal motility in young women with severe idiopathic constipation. Gastroenterology 95:1388–1394, 1988

    Google Scholar 

  5. MacDonald A, Baxter JN, Finlay, IG: Idiopathic slow-transit constipation. Br J Surg 80:1107–1111, 1993

    Google Scholar 

  6. MacDonald A, Baxter JN, Bessent RG, Gray HW, Finlay IG: Gastric emptying in patients with constipation following childbirth and due to idiopathic slow transit. Br J Surg 84: 1141–1143, 1997

    Google Scholar 

  7. Vierhout ME, Schreuder HW, Veen HF: Severe slow-transit constipation following radical hysterectomy. Gynecol Oncol 51:401–403, 1993

    Google Scholar 

  8. Iber FL, Parveen S, Vandrunen M, Sood KB, Reza F, Serlovsky R, Reddy S: Relation of symptoms to impaired stomach, small bowel, and colon motility in long-standing diabetes. Dig Dis Sci 38:45–50, 1993

    Google Scholar 

  9. Maleki D, Camilleri M, Burton DD, Rath-Harvey DM, Oenning L, Pemberton JH, Low PA: Pilot study of pathophysiology of constipation among community diabetics. Dig Dis Sci 43:2373–2378, 1998

    Google Scholar 

  10. Devroede G, Arhan P, Duguay C, Tetreault L, Akoury H, Perey B: Traumatic constipation. Gastroenterology 77: 1258–1267, 1979

    Google Scholar 

  11. Weber J, Grise P, Roquebert M, Hellot MF, Mihout B, Samson M, Beuret-Blanquart F, Pasquis P, Denis P: Radiopaque markers transit and anorectal manometry in 16 patients with multiple sclerosis and urinary bladder dysfunction. Dis Colon Rectum 30:95–100, 1987

    Google Scholar 

  12. Beuret-Blanquart F, Weber J, Gouverneur JP, Demangeon S, Denis P: Colonic transit time and anorectal manometric anomalies in 19 patients with complete transection of the spinal cord. J Auton Nerv Syst 30:199–207, 1990

    Google Scholar 

  13. Keshavarzian A, Barnes WE, Bruninga K, Nemchausky B, Mermall H, Bushnell D: Delayed colonic transit in spinal cord-injured patients measured by indium-111 Amberlite scintigraphy. Am J Gastroenterol 90:1295–1300, 1995

    Google Scholar 

  14. Leduc BE, Giasson M, Favreau-Ethier M, Lepage Y: Colonic transit time after spinal cord injury. J Spinal Cord Med 20:416–421, 1997

    Google Scholar 

  15. De Looze DA, De Muynck MC, Van Laere M, De Vos MM, Elewaut AG: Pelvic floor function in patients with clinically complete spinal cord injury and its relation to constipation. Dis Colon Rectum 41:778–786, 1998

    Google Scholar 

  16. Basilisco G, Barbera R, Vanoli M, Bianchi P: Anorectal dysfunction and delayed colonic transit in patients with progressive systemic sclerosis. Dig Dis Sci 38:1525–1529, 1993

    Google Scholar 

  17. Knowles CH, Martin JE: Slow transit constipation: model of human gut dysmotility. Possible aetiologies. Neurogastroenterol Motil 12:181–196, 2000

    Google Scholar 

  18. Krishnamurthy S, Schuffler MD, Rohrmann CA, Pope CE II: Severe idiopathic constipation is associated with a distinctive abnormality of the colonic myenteric plexus. Gastroenterology 88:26–34, 1985

    Google Scholar 

  19. Preston DM, Butler P, Smith B, Lennard-Jones JE: The neuropathology of slow-transit constipation. Br J Surg 24:A997, 1984 (abstract)

    Google Scholar 

  20. Zenilman ME, Dunnegan DL, Soper NJ, Becker JM: Successful surgical treatment of idiopathic colonic dysmotility. The role of preoperative evaluation of coloanal motor function. Arch Surg 124:947–951, 1989

    Google Scholar 

  21. Pemberton JH, Rath DM, Ilstrup DM: Evaluation and surgical treatment of severe chronic constipation. Ann Surg 214:403–411, 1991

    Google Scholar 

  22. Porter AJ, Wattchow DA, Hunter A, Costa M: Abnormalities of nerve fibres in the circular muscle of patients with slow transit constipation. Int J Colorect Dis 13:208–216, 1998

    Google Scholar 

  23. Heyman S, Wexner SD, Gulledge AD: MMPI assessment of patients with functional bowel disorders. Dis Colon Rectum 36:593–596, 1993

    Google Scholar 

  24. Christensen J:Gross and microscopic anatomy of the large intestine. In The Large Intestine: Physiology, Pathophysiology, and Disease. SF Phillips, JH Pemberton, RG Shorter (eds). New York, Raven Press, 1991, pp 13–35

  25. Gonella J, Bouvier M, Blanquet F: Extrinsic nervous control of motility of small and large intestines and related sphincters. Physiol Rev 67:902–961, 1987

    Google Scholar 

  26. Williams PL, Warwick R, Dyson M, Bannister LH (eds): Gray's Anatomy, 37th ed. Edinburgh, Churchill Livingstone, 1989

    Google Scholar 

  27. Langley JN, Anderson HK: On the innervation of the pelvic and adjoining viscera. Part I. The lower portion of the intestine. J Physiol 18:67–105, 1895

    Google Scholar 

  28. Langley JN, Anderson HK: The innervation of the pelvic and adjoining viscera. Part VII. Anatomical observations. J Physiol 20:372–406, 1896

    Google Scholar 

  29. Garry RC: The nervous control of the caudal region of the large bowel in the cat. J Physiol 77:422–431, 1933

    Google Scholar 

  30. Hultén L, Jodal M, Lundgren O: Extrinsic nervous control of colonic motility and blood flow. An experimental study in the cat. Acta Physiol Scand 335(suppl):1–116, 1969

    Google Scholar 

  31. Rostad H: Colonic motility in the cat. II. Extrinsic nervous control. Acta Physiol Scand 89:91–103, 1973

    Google Scholar 

  32. Nadelhaft I, Degroat WC, Morgan C: Location and morphology of parasympathetic preganglionic neurons in the sacral spinal cord of the cat revealed by retrograde axonal transport of horseradish peroxidase. J Comp Neurol 193:265–281, 1980

    Google Scholar 

  33. Stromberg MW: The autonomic nervous system. In Anatomy of the Dog. ME Miller, GC Christensen, HE Evans (eds). Philadelphia, WB Saunders Company, 1964, pp 626–644

    Google Scholar 

  34. Nadelhaft I, Roppolo J, Morgan C, de Groat WC: Parasympathetic preganglionic neurons and visceral primary afferents in monkey sacral spinal cord revealed following application of horseradish peroxidase to pelvic nerve. J Comp Neurol 216:36–52, 1983

    Google Scholar 

  35. Telford ED, Stopford JSB: The autonomic nerve supply of the distal colon. An anatomical and clinical study. BMJ 1: 572–574, 1934

    Google Scholar 

  36. Davis AA: The presacral nerve. BMJ 2:1–6, 1934

    Google Scholar 

  37. Trumble HC: The plan of the visceral nerves in the lumbar and sacral outflows of the autonomic nervous system. Br J Surg 21:664–676, 1934

    Google Scholar 

  38. Trumble HC: The innervation and muscular activities of the distal colon: with a note on the surgical treatment of constipation. Br J Surg 23:214–230, 1935

    Google Scholar 

  39. Mitchell GAG: The innervation of the distal colon. Edinb Med J 42:11–20, 1935

    Google Scholar 

  40. Lannon J, Weller E: The parasympathetic supply of the distal colon. Br J Surg 34:373–378, 1946/47

    Google Scholar 

  41. Schmidt CA: Distribution of vagus and sacral nerves to the large intestine. Proc Soc Exp Biol 30:739–740, 1933

    Google Scholar 

  42. M'Fadden GDF, Loughridge JS, Milroy TH: The nerve control of the distal colon. Q J Exp Physiol 25:315–327, 1935

    Google Scholar 

  43. Mizeres NJ: The anatomy of the autonomic nervous system in the dog. Am J Anat 96:285–318, 1955

    Google Scholar 

  44. Stach W: Uber die in der Dickdarmwand aszendierenden Nerven des Plexus pelvinus und die Grenze der vagalen und sakralparasympathischen Innervation. Z Mikrosk Anat Forsch 84:65–90, 1971

    Google Scholar 

  45. Fukai K, Fukuda H: The intramural pelvic nerves in the colon of dogs. J Physiol 354:89–98, 1984

    Google Scholar 

  46. Christensen J, Stiles MJ, Rick GA, Sutherland J: Comparative anatomy of the myenteric plexus of the distal colon in eight mammals. Gastroenterology 86:706–713, 1984

    Google Scholar 

  47. Christensen J, Rick GA: Nerve cell density on the submucous plexus throughout the gut of the cat and opossum. Gastroenterology 89:1064–1069, 1985

    Google Scholar 

  48. Christensen J, Rick GA: Distribution of myelinated nerves in ascending nerves and myenteric plexus of the cat. Am J Anat 178:250–258, 1987

    Google Scholar 

  49. Christensen J, Schulze-Delrieu K: Nerves in the colon: Discovery and rediscovery. Gastroenterology 89:222–223, 1985

    Google Scholar 

  50. Gillespie JS: Electrical activity in the colon. In Handbook of Physiology, Section 6, Alimentary Canal, Vol 4. CF Code (ed). Washington, DC, American Physiological Society, 1968, pp 2093–2120

    Google Scholar 

  51. De Groat WC, Krier J: The sacral parasympathetic reflex pathway regulating colonic motility and defaecation in the cat. J Physiol 276:481–500, 1978

    Google Scholar 

  52. Fukai K, Fukuda H: Three serial neurones in the innervation of the colon by the sacral parasympathetic nerve of the dog. J Physiol 362:69–78, 1985

    Google Scholar 

  53. De Groat WC, Krier J: An electrophysiological study of the sacral parasympathetic pathway to the colon of the cat. J Physiol 260:425–445, 1976

    Google Scholar 

  54. Sarna SK: Physiology and pathophysiology of colonic motor activity (part one of two). Dig Dis Sci 36:827–862, 1991

    Google Scholar 

  55. Scott HW, Cantrell JR: Colonmetrographic studies of the effects of section of the parasympathetic nerves of the colon. Bulls John Hopkins Hosp 85:310–319, 1969

    Google Scholar 

  56. Lister J: Preliminary account of an inquiry into the functions of the visceral nerves, with special reference to the so-called “inhibitory system.” Proc R Soc 9:367–380, 1858

    Google Scholar 

  57. Learmonth J, Markowitz J: Studies on the innervation of the large bowel. II. Am J Physiol 94:501–504, 1930

    Google Scholar 

  58. De Groat WC, Krier J: The central control of the lumbar sympathetic pathway to the large intestine of the cat. J Physiol 289:449–468, 1979

    Google Scholar 

  59. Holzknecht G: Die normale peristaltik des kolon. Muench Med Wochenschr 56:2401–2403, 1909

    Google Scholar 

  60. Barclay AE: Note on the movements of the large intestine. Arch Roentgen Ray 16:422–424, 1912

    Google Scholar 

  61. Richie JA, Ardran GM, Truelove SC: Motor activity of the sigmoid colon of humans. A combined study by intraluminal pressure recording and cineradiography. Gastroenterology 43:642–668, 1962

    Google Scholar 

  62. Hardcastle JD, Mann CV: Study of large bowel peristalsis. Gut 9:512–520, 1968

    Google Scholar 

  63. Torsoli A, Ramorino ML, Ammaturo MV, Capurso L, Paoluzi P, Anzini F: Mass movements and intracolonic pressures. Am J Dig Dis 16:693–696, 1971

    Google Scholar 

  64. Karaus M, Sarna SK: Giant migrating contractions during defecation in the dog colon. Gastroenterology 92:925–933, 1987

    Google Scholar 

  65. Shibata C, Sasaki I, Matsuno S, Mizumoto A, Iwanaga Y, Itoh Z: Characterisation of colonic motor activity in conscious dogs. J Gastrointest Motil 5:9–16, 1993

    Google Scholar 

  66. Scott SM, Pilot M-A, Barnett TG, Williams NS: Prolonged ambulatory canine motility. Am J Physiol 268:G650–G662, 1995

    Google Scholar 

  67. Matsushima Y: Studies on colonic motor correlates of spontaneous defecation in conscious dogs. Jpn J Smooth Muscle Res 25:137–146, 1989

    Google Scholar 

  68. Ishikawa M, Mibu R, Iwamoto T, Knomi H, Oohata Y, Tanaka M: Change in colonic motility after extrinsic autonomic denervation in dogs. Dig Dis Sci 42:1950–1956, 1997

    Google Scholar 

  69. Bayliss WM, Starling EH: The movements and the innervation of the large intestine. J Physiol 26:107–118, 1900

    Google Scholar 

  70. Elliott TR, Barclay-Smith E: Antiperistalsis and other muscular activities of the colon. J Physiol 31:272–304, 1904

    Google Scholar 

  71. Wells JA, Mercer TH, Gray JS, Ivy AC: The motor innervation of the colon. Am J Physiol 138:83–93, 1942

    Google Scholar 

  72. Gray GW, Hendershot LC, Whitrock RM, Seevers MH: Influence of the parasympathetic nerves and their relation to the action of atropine in the ileum and colon of the dog. Am J Physiol 181:679–687, 1955

    Google Scholar 

  73. Garry RC, Gillespie JS: The responses of the musculature of the colon of the rabbit to stimulation, in vitro, of the parasympathetic and of the sympathetic outflows. J Physiol 128:557–576, 1955

    Google Scholar 

  74. Fasth S, Hultén L, Nordgren S: Evidence for a dual pelvic nerve influence on large bowel motility in the cat. J Physiol 298:159–169, 1980

    Google Scholar 

  75. Andersson PO, Bloom SR, Jarhuet J: Colonic motor and vascular responses to pelvic nerve stimulation and their relation to local peptide release in the cat. J Physiol 334:293–307, 1983

    Google Scholar 

  76. Gillespie JS, Khoyi MA: The site and receptors responsible for the inhibition by sympathetic nerves of intestinal smooth muscle and its parasympathetic motor nerves. J Physiol 267:767–789, 1977

    Google Scholar 

  77. Hedlund H, Fasth S, Hultén L, Nordgren S: Studies on the integrated extrinsic nervous control of rectal motility in the cat. Acta Physiol Scand 124:43–51, 1985

    Google Scholar 

  78. Wingate DL: Intrinsic and extrinsic neural control. In An Illustrated Guide to Gastrointestinal Motility, 2nd ed. D Kumar, D Wingate (eds). London, Churchill Livingstone 1993, pp 64–77

    Google Scholar 

  79. Bayliss WM, Starling EH: The movements and innervation of the small intestine. J Physiol 24:99–143, 1899

    Google Scholar 

  80. Brugére HB, Ferré J-P, Ruckebusch Y: Colonic motility and transit after intermesenteric nerve transection and mesenteric ganglionectomy in dogs. J Gastrointest Motil 3:107–116, 1991

    Google Scholar 

  81. Kreulen DL, Szurszewski JH: Reflex pathways in the abdominal prevertebral ganglia: Evidence for a colo-colonic inhibitory reflex. J Physiol 295:21–32, 1979

    Google Scholar 

  82. Musial F, Crowell MD, French AW, Guiv N: Effect of prolonged, continuous rectal distention on mouth-to-cecum and colonic transit time in pigs. Physiol Behav 52:1021–1024, 1992

    Google Scholar 

  83. Gué M, Del Rio C, Juníen JL, Buéno L. Interaction between CCK and opioids in the modulation of the rectocolonic inhibitory reflex in rats. Am J Physiol 269:G240–G245, 1995

    Google Scholar 

  84. Pearcy JF, van Liere EJ: Studies on the visceral nervous system. XVII. Reflexes from the colon. I. Reflexes to the stomach. Am J Physiol 78:64–73, 1926

    Google Scholar 

  85. Youmans WB, Meek WJ: Reflex and humoral gastrointestinal inhibition in unanesthetized dogs during rectal stimulation. Am J Physiol 120:750–757, 1937

    Google Scholar 

  86. Glickman S, Kamm MA: Bowel dysfunction in spinal-cordinjury patients. Lancet 347:1651–1653, 1996

    Google Scholar 

  87. Menardo G, Bausano G, Corazziari E, Fazio A, Marangi A, Genta V, Marenco G: Large-bowel transit in paraplegic patients. Dis Colon Rectum 30:924–928, 1987

    Google Scholar 

  88. Nino-Murcia M, Stone JM, Chang PJ, Perkash I: Colonic transit in spinal cord-injured patients. Invest Radiol 25: 109–112, 1990

    Google Scholar 

  89. Aaronson MJ, Freed MM, Burakoff R: Colonic myoelectric activity in persons with spinal cord injury. Dig Dis Sci 30: 295–300, 1985

    Google Scholar 

  90. Connell AM, Frankel H, Guttmann L: The motility of the pelvic colon following complete lesions of the spinal cord. Paraplegia 1:98–115, 1963

    Google Scholar 

  91. Meshkinpour H, Nowroozi F, Glick ME: Colonic compliance in patients with spinal cord injury. Arch Phys Med Rehabil 64:111–112, 1983

    Google Scholar 

  92. Glick ME, Meshkinpour H, Haldeman S, Hoehler F, Downey N, Bradley WE: Colonic dysfunction in patients with thoracic spinal cord injury. Gastroenterology 86:287–294, 1984

    Google Scholar 

  93. MacDonagh RP, Sun WM, Smallwood R, Forster D, Read NW: Control of defecation in patients with spinal injuries by stimulation of sacral anterior nerve roots. BMJ 300: 1494–1497, 1990

    Google Scholar 

  94. Sun WM, MacDonagh R, Forster D, Thomas DG, Smallwood R, Read NW: Anorectal function in patients with complete spinal transection before and after sacral posterior rhizotomy. Gastroenterology 108:990–998, 1995

    Google Scholar 

  95. Bruninga K, Camilleri M: Colonic motility and tone after spinal cord and cauda equina injury. Am J Gastroenterol 92:891–894, 1997

    Google Scholar 

  96. White JC, Verlot MG, Ehrentheil O: Neurogenic disturbances of the colon and their investigation by the proctometrogram. Ann Surg 112:1042–1045, 1940

    Google Scholar 

  97. Devroede G, Lamarche J: Functional importance of extrinsic parasympathetic innervation to the distal colon and rectum in man. Gastroenterology 66:273–280, 1974

    Google Scholar 

  98. Gunterberg B, Kewenter J, Petersen I, Stener B: Anorectal function after major resections of the sacrum with bilateral or unilateral sacrifice of sacral nerves. Br J Surg 63:546–554, 1976

    Google Scholar 

  99. Brindley GS, Polkey CE, Rushton DN: Sacral anterior root stimulators for bladder control in paraplegia. Paraplegia 20:365–381, 1982

    Google Scholar 

  100. Binnie NR, Smith AN, Creasey GH, Edmond P: Constipation associated with spinal cord injury: The effect of pelvic parasympathetic stimulation by the Brindley stimulator. Paraplegia 29:463–469, 1991

    Google Scholar 

  101. Varma JS: Autonomic influences on colorectal motility and pelvic surgery. World J Surg 16:811–819, 1992

    Google Scholar 

  102. Chia YW, Lee TK, Kour NW, Tung KH, Tan ES: Microchip implants on the anterior sacral roots in patients with spinal trauma: Does it improve bowel function? Dis Colon Rectum 39:690–694, 1996

    Google Scholar 

  103. Taylor T, Smith AN, Fulton PM: Effect of hysterectomy on bowel function. BMJ 299:300–301, 1989

    Google Scholar 

  104. Prior A, Wilson PJ, Faragher EB: Irritable bowel syndrome in the gynecological clinic: survey of 798 new referrals. Dig Dis Sci 35:1820–1824, 1990

    Google Scholar 

  105. Smith AN, Varma JS, Binnie NR: Disordered colorectal motility in intractable constipation following hysterectomy. Br J Surg 77:1361–1365, 1990

    Google Scholar 

  106. Heaton KW, Parker D, Cripps H: Bowel function and irritable bowel problems after hysterectomy and cholecystectomy- a population based study. Gut 34:1108–1111, 1993

    Google Scholar 

  107. van Dam JH, Gosselink MJ, Drogendijk AC, Hop WC, Schouten WR: Changes in bowel function after hysterectomy. Dis Colon Rectum 40:1342–1347, 1997

    Google Scholar 

  108. Parys BT, Haylen BT, Parsons KF: Urodynamic evaluation prior to total hysterectomy: indications and incidence of abnormality. Maturitas 12:61–66, 1990

    Google Scholar 

  109. Long DM, Bernstein WC: Sexual dysfunction as a complication of abdomino-perineal resection of the rectum in a male: An anatomic and physiologic study. Dis Colon Rectum 2: 540–548, 1959

    Google Scholar 

  110. Smith PH, Ballantyne B: The neuroanatomical basis for denervation of the urinary bladder following major pelvic surgery. Br J Surg 55:929–933, 1968

    Google Scholar 

  111. Snooks SJ, Swash M, Mathers SE, Henry MM: Effect of vaginal delivery on the pelvic floor: A 5-year follow-up. Br J Surg 77:1358–1360, 1990

    Google Scholar 

  112. Karasick S, Spettell CM: The role of parity and hysterectomy on the development of pelvic floor abnormalities revealed by defecography. Am J Roentgenol 169:1555–1558, 1997

    Google Scholar 

  113. Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI: Anal-sphincter disruption during vaginal delivery. N Engl J Med 329:1905–1911, 1993

    Google Scholar 

  114. Jorge JM, Wexner SD: Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97, 1993

    Google Scholar 

  115. Engel AF, Kamm MA: The acute effect of straining on pelvic floor neurological function. Int J Colorectal Dis 9:8–12, 1994

    Google Scholar 

  116. Lin AS, Carrier S, Morgan DM, Lue TF: Effect of simulated birth trauma on the urinary continence mechanism in the rat. Urology 52:143–151, 1998

    Google Scholar 

  117. Cannon WB: Law of denervation. Am J Med Sci 198: 737, 1939

    Google Scholar 

  118. Lapides J, Friend CR, Ajemian EP, Reus WF: A new test for neurogenic bladder. J Urol 88:245–247, 1962

    Google Scholar 

  119. Turnbull G, Bartram C, Lennard-Jones J: Radiological studies of rectal evacuation in adults with idiopathic constipation. Dis Colon Rectum 31:190–197, 1988

    Google Scholar 

  120. Bannister JJ, Lawrence WT, Smith A, Thomas DG, Read NW: Urological abnormalities in young women with severe constipation. Gut 29:17–20, 1988

    Google Scholar 

  121. Wald A, Caruana BJ, Freimanis MG, Bauman DH, Hinds JP: Contributions of evacuation proctography and anorectal manometry to evaluation of adults with constipation and defecatory difficulty. Dig Dis Sci 35:481–487, 1990

    Google Scholar 

  122. Baldi F, Ferrarini F, Corinaldesi R, Balestra R, Cassan M, Ferati GP, Barbara L: Function of the internal anal sphincter and rectal sensitivity in idiopathic constipation. Digestion 24:14–22, 1982

    Google Scholar 

  123. De Medici A, Badiali D, Corazziari E, Bausano G, Anzini F. Rectal sensitivity in chronic constipation. Dig Dis Sci 34: 747–753, 1989

    Google Scholar 

  124. Kamm MA, Lennard-Jones JE: Rectal mucosal electrosensory testing-evidence for a rectal sensory neuropathy in idiopathic constipation. Dis Colon Rectum 33:419–423, 1990

    Google Scholar 

  125. Bassotti G, Chiarioni G, Vantini I, Fusaro C, Pelli MA, Morelli A: Anorectal manometric abnormalities and colonic propulsive impairment in patients with severe chronic idiopathic constipation. Dig Dis Sci 39:1558–1564, 1994

    Google Scholar 

  126. Abdel-Rahman M, Toppercer A, Duguay C, Watier A, Tetreault L, Arhan P, Devroede G, Elhilali M: Urorectodynamics in patients with colonic inertia. Urology 18:428–432, 1981

    Google Scholar 

  127. Watier A, Devroede G, Duranceau A, Abdel-Rahman M, Duguay C, Forand MD, Tètreault L, Arhan P, Lamarche J, Elhilali M: Constipation with colonic inertia. A manifestation of systemic disease? Dig Dis Sci 28:1025–1033, 1983

    Google Scholar 

  128. Kerrigan DD, Lucas MG, Sun WM, Donnelly TC, Read NW: Idiopathic constipation associated with impaired urethrovesical and sacral reflex function. Br J Surg 76:748–751, 1989

    Google Scholar 

  129. Slater BJ, Varma JS, Gillespie JI: Abnormalities in the contractile properties of colonic smooth muscle in idiopathic slow transit constipation. Br J Surg 84:181–184, 1997

    Google Scholar 

  130. Kamm MA, Lennard-Jones JE, Thompson DG, Sobnack R, Garvie NW, Granowska M: Dynamic scanning defines a colonic defect in severe idiopathic constipation. Br J Surg 29:1085–1092, 1988

    Google Scholar 

  131. Krevsky B, Maurer AH, Fisher RS: Patterns of colonic transit in chronic idiopathic constipation. Am J Gastroenterol 84:127–132, 1989

    Google Scholar 

  132. Roberts JP, Newell MS, Deeks JJ, Waldron DW, Garvie NW, Williams NS: Oral [111In] DTPA scintigraphic assessment of colonic transit in constipated subjects. Dig Dis Sci 8: 1032–1039, 1993

    Google Scholar 

  133. van der Sjip JRM, Kamm MA, Nightingale JMD, Britton KE, Mather SJ, Morris GP, Akkermans LMA, Lennard-Jones JE: Radioisotope determination of regional colonic transit in severe constipation: Comparison with radioopaque markers. Br J Surg 34:402–408, 1993

    Google Scholar 

  134. Knowles CH, Scott SM, Lunniss PJ, Newell M, Garvie N, Williams NS: Colonic scintigraphy highlights differences in subgroups of patients with slow-transit constipation. Gastroenterology 114:A779, 1998 (abstract)

    Google Scholar 

  135. Stivland T, Camilleri M, Vassallo M, Proano M, Rath D, Brown M, Thomforde G, Pemberton J, Phillips S: Scintigraphic measurement of regional gut transit in idiopathic constipation. Gastroenterology 101:107–115, 1991

    Google Scholar 

  136. Bassotti G, Gaburri M, Imbimbo BP, Rossi L, Farroni F, Pelli MA, Morelli A: Colonic mass movements in idiopathic chronic constipation. Gut 29:1173–1179, 1988

    Google Scholar 

  137. O'Brien MD, Camilleri M, von der Ohe MR, Phillips SF, Pemberton JH, Prather CM, Wiste JA, Hanson RB: Motility and tone of the left colon in constipation: A role in clinical practice? Am J Gastroenterol 91:2532–2538, 1996

    Google Scholar 

  138. De Groat WC, Kawatani M: Reorganisation of sympathetic preganglionic connections in cat bladder ganglia following parasympathetic denervation. J Physiol 409:431–449, 1989

    Google Scholar 

  139. Gillis RA, Dias Souza J, Hicks KA, Mangel AW, Pagani FD, Hamilton BL, Garvey TQ III, Pace DG, Browne RK, Norman WP: Inhibitory control of proximal colonic motility by the sympathetic nervous system. Am J Physiol 253:G531–G539, 1987

    Google Scholar 

  140. Klauser AG, Voderholzer WA, Heinrich CA, Schindlbeck NE, Muller-Lissner SA: Behavioural modification of colonic function. Can constipation be learned? Dig Dis Sci 35: 1271–1275, 1990

    Google Scholar 

  141. Warren SJ, Rowntree A, Williams NS: Human rectocolonic inhibitory reflex. Br J Surg 81:762–763, 1994 (abstract)

    Google Scholar 

  142. Youle MS, Read NW: Effect of painless rectal distension on gastrointestinal transit of solid meal. Dig Dis Sci 29:902–906, 1984

    Google Scholar 

  143. Kellow JE, Gill RC, Wingate DL: Modulation of human upper gastrointestinal motility by rectal distension. Gut 28:864–868, 1987

    Google Scholar 

  144. Bojö L, Cassuto J: Gastric reflex relaxation by colonic distension. J Auton Nerv Syst 38:57–64, 1992

    Google Scholar 

  145. Tjeerdsma HC, Smout AJ, Akkermans LM: Voluntary suppression of defecation delays gastric emptying. Dig Dis Sci 38:832–836, 1993

    Google Scholar 

  146. Bassotti G, Stanghellini V, Chiarioni G, Germani U, De Giorgio R, Vantini I, Morelli A, Corinaldesi R: Upper gastrointestinal motor activity in patients with slow-transit constipation. Further evidence for an enteric neuropathy. Dig Dis Sci 41:1999–2005, 1996

    Google Scholar 

  147. Mollen RM, Hopman WP, Kuijpers HH, Jansen JB: Abnormalities of upper gut motility in patients with slow-transit constipation. Eur J Gastroenterol Hepatol 11:701–708, 1999

    Google Scholar 

  148. Chaussade S, Khyari A, Roche H, Garret M, Gaudric M, Couturier D, Guerre J: Determination of total and segmental colonic transit time in constipated patients: Results in 91 patients with a new simplified method. Dig Dis Sci 34: 1168–1172, 1989

    Google Scholar 

  149. Knowles CH, Scott SM, Wellmer AC, Pilot M-A, Williams NS, Anand P: Sensory and autonomic neuropathy in patients with idiopathic slow transit constipation. Br J Surg 86:54–60, 1999

    Google Scholar 

  150. Lyonnet S, Bolino A, Pelet A, Abel L, Nihoul-Fekete C, Briard ML, Mok-Siu V, Kaarianen H, Martucciello G, Lerone M, Puliti A, Luo Y, Weissenbach J, Devoto M, Munnich A, Romeo G: A gene for Hirschsprung's disease maps to the proximal long arm of chromosome 10. Nat Genet 4:346–350, 1993

    Google Scholar 

  151. Schuchardt A, D'Agati V, Larson-Blomberg L, Costantini F, Pachnis V: Defects in the kidney and enteric nervous system of mice lacking the tyrosine kinase receptor. Ret. Nature 367:380–383, 1994

    Google Scholar 

  152. Gershon MD: Genes and lineages in the formation of the enteric nervous system. Curr Opin Neurobiol 7:101–109, 1997

    Google Scholar 

  153. Chalazonitis A, Rothman TP, Chen J, Vinson A, MacLennan J, Gershon MD: Promotion of the development of enteric neurons and glia by neuropoietic cytokines: interactions with NT3. Dev Biol 198:343–365, 1998

    Google Scholar 

  154. Heuckeroth RO, Enomoto H, Grider JR, Golden JP, Hanke JA, Jackman A, Molliver DC, Bardgett ME, Snider WD, Johnson EM Jr, Milbrandt J: Gene targeting reveals a critical role for neurturin in the development and maintenance of enteric, sensory, and parasympathetic neurons. Neuron 22:253–263, 1999

    Google Scholar 

  155. Lennon VA, Sas DF, Busk MF, Scheithauer B, Malagelada JR, Camilleri M, Miller LJ: Enteric neuronal autoantibodies in pseudoobstruction with small-cell lung carcinoma. Gastroenterology 100:137–142, 1991

    Google Scholar 

  156. Howe S, Eaker EY, Sallustio JE, Peebles C, Tan EM, Williams RC Jr: Antimyenteric neuronal antibodies in scleroderma. J Clin Invest 94:761–770, 1994

    Google Scholar 

  157. Smith VV, Gregson N, Foggensteiner L, Neale G, Milla PJ: Acquired intestinal aganglionosis and circulating autoantibodies without neoplasia or other neural involvement. Gastroenterology 112:1366–1371, 1997

    Google Scholar 

  158. Lindberg G, Glia A, Nyberg B, Veress B: Lymphocytic epithelioganglionitis- a new entity causing severe motility disorders of the gut. Gastroenterology 116:G4476, 1999 (abstract)

    Google Scholar 

  159. Wood JN, Hudson L, Jessel TM, Yamamoto M: A monoclonal antibody defining antigenic determinants on subpopulations of mammalian neurones and Trypanosoma cruzi parasites. Nature 296:34–37, 1982

    Google Scholar 

  160. Vassallo M, Camilleri M, Caron L, Low P: Gastrointestinal motor dysfunction in acquired selective cholinergic dysautonomia associated with infectious mononucleosis. Gastroenterology 100:252–258, 1991

    Google Scholar 

  161. Debinski HS, Kamm MA, Talbot IC, Khan G, Kangro HO, Jeffries DJ: DNA viruses in the pathogenesis of sporadic chronic idiopathic intestinal pseudo-obstruction. Br J Surg 41:100–106, 1997

    Google Scholar 

  162. Goin JC, Sterin-Borda L, Bilder CR, Varrica LM, Iantorno G, Rios MC, Borda E: Functional implications of circulating muscarinic cholinergic receptor autoantibodies in Chagasic patients with achalasia. Gastroenterology 117:798–805, 1999

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Knowles, C.H., Scott, S.M. & Lunniss, P.J. Slow Transit Constipation. Dig Dis Sci 46, 389–401 (2001). https://doi.org/10.1023/A:1005665218647

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1005665218647

Navigation