GASTROENTEROLOGY ARTICLE OF THE WEEK

April 19, 2001

 1.  Features typical of pelvic floor dysfunction include:

            a.  passage of hard stools without straining

            b.  prolonged and excessive straining, even with soft stools

            c.  need for perineal or vaginal pressure to pass a bowel movement

            d.  do not respond well to standard laxative programs

 2.  Initial evaluation of constipation should include

            a.  digital rectal exam

            b.  colonoscopy in all patients

            c.  CBC, TSH, serum glucose, creatinine, calcium

            d.  flexible sigmoidoscopy in all patients

            e.  review of concurrent medications

 True or False

 3.  Colonic inertia may be the result of abnormal motility of the distal colon.

 4.  Patients with accumulation of radiopaque markings in the sigmoid and rectum are likely to be suffering from pelvic floor dysfunction

 5.  The presence of significant pain and/or bloating associated with constipation should raise the question of constipation-predominant IBS

 6.  Surgery is not effective for descending perineum syndrome and rarely helps pelvic floor dysfunction.

 7.  Balloon expulsion, defecography and anorectal manometry are ideal tests to detect colonic inertia.

 8.  The inability to pass stools softened or liquefied by laxative is pathognomonic of an abnormality of pelvic floor/sphincter function.

 9.  Stimulant laxatives such as senna or bisacodyl should not be used as they damage the enteric nervous system.

 10.  The surgical therapy of choice for well documented colonic inertial is total colectomy with ileorectostomy, symptoms of bloating and pain may not respond.

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