Correlation of bowel symptoms with colonic transit, length, and faecal load in functional faecal retention

INTRODUCTION: Abdominal pain, bloating, and defecation disturbances are common complaints in gastrointestinal functional disorders. This study explores whether bowel symptoms are correlated to colon transit time (CTT), faecal loading (coprostasis), and colon length; and whether prokinetic intervention can reduce CTT, faecal retention, and symptoms. METHODS: This observational and interventional study includes 281 patients, and 44 asymptomatic controls. Evaluations included symptoms, physical signs, CTT, faecal loading, barium enema, endoscopy, sonography, anal manometry and biochemistry. Interventions included a low-fat, high-fiber diet, cisapride or domperidone, and exercise for a mean of 21.6 months. RESULTS: The mean CTT was 40.71 h in patients vs 24.75 h in controls (p = 0.013). In patients, faecal loading was significantly greater than in controls (p<0.001). Bloating correlated significantly positively with CTT ( r = 0.174, p = 0.009), and faecal load. Abdominal pain correlated significantly positively with distal faecal loading ( r = 0.151; p = 0.036). The mean CTTs in patients with zero to four colon redundancies were: 36.26 h, 43.80 h, 41.65 h and 52.27 h, respectively (p = 0.030), and symptoms increased significantly with increase in the number of redundancies (p<0.001). A subgroup of patients (n = 90) with normal CTTs (< or = 24.75 h) had significantly higher faecal loading compared to controls (p = 0.033). Factor analysis showed that bloating correlated significantly with abdominal pain and defecation rate (p<0.05) and that CTT and faecal load correlated inversely with daily defecation rate, ease, incompleteness, repetitiveness, and faecal consistency. Intervention significantly reduced CTT, faecal loading, bloating, abdominal pain, and improved defecation patterns (p<0.05). CONCLUSIONS: Faecal retention with or without increased CTT, caused bloating, abdominal pain and altered defecation patterns in patients with bowel symptoms. An elongated colon aggravated the symptoms. Measurements of CTT, faecal load and the number of colon redundancies can be useful guides in clinical practice. Prokinetic intervention reduces abdominal and anorectal symptoms, and improves quality of life.