Constipation in Ulcerative Colitis: An Underestimated Problem

Abstract

Ulcerative colitis is a chronic intestinal disorder that belongs to the category of inflammatory bowel diseases, and is usually characterized by the presence of bloody diarrhea and abdominal pain, due to an accelerated transit and intestinal sensibilization following inflammation of the colonic mucosa. However, the literature reports that ulcerative colitis may sometimes feature fecal stasis with constipation. This apparent paradox may be partially explained by the motor abnormalities of the large bowel following inflammation, damage to the enteric innervation, and the onset of parietal fibrosis over time. Moreover, some anorectal abnormalities such pelvic floor dyssynergia may explain the symptoms of constipation reported in subsets of patients. Since these abnormalities may be responsible for diagnostic delays and non- or partial responses to therapy, it is important to recognize them as early as possible to avoid incorrect clinical and therapeutic approaches to these patients.

Keywords: colon; colon motility; constipation; inflammatory bowel diseases; ulcerative colitis.

Figure 1

(A) Archival manometric tracing of a patient with moderately active UC, showing the presence of high-amplitude propagated contractions (arrow) with concomitant stimulus to defecation (asterisk). Recording points (distanced 12 cm apart) spanning from the mid transverse (first tracing) to the anal sphincter (last tracing). (B) Archival manometric tracing of a patient with UC in remission, showing the presence of pancolonic pressurizations (arrow) concomitant with relaxations of the anal sphincter (asterisk). Recording points as in tracing A.

Figure 2

Schematic representation of the possible pathophysiological mechanisms underlying fecal stasis and constipation in patients with ulcerative colitis (UC).