Physiopathological evaluation of defecatory problems in elderly people using saline enema test and fecoflowmetry

The population of the aged people is increasing rapidly in developed countries. Bowel care is recognized as an important factor to the wellbeing of the disabled elderly people. To evaluate the physiopathology of defecatory problems in the elderly, we applied saline enema test and fecoflowmetry; that is, pressure fluctuations of the rectum and anal canal were simultaneously recorded during saline infusion in the rectum, and then the saline evacuation curve was recorded in the elderly subjects. The patterns of the pressure fluctuations in the rectum and anal canal were analyzed in saline enema test. In fecoflowmetry, the shape of the evacuation curve and several parameters such as, flow rate and evacuation time were evaluated. The saline volume required to elicit rectal contractions and relaxations of the anal canal were significantly decreased in the patients with the lesions narrowing the spinal canal. The shape of evacuation curve represented the state of defecation in each subject. Subjects without defecatory problems had high flow rates and short evacuation time, while subjects with incontinence and/or constipation had low flow rates and long evacuation time. Furthermore, big and slow periodic pressure fluctuations of the anal canal, so called ultra slow waves, were seen in some patients with severe chronic constipation accompanying megacolon. These findings suggested that the physiopathology of defecatory problems in the elderly is variable and complicated, and that the appropriate treatment for these patients is achieved through appropriate evaluation.