Constipation--some provocative thoughts.

Constipation is a collective term with different definitions and manifestations. In the present communication, I hope to shed light on the pathogenesis, investigation, and treatment of these manifestations. The levator ani is the principal muscle of defecation; together with anorectal reflex actions, it conducts the act of defecation. Strainodynia is the term I give to excessive and exhaustive straining at defecation. Band strainodynia has normal stool character but elevated rectal neck pressure due to the presence of a fibrous band in the rectal neck. Diet strainodynia presents with lower stool weight and frequency than normal; the internal anal sphincter is fibrous. The stools in levator strainodynia have been repeatedly obstructed at defecation due to levator dysfunction. Idiopathic oligofecorrhea or infrequent defecation was studied in 146 patients. Three stages could be identified: the deep and the everted intersphincteric groove and the cone anus. Fecoflowmetry is introduced as a new method for investigating anorectal disorders. It measures the defecated volume per time unit, and provides quantitative as well as qualitative data concerning the act of defecation. Changes in the fecal flow parameters or curve configuration from normal point to a defecation disorder.