The authors present a report of their study on a group of patients affected by serious chronic constipation undergoing multidisciplinary evaluation by a radiologist, a neurologist and, if necessary, also a psychiatrist. From June 1989 to October 1990, 40 patients were examined using anal manometry, intestinal transit time, proctogram and electromyography of the pelvic floor. The examinations carried out by the different specialists led to the following results: 10 patients were found to be affected by slowed transit due to right colon constipation; in 16 cases, spastic pelvic floor syndrome (S.P.F.S.) was diagnosed; 5 subjects showed a rectocele which in 3 was associated with S.P.F.S.; 3 patients presented with an anterior rectal prolapse; in 6 cases the diagnosis was perineal descent syndrome, associated in 3 cases with S.P.F.S.; the remaining 6 subjects manifested a diminished ampullary sensitivity. This experience reveals the complexity of the alterations that, alone or in association, cause chronic idiopathic constipation. The authors' conclusion is that a correct diagnostic approach requires close collaboration between various specialists, who, by careful examination of different aspects of the colo-recto-anal region, arrive at an accurate physiopathological diagnosis leading to the most suitable therapy.
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