Toward a definition of colonic inertia

Table 1 Rome II Criteria for constipation[4]

Two or more of the following for at least 12 wk (not necessarily consecutive) in the preceding 12 mo:

- Straining during > 25% of bowel movements;

- Lumpy or hard stools for > 25% of bowel movements;

- Sensation of incomplete evacuation for > 25% of bowel movements;

- Sensation of anorectal blockage for > 25% of bowel movements;

- Manual maneuvers (digital evacuation, support of the pelvic floor) to facilitate > 25% of bowel movements;

- Less than 3 bowel movements per week;

Loose stools are not present, and there are insufficient criteria for irritable bowel syndrome

Table 2 The various definitions of colonic inertia in literature

According to radiopaque transit studies:

- Delayed colonic transit with markers distributed throughout the colon;

- Colonic inertia equates to slow transit constipation;

- Delayed transit in the right colon;

- Delayed transit in the left colon, or both in the left and right colon;

- Delayed transit in the right and left colon, with normal transit in the sigmoid and rectum

According to scintigraphic transit studies:

- Scintigraphic delay in the transverse and splenic flexure;

- Scintigraphic delay in the cecum, ascending colon, hepatic flexure, and transverse colon;

- Scintigraphic delay in the whole colon

According to manometric and/or electromyographic findings:

- Almost complete or complete absence of colonic motility

Miscellaneous:

- Decreased colonic motility;

- Severe constipation and abdominal pain, abnormal transit study, normal anorectal manometry;

- Refractory constipation and motility abnormalities only of the lower gastrointestinal tract