Neurological Disorders Associated With Diabetes
December 9, 2021
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December 9, 2021
Specific disorders of the colon for which adults with diabetes mellitus (DM) are at a higher risk include chronic constipation, enteropathic diarrhoea, inflammatory bowel disease, and colorectal cancer (CRC), among others.
Smooth muscle structure as well as the function and density of the interstitial cells of Cajal along with the health and function of the enteric and autonomic colonic nerves are all potentially affected by DM.
The evaluation, as well as treatment for slow-transit constipation and pelvic floor dysfunction, must be considered when the symptoms of constipation are refractory to initial measures of treatment.
Diabetes And Constipation
Individuals with DM are at a higher risk for a wide range of gastrointestinal (GI) complications that span across the entire GI tract, including gastroesophageal reflux, impaired gastric relaxation and accommodation, and dysmotility of the small bowel, colon, and rectum, among others.
It has been suggested that approximately 75% of individuals with DM possess associated GI symptoms, which may include constipation, bloating, abdominal pain, faecal incontinence, diarrhoea, and acid regurgitation, to name a few.
The focus of this article is on chronic constipation that poses a considerably higher risk in those with DM in comparison with the general population. Some of the other colonic disorders include inflammatory bowel disease, enteropathic diarrhoea, and colorectal cancer.
Pathophysiology
When it comes to the underlying mechanisms of GI dysfunction that is associated with DM, they appear to be multifactorial, complex, and incompletely defined. Known, emerging mechanisms include neuropathic injury as well as changes to the autonomic nervous system, interstitial cells of cajal (ICCs), enteric nervous system, as well as direct myopathic alterations to the smooth muscles.
The neuropathic effects of DM may involve the entire GI tract, including the colon. The well-described alterations to the vagus nerve, including segmental demyelination, axonal degeneration, and a reduction in motor and sensory ganglions are also presumed to involve the colonic autonomic nerves.
DM-related alterations to the colon’s myenteric plexus have been demonstrated repeatedly in rat models to include neuronal reduction and neuronal degeneration.
Emerging evidence has successfully demonstrated remodelling of the colon’s muscle layer, resulting in colonic wall-thickening, decreased compliance, and an overall reduction in the relaxation and contraction of the muscle.
These myopathic alterations in the colon are considered to be the result of increased glycation end-products, which, in turn, lead to an increase in the production of collagen.
The result could range from minor effects with unperceived symptoms of the GI to that of severe effects with highly disabling GI symptoms.
Occurrence Of Constipation
Constipation is by far the most common GI symptom that is reported by those with DM. In one study comprising of 136 adults with DM, approximately 60% reported constipation symptoms. Several other epidemiological studies have reported a prevalence of constipation ranging from 11-56%. One thing is clear, the prevalence of constipation is higher in adults with DM in comparison with the general population.
Though the underlying cause of constipation in those with DM is multifactorial, given the increase in the risk of both enteric and autonomic neuropathy, there is a higher chance of altered colonic motility that underlies the problem of constipation in comparison with the general population. One pilot study found extended colonic transit-time in a group of ten individuals with DM and constipation symptoms in comparison with controls.
Evaluation
While evaluating constipation in those with DM, careful attention must be taken to review all medications because these may contribute to constipation. It must also be noted that anorectal disorders are common among diabetics, which can further contribute to constipation.
A careful rectal examination must be performed to screen for coexistent pelvic floor muscle dysfunction. Although there is evidence of altered colonic motility and a potentially high prevalence of slow-transit constipation in diabetics, from a practical viewpoint colonic transit testing must be reserved for those who fail to respond to initial laxative therapies.
On A Final Note:
To sum it up, DM is directly associated with a higher risk of a wide range of colonic disorders, including chronic constipation, colorectal cancer, inflammatory bowel disease, and enteropathic diarrhoea, to name a few. Preventive measures, early detection, and treatment will improve the outcomes in those with diabetes and constipation.
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