The treatment for functional constipation (FC) generally relies on the classification by clinical symptoms, but whether the classification by clinical symptoms is consistent with that by colorectal and anal function examinations still remains unclear.

To examine the consistency between FC classification by clinical symptoms and colorectal and anal functional examinations.

Forty FC outpatients and inpatients completing colorectal and anal functional examinations in Department of Gastroenterology, Hebei General Hospital from January 2018 to August 2021 were enrolled in this retrospective study. Symptoms were acquired for classifying FC by use of a questionnaire survey, including the frequency of spontaneous defecation per week, shape and type of stool assessed using the Bristol Stool Scale, difficulty in defecation, sense of anorectal blockage during defecation, requirement for manual assistance in defecation, and the frequency and degree of feeling of incomplete evacuation. And the results detected by examinations, including anorectal manometry (ARM) , defecography and gastrointestinal transit time (GITT) were also used for FC classification. The consistency of FC classification by symptoms and the three examinations was assessed.

The FC classification by symptoms was as follows: slow transit constipation (STC) 〔27.5% (11/40) 〕, defecation disorder constipation〔20.0% (8/40) 〕, mixed constipation〔37.5% (15/40) 〕, and normal-transit constipation (NTC) 〔15.0% (6/40) 〕. FC classified by ARM included defecation disorder constipation〔80.0% (32/40) 〕and NTC〔20.0% (8/40) 〕, and by defecography also only included defecation disorder constipation〔67.5% (27/40) 〕 and NTC 〔32.5% (13/40) 〕. By GITT, FC classification contained three types: STC〔20.0% (8/40) 〕, defecation disorder constipation 〔15.0% (6/40) 〕, and NTC〔65.0% (26/40) 〕. The weighted Kappa test indicated that the FC classification by symptoms was not consistent with that by ARM, defecography or GITT (Kappa=-0.123, P=0.502; Kappa=-0.040, P=0.794; Kappa=-0.140, P=0.215) , and there was no overall consistency between FC classification by symptoms and the three examinations (Kappa=-0.005, P=0.944) .

Mixed constipation was the major type of FC classified by symptoms, while defecation disorder constipation was the major type of FC classified by the three examinations. As there are differences between clinical symptom classification and examination classification, FC should be diagnosed based on both clinical symptoms and examination results, accompanied with the individualized analysis.

目前功能性便秘（FC）常依靠患者的临床症状进行分型指导治疗，但依据临床症状的分型结果与结直肠肛门功能检查的分型结果是否一致尚不明确。

探究FC患者临床症状与结直肠肛门功能检查分型的一致性。

本研究为回顾性研究。在2018年1月至2021年8月就诊于河北省人民医院消化内科的FC患者（含门诊及住院）中选取40例完成结直肠肛门功能检查的患者为研究对象。采用调查问卷的形式询问患者症状（包括每周自发排便次数、Bristol粪便性状量表分型、排便费力、排便时肛门直肠堵塞感、需要手法辅助排便、排便不尽感的频度和程度），并依此判断其临床症状分型。结直肠肛门功能检查包括肛门直肠压力测定（ARM）检查、排粪造影、胃肠传输时间（GITT）检查。比较患者临床症状分型和结直肠肛门功能检查分型的一致性。

40例FC患者临床症状分型结果：结肠慢传输型便秘（STC）、排便障碍型便秘、混合型便秘分别占27.5%（11/40）、20.0%（8/40）、37.5%（15/40），正常传输型便秘（NTC）占15.0%（6/40）。ARM检查分型结果示，80.0%（32/40）的患者为排便障碍型便秘，20.0%（8/40）的患者为NTC。排粪造影分型结果示，67.5%（27/40）的患者为排便障碍型便秘，32.5%（13/40）的患者为NTC。GITT检查分型结果示，20.0%（8/40）的患者为STC，15.0%（6/40）的患者为排便障碍型便秘，65.0%（26/40）的患者为NTC。加权Kappa检验结果显示，临床症状分型与ARM检查、排粪造影、GITT检查分型结果无一致性（Kappa值=-0.123，P=0.502；Kappa值=-0.040，P=0.794；Kappa值=-0.140，P=0.215）。临床症状分型与结直肠肛门功能检查分型结果无一致性（Kappa值=-0.005，P=0.944）。

FC患者临床表现以混合型便秘症状为主，而客观检查中以排便障碍型便秘为主。FC患者的临床症状与结肛门直肠功能检查分型之间存在差异。因此，在FC诊断中，需要将症状和客观检查分型相结合，且需要个体化分析。