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Function of hollow viscera in children with constipation and voiding difficulties
C Lucanto1, S B Bauer, P E Hyman
1Department of Pediatrics, Children's Hospital of Pittsburgh, Pennsylvania 15213, USA.
Insights
Children with severe constipation and urinary issues often have abnormal colonic motility and bladder function, suggesting a possible neuropathy. Treating constipation may not resolve urinary symptoms in these cases.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Urology
- Neuroenterology
Background:
- Severe chronic constipation in children is often associated with lower urinary tract symptoms (LUTS).
- The underlying pathophysiology linking these conditions is not fully understood.
- Investigating the neurogenic connection between the colon and bladder is crucial.
Purpose of the Study:
- To investigate the urodynamic characteristics and colonic motility in children with severe chronic constipation and LUTS.
- To explore potential neuropathic links between the gastrointestinal and genitourinary systems.
Main Methods:
- Colonic manometry using an endoscopically placed catheter.
- Urodynamic studies including cystometry, external urethral sphincter electromyography, urinary flow rate, and urethral pressure profile.
- Assessment of colonic motility patterns like gastrocolonic response and high-amplitude propagated contractions (HAPCs).
Main Results:
- All patients exhibited abnormal colonic motility, including absent gastrocolonic response (N=8), absent HAPCs (N=4), and abnormal HAPC propagation (N=7).
- Urodynamic abnormalities were present in 10 children, with findings such as uninhibited bladder contractions (N=6) and sphincter dyssynergy (N=2).
- Constipation improved in all children, but urinary symptoms persisted despite treatment.
Conclusions:
- Abnormal colonic motility and urodynamic findings suggest a potential neuropathy affecting both the colonic and lower urinary tracts in some children.
- Treatment of constipation alone may not resolve persistent urinary symptoms in this patient group.
- Further research into neurogenic mechanisms is warranted for comprehensive management.
Abstract:
We wished to investigate the urodynamic characteristics and colonic motility in a group of children with severe chronic constipation and lower urinary tract symptoms. We performed colonic manometry using an endoscopically placed catheter. The urodynamic studies consisted of cystometry, electromyography of the external urethral sphincter, measurement of urinary flow rate, and urethral pressure profile. We found abnormal colonic motility in all patients. Findings included: absent gastrocolonic response (N = 8), absent high-amplitude propagated contractions (HAPCs) (N = 4), and abnormal propagation of HAPCs (N = 7). Urodynamic features were abnormal in 10 children. Findings included: uninhibited bladder contractions (N = 6), hypertonic bladder (N = 2), sphincter dyssynergy (N = 2), small capacity bladder (N = 1). In all children constipation improved, in three after a partial colectomy. Urinary symptoms persisted. We conclude that some children with severe constipation may have a neuropathy affecting both the colonic and lower urinary tracts systems. In this group of patients treatment of constipation does not result in resolution of urinary symptoms.