Function of hollow viscera in children with constipation and voiding difficulties

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.