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Dyssynergic Defecation and Anal Sphincter Disorders in Children in High-Resolution Anorectal Manometry Investigation

Ryszard Makosiej1, Aleksandra Makosiej1, Artur Bossowski2

  • 1Department of Gastroenterology, Allergology and Pediatrics, PMMH-RI, Lodz.

Journal of Pediatric Gastroenterology and Nutrition
|September 22, 2020
PubMed

Insights

Dyssynergic defecation affects over 80% of children with functional constipation, often due to puborectalis muscle dysfunction. This study used 3D HRAM to identify specific pressure changes during simulated defecation in these children.

Area of Science:

  • Pediatric Gastroenterology
  • Colorectal Surgery
  • Physiology

Background:

  • Dyssynergic defecation is a common cause of functional constipation (FC) in children.
  • It involves impaired relaxation of the anal sphincter and pelvic floor muscles during defecation.
  • Understanding the specific manometric findings is crucial for diagnosis and management.

Purpose of the Study:

  • To determine the frequency and types of dyssynergic defecation in children with FC.
  • To assess anal canal pressures during simulated evacuation.
  • To evaluate puborectalis muscle function in children with FC.

Main Methods:

  • Utilized three-dimensional (3D) high-resolution anorectal manometries (3D HRAM).
  • Evaluated 131 children (ages 5-17) diagnosed with functional constipation.
  • Measured resting pressure in four anal canal poles during simulated defecation.

Main Results:

  • Dyssynergic defecation was identified in 80.9% of the children studied.
  • Significant differences in intrarectal pressures were observed across anal canal measuring points.
  • Puborectalis muscle dysfunction, leading to increased rectal pressure, was noted in 40.5% of cases.

Conclusions:

  • The high prevalence of dyssynergic defecation in children with FC is confirmed.
  • Abnormal sphincter pressure patterns correlate with puborectalis muscle relaxation disorders.
  • 3D HRAM is valuable for characterizing defecatory dyssynergia in pediatric functional constipation.
Abstract

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