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

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.