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[The urorectal syndrome caused by abdomen-levator incoordination in children]
Insights
Severe constipation in children can stem from a urorectal outlet obstruction syndrome. Biofeedback therapy shows promise in improving symptoms for some young patients with this condition.
Area of Science:
- Pediatric Gastroenterology
- Urology
- Pelvic Floor Dysfunction
Context:
- Functional constipation and encopresis are common in children.
- A subset of these children exhibit voiding disorders.
- Pelvic floor dysfunction can impact both defecation and urination.
Purpose:
- To investigate the prevalence of urorectal outlet obstruction syndrome in children with severe functional constipation.
- To identify associated voiding disorders in this patient group.
- To evaluate the efficacy of biofeedback therapy for this condition.
Summary:
- Thirty-four children with severe functional constipation underwent evaluation.
- Defecography revealed persistent anorectal angle in 23 children due to puborectalis muscle dysfunction.
- Obstructive uroflowmetry identified voiding disorders in 19 children, suggesting a urorectal outlet obstruction syndrome.
- Biofeedback training was administered to all participants.
- A satisfactory outcome was achieved in 14 children after a six-month follow-up.
Impact:
- Highlights the link between functional constipation and pelvic floor dysfunction in children.
- Underscores the importance of assessing for voiding disorders in constipated children.
- Demonstrates the potential of biofeedback as a therapeutic intervention for urorectal outlet obstruction syndrome.
Abstract:
We have studied thirty four children (mean age 6.6 years) with severe functional constipation, associated or not with encopresis. In twenty three cases the defecography showed a persistent anorectal angle due to failure of puborectalis sling relaxation during defecation straining. Voiding disorders, unknown to parents, but demonstrated by obstructive uroflowmetry, are also seen in nineteen of these children. Therefore is definite a true urorectal outlet obstruction syndrome by spastic pelvic floor mechanism. The exact etiologic factor of these functional abnormalities remains undefined. All children were managed by biofeedback training. A satisfactory result (with six months follow up), has obtained in fourteen cases.