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Abnormal defecation dynamics in chronically constipated children with encopresis

V A Loening-Baucke, B M Cruikshank

    The Journal of Pediatrics
    |April 1, 1986
    PubMed

    Insights

    Constipated children with encopresis struggle to pass rectal balloons due to increased external anal sphincter activity. This impaired defecation response hinders recovery from chronic constipation.

    Area of Science:

    • Pediatric Gastroenterology
    • Colorectal Surgery
    • Physiology

    Background:

    • Chronic constipation and encopresis are common in children.
    • Defecation involves complex coordination of pressures and muscle activity.
    • Understanding defecation mechanics is crucial for treating constipation.

    Purpose of the Study:

    • To investigate the defecation dynamics in children with chronic constipation and encopresis.
    • To identify physiological factors contributing to fecal retention.
    • To assess the impact of defecation dysfunction on treatment outcomes.

    Main Methods:

    • Assessed balloon expulsion in 16 healthy and 37 constipated children.
    • Measured intra-abdominal pressure, rectal pressure, and anal sphincter electromyography (EMG) during defecation attempts.
    • Evaluated rectal sensation and the volume required to inhibit anal sphincters.

    Main Results:

    • 20 of 37 constipated children could defecate balloons, compared to 15/16 controls.
    • Reduced external anal sphincter relaxation during bearing down was observed in 58% of constipated children who could expel balloons, and 7% of those who could not.
    • Children unable to expel balloons showed poorer recovery with laxative treatment (P < 0.02).

    Conclusions:

    • Elevated external anal sphincter activity during defecation impedes balloon expulsion in constipated children.
    • This defecatory dysfunction is a significant factor in chronic fecal retention.
    • Targeting sphincter dysfunction may improve treatment efficacy for encopresis.

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