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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
    Summary

    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.

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    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.