The Study of Anorectal Function Using High-resolution Anorectal Manometry in Patients With Fecal Impaction
Constanza Ciriza de Los Ríos1, Marta Aparicio Cabezudo, Ana Zatarain Valles
1Gastroenterology Department, Neurogastroenterology and Digestive Motility Unit, Hospital Clínico San Carlos, Madrid.
Journal of Clinical Gastroenterology
|February 25, 2025
Summary
High-resolution anorectal manometry reveals rectal hyposensitivity and anal hypo-contractility are key factors in fecal impaction. Fecal incontinence often coexists, indicating reduced anal pressures in these patients.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Physiology
Background:
- Constipation and fecal impaction are common conditions with significant impact on quality of life.
- Understanding the underlying anorectal functional abnormalities is crucial for effective management.
- High-resolution anorectal manometry (HRAM) offers detailed insights into anorectal physiology.
Purpose of the Study:
- To evaluate anorectal function using HRAM in patients with constipation and fecal impaction.
- To identify manometric variables and clinical factors associated with fecal impaction.
- To explore the relationship between fecal impaction and fecal incontinence.
Main Methods:
- Retrospective review of 785 HRAM procedures performed between January 2021 and November 2023.
- Patients with fecal impaction were compared to constipated patients without impaction (control group).
- Logistic regression analysis was used to identify risk factors for fecal impaction.
Main Results:
- Fecal incontinence was strongly associated with fecal impaction (aOR: 20.4).
- Severe rectal hyposensitivity was significantly more prevalent in patients with fecal impaction (38.2% vs 5.9%, P=0.001).
- Lower squeeze pressure and severe rectal hyposensitivity were independent risk factors for fecal impaction.
Conclusions:
- Rectal hyposensitivity and anal hypo-contractility are independent risk factors for fecal impaction.
- Fecal incontinence is linked to fecal impaction, with co-occurrence associated with reduced anal canal pressures.
- HRAM is valuable in assessing anorectal dysfunction in patients with constipation and fecal impaction.
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