Anorectal manometry results in defecation disorders.

Area of Science:

• Pediatric Gastroenterology
• Colorectal Surgery
• Neurogastroenterology

Background:

• Constipation and soiling are common pediatric issues.
• Understanding the underlying physiological mechanisms is crucial for effective treatment.

Purpose of the Study:

• To investigate anorectal manometry and suction biopsy findings in children with constipation or soiling.
• To differentiate between functional fecal retention and functional fecal soiling without retention.

Main Methods:

• Anorectal manometry and suction biopsy were performed on 47 children.
• Patients were categorized into functional fecal retention (Group 1) and functional fecal soiling without retention (Group 2).
• Histological examination for ganglion cells and acetylcholinesterase staining was conducted.

Main Results:

• All patients demonstrated normal ganglion cells or acetylcholinesterase staining.
• Internal sphincter inhibition by rectal distension was normal in most, except for 2 children with severe constipation.
• Resting sphincteric pressures, pressure responses, and rectal sensitivity thresholds were elevated compared to controls and similar between groups.
• In Group 1, critical volume correlated with rectal sensitivity threshold.
• In soilers without retention, internal sphincter relaxation preceded rectal sensation.

Conclusions:

• Children with constipation and soiling generally have normal rectal innervation and musculature.
• Abnormalities in internal sphincter function and rectal sensation may play a role in pediatric constipation and soiling.
• The timing of internal sphincter relaxation relative to rectal sensation could be a key factor in functional fecal soiling without retention.