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[Anorectal asynchronism. Clinical, manometric and therapeutic data]
I Sielezneff1, J C Sarles, B Sastre
1Service de Chirurgie générale et digestive, Hôpital Sainte-Marguerite, Marseille.
Objectives:
Anorectal asynchronism is a frequent and unrecognized cause of terminal constipation. The aim of this study was to describe clinical and instrumental findings, and results of biofeedback therapy.
Methods:
From 1987 to 1991, 18 patients with anorectal asynchronism were studied then treated by biofeedback training.
Results:
We found high rates of pelvic and perineal trauma (77.7%), of psychogenic factors (6.5%), of urinary incontinence (27.8%). The manometrical study confirmed puborectalis paradoxical contraction during defecation straining, and all the patients could not expel a rectal balloon containing 50 ml of air; non-specific manometrical abnormality was found in 44.5% patients. Excessive stamp of puborectalis muscle was always found at defecography; 77.7% of the patients had incomplete rectal evacuation, and 61.1% had an associated pelvic floor disorder. Biofeedback training was successful, and 88.9% of the patients were cured by 5 or 6 sessions. There was no predictive parameter in our study, but recovery rate seemed to be lower for patients from 45 to 55 years old.
Conclusion:
The diagnosis of the anorectal asynchronism is easily made with manometry and defecography. Treatment with biofeedback gives very good results in almost all patients.