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Published on: January 11, 2016
Anorectal function of children with neurological problems. II: cerebral palsy
U Agnarsson1, C Warde, G McCarthy
1United Medical School, London.
Insights
Children with cerebral palsy often face defecation difficulties due to anal sphincter and pelvic floor muscle incoordination. Medical treatment for constipation and fecal incontinence in these children may require improvement.
Area of Science:
- Pediatric Gastroenterology
- Neurology
- Physiology
Background:
- Children with cerebral palsy (CP) frequently experience defecation difficulties.
- Constipation and fecal incontinence are common comorbidities in pediatric CP.
- Understanding the underlying mechanisms is crucial for effective management.
Purpose of the Study:
- To investigate the defecation function in children with cerebral palsy.
- To identify potential causes of constipation and fecal incontinence in this population.
- To evaluate the suitability of current treatment approaches.
Main Methods:
- A cohort of 34 children with cerebral palsy underwent investigation.
- Methods included standardized questionnaires and anorectal manometry.
- A control group of 24 enuretic children was used for manometry comparison.
Main Results:
- Constipation was prevalent in 26 of 29 index children.
- Defecation distress and mild fecal incontinence were also reported.
- Anorectal manometry revealed low resting anal pressure and impaired anal activity.
Conclusions:
- Findings suggest anal sphincter and/or pelvic floor muscle incoordination in children with CP.
- No evidence of abnormal rectal function was found.
- Surgical intervention is not indicated; medical treatment optimization is recommended.
Abstract:
In response to the frequent complaint of difficulties with defecation experienced by children with cerebral palsy, 34 children (13 girls and 21 boys, mean age 10 years) with cerebral palsy were investigated by questionnaire and anorectal manometry. 24 enuretic children served as controls for the anorectal manometry. Constipation affected 26 of 29, defecation distress eight and faecal incontinence 16 of the index children, but incontinence was mild in most cases. Index children had a low resting pressure in the first centimetre of the anal canal, slow anal rhythmical activity and a pressure increase in the first centimetre during maximum rectal distension. These findings suggest anal sphincter and/or pelvic floor muscle incoordination, but no evidence of abnormal rectal function. The authors conclude that surgical intervention was not indicated for the index children, but that medical treatment could be improved.
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