Related Experiment Videos
Idiopathic constipation in childhood is associated with thickening of the internal anal sphincter
1Department of Paediatric Surgery, Institute of Child Health and Great Ormond Street Children's Hospital, London, England.
Insights
Children with chronic constipation show a thickened internal anal sphincter. This finding supports anal dilatation and internal sphincterotomy as effective treatments for this condition.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
Background:
- Chronic constipation is a common pediatric issue.
- Current treatments lack a clear rational basis for some cases.
Purpose of the Study:
- To investigate the morphological basis for treating pediatric chronic constipation.
- To evaluate the role of anal sphincter morphology in constipation.
Main Methods:
- Compared 16 children with chronic constipation to 39 age-matched controls.
- Assessed symptoms via questionnaire and sphincter morphology via endosonography.
- Measured internal and external anal sphincter thickness.
Main Results:
- Children with constipation had significantly thickened internal anal sphincters (P = .005).
- Internal sphincter thickness correlated with age and weight in controls, but not in constipated children.
- No differences were found in external anal sphincter morphology.
Conclusions:
- A hypertrophied internal anal sphincter provides a rational basis for surgical interventions.
- Anal dilatation and internal sphincterotomy may be effective for pediatric idiopathic constipation.
Abstract:
This study was undertaken to search for a rational basis for the use of anal dilatation and internal sphincterotomy as the treatment for chronic intractable constipation in children. Sixteen children, age 5 months to 13 years, who had constipation resistant to conservative treatment were compared with 39 age-matched controls. History and current symptoms were assessed using a standard questionnaire. Internal and external and sphincter morphology was assessed on clinical examination and by anal endosonography, using a 10-MHz rotating endoprobe to provide accurate measurement of the various components of the anal canal. The control group showed a linear correlation between the thickness of the internal anal sphincter and both age and weight, increasing from 0.4 mm in infancy to 0.9 mm in adolescence. Children who had constipation displayed significant thickening of the internal sphincter (range, 0.5 to 1.9 mm, P = .005) which was independent of the length of the history (P = .103). There was no difference in the morphology of the external anal sphincters between the groups. The finding of a hypertrophied internal anal sphincter could provide a rational basis for anal dilatation and internal sphincterotomy as treatment for idiopathic constipation.