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Anorectal manometric examination in encopretic-constipated children
J Sutphen1, S Borowitz, W Ling
1University of Virginia Health Sciences Center, Department of Pediatrics, Charlottesville 22901, USA.
Insights
Anorectal manometry effectively distinguishes children with encopretic constipation from controls. Key indicators include anal sphincter pressure changes and rectal pressure gradients during defecation attempts.
Area of Science:
- Pediatric Gastroenterology
- Physiology
Background:
- Encopretic constipation is a common pediatric condition.
- Accurate diagnosis is crucial for effective treatment.
Purpose of the Study:
- To evaluate anorectal manometry's utility in differentiating encopretic-constipated children from healthy controls.
- To identify specific manometric parameters indicative of encopretic constipation.
Main Methods:
- Anorectal manometry was performed on 88 encopretic-constipated children and 27 controls.
- Key variables included anal sphincter pressures, rectoanal inhibitory reflex, rectal sensation, and defecation dynamics.
- The ability to defecate a water-filled balloon was assessed.
Main Results:
- Significant differences were observed in anal sphincter pressure change during attempted defecation (P=0.03).
- Rectal and sphincter pressure gradients during attempted defecation (P=0.02) and critical distending volume for fecal urgency (P=0.02) were distinguishing factors.
- The ability to defecate a balloon (P=0.05) also differentiated the groups.
Conclusions:
- Pediatric constipation-encopresis is associated with pathophysiologic abnormalities.
- Anal sphincter spasm and megacolon are identified as key contributing factors.
Purpose:
We have investigated the use of anorectal manometry to distinguish encopretic-constipated children (n = 88) from sibling controls (n = 16) and nonsibling controls (n = 11).
Methods:
Study variables included manometrically determined resting and maximum voluntary anal sphincter pressure, depth and speed of rectoanal inhibitory reflex, minimum rectal volume sensation, critical distending volume for fecal urgency, rectal and anal pressure responses during attempted defecation, and ability to defecate a water-filled balloon.
Results:
Change in anal sphincter pressure during attempted defecation (P = 0.03), gradient between rectal and sphincter pressure during attempted defecation (P = 0.02), critical distending volume for fecal urgency (P = 0.02), and ability to defecate a water-filled balloon (P = 0.05) distinguished encopretic-constipated from control children. The change in rectal pressure associated with the rectoanal inhibitory reflex just escaped significance at P = 0.07.
Conclusions:
Anal sphincter spasm and megacolon are pathophysiologic abnormalities associated with pediatric constipation-encopresis.