[Diagnosis and therapy of chronic constipation]

Severe chronic constipation is an extremely rare disorder. Out of 39 370 patients seen in our hospital during the past two years only 309 children (=0,78%) were suffered from severe chronic constipation. Radiologic and electromanometrical examinations revealed as an organic cause anal sphincter achalasia or Hirschsprung's disease in 30,7% of these constipated children. In 54,9% however no pathomorphologic results could be found. Of all cases 14,4% examined were postoperative controls. Careful electromanometric and defecographic examination of every chronically constipated child is crucially important in determining the therapy as in most cases chronic constipation in childhood, is due to a functional asynchronism of the internal and external anal sphincter relaxation reflexes, it can most reliably be diagnosed by electromanometrical examinations. The accuracy and reliability of our electromanometrical method has been proved not only by comparison with radiologic and histologic techniques but also statistically by analysis of discriminance of the recorded parameters. The therapeutic approach depends on the underlying disease. Mechanical obstruction of the intestine, nervous dysregulation of colonic motility causing Hirschsprung's disease and organic anal sphincter achalasia require surgical treatment. In cases of achalasia myotomia of the internal anal sphincter gives excellent functional results. In 73 cases treated by myotomy no symptoms of anal incontinence were seen. Medical therapy includes administration of laxatives combined with high roughage diet, adjustment of living conditions including increased physical activity and bowel training in order to learn a conditioned defecation reflex. The matter can be more easily achieved by administering Dihydroergotamine and Lactulose initially.