Idiopathic Disorders of Fecal Continence in Children

Abstract

A group of 176 patients aged 2 to 15 years was investigated for idiopathic disorders of bowel function other than Hirschsprung's disease. Anorectal motility, as well as colorectal transit of radiopaque markers, were investigated. Before the end of the first month of life, 70 of the patients were constipated. Resting pressure was more unstable (P < 0.001) and higher than normal in the rectal ampulla and upper anal canal (P < 0.01). Retardation of markers occurred in the proximal and/or distal large bowel of 61% of the patients. The existence of functional abnormalities was demonstrated in the majority of children with idiopathic disorders of fecal continence.

Regional Gastrointestinal Motility in Healthy Children

“…ROM have been used since the 1980s to assess colonic transit time in both healthy children and children with GI dysmotility (20)(21)(22). Mean colonic transit times reported in studies on healthy children range from 15.1 to 39.6 hours (20,(23)(24)(25)(26).…”

Total and Segmental Colonic Transit Time and Anorectal Manometry in Children With Chronic Idiopathic Constipation

“…In our study, the clinical characteristics of children with constipation who had normal or prolonged colonic transit times were essentially similar, although the children with prolonged transit times had a higher frequency Thirty-seven percent of the children in our study showed delayed transit in the left colon and rectosigmoid colon. This constitutes the most commonly reported pattern in childhood constipation (6,43,44), suggesting evacuation obstruction. The results of our study support this hypothesis because up to 64% of the children with delayed transit times showed anismus when attempting to defecate.…”

“…Thirty‐seven percent of the children in our study showed delayed transit in the left colon and rectosigmoid colon. This constitutes the most commonly reported pattern in childhood constipation (6,43,44), suggesting evacuation obstruction. The results of our study support this hypothesis because up to 64% of the children with delayed transit times showed anismus when attempting to defecate.…”

“…Up to 63% of children with encopresis have histories of painful defecation before the age of 3 years (5). However, up to 25% of children have the dis-order before 1 year of age, suggesting that voluntary suppression of defecation is not a constant predisposing phenomenon (6). However, in clinical practice, patients commonly do not respond to conventional treatment, suggesting the existence of other physiopathologic mechanisms.…”

Physiological Assessment of Rectoanal Motor Function

“…Simultaneously, careful examinations of the traces of rectoanal manometry revealed some interesting functional abnormalities, which can be classified according to their origin: smooth muscle and striated external anal sphincter (5).…”