Inadequate Rectal Pressure and Insufficient Relaxation and Abdominopelvic Coordination in Defecatory Disorders

Deb, Brototo; Sharma, Mayank; Fletcher, Joel G.; Srinivasan, Sushmitha Grama; Chronopoulou, Alexandra; Bailey, Kent R.; Feuerhak, Kelly; Bharucha, Adil E.

doi:10.1053/j.gastro.2021.12.257

Cited by 15 publications

(12 citation statements)

References 40 publications

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“…Assuming an intraindividual variation of 40%, which is greater than the observed variation of 36%, a trial comparing two groups (e.g., voluntary effort, 12 which probably explains why the rectal pressure and the rectoanal gradient were more variable among and within patients. Arguably, coaching patients prior to the maneuver may reduce the variability in these pressures.…”

Section: Discussionmentioning

confidence: 97%

Reproducibility of high‐resolution manometry among healthy and constipated persons

Mishra

Gautam

Oblizajek

et al. 2022

Neurogastroenterology Motil

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Background and Aims Although high‐resolution manometry (HR_ARM) is commonly used to diagnose defecatory disorders, its intraindividual day‐to‐day reproducibility is unknown. Since these measurements entail voluntary effort, this study aimed to evaluate the intraindividual day‐to‐day reproducibility of HR_ARM. Methods In 22 healthy women (35 years [14] mean [SD]) and 53 constipated patients (42 years [13], 46 women), the rectal balloon expulsion time (BET), and anorectal pressures were measured with HR_ARM on 2 days separated by a median (interquartile range) of 15 days (11–53) in healthy and 40 days (8–75) in constipated patients. Anorectal pressures were evaluated at rest (20 s), during squeeze, and during evacuation. Rectal sensation was also evaluated in constipated patients. The agreement between both measurements was evaluated with Lin's concordance correlation coefficient (CCC) and other tests. Results Among constipated patients, the anal resting (mean CCC [95%CI] 0.62 [0.43–0.76]) and squeeze pressures (CCC 0.65 [0.47–0.79]), rectoanal gradient during evacuation (CCC 0.42 [0.17–0.62]), and rectal sensory thresholds (CCC for urgency 0.72 [0.52–0.84]) were concordant. Between days 1 and 2, one or more outcomes, characterized as normal or abnormal, differed in 79% of constipated patients, i.e., anal resting and squeeze pressures, the gradient, and the rectal BET differed in, respectively, 25%, 19%, 36%, and 10% of constipated patients. The rectal BET was prolonged in three healthy persons (both days) and either on 1 day (six patients) or 2 days (33 patients) in constipated patients. Conclusions While HR_ARM variables and the BET are reproducible within healthy and constipated persons, the outcome on repeat testing differed in 79% of constipated patients.

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Section: Discussionmentioning

confidence: 97%

Reproducibility of high‐resolution manometry among healthy and constipated persons

Mishra

Gautam

Oblizajek

et al. 2022

Neurogastroenterology Motil

Self Cite

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“…56 However, the rectoanal pressure profiles suggest dyssynergia (e.g., anal contraction or a negative rectoanal gradient during evacuation) in approximately 20% and 90% of healthy persons, respectively, with non-HR-ARM and HR-ARM. 56,57 These differences from the idealized normal pattern may be explained by one or more of the following factors: inability to replicate defecation in a laboratory environment 58 ; artifact resulting from impingement of the catheter against the anal mucosa 59 ; absence of rectal filling during manometry; and/or performing manometry in the left lateral position. Regardless, these findings undermine the utility of manometry for diagnosing DD.…”

Section: Discussionmentioning

confidence: 99%

“… 55 Earlier studies have suggested that the rectoanal pressure profile during simulated evacuation was useful for diagnosing DD 56 . However, the rectoanal pressure profiles suggest dyssynergia (e.g., anal contraction or a negative rectoanal gradient during evacuation) in approximately 20% and 90% of healthy persons, respectively, with non‐HR‐ARM and HR‐ARM 56,57 58 ; artifact resulting from impingement of the catheter against the anal mucosa 59 ; absence of rectal filling during manometry; and/or performing manometry in the left lateral position.…”

Section: Methodsmentioning

confidence: 99%

Review of the indications, methods, and clinical utility of anorectal manometry and the rectal balloon expulsion test

Bharucha

Basilisco

Malcolm

et al. 2022

Neurogastroenterology Motil

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Anorectal manometry (ARM) is a sophisticated technique that quantifies several aspects of the complex and multifactorial mechanisms that regulate defecation and continence. 1 ARM records contractility and tone of the internal (IAS) and external anal sphincters (EAS); rectal sensitivity and compliance; the reflex relaxation of the IAS in response to rectal distension; the reflex contraction of the EAS in response to cough or Valsalva maneuver; and the dynamic changes of rectal and anal pressures during simulated evacuation. The technological advances of ARM and other techniques that assess colonic and anorectal functions (e.g., high-resolution colonic manometry and magnetic resonance imaging [MRI] proctography) have enhanced our understanding of the physiology of defecation and continence and related disorders. Anorectal manometry and the rectal balloon expulsion test are recommended initial tests for diagnosing DD in patients who have

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“…In the context of this bleak epidemiology, there is strong agreement that efforts must be directed towards a mechanistic description of the defaecatory function [1,11]. Among the different gaps that have been identified in recent reviews [1,11,13], we focused in this paper on the modelling of the anorectal pressure forces generated during evacuation. Indeed, the relationships between the pressure and the flow depends on (i) the anorectal geometry, (ii) the forces applied by the rectal muscles, (iii) the straining of the abdomen and (iv) the rheological properties of the faeces.…”

Section: Introductionmentioning

confidence: 99%

“…For example, manometry and evacuation are typically measured asynchronously under different conditions. Manometry is generally performed in non-physiological conditions with an empty rectum, whereas evacuation is assessed with the expulsion of a balloon [13,14]. To circumvent these limitations, researchers are developing and validating a soft core with embedded pressure sensors to combine manometry and defaecography [15].…”

Section: Introductionmentioning

confidence: 99%

Flow simulations of rectal evacuation: towards a quantitative evaluation from video defaecography

Ahmad

Tanguy

et al. 2022

Interface Focus.

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Mechanistic understanding of anorectal (patho)physiology is missing to improve the medical care of patients suffering from defaecation disorders. Our objective is to show that complex fluid dynamics modelling of video defaecography may open new perspectives in the diagnosis of defaecation disorders. Based on standard X-ray video defaecographies, we developed a bi-dimensional patient-specific simulation of the expulsion of soft materials, the faeces, by the rectum. The model quantified velocity, pressure and stress fields during the defaecation of a neostool with soft stool-like rheology for patients showing normal and pathological defaecatory function. In normal defaecation, the proximal–distal pressure gradient resulted from both the anorectal junction which formed a converging channel and the anal canal. The flow of the neostool through these anatomical parts was dominated by its shear-thinning viscous properties, rather than its yield stress. Consequently, the evacuation flow rate was significantly affected by variations in pressure applied by the rectum, and much less by the geometry of the anorectal junction. Lastly, we simulated impaired defaecations in the absence of obvious obstructive phenomena. Comparison with normal defaecation allowed us to discuss critical elements which should lead to effective medical management.

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Inadequate Rectal Pressure and Insufficient Relaxation and Abdominopelvic Coordination in Defecatory Disorders

Cited by 15 publications

References 40 publications

Reproducibility of high‐resolution manometry among healthy and constipated persons

Reproducibility of high‐resolution manometry among healthy and constipated persons

Review of the indications, methods, and clinical utility of anorectal manometry and the rectal balloon expulsion test

Flow simulations of rectal evacuation: towards a quantitative evaluation from video defaecography

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