Lack of correlation of anorectal manometry with symptoms of chronic childhood constipation and encopresis

Borowitz, Stephen M.; Sutphen, James L.; Ling, William; Cox, Daniel J.

doi:10.1007/bf02054054

Cited by 26 publications

(19 citation statements)

References 14 publications

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“…This finding is in accordance with a study by Borowitz et al, 10 which showed no association between diminished ability to sense rectal distension and frequency of spontaneous bowel movements. This observation together with the absence of a therapeutic effect of BF or the performance of anorectal manometry as well as the absence of a correlation between defecation dynamics and achievement of success leaves no diagnostic or therapeutic role for the performance of anorectal manometry in children with chronic constipation, except its use as a diagnostic test to exclude Hirschsprung's disease.…”

Section: Discussionsupporting

confidence: 93%

The Effect of Anorectal Manometry on the Outcome of Treatment in Severe Childhood Constipation: A Randomized, Controlled Trial

Ginkel¹,

Büller

Boeckxstaens

et al. 2001

Pediatrics

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ABSTRACT.Objective. Approximately 50% of constipated children contract rather than relax the external sphincter complex during a defecation attempt. Although biofeedback training (BF) is able to change this defecation behavior, there is no additional effect of BF to conventional treatment (CT) on clinical outcome compared with CT alone. It has been postulated that the absence of a significant difference between these 2 treatment options might be because of a therapeutic, "demystifying" effect of performing anorectal manometry in conventionally treated children, necessary to obtain basal manometric data. The objective of this prospective, controlled, randomized study was to evaluate the effect of CT with 2 anorectal manometry sessions compared with CT alone (dietary advice, diary, toilet training, oral laxatives, and enemas) on clinical outcome.Methods. A total of 212 constipated children (143 boys) who were visiting a referral pediatric gastroenterologic practice were randomized prospectively to CT alone (115 patients) or to CT combined with 2 manometry sessions (CTM; 97 patients). Patients were included in the study when they fulfilled at least 2 of the 4 following criteria: stool frequency fewer than 3 per week, 2 or more soiling and/or encopresis episodes per week, periodic passage of very large amounts of stool every 7 to 30 days, or a palpable rectal or abdominal fecal mass. CT comprises dietary advice, a daily diary, toilet training, and oral laxative treatment preceded by rectal disimpaction with enemas on 3 consecutive days. During both manometries, the child and the parent could watch the tracing on the computer screen. No explanation was given to either the child or the parents during the procedure. When the procedure was finished, the tracings were clarified. Successful treatment was defined as a defecation frequency of 3 or more per week and fewer than 1 soiling/encopresis episode per 2 weeks and no use of laxatives.Results. Only 4 and 2 children from the CT and CTM groups showed no soiling and/or encopresis, whereas 76% and 65%, respectively, reported the periodic passage of large stools. In 26% and 30% of the patients, a rectal scybalum was found on physical examination. The success rates at 6, 26, 52, and 104 weeks' follow-up were 4%, 24%, 32%, and 43% and 7%, 22%, 30%, and 35% in the CT and CTM group, respectively. No significant difference in success percentage was observed between the 2 groups at any time of follow-up with relative risks (CT/CTM) and 95% confidence intervals, respectively, of 0.55 (0.16 -1.89), 1.13 (0.67-1.89), 1.07 (0.69 -1.65), and 1.23 (0.81-1.85). A significant increase in defecation frequency was observed between the first (intake) and second visits, which was sustained at all subsequent visits and stages of follow-up in both groups (not significant). Also in relation to the first visit, a significant decrease in encopresis episodes was shown and a further slow but significant decrease at 52 weeks of follow-up in both groups. The manometric data obtained from the CTM grou...

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Section: Discussionsupporting

confidence: 93%

The Effect of Anorectal Manometry on the Outcome of Treatment in Severe Childhood Constipation: A Randomized, Controlled Trial

Ginkel¹,

Büller

Boeckxstaens

et al. 2001

Pediatrics

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“…Moreover, in several studies on anismus, manometry and defecography have yielded similar results (4,8,12,26) .…”

Section: Discussionsupporting

confidence: 54%

“…Once identified and quantified, anatomical and functional changes can be correlated with clinical symptoms and proctological findings (6) . Defecography, manometry, electromyography and, more recently, dynamic magnetic resonance scanning and dynamic anorectal ultrasonography, have all been used to diagnose patients with pelvic floor dysfunctions (1,2,3,4,5,6,7,8,9,11,12,13,14,15,16,17,18,19,20,21,22,23,24,26,27,28,29,30) . Advances in ultrasound technology includes the development of the three-dimensional (3D) anorectal transducer and allows to clearly visualize the anatomic configuration of the anal canal in multiplane images (27) but the twodimensional (2D) ultrasound can be useful in the diagnosis of anorectal disease (7,10,24) .…”

Section: Introductionmentioning

confidence: 99%

Is dynamic two-dimensional anal ultrasonography useful in the assessment of anismus? A comparison with manometry

Murad-Regadas

Regadas

Barreto³

et al. 2010

Arq. Gastroenterol.

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-Context -Anismus is a prevalent functional cause of outlet delay. It is characterized by symptoms of obstructed defecation associated with paradoxical contraction of the pelvic floor muscles. Objective -To evaluate the ability of two dimensional anal ultrasonography to identify anismus patients with paradoxical contraction or normal relaxation, comparing findings with manometric measurements. Methods -Forty-nine women presenting with outlet delay and a mean validated Wexner constipation score of 13.5 were included in a prospective study. Following screening with anal manometry, the patients were assigned to one of two groups: G-I -with normal relaxation and G-II -patients with anismus. Dynamic anorectal ultrasonography was used to quantifier the movement of the puborectalis muscle and to measure changes in the angle between two converging lines drawn from the 3 o'clock and the 9 o'clock positions of the endoprobe circumference to the internal border of the puborectalis muscle. The angle decreases during straining in patients with normal relaxation, but increases in patients with anismus. The agreement between the two techniques was verified with the Kappa index. Results -In manometry, during straining the anal canal pressure decreased by 41.3% in G-I and increased by 168.6% in G-II, indicating a diagnosis of anismus for the second group. In US, during straining, the angle produced by the movement of the puborectalis muscle decreased from 63 ± 1.31 to 58 ± 1.509 degrees (P = 0.0135) in 23 of the 30 patients in G-I, indicating normal relaxation, and increased from 66 ± 0.972 to 72 ± 0.897 degrees (P = 0.0001) in 16 of the 19 patients in G-II, indicating anismus. The index of agreement between manometry and two dimensional anal ultrasonography was moderate: 77% (23/30) for G-I and 84% (16/19) for G-II. Conclusion -Two-dimensional dynamic anal ultrasonography showed similar results previously suggested by anal manometry at identifying patients with normal relaxation or paradoxical contraction.

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“…Despite clinical recovery, high anal resting pressure and decreased relaxation of the internal anal sphincter continued to be abnormal 6 – 8. In addition, while rectum and sigmoid contractility improved during and after treatment, no difference in contractility was found between recovered and non-recovered patients 9.…”

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confidence: 98%

Rectal compliance and rectal sensation in constipated adolescents, recovered adolescents and healthy volunteers

Berg

Voskuijl

Boeckxstaens

et al. 2007

Gut

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Lack of correlation of anorectal manometry with symptoms of chronic childhood constipation and encopresis

Cited by 26 publications

References 14 publications

The Effect of Anorectal Manometry on the Outcome of Treatment in Severe Childhood Constipation: A Randomized, Controlled Trial

The Effect of Anorectal Manometry on the Outcome of Treatment in Severe Childhood Constipation: A Randomized, Controlled Trial

Is dynamic two-dimensional anal ultrasonography useful in the assessment of anismus? A comparison with manometry

Rectal compliance and rectal sensation in constipated adolescents, recovered adolescents and healthy volunteers

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