Skip to main content

Advertisement

SpringerLink
Log in

The value of fluoroscopic defecography in the diagnostic and therapeutic management of defecation disorders in children

  • Original Article
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Background

Defecography is a study to assess anorectal function during evacuation.

Objective

To investigate the value of fluoroscopic defecography in directing diagnostic and therapeutic management in children with defecation disorders.

Materials and methods

We reviewed all fluoroscopic defecography studies performed (2003–2009) in children with defecation problems and normal anorectal motility studies. Results were classified into three groups: (1) normal pelvic floor function; (2) pelvic floor dyssynergia, including incomplete relaxation of pelvic musculature, inconsistent change in anorectal angle and incomplete voluntary evacuation; (3) structural abnormality, including excessive pelvic floor descent with an intra-rectal intussusception, rectocele or rectal prolapse.

Results

We included 18 patients (13 boys, median age 9.1 years). Indication for fluoroscopic defecography was chronic constipation in 56%, fecal incontinence in 22% and rectal prolapse in 22%. Defecography showed pelvic floor dyssynergia in 9 children (50%), a structural abnormality in 4 (22%) and normal pelvic floor function in 5 (28%). In 12 children (67%) the outcome of fluoroscopic defecography directly influenced therapeutic management. After defecography 4 children (22%) were referred for anorectal biofeedback treatment, 4 children (22%) for surgery, 2 children (11%) for additional MR defecography, and 1 child to the psychology department, and medication was changed in 1 child. In 6 children (33%) the result did not change the management. In 9 children (75%) the change of management was successful.

Conclusions

Fluoroscopic defecography can be a useful tool in understanding the pathophysiology and it may provide information that impacts management of children with refractory defecation disorders.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Mugie SM, Di Lorenzo C, Benninga MA (2011) Constipation in childhood. Nat Rev Gastroenterol Hepatol 8:502–511

    Article  PubMed  Google Scholar 

  2. Van Ginkel R, Reitsma JB, Büller HA et al (2003) Childhood constipation: longitudinal follow-up beyond puberty. Gastroenterology 125:357–363

    Article  PubMed  Google Scholar 

  3. Benninga MA, Voskuijl WP, Taminiau JA (2004) Childhood constipation: is there new light in the tunnel? J Pediatr Gastroenterol Nutr 39:448–464

    Article  CAS  PubMed  Google Scholar 

  4. Lembo A, Camilleri M (2003) Chronic constipation. N Engl J Med 349:1360–1368

    Article  CAS  PubMed  Google Scholar 

  5. Locke GR, Pemberton JH, Phillips SF (2000) AGA technical review on constipation. Gastroenterology 119:1766–1778

    Article  PubMed  Google Scholar 

  6. Nurko S (2005) What’s the value of diagnostic tools in defecation disorders? J Pediatr Gastroenterol Nutr 41:S53–S55

    Article  PubMed  Google Scholar 

  7. Rosen R, Buonomo C, Andrade R et al (2004) Incidence of spinal cord lesions in patients with intractable constipation. J Pediatr 145:409–411

    Article  PubMed  Google Scholar 

  8. Yang X, Partanen K, Farin P et al (1995) Defecography. Acta Radiol 36:460–468

    Article  CAS  PubMed  Google Scholar 

  9. Wald A, Caruana BJ, Freimanis MG et al (190) Contributions of evacuation proctography and anorectal manometry to evaluation of adults with constipation and defecatory difficulty. Dig Dis Sci 35:481–487

  10. Varea Calderon V, Delgado Carbajal L, Camacho Diaz E et al (2000) Role of manometry, defecography and anal endosonography in the evaluation of colorectal disorders. Rev Esp Enferm Dig 92:154–159

    Google Scholar 

  11. Andromanakos N, Skandalakis P, Troupis T et al (2006) Constipation of anorectal outlet obstruction: pathophysiology, evaluation and management. J Gastroenterol Hepatol 21:638–646

    Article  PubMed  Google Scholar 

  12. Goei R (1993) Defecography: principles of technique and interpretation. Radiologe 33:356–360

    CAS  PubMed  Google Scholar 

  13. Morris A, Parker S (2006) Defecography: technique, interpretation, and current use. In: Wexner S, Duthie G (eds) Constipation: etiology, evaluation and management, 2nd edn. Springer, London, pp 85–98

    Chapter  Google Scholar 

  14. Wallden L (1952) Defecation block in cases of deep rectogenital pouch. Acta Chir Scand 103:236–238

    CAS  PubMed  Google Scholar 

  15. Mahieu P, Pringot J, Bodart P (1984) Defecography: I. Description of a new procedure and results in normal patients. Gastrointest Radiol 9:247–251

    Article  CAS  PubMed  Google Scholar 

  16. Hiltunen K, Kolehmainen H, Matikainen M (1994) Does defecography help in diagnosis and clinical decision-making in defecation disorders? Abdom Imaging 19:355–358

    Article  CAS  PubMed  Google Scholar 

  17. Muller-Lissner S, Bartolo D, Christiansen J et al (1998) Interobserver agreement in defecography — an international study. Z Gastroenterol 36:273–279

    CAS  PubMed  Google Scholar 

  18. Yang A, Mostwin J, Rosenshein N et al (1991) Pelvic floor descent in women: dynamic evaluation with fast MR imaging and cinematic display. Radiology 179:25–33

    Article  CAS  PubMed  Google Scholar 

  19. El Sayed RF (2008) Pelvic floor dysfunction: assessment with combined analysis of static and dynamic MR imaging findings. Radiology 248:518–530

    Article  PubMed  Google Scholar 

  20. Shorvon PJ, McHugh S, Diamant NE et al (1989) Defecography in normal volunteers: results and implications. Gut 30:1737–1749

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Brennan D, Williams G, Kruskal J (2008) Practical performance of defecography for the evaluation of constipation and incontinence. Semin Ultrasound CT MR 29:420–426

    Article  PubMed  Google Scholar 

  22. Jorge JM, Ger GC, Gonzalez L et al (1994) Patient position during cinedefecography. Influence on perineal descent and other measurements. Dis Colon Rectum 37:927–931

    Article  CAS  PubMed  Google Scholar 

  23. Brandão A, Ianez P (2013) MR imaging of the pelvic floor: defecography. Magn Reson Imaging Clin N Am 21:427–445

    Article  PubMed  Google Scholar 

  24. Diamant N, Kamm M, Wald A et al (1999) AGA technical review on anorectal testing techniques. Gastroenterology 116:735–760

    Article  CAS  PubMed  Google Scholar 

  25. Mellgren A, Bremmer S, Johansson C et al (1994) Defecography. Results of investigations in 2,816 patients. Dis Colon Rectum 37:1133–1141

    Article  CAS  PubMed  Google Scholar 

  26. Ekberg O, Nylander G, Fork F (1985) Defecography. Radiology 155:45–48

    Article  CAS  PubMed  Google Scholar 

  27. Fiaschetti V, Pastorelli D, Squillaci E et al (2013) Static and dynamic evaluation of pelvic floor disorders with an open low-field tilting magnet. Clin Radiol 68:293–300

    Article  Google Scholar 

  28. Newman J (1997) Defecation disorders and the role of defecography. Radiol Technol 68:399–416

    CAS  PubMed  Google Scholar 

  29. Fotter R (1998) Pediatric radiology review article imaging of constipation in infants and children. Imaging 258:248–258

    Google Scholar 

  30. Van der Plas R, Benninga M, Büller H et al (1996) Biofeedback training in treatment of childhood constipation: a randomised controlled study. Lancet 348:776–780

    Article  PubMed  Google Scholar 

  31. Brazzelli M, Griffiths PV, Cody JD et al (2011) Behavioural and cognitive interventions with or without other treatments for the management of faecal incontinence in children. Cochrane Database Syst Rev 12, CD002240

    PubMed  Google Scholar 

  32. Rao S, Go J (2009) Treating pelvic floor disorders of defecation: management or cure? Curr Gastroenterol Rep 11:278–287

    Article  PubMed Central  PubMed  Google Scholar 

  33. Deutekom M, Terra M, Dijkgraaf M et al (2006) Patients’ perception of tests in the assessment of faecal incontinence. Br J Radiol 79:94–100

    Article  CAS  PubMed  Google Scholar 

  34. Goei R, Kemerink G (1990) Radiation dose in defecography. Radiology 176:137–139

    Article  CAS  PubMed  Google Scholar 

  35. Faccioli N, Comai A, Mainardi P et al (2010) Defecography: a practical approach. Diagn Interv Radiol 16:209–216

    PubMed  Google Scholar 

  36. Kim AY (2011) How to interpret a functional or motility test — defecography. J Neurogastroenterol Motil 17:416–420

    Article  PubMed Central  PubMed  Google Scholar 

  37. Koivusalo AI, Pakarinen MP, Rintala RI et al (2012) Dynamic defecography in the diagnosis of paediatric rectal prolapse and related disorders. Pediatr Surg Int 28:815–820

    Article  CAS  PubMed  Google Scholar 

  38. Yong C, Ruo-yi W, Yuan Z et al (2013) MRI findings in patients with defecatory dysfunction after surgical correction of anorectal malformation. Pediatr Radiol 43:964–970

    Article  PubMed  Google Scholar 

  39. Harvey C, Halligan S, Bartram C et al (1999) Evacuation proctography: a prospective study of diagnostic and therapeutic effects. Radiology 211:223–227

    Article  CAS  PubMed  Google Scholar 

  40. Halverson AL, Orkin BA (1998) Which physiologic tests are useful in patients with constipation? Dis Colon Rectum 41:735–739

    Article  CAS  PubMed  Google Scholar 

  41. Pfeifer J, Oliveira L, Park UC et al (1997) Are interpretations of video defecographies reliable and reproducible? Int J Colorectal Dis 12:67–72

    Article  CAS  PubMed  Google Scholar 

  42. Ferrante S, Perry R, Schreiman J et al (1991) The reproducibility of measuring the anorectal angle in defecography. Dis Colon Rectum 34:51–55

    Article  CAS  PubMed  Google Scholar 

  43. Penninckx F, Debruyne C, Lestar B et al (1990) Observer variation in the radiological measurement of the anorectal angle. Int J Colorectal Dis 5:94–97

    Article  CAS  PubMed  Google Scholar 

  44. Ikenberry S, Lappas J, Hana M et al (1996) Defecography in healthy subjects: comparison of three contrast media. Radiology 201:233–238

    Article  CAS  PubMed  Google Scholar 

Download references

Conflicts of interest

None

Author information

Authors and Affiliations

  1. Division of Pediatric Gastroenterology, Nationwide Children’s Hospital, Columbus, OH, USA

    Suzanne M. Mugie, Jaya B. Punati, Carlo Di Lorenzo & Hayat M. Mousa

  2. Department of Pediatric Gastroenterology & Nutrition, Emma Children’s Hospital/Academic Medical center, Meibergdreef 9, Room C2-312, 1105, AZ, Amsterdam, The Netherlands

    Suzanne M. Mugie & Marc A. Benninga

  3. Division of Radiology, Nationwide Children’s Hospital, Columbus, OH, USA

    D. Gregory Bates

Authors
  1. Suzanne M. Mugie
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Gregory Bates
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jaya B. Punati
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marc A. Benninga
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carlo Di Lorenzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hayat M. Mousa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Suzanne M. Mugie.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mugie, S.M., Bates, D.G., Punati, J.B. et al. The value of fluoroscopic defecography in the diagnostic and therapeutic management of defecation disorders in children. Pediatr Radiol 45, 173–180 (2015). https://doi.org/10.1007/s00247-014-3137-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-014-3137-3

Keywords

Search

Navigation