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Recto-anal Pressures in Constipated Men and Women Undergoing High-Resolution Anorectal Manometry

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Abstract

Background

In constipated individuals, high-resolution anorectal manometry (HRM) may suggest the presence of a defecatory disorder. Despite known physiological differences between men and women, our understanding of functional anorectal pathophysiology is based upon predominantly female cohorts. Results are generalized to men.

Aims

To evaluate whether recto-anal pressure patterns in constipated men are similar to those in constipated women.

Methods

The electronic health records at Mayo Clinic, Rochester were used to identify constipated adult patients, without organic anorectal disease, who had undergone HRM and balloon expulsion testing (BET) in 2018, 2019, and 2020. Comparative analyses were performed.

Results

Among 3,298 constipated adult patients (2,633 women, 665 men), anal and rectal pressures were higher in men. Women more likely to have HRM findings suggestive of a defecatory disorder (39% versus 20%, P < 0.001). Women were more likely to exhibit a type 4 pattern (27% versus 14%, P < 0.001), and less likely to exhibit a type 1 pattern (14% versus 38%, P < 0.001), of dyssynergia. Men were more likely to have an abnormal balloon expulsion test (BET, 34% versus 29%, P = 0.006). Nominal logistic regression demonstrates that male sex, age over 50 years, reduced recto-anal gradient during simulated evacuation, and types 2 and 4 dyssynergia are associated with an abnormal BET.

Conclusions

In this large retrospective study, constipated men and women exhibited different patterns of dyssynergia both in the presence and absence of an abnormal BET. These findings were independent of sex-specific baseline physiological differences.

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Abbreviations

BET:

Balloon expulsion test

HRM:

High-resolution anorectal manometry

OR:

Odds Ratio

RAG:

Rectoanal gradient

RST:

Rectal sensory testing

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Acknowledgments

The authors would like to acknowledge the assistance of the AGILE team in extracting the data for this research.

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  1. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, USA

    David O. Prichard & Jeffrey Fetzer

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  1. David O. Prichard
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  2. Jeffrey Fetzer
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Correspondence to David O. Prichard.

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Prichard, D.O., Fetzer, J. Recto-anal Pressures in Constipated Men and Women Undergoing High-Resolution Anorectal Manometry. Dig Dis Sci 68, 922–930 (2023). https://doi.org/10.1007/s10620-022-07590-w

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  • DOI: https://doi.org/10.1007/s10620-022-07590-w

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