World Journal of Surgery

, Volume 16, Issue 5, pp 831–835 | Cite as

Anismus: The cause of constipation? Results of investigation and treatment

  • G. S. Duthie
  • D. C. C. Bartolo
World Progress In Surgery

Abstract

Anismus, or failure of the somatic sphincter apparatus to relax at defecation, has been implicated as a major contributor to the problem of obstructed defecation. Current diagnostic methods depend on laboratory measurements of attempted defecation and the most complex, dynamic proctography has been the mainstay of diagnosis. Using a new computerized ambulatory method of recording sphincter function in these patients at home, we report an 80% reduction in our diagnostic rate suggesting that conventional tests fail to accurately diagnose this condition, probably because they poorly represent the natural physiology of defecation. Treatment of this distressing condition is more complex and a variety of surgical and pharmacological measures have failed. Biofeedback retraining of anorectal function of these patients has been very successful and represents the management of choice.

Résumé

L'anisme, ou impossibilité de relaxation de l'appareil sphincterien de l'anus lors de la défecation, a été impliqué comme facteur majeur dans le problème de constipation. Les méthodes actuelles de diagnostic de l'anisme dépendent des examens de laboratoire; la proctographie dynamique, l'examen le plus complexe, a été, jusqu'à présent, l'examen le plus probant. Avec l'utilisation d'un enregistrement informatisé ambulatoire, nous avons constaté une réduction de 80% dans notre taux de diagnostic, ce qui suggère que les examens conventionels ne font pas de diagnostic correct, probablement parce qu'ils ne tiennent pas bien compte de la physiologie naturelle de la défecation. Le traitement de cette entité inquiètante est complexe et beaucoup des méthodes chirurgicales ou pharmacologiques sont des échecs. Par contre, le biofeedback et l'entrainement anorectal sont souvent couronnés de succès et représentent la méthode therapeutique de choix.

Resumen

El anismus, o sea la falla en el fenómeno de relajación del aparato somático esfinteriano que permite la defecación, ha sido implicado como el factor principal en el problema de la defecación obstruida. Los actuales métodos de diagnóstico, que dependen de mediciones fisiológicas de laboratorio durante el intento de defecación y de la muy compleja proctografía dinámica, han venido a ser esenciales para el diagnóstico. Con la utilización de un novedoso método computadorizado ambulatorio de registro de la función esfinteriana con el paciente en el hogar, podemos informar una reducción de 80% en nuestra tasa de diagnóstico de anismo, lo cual sugiere que las pruebas convencionales fallan en el diagnóstico certero de esta condición, probablemente porque representan de manera muy pobre la fisiología natural de la defecación. El tratamiento de esta incapacitante condición es más complejo y toda una variedad de procedimientos quirúrgicos y farmacológicos han fallado. En estos pacientes el reentrenamiento de la función ano-rectal por biorectroalimentación ha sido muy exitoso y representa la modalidad de manejo preferencial.

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Copyright information

© Société Internationale de Chirurgie 1992

Authors and Affiliations

  • G. S. Duthie
    • 1
  • D. C. C. Bartolo
    • 1
  1. 1.Department of SurgeryRoyal Infirmary of EdinburghEdinburghScotland

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