Abstract
Chronic constipation is an extremely common problem in children. Many authors have advocated using anorectal manometric examination during evaluation of chronic childhood constipation and encopresis as a means of developing individualized modes of treatment. PURPOSE: This study was designed to prospectively examine frequency and severity of symptoms of childhood constipation and encopresis and associate these symptoms with anorectal manometric findings. METHODS: Forty-four children with chronic constipation participated in the study. Before performing anorectal manometry, bowel-related symptoms were collected for two consecutive weeks with a computerized voice mail system. Anorectal manometry was performed using a triple lumen catheter attached to a hydraulic manometry infusion system. RESULTS: Frequency of voluntary bowel movements did not correlate with any manometric parameters. Frequency of fecal soiling, age at onset of symptoms, and duration of symptoms were all highly correlated with degree of sphincter spasm during attempted defecation; however, none of these variables correlated with any other manometric parameter. Amount of pain associated with bowel movements correlated with frequency of soiling and was inversely correlated with maximum squeeze pressure but was not correlated with any other manometric parameter. CONCLUSIONS: In children with chronic constipation and encopresis, sphincter spasm demonstrated with anorectal manometry is highly correlated with frequency of fecal soiling, age at onset, and duration of symptoms; however, none of the other commonly measured manometric parameters appear to correlate with symptoms of chronic childhood constipation and encopresis.
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References
Levine MD. Children with encopresis: a descriptive analysis. Pediatrics 1975;56:412–6.
Taitz LS, Water JK, Urwin OM, Molnar D. Factors associated with outcome in management of defecation disorders. Arch Dis Child 1986;61:472–7.
Loening-Baucke V. Factors determining outcome in children with chronic constipation and faecal soiling. Gut 1989;30:999–1006.
Meunier P, Marechal JM, Jaubert del Beaujeu M. Rectoanal pressures and rectal sensitivity studies in chronic childhood constipation. Gastroenterology 1979;77:330–6.
Wald A, Chandra R, Chiponis D, Gabel S. Anorectal function and continence mechanisms in childhood encopresis. J Pediatr Gastroenterol Nutr 1986;5:346–51.
Cucchiara S, Coremans G, Staiano A,et al. Gastrointestinal transit time and anorectal manometry in children with fecal soiling. J Pediatr Gastroenterol Nutr 1984;3:545–50.
Loening-Baucke V, Pringle KC, Ekwo EE. Anorectal manometry for the exclusion of Hirschsprung's disease in neonates. J Pediatr Gastroenterol Nutr 1985;4:596–603.
Low PS, Quak SH, Prabhakaran K, Joseph VT, Chiang GS, Aiyathurai EJ. Accuracy of anorectal manometry in the diagnosis of Hirschsprung's disease. J Pediatr Gastroenterol Nutr 1989;9:342–6.
Sutphen JL, Borowitz SM, Ling W, Cox DJ. Sensitivity and specificity of the rectal manometric examination in encopretic-constipated children. Dig Dis Sci (in press).
Keren S, Wagner Y, Heldenberg DR, Golan M. Studies of manometric abnormalities of the rectoanal region during defecation in constipated and soiling children: modification through biofeedback therapy. Am J Gastroenterol 1988;83:827–31.
Weber J, Ducrotte P, Touchais J, Roussignol C, Denis P. Biofeedback training for constipation in adults and children. Dis Colon Rectum 1987;30:844–6.
Benninga MA, Buller HA, Taminiau JA. Biofeedback training in chronic constipation. Arch Dis Child 1993;68:126–9.
Loening-Baucke VA, Cruikshank BM. Abnormal defecation dynamics in chronically constipated children with encopresis. J Pediatr 1986;108:562–6.
Wexner SD, Jorge JM. Colorectal physiological tests: use or abuse of technology. Eur J Surg 1994;160:167–74.
De Medici A, Badiali D, Corazziari E, Bausano G, Anzini F. Rectal sensitivity in chronic constipation. Dig Dis Sci 1989;34:747–53.
Loening-Baucke VA. Sensitivity of the sigmoid colon and rectum in children treated for chronic constipation. J Pediatr Gastroenterol Nutr 1984;3:454–9.
Marshall BJ, Hoffman SR, Babadzhov V, Babadzhov M, McCallum R. The Automatic Patient Symptom Monitor (APSM): a voice mail system for clinical research. Proc Annu Symp Comput Appl Med Care 1993:32–6.
Loening-Baucke V. Chronic constipation in children. Gastroenterology 1993;105:1557–64.
Partin JD, Hamill SK, Fischl JE, Partin JS. Painful defecation and fecal soiling in children. Pediatrics 1992;89:1007–9.
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Supported by National Institutes of Health Grant RO1 HD 28160.
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Borowitz, S.M., Sutphen, J., Ling, W. et al. Lack of correlation of anorectal manometry with symptoms of chronic childhood constipation and encopresis. Dis Colon Rectum 39, 400–405 (1996). https://doi.org/10.1007/BF02054054
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DOI: https://doi.org/10.1007/BF02054054