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Assessment of the Paediatric Patient

  • V. Loening-Baucke

Abstract

In man, very special control mechanisms are developed to save the individual from the embarrassment of passage of wind, stool or urine. Unconscious regulation of bowel movements is the normal phenomenon at birth. Conscious regulation of bowel movement is achieved at an average age of 28 months. Anal malformation, spina bifida and some muscle disorders can interfere with bowel control. Constipation in infancy and the toddler years may inhibit or delay bowel control and in later childhood may disturb the mechanism for bowel control after normal control had been established. The purpose of this chapter is to review the techniques of anorectal manometry and their application in the investigation and management of disorders of the colon and anorectum in childhood.

Keywords

Anal Sphincter Anal Canal Anal Verge External Anal Sphincter Internal Anal Sphincter 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Anuras S, Mitros FA, Novak RV et al. (1983) A familial visceral myopathy with external opthalmoplegia and autosomal recessive transmission. Gastroenterology 84: 346–353PubMedGoogle Scholar
  2. Anuras S, Hade J, Soffer E et al. (1984) Natural history of adult Hirschsprung’s disease. J Clin Gastroenterol 6: 205–210PubMedGoogle Scholar
  3. Arhan P, Faverdin CL, Thouvenot J (1972) Anorectal motility in sick children. Scand J Gastroenterol 7: 309–314PubMedCrossRefGoogle Scholar
  4. Arhan P, Faverdin C, Devroede G et al. (1976) Manometric assessment of continence after surgery for imperforate anus. J Pediatr Surg 11: 157–166PubMedCrossRefGoogle Scholar
  5. Arhan P, Faverdin C, Devroede G et al. (1984) Anorectal motility after surgery for spina bifida. Dis Colon Rectum 27: 159–163PubMedCrossRefGoogle Scholar
  6. Berdon WE, Baker DH, Blanc WA et al. (1976) Megacystismicrocolon intestinal hypoperistalsis syndrome: a new cause of intestinal obstruction in the newborn-report of radiologic findings in five newborn girls. Am J Roentgenol 126: 957–964Google Scholar
  7. Callaghan RP, Nixon HH (1964) Megarectum: physiological observations. Arch Dis Child 39: 153–157PubMedCrossRefGoogle Scholar
  8. Chantraine A (1973) EMG examination of the anal and urethral sphincters. In: Desmedt JE (ed) New developments in electromyography and clinical neurophysiology, vol 2. Karger, Basle, pp 421–432Google Scholar
  9. Dent JA (1976) A new technique for continuous sphincter pressure measurement. Gastroenterology 71: 263–267PubMedGoogle Scholar
  10. De Vries PA, Cox K (1985) Surgery of anorectal anomalies. Surg Clin North Am 65: 1139–1168Google Scholar
  11. Devroede G (1985) Mechanisms of constipation. In: Read NW (ed) Irritable bowel syndrome. Grune and Stratton, New York, pp 127–139Google Scholar
  12. El Haddad M, Corkery JJ (1985) The anus in the newborn. Pediatrics 76: 927–928PubMedGoogle Scholar
  13. Falk DL, Anuras S, Christensen J (1978) Chronic intestinal pseudoobstruction. Gastroenterology 74: 922–931Google Scholar
  14. Haynes WG, Read NW (1982) Anorectal activity in man during rectal infusion of saline: a dynamic assessment of the anal continence mechanism. J Physiol 47: 57–65Google Scholar
  15. Holschneider AM (1983) Elektromanometrie des Enddarms. Diagnostik und Therapie der Inkontinenz und der chronischen Obstipation. Urban and Schwarzenberg, ViennaGoogle Scholar
  16. Howard ER, Nixon HH (1968) Internal anal sphincter: observations on the development and mechanism of inhibitory responses in premature infants and children with Hirschsprung’s disease. Arch Dis Child 43: 569–578PubMedCrossRefGoogle Scholar
  17. Loening-Baucke V (1984a) Sensitivity of the sigmoid colon and rectum in children treated for chronic constipation. J Pediatr Gastroenterol Nutr 3: 454–459CrossRefGoogle Scholar
  18. Loening-Baucke V (1984b) Abnormal rectoanal function in children recovered from chronic constipation and encopresis. Gastroenterology 87: 1299–1304Google Scholar
  19. Loening-Baucke V (1987) Encopresis and enuresis. In: Wolraich M (ed) Practical assessment and management of children with disorders of development and learning. Year Book Medical, Chicago, pp 352–378Google Scholar
  20. Loening-Baucke V (1988) Emptying of rectal infused saline in children with chronic constipation. Gastroenterology 94: 267AGoogle Scholar
  21. Loening-Baucke V (1989) Factors determining outcome in children with chronic constipation and faecal soiling. Gut 30: 999–1006PubMedCrossRefGoogle Scholar
  22. Loening-Baucke V (1990) Modulation of abnormal defecation dynamics by biofeedback treatment in chronically constipated children with encopresis. J Pediatr 116: 214–222PubMedCrossRefGoogle Scholar
  23. Loening-Baucke V, Cruikshank B (1986) Abnormal defecation dynamics in chronically constipated children with encopresis. J Pediatr 108: 562–566PubMedCrossRefGoogle Scholar
  24. Loening-Baucke V, Younoszai MK (1982) Abnormal anal sphincter response in chronically constipated children. J Pediatr 100: 213–218PubMedCrossRefGoogle Scholar
  25. Loening-Baucke V, Pringle KC, Ekwo EE (1985) Anorectal manometry for the exclusion of Hirschsprung’s disease in neonates. J Pediatr Gastroenterol Nutr 4: 596–603PubMedCrossRefGoogle Scholar
  26. Loening-Baucke V, Desch L, Wolraich M (1988) Biofeedback training in patients with meningomyelocele and fecal incontinence. Develop Med Child Neurol 30: 781–790PubMedCrossRefGoogle Scholar
  27. Louis D, Valancogne G, Loras O et al. (1985) Techniques et indications du bio-feedback dans les constipations chez l’enfant. Psychologie Medicale 17: 1625–1627Google Scholar
  28. McParland FA, Olness K (1979) Diagnostic uses of anorectal manometry in pediatrics. Minn Med 62: 447–450PubMedGoogle Scholar
  29. Meunier P, Mollard P, Jaubert de Beaujeu M (1976) Manometric studies of anorectal disorders in infancy and childhood: an investigation of pathophysiology of incontinence and defaecation. Br J Surg 63: 402–407PubMedCrossRefGoogle Scholar
  30. Meunier P, Marechal JM, Mollard P (1978) Accuracy of the manometric diagnosis of Hirschsprung’s disease. J Pediatr Surg 13: 411–415PubMedCrossRefGoogle Scholar
  31. Meunier P, Marechal JM, Jaubert de Beaujeu M (1979) Rectoanal pressures and rectal sensitivity studies in chronic childhood constipation. Gastroenterology 77: 330–336PubMedGoogle Scholar
  32. Meunier P, Louis D, Jaubert de Beaujeu M (1984) Physiologic investigation of primary chronic constipation in children: Comparison with the barium enema study. Gastroenterology 87: 1351–1357PubMedGoogle Scholar
  33. Mischalany HG, Wooley MG (1984) Chronic constipation: manometric patterns and surgical considerations. Arch Surg 119: 1257–1259CrossRefGoogle Scholar
  34. Molnar D, Taitz LS, Urwin OM et al. (1983) Anorectal manometry results in defecation disorders. Arch Dis Child 58: 257–261PubMedCrossRefGoogle Scholar
  35. Morikawa Y, Donahoe PK, Hendren WH (1979) Manometry and histochemistry in the diagnosis of Hirschsprung’s disease. Pediatrics 63: 865–871PubMedGoogle Scholar
  36. Nixon HH (1966) What is pseudo-Hirschsprung’s disease? Arch Dis Child 41: 147–149Google Scholar
  37. Pescatori M, Ravo B (1988) Diagnostic anorectal functional studies: manometry, sphincter electromyography and defecography. Surg Clin N Am 68: 1231–1248PubMedGoogle Scholar
  38. Schuffler MD, Jonak Z (1982) Chronic idiopathic intestinal pseudoobstruction caused by a degenerative disorder of the myenteric plexus. The use of Smith’s method to define the neuropathology. Gastroenterology 82: 476–486PubMedGoogle Scholar
  39. Schuster MM, Hookman P, Hendrix TR et al. (1965) Simultaneous manometric recording of internal and external anal sphincter reflexes. Bull Johns Hopkins Hosp 116: 79–88PubMedGoogle Scholar
  40. Snape WJ Jr, Sullivan MA, Cohen S (1980) Abnormal gastrocolonic response in patients with intestinal pseudo-obstruction. Arch Intern Med 140: 386–387PubMedCrossRefGoogle Scholar
  41. Swash M, Snooks SJ (1985) Electromyography in pelvic floor disorders. In: Henry MM, Swash M (eds) Coloproctology and the pelvic floor. Butterworth, London, pp 88–103Google Scholar
  42. Taylor I, Duthie HL, Zachary RB (1973) Anal continence following surgery for imperforate anus. J Pediatr Surg 8: 497–503PubMedCrossRefGoogle Scholar
  43. Tobon F, Nigel C, Talbert J et al. (1968) Non-surgical test for the diagnosis of Hirschsprung’s disease. N Engl J Med 278: 188–194PubMedCrossRefGoogle Scholar
  44. Wald A (1981) Use of biofeedback in treatment of fecal incontinence in patients with meningomyelocele. Pediatrics 68: 45–49PubMedGoogle Scholar
  45. Wald A (1983) biofeedback for neurogenic fecal incontinence: rectal sensation is a determinant of outcome. J Pediatr Gastroenterol Nutr 2:302–306PubMedGoogle Scholar
  46. Wald A, Chandra R, Gabel S et al. (1987) Evaluation of biofeedback in childhood encopresis. J Pediatr Gastroenterol Nutr 6: 554–558PubMedCrossRefGoogle Scholar
  47. Whitehead WE, Parker LH, Masek BJ et al. (1981) Biofeedback treatment of fecal incontinence in patients with myelomeningocele. Develop Med Child Neurol 23: 313–322PubMedGoogle Scholar
  48. Whitehead WE, Parker LH, Basmajian L et al. (1986) Treatment of fecal incontinence in children with spina bifida: comparison of biofeedback and behavior modification. Arch Phys Med Rehabil 67: 218–224PubMedGoogle Scholar

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© Springer-Verlag London Limited 1991

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  • V. Loening-Baucke

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