Anorectal manometric examination in encopretic-constipated children

Sutphen, James L.; Borowitz, Stephen M.; Ling, William; Cox, Daniel J.; Kovatchev, Boris

doi:10.1007/bf02050928

Cited by 40 publications

(27 citation statements)

References 12 publications

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“…This sudden contraction increases sphincter pressure values so that they are higher than rectal pressure, thereby contributing towards fecal continence. This response is considered to be a reflex from pelvic receptors and acts on external sphincter and puborectal bundle [10][11][12][13][14][15] .…”

Section: Discussionmentioning

confidence: 99%

“…In Hirschsprung's disease, this reflex is not obtained from any length of rectal segment 3,5,10,11,13 . In practical terms, if the rectosphincteric reflex can be demonstrated, the hypothesis of Hirschsprung's disease can be excluded.…”

Section: Discussionmentioning

confidence: 99%

“…In practical terms, if the rectosphincteric reflex can be demonstrated, the hypothesis of Hirschsprung's disease can be excluded. On the other hand, the absence of the rectosphincteric reflex may be indicative of Hirschsprung's disease or it may be due to technical problems of execution or recording the reflex, or because of the immaturity of its development 10,13,16,17 .…”

Section: Discussionmentioning

confidence: 99%

“…Several techniques have been proposed when performing this examination: perfusion, balloons and transducing probes [6][7][8][9][10][11][12][13] .…”

Section: Introductionmentioning

confidence: 99%

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Comparison between perfusion and balloon techniques for performing anorectal manometry in children with intestinal constipation

2008

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INTRODUCTION: Two anorectal manometry techniques have commonly been utilized: the perfusion technique and the balloon technique. PURPOSE: To compare both techniques in children with intestinal constipation who had not undergone surgical treatment for its correction. METHODS: Thirty-nine children aged between four and fourteen years underwent anorectal manometry using both techniques at random. Resting pressure, pressure response to voluntary contraction, coughing and perianal stimulation, maximum pressure on the anal canal pressure curve, and presence of rectosphincteric reflex were registered and submitted to statistics. Vectorgraphy of the sphincter muscle complex was obtained by perfusion technique. RESULTS: The statistical comparison between the techniques revealed statistically significant differences in resting pressure (p=0.041), pressure response to voluntary contraction (p=0.026) and maximum pressure within the pressure curve (p=0.010). The rectosphincteric reflex was demonstrated in 21 patients by both techniques. CONCLUSIONS: The perfusion technique presented greater sensitivity in the following parameters: resting pressure, pressure response to voluntary contraction and maximum pressure within the pressure curve. The methods studied are equivalent regarding the measurement of pressure responses to coughing and perianal stimulation and the investigation of rectosphincteric reflex.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Several techniques have been proposed when performing this examination: perfusion, balloons and transducing probes [6][7][8][9][10][11][12][13] .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comparison between perfusion and balloon techniques for performing anorectal manometry in children with intestinal constipation

2008

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“…Once identified and quantified, anatomical and functional changes can be correlated with clinical symptoms and proctological findings (6) . Defecography, manometry, electromyography and, more recently, dynamic magnetic resonance scanning and dynamic anorectal ultrasonography, have all been used to diagnose patients with pelvic floor dysfunctions (1,2,3,4,5,6,7,8,9,11,12,13,14,15,16,17,18,19,20,21,22,23,24,26,27,28,29,30) . Advances in ultrasound technology includes the development of the three-dimensional (3D) anorectal transducer and allows to clearly visualize the anatomic configuration of the anal canal in multiplane images (27) but the twodimensional (2D) ultrasound can be useful in the diagnosis of anorectal disease (7,10,24) .…”

Section: Introductionmentioning

confidence: 99%

Is dynamic two-dimensional anal ultrasonography useful in the assessment of anismus? A comparison with manometry

Murad-Regadas

Regadas

Barreto³

et al. 2010

Arq. Gastroenterol.

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-Context -Anismus is a prevalent functional cause of outlet delay. It is characterized by symptoms of obstructed defecation associated with paradoxical contraction of the pelvic floor muscles. Objective -To evaluate the ability of two dimensional anal ultrasonography to identify anismus patients with paradoxical contraction or normal relaxation, comparing findings with manometric measurements. Methods -Forty-nine women presenting with outlet delay and a mean validated Wexner constipation score of 13.5 were included in a prospective study. Following screening with anal manometry, the patients were assigned to one of two groups: G-I -with normal relaxation and G-II -patients with anismus. Dynamic anorectal ultrasonography was used to quantifier the movement of the puborectalis muscle and to measure changes in the angle between two converging lines drawn from the 3 o'clock and the 9 o'clock positions of the endoprobe circumference to the internal border of the puborectalis muscle. The angle decreases during straining in patients with normal relaxation, but increases in patients with anismus. The agreement between the two techniques was verified with the Kappa index. Results -In manometry, during straining the anal canal pressure decreased by 41.3% in G-I and increased by 168.6% in G-II, indicating a diagnosis of anismus for the second group. In US, during straining, the angle produced by the movement of the puborectalis muscle decreased from 63 ± 1.31 to 58 ± 1.509 degrees (P = 0.0135) in 23 of the 30 patients in G-I, indicating normal relaxation, and increased from 66 ± 0.972 to 72 ± 0.897 degrees (P = 0.0001) in 16 of the 19 patients in G-II, indicating anismus. The index of agreement between manometry and two dimensional anal ultrasonography was moderate: 77% (23/30) for G-I and 84% (16/19) for G-II. Conclusion -Two-dimensional dynamic anal ultrasonography showed similar results previously suggested by anal manometry at identifying patients with normal relaxation or paradoxical contraction.

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Childhood Constipation: Is There New Light in The Tunnel?

Benninga,

Voskuijl,

Taminiau

2004

J. pediatr. gastroenterol. nutr.

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Anorectal manometric examination in encopretic-constipated children

Abstract: Anal sphincter spasm and megacolon are pathophysiologic abnormalities associated with pediatric constipation-encopresis.

Cited by 40 publications

References 12 publications

Comparison between perfusion and balloon techniques for performing anorectal manometry in children with intestinal constipation

Comparison between perfusion and balloon techniques for performing anorectal manometry in children with intestinal constipation

Is dynamic two-dimensional anal ultrasonography useful in the assessment of anismus? A comparison with manometry

Childhood Constipation: Is There New Light in The Tunnel?

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