Anorectal Physiologic Evaluation of Constipation

Denoya, Paula; Sands, Dana R.

doi:10.1055/s-2008-1075860

Cited by 15 publications

(19 citation statements)

References 21 publications

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“…As mentioned earlier, nonrelaxation during straining can be observed in patients with dyssynergic or obstructed defecation [22]. Furthermore, low anal basal pressure and impaired rectal sensation has been described in patients with constipation [4, 19]. Although we agree that ARM provides additional information, patient management is not influenced.…”

Section: Discussionsupporting

confidence: 68%

Clinical examination remains more important than anorectal function tests to identify treatable conditions in women with constipation

Lam

Felt‐Bersma

2012

Int Urogynecol J

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Introduction and hypothesisMany women with chronic constipation are referred for anorectal function tests (AFT) when they fail initial conservative treatment with lifestyle advice and laxatives. Our goal was to prospectively investigate the diagnostic potential of AFT in women with constipation in order to identify treatable conditions.MethodsBetween May 2003 and June 2011, all women with constipation referred to our tertiary referral center completed a questionnaire regarding their perianal complaints and underwent physical examination and were evaluated according to our AFT protocol, including anorectal manometry (ARM) and anal endosonography.ResultsOne hundred and thirteen women were referred and classified as having idiopathic constipation (n = 100), neurological disorder (n = 8), or others (n = 5). Of the 100 women with idiopathic constipation, clinical examination identified 25 (25 %) with hypertonia of the pelvic floor (dyssynergic pelvic floor) and 15 (15 %) with a rectocele. In 37/100 women also complaining of impaired evacuation, the yield of rectocele was 15 (41 %) and of hypertonia 5 (14 %). Women with hypertonia were younger (40 vs. 51 years; P = 0.002) and had no rectoceles identified (P = 0.02), and fewer women could relax during straining on ARM (56 % vs. 92 %; P < 0.001) compared with women without pelvic hypertonia. Other ARM measurements showed no differences between women with evacuation disorders, rectoceles, or hypertonia. Anal endosonography showed no internal sphincter hypertrophia.ConclusionPotentially treatable conditions, such as rectocele and pelvic floor hypertonia, are found on clinical examination in 40 % of women with idiopathic constipation. Impaired evacuation is associated with the presence of a rectocele. AFT contributes little and should be reserved for selected cases.

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Section: Discussionsupporting

confidence: 68%

Clinical examination remains more important than anorectal function tests to identify treatable conditions in women with constipation

Lam

Felt‐Bersma

2012

Int Urogynecol J

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“…Le sujet réalise un effort de poussée abdominale qui est associé à un relâche-ment volontaire du sphincter strié anal. Cette relaxation sphinctérienne déclenche une contraction anale (synergie rectoanale) qui permet une expulsion facile rapide et complète des matières fécales [10].…”

Section: Asynchronisme Abdopelvien Ou Anismeunclassified

“…Cela pourrait traduire une neuropathie pudendale, conséquence des efforts de poussée. Le défaut de contraction rectosigmoïdienne peut également constituer un mécanisme de dyschésie par altération de la progression et de l'évacuation du bol fécal [10].…”

Section: Troubles De La Sensibilité Rectoanaleunclassified

Intérêt des explorations manométriques dans les dyschésies anorectales

et al. 2010

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La dyschésie anorectale est un symptôme fréquent de consultation en situation fonctionnelle ou s'intégrant à une pathologie neurologique. Les plaintes anamnestiques du patient dyschésique sont polymorphes, traduisant des mécanismes différents. La manométrie anorectale permet d'appréhender certains des mécanismes responsables : trouble de la relaxation de l'appareil sphinctérien lors de la défécation (anisme), hypertonie anale de repos, troubles sensitifs du complexe rectoanal, troubles de la commande anale. Néanmoins, la manométrie ne permet pas de mettre en évidence les causes mécaniques d'une dyschésie (consistance des selles, prolapsus pelvien…). Cet examen est rarement réalisé isolément. Pour citer cette revue : Pelvi-Périnéologie 5 (2010). Mots clés Dyschésie · Anisme · Manométrie anorectale · NeuropathieAbstract Distal constipation (DC) is a common symptom observed either in neurologic diseases or functional troubles. DC presentations are numerous depending on the pathophysiology. Rectoanal manometry (RAM) can demonstrate various mechanisms as anismus (lack of sphincter relaxation during defecation), anal sphincter instable hypertony, sensory alterations, or motor dysfunctions. Nevertheless, RAM cannot explain mechanical causes of DC (stool consistence, pelvic prolapses, etc.), and thus rarely performed alone. To cite this journal: Pelvi-Périnéologie 5 (2010).

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“…Primary, or functional, constipation is frequently due to either constipation-predominant irritable bowel syndrome, slow-transit constipation (STC), obstructed defecation (including pudendal neuropathy, paradox-ical contraction, or nonrelaxation of the puborectalis or increased perineal descent), or some combination of these. 4,8,9 Secondary constipation (►Table 2) is more common and causes include dehydration, poor dietary fiber intake, a variety of medications (opiates, iron supplements, etc. ), numerous medical conditions, low physical activity levels, and mechanical obstruction such as rectal stricture, rectocele, or colon cancer.…”

mentioning

confidence: 99%

Functional Disorders: Slow-Transit Constipation

Tillou

Poylin

2016

Clinics in Colon and Rectal Surgery

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Constipation is a very common complaint, with slow-transit constipation (STC) accounting for a significant proportion of cases. Old age, female gender, psychiatric illness, and history of sexual abuse are all associated with STC. The exact cause of STC remains elusive; however, multiple immune and cellular changes have been demonstrated. Diagnosis requires evidence of slowed colonic transit which may be achieved via numerous modalities. While a variety of medical therapies exist, these are often met with limited success and a minority of patients ultimately require operative intervention. When evaluating a patient with STC, it is important to determine the presence of concomitant obstructed defecation or other forms of enteric dysmotility, as this may affect treatment decisions. Although a variety of surgical procedures have been reported, subtotal colectomy with ileorectal anastomosis is the most commonly performed and well-studied procedure, with the best track record of success.

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Anorectal Physiologic Evaluation of Constipation

Cited by 15 publications

References 21 publications

Clinical examination remains more important than anorectal function tests to identify treatable conditions in women with constipation

Clinical examination remains more important than anorectal function tests to identify treatable conditions in women with constipation

Intérêt des explorations manométriques dans les dyschésies anorectales

Functional Disorders: Slow-Transit Constipation

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