Assessing Anorectal Function in Constipation and Fecal Incontinence

Jiang, Alice; Panara, Ami; Yan, Yun; Rao, Satish S.

doi:10.1016/j.gtc.2020.04.011

Cited by 16 publications

(9 citation statements)

References 108 publications

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“…BET data of more than 1- or 2-minute duration are by many considered abnormal. However, the test had considerable numbers of false positive and false negative (33) and should be used in conjunction with other anatomic and functional testing to confirm the diagnosis of evacuation disorder (34). The final categorization between OD and STC was based on symptoms and the results of the 4 tests.…”

Section: Discussionmentioning

confidence: 99%

Characterization of Patients With Obstructed Defecation and Slow Transit Constipation With a Simulated Stool

Gregersen

Chen

Leung

et al. 2021

Clin Transl Gastroenterol

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INTRODUCTION: Defecatory disorders including obstructed defecation (OD) are currently diagnosed using specialized investigations including anorectal manometry and the balloon expulsion test. Recently, we developed a simulated stool named Fecobionics that provides a novel type of pressure measurements and analysis. The aim was to study OD phenotypes compared with slow transit constipation (STC) patients and normal subjects (NS). METHODS: Fecobionics expulsion parameters were assessed in an interventional study design. The Fecobionics device contained pressure sensors at the front, rear, and inside a bag. All constipation patients had colon transit study, defecography, anorectal manometry, and balloon expulsion test performed. The Fecobionics bag was distended in the rectum until desire-to-defecate in 26 OD compared with 8 STC patients and 10 NS. Rear-front pressures (preload-afterload parameters) and defecation indices (DIs) were compared between groups. RESULTS: The Wexner constipation scoring system score was 13.8 ± 0.9 and 14.6 ± 1.5 in the OD and STC patients (P > 0.5). The median desire-to-defecate volume was 80 (quartiles 56–80), 60 (54–80), and 45 (23–60) mL in OD, STC, and NS, respectively (P < 0.01). The median expulsion duration was 37 (quartiles 15–120), 6 (3–11), and 11 (8–11) seconds for the 3 groups (P < 0.03). Fecobionics rear-front pressure diagrams demonstrated clockwise loops with distinct phenotype differences between OD and the other groups. Most DIs differed between OD and the other groups, especially those based on the anal afterload reflecting the nature of OD constipation. Several OD subtypes were identified. DISCUSSION: Fecobionics obtained novel pressure phenotypes in OD patients. DIs showed pronounced differences between groups. Larger studies are needed on OD subtyping.

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Section: Discussionmentioning

confidence: 99%

Characterization of Patients With Obstructed Defecation and Slow Transit Constipation With a Simulated Stool

Gregersen

Chen

Leung

et al. 2021

Clin Transl Gastroenterol

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“…Suggested explanations for LARS include impaired neorectal capacity, decreased compliance, and the loss of rectal sensation [33,47,48], which could be evaluated by anorectal manometry. Anal resting and squeeze pressures help determine the presence of internal and external anal sphincter dysfunction [49]. Abnormally low resting pressure and no relaxation during rectal distension generally indicated that patients have severe weakness of the anal sphincter [47].…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of side-to-end anastomosis versus colonic J-pouch anastomosis in sphincter-preserving resections: an updated meta-analysis of randomized controlled trials

et al. 2021

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Background The application of side-to-end anastomosis (SEA) in sphincter-preserving resection (SPR) is controversial. We performed a meta-analysis to compare the safety and efficacy of SEA with colonic J-pouch (CJP) anastomosis, which had been proven effective in improving postoperative bowel function. Methods The protocol was registered in PROSPERO under number CRD42020206764. PubMed, Embase, Web of Science, and the Cochrane Register of Controlled Trials databases were searched. The inclusion criteria were randomized controlled trials (RCTs) that evaluated the safety or efficacy of SEA in comparison with CJP anastomosis. The outcomes included the pooled risk ratio (RR) for dichotomous variables and weighted mean differences (WMDs) for continuous variables. All outcomes were calculated with 95% confidence intervals (CI) by STATA software (Stata 14, Stata Corporation, TX, USA). Results A total of 864 patients from 10 RCTs were included in the meta-analysis. Patients undergoing SEA had a higher defecation frequency at 12 months after SPR (WMD = 0.20; 95% CI, 0.14–0.26; P < 0.01) than those undergoing CJP anastomosis with low heterogeneity (I2 = 0%, P = 0.54) and a lower incidence of incomplete defecation at 3 months after surgery (RR = 0.28; 95% CI, 0.09–0.86; P = 0.03). A shorter operating time (WMD = − 17.65; 95% CI, − 23.28 to − 12.02; P < 0.01) was also observed in the SEA group without significant heterogeneity (I2 = 0%, P = 0.54). A higher anorectal resting pressure (WMD = 6.25; 95% CI, 0.17–12.32; P = 0.04) was found in the SEA group but the heterogeneity was high (I2 = 84.5%, P = 0.84). No significant differences were observed between the groups in terms of efficacy outcomes including defecation frequency, the incidence of urgency, incomplete defecation, the use of pads, enema, medications, anorectal squeeze pressure and maximum rectal volume, or safety outcomes including operating time, blood loss, the use of protective stoma, postoperative complications, clinical outcomes, and oncological outcomes. Conclusions The present evidence suggests that SEA is an effective anastomotic strategy to achieve similar postoperative bowel function without increasing the risk of complications compared with CJP anastomosis. The advantages of SEA include a shorter operating time, a lower incidence of incomplete defecation at 3 months after surgery, and better sphincter function. However, close attention should be paid to the long-term defecation frequency after SPR.

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“…Anorectal manometry assesses sensory and sphincteric function of the anorectum, including basal tone and contractility of the internal and external anal sphincters, as well as rectal sensation. 9 Anorectal manometry can be useful in identifying sphincter weakness or disruption in sensory thresholds that could influence FI symptoms. [9][10][11][12][13] In addition, ARM values are useful in guiding both the type and response to biofeedback, a treatment modality for FI that uses ARM to enhance pelvic floor muscle contraction, sensory-motor coordination, and perception of rectal distention required for continence.…”

Section: Why This Mattersmentioning

confidence: 99%

“…9 Anorectal manometry can be useful in identifying sphincter weakness or disruption in sensory thresholds that could influence FI symptoms. [9][10][11][12][13] In addition, ARM values are useful in guiding both the type and response to biofeedback, a treatment modality for FI that uses ARM to enhance pelvic floor muscle contraction, sensory-motor coordination, and perception of rectal distention required for continence. 14,15 Biofeedback is effective in improving symptom severity and quality of life in women with FI, with up to 75% demonstrating response to treatment and effects often persisting in long-term follow-up.…”

Section: Why This Mattersmentioning

confidence: 99%

“…Diagnostic testing, such as anorectal manometry (ARM), can be useful in elucidating mechanisms that affect continence. Anorectal manometry assesses sensory and sphincteric function of the anorectum, including basal tone and contractility of the internal and external anal sphincters, as well as rectal sensation 9 . Anorectal manometry can be useful in identifying sphincter weakness or disruption in sensory thresholds that could influence FI symptoms 9–13 .…”

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confidence: 99%

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Differences in Anorectal Manometry Values Among Women With Fecal Incontinence in a Racially, Ethnically, and Socioeconomically Diverse Population

Clearwater¹,

Meyer²,

Halani³

2023

UROGC

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ImportanceAnorectal manometry (ARM) is a valuable diagnostic and therapeutic tool that can both aid in identifying mechanisms contributing to fecal incontinence (FI) and inform management strategies. Consensus on standard reference range values has not been established, and women of varying racial and ethnic backgrounds are not well-represented in the current literature.ObjectiveWe aimed to compare ARM values between women of different racial and ethnic groups with FI.Study DesignWe conducted a retrospective cross-sectional study of women with FI who underwent ARM at a tertiary health system in an urban underserved community between 2016 and 2021. Demographic information and ARM values were collected from the medical record. Socioeconomic status (SES) was represented by the percent of the population living below the poverty line according to zip code using U.S. census data. Anorectal manometry values were compared between racial and ethnic groups, and multivariable logistic regression was conducted to control for patient characteristics.ResultsFifty-eight women were included in the analysis: 33% Hispanic, 22% Black, and 45% White. Hispanic and Black women had higher body mass index and higher rates of diabetes and loose stools and were of significantly lower SES compared with White women. Black and Hispanic women had significantly lower thresholds for volume at first sensation and higher mean anal squeeze pressure. Differences were maintained after controlling for body mass index, diabetes, SES, and diarrhea (P = 0.03 and P = 0.01, respectively). Other ARM values were not significantly different between groups.ConclusionsRacial and ethnic differences in ARM values among women with FI exist. Further studies are needed to determine whether these differences have an impact on symptom severity, treatment selection and outcomes, and patient satisfaction.

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Assessing Anorectal Function in Constipation and Fecal Incontinence

Cited by 16 publications

References 108 publications

Characterization of Patients With Obstructed Defecation and Slow Transit Constipation With a Simulated Stool

Characterization of Patients With Obstructed Defecation and Slow Transit Constipation With a Simulated Stool

Safety and efficacy of side-to-end anastomosis versus colonic J-pouch anastomosis in sphincter-preserving resections: an updated meta-analysis of randomized controlled trials

Differences in Anorectal Manometry Values Among Women With Fecal Incontinence in a Racially, Ethnically, and Socioeconomically Diverse Population

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