Contributions of evacuation proctography and anorectal manometry to evaluation of adults with constipation and defecatory difficulty

Abstract

We prospectively evaluated 36 patients who complained of chronic constipation and/or defecatory difficulties to determine the role of anorectal manometry and evacuation proctography in delineating the pathogenesis of these complaints. Twenty patients with constipation also underwent a colonic transit study with radioopaque markers, which identified one group with normal transit (N = 10) and another with slow transit (N = 10). Nine of 36 patients (25%) had inappropriate puborectalis muscle contraction or exhibited weak expulsion efforts during evacuation proctography, and these correlated highly with poor rectal emptying of barium paste (20 +/- 6% vs 61 +/- 5% in patients with normal relaxation; P less than 0.01). However, poor rectal emptying did not correlate with the presence of high-grade intussusceptions, large rectoceles, anorectal angles at rest or with straining, rectal diameter, clinical features, or colonic transit. Moreover, abnormal expulsion patterns as seen with anorectal manometry correlated poorly with the presence of inappropriate puborectalis contraction and decreased rectal emptying by proctography. Although anatomic abnormalities occurred frequently in patients with constipation and/or defecatory difficulties, they were also prevalent in asymptomatic controls. In view of these findings, surgical intervention to correct anatomic abnormalities in patients with constipation and/or defecatory difficulties should be considered only with great caution.

Avaliação do ângulo ano-retal por meio de defecograma em voluntárias assintomáticas nulíparas e multíparas

“…Muitos autores criticam o valor da proctografia na seleção de pacientes a serem submetidos a tratamento cirúrgico (20)(21)(22) . O fato de achados considerados anormais no exame serem encontrados também em pacientes assintomáticos e a falta de consenso nas medidas obtidas no defecograma são as causas mais comumente citadas nessas crí-ticas.…”

Biofeedback Treatment for Functional Anorectal Disorders: A Comprehensive Efficacy Review

“…Because PFD requires clinical tests to confirm diagnosis, the population prevalence is not well known, but PFD is thought to account for 25-50% of chronic constipation cases (Lestar, Penninck, & Kerremans, 1989;Wald, Caruana, Freimanis, Bauman, & Hinds, 1990) and may be present in 50% of childhood constipation. This would indicate that PFD is very common, because constipation problems are prevalent in the general population.…”

Current status of functional gastrointestinal evaluation in clinical practice

“…(11) Defaecography provides valuable information on the anorectum. (63) In this procedure, barium is injected into the rectum, and the patient is asked to expel the volume of barium. Information gained from this modality includes the identification of an enterocoele, rectoanal gradient and pelvic floor descent.…”