Scientific solution to a complex problem: physiology and multidisciplinary team improve understanding and outcome in chronic constipation and faecal incontinence

Athanasakos, Eleni; Dalton, Sally; McDowell, Susan A.; Shea, Tara; Blakeley, Kate; Rawat, David; Cleeve, Stewart

doi:10.1007/s00383-019-04605-y

Cited by 8 publications

(30 citation statements)

References 59 publications

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“…Thirty-six sphincter dysfunction (32%) was found: 26 low RP, 2 high RP, and 9 patients with RAIR absent. The sensation was analyzed only in awake kids: 22% hyposensitive rectum (20/91) and 21% hypersensitive rectum (19/91) [2].…”

Section: Discussion Of the Arm Resultsmentioning

confidence: 99%

“…On children, the physiopathology of CC with or without FI is multifactorial and complex with a limited scientific background. Understanding the involved pathophysiological and psychological mechanisms remains a challenging problem [2]. Gowers (1887) was the first to explain anorectal physiology [8].…”

Section: Discussionmentioning

confidence: 99%

“…To perform ARM, we use many maneuvers following steps in a sequence which were described by the British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) motility group, between each maneuver, there are 30 s of recovery (Figure 2) [1], [2].…”

Section: How To Perform the Armmentioning

confidence: 99%

“…The child and parent can also interact and at the same time witness the type of defecatory problem. The involvement of parent and child may also have a positive impact on the outcome [2]. While ARM on awake has been commonly used on children with suspected Hirschsprung's disease [13], [21], the use of novel HRAM in this indication is still limited [1].…”

Section: Assessment Of Rectal Sensationmentioning

confidence: 99%

“…One of the solutions to improve the treatment of defecation disorders on children is to use scientific evidence with a multidisciplinary team. For this purpose, The Children's Anorectal Physiology Service (CAPS) was proposed in September 2016; many tests included: HRAM, complimentary tests (endoanal ultrasound and transit marker studies), psychological, and bowel assessments [2]. They concluded that scientific investigations combined with multidisciplinary team can reduce patient self-report illness severity and improve patient satisfaction.…”

Section: Treatment Of Defecation Disordersmentioning

confidence: 99%

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Anorectal Manometry on Children: A Moroccan Series and Literature Review

Delsa

Serraj

Khalis

et al. 2021

Open Access Maced J Med Sci

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Introduction and objectives: Anorectal manometry is a test that evaluates the function of the rectum,but also the anus. It is useful for the diagnosis of several conditions like fecal incontinence and constipation.In children these tests are being increasingly used for all ages.The aim of this study was to determine the benefit of anorectal manometry in children and to report our experience. Material and Methods:Over a period of four years, 273children that underwent anorectal manometry were included in the study,their data and tests results were analyzed. Results:Out of 273 patients included,68,5% were boys and 31,5% were girls.The mean age was 9 years.154patients(51,6%) had Fecal incontinence(Group1),75children(27,5%) had chronic constipation(Group2),and both of them(Group3) were reported in 37children(13,6%).An awake manometry was performed in 248children(91%) however this test under sedation allowed us the exclusion of Hirschsprung’s disease in 21children(84%).In group1, 25%patients had bad anal contraction.In groupe3, 21,6%children had bad anal contraction.The statistical analysis showed a significant difference in age(p=0.022) and resting pressure(p=0.050) between the three groups.Children with fecal incontinence had a higher rate of dyssynergy,80.2% and 83.8% in groups 1 and 3 respectively compared to 60.4% in patients with chronic constipation(p=0,852) Conclusion:The gold standard for the exploration of children’s terminal constipation and encopresis is the anorectal manometry.It is an important tool to establish diagnosis.In our study, this test allow the exclusion of Hirschsprung’s disease in infants with constipation, in other hand we found a higher rate of dyssynergy in children with fecal incontinence(80%) which had allow us to propose a biofeedback therapy.

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Section: Discussion Of the Arm Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%