Streamlining the management of defecation disorders

Abstract

Obstinate constipation is a frequent but elusive gastrointestinal symptom. Increased understanding of defecation physiology and recent availability of simple, ready-to-use tools have increased specificity of both diagnosis and treatment. This patient series includes over 700 severely constipated patients with over 70 percent overall therapeutic success. Cinedefecography, pelvic floor electromyography, and determination of rectoanal inhibitory reflex were performed with simple and readily available equipment to document outlet anatomy and dynamics. Colonic transit time was examined in patients whose defecography and electromyography results were nondiagnostic and/or whose response to medical management was suboptimal, using a commercially available marker capsule, followed by abdominal x-rays. Retention of markers throughout the colon suggested colonic hypomotility or "inertia"; rectosigmoid retention confirmed functional outlet obstruction. With careful history, physical examination, and exclusion of organic causes, orderly application of readily available techniques can afford rapid, objective, and anatomically specific evidence upon which treatment of disordered defecation may be based.

Is constipation a disorder of defecation or impaired motility?: distinction based on defecography and colonic transit studies.

“…Colonic transit studies and evacuation proctography (defecography) are the best available imaging methods for achieving this goal [1][2][3][4][5][6]. Various techniques have been used to measure colonic motility.…”

Korrelation von Symptomen und objektiven Befunden bei Patienten mit Beckenbodendysfunktionen

“…Das Syndrom eines irritablen Reizdarms kann durch obstipations-oder diarrhöähnliche Beschwerden mit krampfartigen Unterbauchschmerzen, Flatulenz und Stuhlunregelmäßigkeiten bei normaler Darmtransitzeit charakterisiert sein. Ätiologisch wird eine unkoordiniert ablaufende Darmperistaltik diskutiert [2].…”

“…Neben anatomischen Veränderungen müssen differentialdiagnostisch auch medikamentöse, degenerative, metabolische, endokrinologische, neurologische und psychiatrische Ursachen einer Darmentleerungsstörung ausgeschlossen werden [2], bevor die (davon in 31% kardiovaskuläre, in 28% metabolische, in 11% pulmonale, in 8% hepatorenale, in 3% psychiatrische und in 19% sonstige Erkrankungen).…”

Treatment of Encopresis by Parent-Mediated Biofeedback in a Child With Corrected Imperforate Anus

“…This equipment serves the principal purpose of assessing anorectal sensory and motor function but, when dynamic pressure changes are fed back to the patient, for instance as a graphic display, the machine can help in training the perineal system (Hauri, 1975). Both faecal expulsion (encopresis) and retention (constipation) have been successfully modified by manometric biofeedback (Wald, Chandra, Gabel, & Chiponis, 1987;Weber, Ducrotte, Touchais, Roussignol, & Denis, 1987), the method being most suitable for primary or idiopathic disorders in which voluntary defaecation has never been achieved (Berman, Manning, & Harris, 1990;Loening-Baucke, 1990). These conditions are typified by an absence of underlying organic pathology.…”