Anorectal manometry in disorders of defecation: a retrospective study
DOI:
https://doi.org/10.18203/2320-6012.ijrms20254373Keywords:
Chronic constipation, Dyssynergic defecation, High resolution anal manometry, Rome IV criteriaAbstract
Background: Prevalence of Chronic Constipation (CC) in India is around 12-30%. Diagnosis of Fecal Evacuation Disorder (FED) requires specialized investigations like Anorectal Manometry (ARM), Balloon Expulsion Test (BET), MR defecography. High resolution ARM is considered first line diagnostic tool for chronic constipation as it measures pressure exerted by the muscles of anus and rectum. This study aimed to evaluate the characteristics of anorectal pressure in a cohort of Indian patients with CC and fecal incontinence and types of FED in patients with CC and age distribution (in young and elderly).
Methods: The present retrospective study was conducted from January 2022 to May 2024 at department of gastroenterology, Yashoda hospitals, Secunderabad, India. A total of 266 patients who presented with CC or Fecal incontinence were included in the study. Sigmoidoscopy or full-length colonoscopy, BET and ARM were done in all the patients. Mean resting and squeeze pressure and other parameters were measured by ARM. Data was compiled and observations tabulated.
Results: Among 266 patients, 136 were young with mean age 21.93±10.54 years and 130 with mean age 60.43±11.87. Gender distribution was 59% men and 41% women. Mean resting anal pressure was 57.06±23.11 mg, mean squeeze pressure was 98.36±35.96 mmHg. In present study, type I dyssynergic defecation was most common with 76 (29%) patients followed by type II 46 (17%).
Conclusions: The present study showed that 65% with constipation subjected for ARM had dysynergic defecation (DD) and type I DD was most common followed by type II. Similar trend was observed in both young and elderly patients.
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References
Ghoshal UC. Chronic constipation in Rome IV era: the Indian perspective. Ind J Gastroenterol. 2017;36(3):163-73. DOI: https://doi.org/10.1007/s12664-017-0757-1
Bharucha AE, Wald A, Enck P, Rao S. Functional anorectal disorders. Gastroenterol. 2006;130(5):1510-18. DOI: https://doi.org/10.1053/j.gastro.2005.11.064
Pare P, Ferrazzi S, Thompson WG, Irvine EJ, Rance L. An epidemiological survey of constipation in Canada: Definitions, rates, demographics, and predictors of health care seeking. Am J Gastroenterol. 2001;96(11):3130-37. DOI: https://doi.org/10.1111/j.1572-0241.2001.05259.x
Peppas G, Alexiou VG, Mourtzoukou E, Falagas ME. Epidemiology of constipation in Europe and Oceania: A systematic review. BMC Gastroenterol. 2008;8(1):05. DOI: https://doi.org/10.1186/1471-230X-8-5
Talley NJ, O’Keefe EA, Zinsmeister AR, Melton LJ 3rd. Prevalence of gastrointestinal symptoms in the elderly: A population-based study. Gastroenterol. 1992;1020(3):895-01. DOI: https://doi.org/10.1016/0016-5085(92)90175-X
Sonnenberg A, Koch TR. Epidemiology of constipation in the United States. Dis Colon Rectum. 1989;32(1):01-08. DOI: https://doi.org/10.1007/BF02554713
Suzanne M Mugie, Marc A Benninga, Carlo Di Lorenzo. Epidemiology of constipation in children and adults: A systematic review. Best Pract Res Clin Gastroenterol. 2011;25(1):03-18. DOI: https://doi.org/10.1016/j.bpg.2010.12.010
Makharia GK, Verma AK, Amarchand R, Goswami A, Singh P, Agnihotri A. Prevalence of irritable bowel syndrome: A community based study from northern India. J Neurogastroenterol Motil. 2011;17(1):82-7. DOI: https://doi.org/10.5056/jnm.2011.17.1.82
Rajput M, Saini SK. Prevalence of constipation among the general population: A community-based survey from India. Gastroenterol Nurs. 2014;37(6):425-29. DOI: https://doi.org/10.1097/SGA.0000000000000074
Baijal R, Jain M. Analysis of indications and results of anorectal manometry in two tertiary hospitals in India. Arch Clin Gastroenterol. 2017;3(1):09-10.
Ghoshal UC, Verma A, Mishra A. Frequency, spectrum, and factors associated with faecal evacuation disorders among patients with chronic constipation referred to a tertiary care centre in northern India. Ind J Gastroenterol. 2016;35(2):83-90. DOI: https://doi.org/10.1007/s12664-016-0631-6
Rao SS, Patel RS. How useful are manometric tests of anorectal function in the management of defecation disorders. Am J Gastroenterol. 1997;92(3):469-75.
Pezim ME, Pemberton JH, Levin KE, Litchy WJ, Phillips SF. Parameters of anorectal and colonic motility in health and in severe constipation. Dis Colon Rectum. 1993;36(5):484-91. DOI: https://doi.org/10.1007/BF02050015
Lee BE, Kim GH. How to perform and interpret balloon expulsion test. J Neurogastroenterol Motil. 2014;20(3):407-09. DOI: https://doi.org/10.5056/jnm14068
Imran Aziz, William WE, Palsson OS, Törnblom H, Simrén M. An approach to the diagnosis and management of Rome IV functional disorders of chronic constipation. Expert Rev Gastroenterol Hepatol. 2020;14(1):39-46. DOI: https://doi.org/10.1080/17474124.2020.1708718
Rao SS, Mudipalli RS, Stessman M, Zimmerman B. Investigation of the utility of colorectal function tests and Rome II criteria in dyssynergic defecation (anismus). Neurogastroenterol Motil. 2004;16(5):589-96. DOI: https://doi.org/10.1111/j.1365-2982.2004.00526.x
Rao SS, Welcher KD, Leistikow JS. Obstructive defecation: A failure of rectoanal coordination. Am J Gastroenterol. 1998;93(7):1042-50. DOI: https://doi.org/10.1111/j.1572-0241.1998.00326.x
Szojda MM, Tanis E, Mulder CJ, Felt-Bersma RJ. Referral for anorectal function evaluation is indicated in 65% and beneficial in 92% of patients. World J Gastroenterol. 2008;14(2):272-77. DOI: https://doi.org/10.3748/wjg.14.272
Schmulson MJ, Drossman DA. What is new in Rome IV. J Neurogastroenterol Motil. 2017;23(2):151-63. DOI: https://doi.org/10.5056/jnm16214
Surrenti E, Rath DM, Pemberton JH, Camilleri M. Audit of constipation in a tertiary referral gastroenterology practice. Am Gastroenterol. 1995;90(9):1471-75.
Chitkara DK, Bredenoord AJ, Cremonini F, Delgado-Aros S, Smoot RL, El-Youssef M, et al. The role of pelvic floor dysfunction and slow colonic transit in adolescents with refractory constipation. Am J Gastroenterol. 2004;99(8):1579-84. DOI: https://doi.org/10.1111/j.1572-0241.2004.30176.x
Gonlachanvit S, Patcharatrakul T. Causes of idiopathic constipation in Thai patients: Associations between the causes and constipation symptoms as defined in the Rome II criteria. J Med Assoc Thai. 2004;87(Suppl 2):S22-28.
Li Y, Yang X, Xu C, Zhang Y, Zhang X. Normal values and pressure morphology for three-dimensional high-resolution anorectal manometry of asymptomatic adults: a study in 110 subjects. Int J Colorect Dis. 2013;28(8):1161-8. DOI: https://doi.org/10.1007/s00384-013-1706-9
Zhao Y, Ren X, Qiao W, Dong L, He S, Yin Y. High-resolution anorectal manometry in the diagnosis of functional defecation disorder in patients with functional constipation: A retrospective cohort study. J Neurogastroenterol Motil. 2019;25(2):250-57. DOI: https://doi.org/10.5056/jnm18032
Sharma A, Misra A, Ghoshal UC. Fecal evacuation disorder among patients with solitary rectal ulcer syndrome: A case-control study. Neurogastroenterol Motil. 2014;20(4):531-38. DOI: https://doi.org/10.5056/jnm.20.531.
Kepenekci I, Keskinkilic B, Akinsu F. Prevalence of pelvic floor disorders in the female population and the impact of age, mode of delivery, and parity. Dis Colon Rectum. 2011;54(1):85-94 DOI: https://doi.org/10.1007/DCR.0b013e3181fd2356
Ratuapli S, Bharucha AE, Harvey D, Zinsmeister AR. Comparison of rectal balloon expulsion test in seated and left lateral positions. Neurogastroenterol Motil. 2013;25(12):e813-20. DOI: https://doi.org/10.1111/nmo.12208
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