Abstract
Background We aimed to evaluate the etiologies of constipation in adolescents and adult patients with anorectal malformations with colon transit time and high resolution anorectal manometry Methods We included twenty-five patients from the Odense university hospital in Denmark. Written and verbal informed consent was obtained. Patients were subjected to colon transit time examination and high resolution anorectal manometry. Presence of constipation was diagnosed based on the Rome IV criteria. Questionnaires regarding functional bowel outcome and severity of constipation were filled in. Results The median age was 18(14-24) and 48% (12/25) were females. Fifty-two % (13/25) of patients were diagnosed with constipation. Most frequent type of anorectal malformation was anocutaneous fistula (9/25), vestibular fistula (8/25) and urethral bulbar fistula (4/25). No difference in neither total colon transit time nor segmental colon transit times were found based on the presence of constipation. Constipated patients and patients without constipation were equal on manometric parameters. Only four of the constipated patients fulfilled criteria for dyssynergic defecation with dyssynergic defecation pattern and prolonged colon transit time. A Type I dyssynergic pattern was dominant in constipated patients as it was detected in 54% (7/13). Dyssynergic defecation pattern was due to isolated contraction of puborectalis muscle in 69% (9/13) of constipated patients. Conclusions We found a dyssynergic defecation pattern during attempted defecation in patients with anorectal malformations disregarded the presence of constipation. In the majority of constipated patients an isolated contraction of the puborectalis muscle was visualized with high resolution anorectal manometry. Trial registration: Clinical.Trials.gov. (NCT02624232).
Colon transit time and anorectal manometry in children and young adults with spina bifida
