Predictive value of balloon expulsion test and symptom diary for selecting constipated patients without pelvic floor dyssynergia

Abstract Purpose A Defecation Disorder (DD) is a difficulty in evacuation documented by physiological exams. However, this physiological evaluation can be cumbersome, inaccessible and costly. Three “low-cost” tools to evaluate DD – a clinical DD score, the balloon expulsion test (BET) and a digital rectal examination (DRE) score were evaluated as separate or combined tests for DD screening. Methods This prospective study occurred between January 2015 and March 2019 in the Gastroenterology Department of a tertiary hospital. Besides the gold standard physiological tests, constipated patients answered the clinical DD score and were evaluated by DRE and BET (standard and variable volume (vv)). Results From 98 constipated patients, 35 (38.9%) were diagnosed with DD according to Rome IV criteria, mainly female (n = 30, 86%) with a median age of 60 years old. The clinical DD score revealed an AUC of 0.417 (SE = 0.07, p = 0.191). The DRE score displayed an AUC of 0.56 (SE = 0.063, p = 0.301). The standard BET displayed a sensitivity of 86%, specificity of 58%, positive predictive value (PPV) of 57% and negative predictive value (NPV) of 86%. The sequential vvBET followed by standard BET improved the BET performance regarding the evaluation of DD, with a sensitivity of 86%, specificity of 67%, PPV of 63% and NPV of 87%. The sequential BET had an OR 8.942, p > 0.001, CI 3.18–25.14, revealing to be the most significant predictor for DD screening. Conclusion The sequential BET is a low cost, well-performing DD screening tool, appropriate to the Primary Care Setting.

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Pelvic floor dyssynergia (PFD): subgroups defined by different methods of balloon expulsion and defecation index

The American Journal of Gastroenterology ◽

10.1016/s0002-9270(02)05341-8 ◽

2002 ◽

Vol 97 (9) ◽

pp. S282

Author(s):

M SHAPIRO

Keyword(s):

Pelvic Floor ◽

Pelvic Floor Dyssynergia ◽

Balloon Expulsion

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Does sequential balloon expulsion test improve the screening of defecation disorders?

BMC Gastroenterology ◽

10.1186/s12876-020-01490-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

A. C. Caetano ◽

D. Costa ◽

R. Gonçalves ◽

J. Correia-Pinto ◽

C. Rolanda

Keyword(s):

Predictive Value ◽

Low Cost ◽

Digital Rectal Examination ◽

Tertiary Hospital ◽

Balloon Expulsion ◽

Defecation Disorders ◽

Physiological Evaluation ◽

Balloon Expulsion Test ◽

Physiological Tests ◽

Defecation Disorder

Abstract Background A defecation disorder (DD) is a difficulty in evacuation documented by physiological exams. However, this physiological evaluation can be cumbersome, inaccessible and costly. Three “low-cost” tools to evaluate DD—a clinical DD score, the balloon expulsion test (BET) and a digital rectal examination (DRE) score were evaluated as separate or combined tests for DD screening. Methods This prospective study occurred between January 2015 and March 2019 in the Gastroenterology Department of a tertiary hospital. Besides the gold standard physiological tests, constipated patients answered the clinical DD score and were evaluated by DRE and BET [standard and variable volume (VV)]. Results From 98 constipated patients, 35 (38.9%) were diagnosed with DD according to Rome IV criteria, mainly female (n = 30, 86%) with a median age of 60 years old. The clinical DD score revealed an AUC of 0.417 (SE = 0.07, p = 0.191). The DRE score displayed an AUC of 0.56 (SE = 0.063, p = 0.301). The standard BET displayed a sensitivity of 86%, specificity of 58%, positive predictive value (PPV) of 57% and negative predictive value (NPV) of 86%. The sequential VVBET followed by standard BET improved the BET performance regarding the evaluation of DD, with a sensitivity of 86%, specificity of 67%, PPV of 63% and NPV of 87%. The sequential BET had an OR 8.942, p > 0.001, CI 3.18–25.14, revealing to be the most significant predictor for DD screening. Conclusion The sequential BET is a low cost, well-performing DD screening tool, appropriate to the Primary Care Setting.

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Faculty Opinions recommendation of Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1047039.501258 ◽

2006 ◽

Author(s):

Filippo La Torre

Keyword(s):

Pelvic Floor ◽

Pelvic Floor Dyssynergia ◽

Transit Constipation

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Benefit of Pelvic Floor Physical Therapy in Pediatric Patients with Dyssynergic Defecation Constipation

Digestive Diseases ◽

10.1159/000500121 ◽

2019 ◽

Vol 37 (6) ◽

pp. 478-485 ◽

Cited By ~ 1

Author(s):

Claire Zar-Kessler ◽

Braden Kuo ◽

Elizabeth Cole ◽

Anna Benedix ◽

Jaime Belkind-Gerson

Keyword(s):

Physical Therapy ◽

Pelvic Floor ◽

Chronic Constipation ◽

Muscle Tone ◽

Colonic Surgery ◽

Tertiary Referral Center ◽

Dyssynergic Defecation ◽

Pelvic Floor Physical Therapy ◽

Novel Treatment ◽

Balloon Expulsion

Objectives: Chronic constipation is a common childhood problem and often caused or worsened by abnormal dynamics of defecation. The aim of this study was to assess the benefit of pelvic floor physical therapy (PFPT), a novel treatment in pediatrics for the treatment of chronic constipation with dyssynergic defecation. Methods: This was a retrospective study of 69 children seen at a pediatric neurogastroenterology program of a large tertiary referral center for chronic constipation and dyssynergic defecation, determined by anorectal manometry and balloon expulsion testing. We compared the clinical outcome of patients who underwent PFPT (n = 49) to control patients (n = 20) whom received only medical treatment (laxatives/stool softeners). Additionally, characteristics of the treatment group were analyzed in relation to therapeutic response. Results: Thirty-seven (76%) of the patients who received physical therapy had improvement in constipation symptoms, compared to 5 (25%) of the patients on conservative treatment (p < 0.01). Additionally, patients who received pelvic physical therapy had fewer hospitalizations for cleanouts (4 vs. 25%, p = 0.01) and colonic surgery than those that were treated with medical therapy exclusively (0 vs. 10%, p = 0.03). Among the patients who received physical therapy, those that suffered from anxiety and/or low muscle tone had a higher response rate (100%). There were no adverse effects from the intervention. Conclusion: The new field of pediatric PFPT is a safe and effective intervention for children with dyssynergic defecation causing or contributing to chronic constipation, particularly in children whose comorbidities include anxiety and low muscle tone.

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