Dyssynergic patterns of defecation in constipated adolescents and young adults with anorectal malformations

AbstractWe aimed to evaluate the etiologies of constipation in patients with anorectal malformations having a good prognosis for bowel control but a high risk of constipation. We included twenty-five patients from the Odense university hospital in Denmark. Patients were subjected to colon transit time examination and high resolution anorectal manometry (HRAM). The median age was 18 (14–24) and 48% (12/25) were females. Fifty-two % (13/25) of patients were diagnosed with constipation. Types of anorectal malformation were perineal fistula (9/25), rectovestibular fistula (8/25), rectourethral bulbar fistula (5/25) and no fistula (3/25). No difference in neither total colon transit time nor segmental colon transit times were found based on the presence of constipation. Only four of the constipated patients fulfilled criteria for dyssynergic defecation with a dyssynergic pattern at HRAM and prolonged colon transit time. A Type I dyssynergic pattern was dominant in constipated patients (7/13). A Dyssynergic defecation pattern was due to isolated contraction of puborectalis muscle in 9 out of 13constipated patients. We found a dyssynergic 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 HRAM.

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Isolated puborectalis muscle contraction is a common cause of dyssynergic defecation in constipated adolescents and adults with anorectal malformations

10.21203/rs.2.17149/v1 ◽

2019 ◽

Author(s):

Thomas Bjørsum-Meyer ◽

Peter Christensen ◽

Gunnar Baatrup ◽

Marianne Skytte Jakobsen ◽

Jon Asmussen ◽

...

Keyword(s):

High Resolution ◽

Transit Time ◽

Anorectal Manometry ◽

Anorectal Malformations ◽

University Hospital ◽

Puborectalis Muscle ◽

Type I ◽

Dyssynergic Defecation ◽

Colon Transit Time ◽

Colon Transit

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).

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