scholarly journals Paradoxical sphincter contraction is rarely indicative of anismus

Gut ◽  
1997 ◽  
Vol 41 (2) ◽  
pp. 258-262 ◽  
Author(s):  
W A Voderholzer ◽  
D A Neuhaus ◽  
A G Klauser ◽  
K Tzavella ◽  
S A Müller-Lissner ◽  
...  
Keyword(s):  
Chronic Constipation ◽  
Anorectal Manometry ◽  
Digital Rectal Examination ◽  
Common Finding ◽  
Puborectalis Muscle ◽  
Sphincter Pressure ◽  
Healthy Controls ◽  
Rectal Examination ◽  
Stool Incontinence ◽  
Paradoxical Sphincter

Background—Anismus is thought to be a cause of chronic constipation by producing outlet obstruction. The underlying mechanism is paradoxical contraction of the anal sphincter or puborectalis muscle. However, paradoxical sphincter contraction (PSC) also occurs in healthy controls, so anismus may be diagnosed too often because it may be based on a non-specific finding related to untoward conditions during the anorectal examination.Aims—To investigate the pathophysiological importance of PSC found at anorectal manometry in constipated patients and in patients with stool incontinence.Methods—Digital rectal examination and anorectal manometry were performed in 102 chronically constipated patients, 102 patients with stool incontinence, and in 18 controls without anorectal disease. In 120 of the 222 subjects defaecography was also performed. Paradoxical sphincter contraction was defined as a sustained increase in sphincter pressure during straining. Anismus was assumed when PSC was present on anorectal manometry and digital rectal examination and the anorectal angle did not widen on defaecography.Results—Manometric PSC occurred about twice as often in constipated patients as in incontinent patients (41.2% versus 25.5%, p<0.017) and its prevalence was similar in incontinent patients and controls (25.5% versus 22.2%). Oroanal or rectosigmoid transit times in constipated patients with and without PSC did not differ significantly (total 64.6 (8.9) hours versus 54.2 (8.1) hours; rectosigmoid 14.9 (2.4) hours versus 13.8 (2.5) hours).Conclusions—Paradoxical sphincter contraction is a common finding in healthy controls as well as in patients with chronic constipation and stool incontinence. Hence, PSC is primarily a laboratory artefact and true anismus is rare.

scholarly journals IS THE PHYSICIAN EXPERTISE IN DIGITAL RECTAL EXAMINATION OF VALUE IN DETECTING ANAL TONE IN COMPARISON TO ANORECTAL MANOMETRY?

2019 ◽  
Vol 56 (1) ◽  
pp. 79-83 ◽  
Author(s):  
Rodrigo Ambar PINTO ◽  
Isaac José Felippe CORRÊA NETO ◽  
Sérgio Carlos NAHAS ◽  
Ilario FROEHNER JUNIOR ◽  
Diego Fernandes Maia SOARES ◽  
...  
Keyword(s):  
Anal Sphincter ◽  
Anorectal Manometry ◽  
Descriptive Analysis ◽  
Digital Rectal Examination ◽  
Sphincter Pressure ◽  
Functional Evaluation ◽  
Study Objective ◽  
Rectal Examination ◽  
Colorectal Surgeon ◽  
Colorectal Surgeons

ABSTRACT BACKGROUND: Digital rectal examination (DRE) is part of the physical examination, is also essential for the colorectal surgeon evaluation. A good DRE offers precious information related to the patient’s complaints, which will help in decision making. It is simple, quick and minimally invasive. In many centers around the world, the DRE is still the only method to evaluate the anal sphincter prior to patient’s management. On the other hand, anorectal manometry (ARM) is the main method for objective functional evaluation of anal sphincter pressures. The discrepancy of DRE depending on the examiner to determine sphincter tonus in comparison to ARM motivated this study. OBJECTIVE: To compare the DRE performed by proficient and non-experienced examiners to sphincter pressure parameters obtained at ARM, depending on examiners expertise. METHODS: Thirty-six consecutive patients with complaints of fecal incontinence or chronic constipation, from the anorectal physiology clinic of the University of São Paulo School of Medicine, were prospectively included. Each patient underwent ARM and DRE performed by two senior colorectal surgeons and one junior colorectal surgeon prior to the ARM. Patient’s history was blinded for the examiner’s knowledge, also the impressions of each examiner were blinded from the others. For the DRE rest and squeeze pressures were classified by an objective scale (DRE scoring system) that was compared to the parameters of the ARM for the analysis. The results obtained at the ARM were compared to the DRE performed by the seniors and the junior colorectal surgeons. STATISTICAL ANALYSIS: Descriptive analysis was performed for all parameters. For the rest and squeeze pressures the Gamma index was used for the comparison between the DRE and ARM, which varied from 0 to 1. The closer to 1 the better was the agreement. RESULTS: The mean age was 48 years old and 55.5% of patients were female. The agreement of rest anal pressures between the ARM and the DRE performed by the senior proficient examiners was 0.7 (CI 95%; 0.32-1.0), while for the junior non-experienced examiner was 0.52 (CI 95%; 0.09-0.96). The agreement of squeeze pressures was 0.96 (CI 95%; 0.87-1.0) for the seniors and 0.52 (CI 95%; 0.16-0.89) for the junior examiner. CONCLUSION: More experienced colorectal surgeons used to DRE had a more significant agreement with the ARM, thereafter would have more appropriate therapeutic management to patients with sphincter functional problems. ARM, therefore, persists as an important exam to objectively evaluate the sphincter complex, justifying its utility in the clinical practice.

scholarly journals Comparison of Anorectal Function Measured using Wearable Digital Manometry and a High Resolution Manometry System

2020 ◽  
Author(s):  
Ali Attari ◽  
William D. Chey ◽  
Jason R. Baker ◽  
James A. Ashton-Miller
Keyword(s):  
High Resolution ◽  
Fecal Incontinence ◽  
Anal Sphincter ◽  
Chronic Constipation ◽  
Anorectal Function ◽  
Puborectalis Muscle ◽  
Myoelectric Activity ◽  
Sphincter Pressure ◽  
High Resolution Manometry ◽  
Anal Sphincter Pressure

AbstractThere is a need for a lower cost manometry system for assessing anorectal function in primary and secondary care settings. We developed an index finger-based system (termed “digital manometry”) and tested it in healthy volunteers, patients with chronic constipation, and fecal incontinence. Anorectal pressures were measured in 16 participants with the digital manometry system and a 23-channel high-resolution anorectal manometry system. The results were compared using a Bland-Altman analysis at rest as well as during maximum squeeze and simulated defecation maneuvers. Myoelectric activity of the puborectalis muscle was also quantified simultaneously using the digital manometry system. The limits of agreement between the two methods were −7.1 ± 25.7 mmHg for anal sphincter resting pressure, 0.4 ± 23.0 mmHg for the anal sphincter pressure change during simulated defecation, −37.6 ± 50.9 mmHg for rectal pressure changes during simulated defecation, and −20.6 ± 172.6 mmHg for anal sphincter pressure during the maximum squeeze maneuver. The change in the puborectalis myoelectric activity was proportional to the anal sphincter pressure increment during a maximum squeeze maneuver (slope = 0.6, R2 = 0.4). Digital manometry provided a similar evaluation of anorectal pressures and puborectalis myoelectric activity at an order of magnitude less cost than high-resolution manometry, and with a similar level of patient comfort. Digital Manometry provides a simple, inexpensive, point of service means of assessing anorectal function in patients with chronic constipation and fecal incontinence.

scholarly journals Currarino syndrome or Hirschsprung disease: how to prevent diagnostic dilemma in chronic constipation

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Md Mokarram Ali ◽  
Ram Jeewan Singh ◽  
Rashi Rashi ◽  
Amit Kumar ◽  
Amit Kumar Sinha ◽  
...  
Keyword(s):  
Chronic Constipation ◽  
Digital Rectal Examination ◽  
Hirschsprung Disease ◽  
Age Group ◽  
Pediatric Age ◽  
Diagnostic Dilemma ◽  
Common Cause ◽  
Currarino Syndrome ◽  
Rectal Examination ◽  
Pediatric Age Group

Abstract Background Currarino syndrome is a rare congenital malformation having autosomal dominant inheritance. It comprises of anorectal malformation, presacral mass, and sacral vertebral defect occurring in variable proportion. The most common presentation is chronic constipation which is usually due to compression of rectum by anterior sacral mass. If clinical examination is not properly done and digital rectal examination is excluded from the examination, it can be misdiagnosed as other common cause of constipation like Hirschsprung disease. Case presentation We are reporting one such case of one-and-half-year-old female child with chronic constipation which was initially managed as Hirschsprung disease, but later on, after a repeat clinical examination with digital rectal examination, it was evaluated on the line of Currarino syndrome. The diagnosis was confirmed by contrast-enhanced computed tomography of abdomen with 3 dimensional reconstruction. It was then managed by posterior sagittal approach with excision of mass and anorectoplasty. Conclusion A proper protocol for clinical evaluation of patient with constipation prevents diagnostic dilemma between surgical causes of constipation in pediatric age group. Digital rectal examination must be included in the protocol for evaluation of chronic constipation. In pediatric age group, clinical workup should be done with keeping in mind the rare diagnosis of Currarino syndrome along with common cause of constipation like Hirschsprung disease.

scholarly journals Frequency of Digital Rectal Examination in Children With Chronic Constipation

1999 ◽  
Vol 153 (4) ◽  
Author(s):  
David M. Gold ◽  
Jeremiah Levine ◽  
Toba A. Weinstein ◽  
Bradley H. Kessler ◽  
Michael J. Pettei
Keyword(s):  
Chronic Constipation ◽  
Digital Rectal Examination ◽  
Rectal Examination

scholarly journals Measurement of Rectal Diameter and Anterior Wall Thickness by Ultrasonography in Children With Chronic Constipation

2021 ◽  
Author(s):  
Güzide Doğan ◽  
Merter KEÇELİ ◽  
Sibel Yavuz ◽  
Adem Topçu ◽  
Erhun Kasırga
Keyword(s):  
Wall Thickness ◽  
Chronic Constipation ◽  
Digital Rectal Examination ◽  
Functional Constipation ◽  
Thickness Measurement ◽  
Anterior Wall ◽  
Symphysis Pubis ◽  
Radiology Department ◽  
Control Group ◽  
Rectal Examination

Abstract Introduction: Measurement of rectal diameter by ultrasonograpy helps the clinician in the diagnosis of chronic constipation in children for whom rectal examination cannot be performed. The aim of the study is to determine the rectal diameter and anterior wall thickness values with constipated and healthy subjects, and to evaluate the usability of ultrasonography in the diagnosis of functional constipation in children for whom refuse digital rectal examination Materials and Methods: The constipated group included 140 children, while the control group included 164 children. All patients were divided into four subgroups according to their ages and were referred to the radiology department for rectal measurements. Results: At the symphysis pubis plane the rectal diameter measurement of the constipated patients with fecal retention positive group was statistically greater than the control group. At the ischial spine plane, rectum diameter of constipated children with fecal retention positive or negative was found to be statistically greater than the control group. At the bladder neck plane rectum diameter of constipated patients with fecal retention positive was statistically greater than the control group. Rectum anterior wall thickness measurement was found to be higher in constipated patients with fecal retention positive compared to the control (p = 0.000). It’s measurements of constipated patients in group II, group III, and group IV with empty rectum were found to be statistically higher than the control group. Conclusion: Measurement of rectal diameter and anterior wall thickness by ultrasonograpy as a noninvasive method in children who do not want the digital rectal examination and may be useful in the diagnosis of constipation.

Diagnosis of Megacolon: The Rectal Examination

PEDIATRICS ◽  
1966 ◽  
Vol 37 (3) ◽  
pp. 535-536
Author(s):  
JOHN G. LOEFFLER
Keyword(s):  
Newborn Infant ◽  
Barium Enema ◽  
Chronic Constipation ◽  
Digital Rectal Examination ◽  
Rectal Biopsy ◽  
Functional Constipation ◽  
Diagnostic Dilemma ◽  
Rectal Examination ◽  
Older Child

The following comments pertain to an article in Pediatrics, 36:572, 1965. In their article, "Aganglionic and Functional Megacolon in Children—a Diagnostic Dilemma," Drs. Kottmeier and Clatworthy have done a commendable job in pointing out the pitfalls of diagnosing aganglionic megacolon in the newborn infant. I am afraid, however, that the authors have given the impression that reliance should be made on barium enema and rectal biopsy when distinguishing between aganglionic megacolon and functional constipation in the older child who presents with chronic constipation. In the article no mention was made about the value of a simple digital rectal examination.

scholarly journals Image of the Month: Decision-Making in Surgery for Late Onset Hirschsprung Disease

2020 ◽  
Vol 08 (01) ◽  
pp. e99-e101
Author(s):  
Anisha Apte ◽  
Elise McKenna ◽  
Marc A. Levitt
Keyword(s):  
Decision Making ◽  
Chronic Constipation ◽  
Anorectal Manometry ◽  
Late Onset ◽  
Hirschsprung Disease ◽  
Rectal Biopsy ◽  
Poor Growth

AbstractWe present a case of a 14-year-old boy with chronic distension, poor growth, and chronic constipation. He undergoes anorectal manometry and rectal biopsy, confirming the diagnosis of Hirschsprung disease (HD). The case is presented with a key image and associated questions to prompt discussion on strategies for management and treatment of HD in late-diagnosed children.

Sign in / Sign up

Export Citation Format

Share Document