Clinical Value of Positive BET and Pelvic Floor Dyssynergia in Chinese Patients with Functional Defecation Disorder

Background Functional defecation disorder (FDD) is a common subtype of functional constipation (FC). Balloon expulsion test (BET) and high resolution anorectal manometry (HR-ARM) are significant tools but their results are not always consistent. Aims To investigate the characteristics of patients with positive BET and pelvic floor dyssynergia (PFD) and explore the value of both positive results in FDD diagnosis. Methods We retrospectively diagnose FC subtypes and enrolled FDD patients based on Rome-IV criteria. They underwent HR-ARM, BET and CTT tests. Then they were classified to 2 groups and further stratified by FDD subtypes. Validated questionnaires were applied to investigate patients’ constipation, anxiety/depression and quality of life. Results 335 FDD patients were finally enrolled. They were classified into 2 groups according to whether BET and PFD were both positive (consistent or not). 84.48% showed consistent results. These patients had significantly higher anal residual pressure, lower anal relaxation rate, MDI and a more negative RAPG (Ps < 0.05). The specific distribution of FDD phenotypes in two groups showed significant difference (P = 0.021). Males suffered a more negative RAPG (P < 0.001) and age was correlated with anal relaxation rate (P < 0.001). 177 individuals among them were investigated with validated questionnaires. Scores for Defecation Symptoms, Physical Discomfort and GAD-7 score were significantly high in Consistent Group (Ps < 0.05). GAD-7 score was associated with Defecation Symptoms (P < 0.001) while anal residual pressure, GAD-7 and Defecation Symptoms score were linked to Physical Discomfort (Ps < 0.05). The diagnostic specificity and PPV for FDD rose significantly with positive BET and PFD. Conclusion FDD patients with positive BET and PFD suffer severe defecation symptoms, anxiety and impaired QOL. Positive BET and PFD could be an ideal tool for screening FDD.

Biofeedback Therapy in Children with Functional Constipation in Tehran, Iran

Background: Functional constipation is a common disorder in pediatrics and affects about 30 percent of children, causing several physical and emotional complications and having a considerable impact on health expenses and quality of life. Biofeedback is a behavioral therapy that gives the patient information about the activity of pelvic floor muscles and teaches the patients how to properly contract and relax the sphincter. Biofeedback therapy is the most effective in those with constipation due to pelvic floor dyssynergia, which is the abnormal function of sphincter muscles and affects 40% of children with constipation. Objectives: This study aimed to evaluate the effect of biofeedback therapy in children with chronic functional constipation unresponsive to medical and conventional treatments. Methods: Forty-four children with functional constipation (according to ROME 4 criteria) unresponsive to at least six months of taking medical treatment and pelvic floor dyssynergia according to anorectal manometry were selected for biofeedback therapy. After six months, symptoms of patients and the need for laxative consumption were compared to those before therapy. Results: Considering ROME 4 criteria, clinical improvement was achieved in 59.1% of patients. Comparison of symptoms shows improvement in 52 - 89 % of cases. Conclusions: In pediatric patients with functional constipation and pelvic floor dyssynergia who do not respond to conventional treatments, biofeedback therapy could be an alternative therapy, and its effects last for at least six months.

Comparison of 3-Dimensional Pelvic Floor Ultrasonography and Defecography for Assessment of Posterior Pelvic Floor Disorders

Purpose: The aim of this study was to determine the accuracy of 3-dimensional (3D) pelvic floor ultrasonography and compare it with defecography in assessment of posterior pelvic disorders.Methods: Eligible patients were consecutive women undergoing 3D pelvic floor ultrasonography at one hospital between August 2017 and February 2019. All 3D pelvic floor ultrasonography was performed by one examiner. A total of 167 patients with suspected posterior pelvic disorder was retrospectively enrolled in the study. The patients were divided into 3 groups according to the main symptoms.Results: There were 82 rectoceles on defecography (55 barium trapping) and 84 on 3D pelvic floor ultrasonography. Each modality identified 6 enteroceles. There were 43 patients with pelvic floor dyssynergia on defecography and 41 on ultrasonography. There were 84 patients with intussusception on defecography and 41 on 3D pelvic floor ultrasonography. Agreement of the 2 diagnostic tests was confirmed using Cohen’s kappa value. Rectocele (kappa, 0.784) and enterocele (kappa, 0.654) both indicated good agreement between defecography and 3D pelvic floor ultrasonography. In addition, pelvic floor dyssynergia (kappa, 0.406) showed moderate agreement, while internal intussusception (kappa, 0.296) had fair agreement.Conclusion: This study showed good agreement for detection of posterior pelvic disorders between defecography and 3D pelvic floor ultrasonography.

Three-dimensional ultrasonography study of female defecation disorder caused by changes of the puborectalis muscle

Objective To investigate the correlation between pelvic floor dyssynergia-type constipation and the puborectalis muscle using three-dimensional ultrasonography. Methods Eighty-seven patients with pelvic floor dyssynergia-type constipation (observation group) and 87 healthy volunteers (control group) were enrolled in this study. Three-dimensional ultrasonography of the pelvic floor was performed on patients and healthy volunteers in a lithotomy position at rest and during straining and squeezing. The three-dimensional reconstructed sonogram was analysed to determine the puborectalis angle and puborectalis thickness at the 6 o’clock position (patients in a lithotomy position). Results (1) The puborectalis angles of the observation and control groups were not significantly different at rest [(85.664 ± 1.926)°, (85.813 ± 1.500)°] and during squeezing [(87.478 ± 2.125)°, (86.960 ± 1.751)°] (P > 0.05) but were significantly different when straining [(80.389 ± 2.268)°, (94.382 ± 1.540)°] (P < 0.05). The difference in the puborectalis angles of the two groups between rest and straining [(5.275 ± 1.236)°, (-8.569 ± 1.209)°] was statistically significant (P < 0.05). (2) The puborectalis thickness of the observation and control groups was not significantly different at rest ([3.994 ± 0.128) mm, (3.983 ± 0.091) mm] and during anal squeezing [(4.082 ± 0.154) mm, (4.126 ± 0.113) mm] (P > 0.05) but was significantly different when straining [(4.630 ± 0.199) mm, (4.296 ± 0.121) mm] (P < 0.05). The differences in the puborectalis thickness at rest and during straining in the observation and control groups were (-0.636 ± 0.217) mm and (-0.316 ± 0.089) mm, respectively, resulting in a statistically significant difference between the two groups (P < 0.05). Conclusion The puborectalis angle in patients with pelvic floor dyssynergia-type constipation was smaller than that in healthy volunteers during straining. The puborectalis thickness at the 6 o’clock position with the patient in a lithotomy position in patients with pelvic floor dyssynergia-type constipation was larger than that in healthy volunteers. Moreover, larger differences between rest and straining are associated with a more severe degree of constipation. Project funding Natural Science Foundation of Shandong (ZR2012HM086)