GASTROENTEROLOGY 1984;87:1299-1304 Abnormal Rectoanal Function in Children Recovered From Chronic Constipation and Encopresis VERA A. LOENING-BAUCKE Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, Iowa It is unknown if abnormal anal sphincter function as assessed by anorectal manometry is still present years after resolution of chronic constipation and encopresis. Twenty healthy controls, 12 children with constipation but no encopresis, and 20 children with chronic constipation and encopresis under- went anorectal manometric testing, using intralu- minal pressure transducers and a balloon for rectal distention. Anorectal measurements were repeated in the 20 constipated and encopretic children 2.5-4 yr after treatment began; 11 children had recovered for at least 1 yr. The mean values of anal resting tone and of anal pull-through pressure were lower in the constipated and encopretic children than in the 20 control children (p < 0.003). Percent relaxation of the rectosphincteric reflex after rectal distention of 30 and 60 ml was lower in constipated children with and without encopresis than in controls [p < O.O03), whereas the means of rectosphincteric reflex thresh- old were comparable in the three groups of children. Three years after initiation of treatment with milk of magnesia, high-fiber diet, and bowel training tech- niques, the mean values of anal resting tone, anal pull-through pressure, and percent relaxation of r,ectosphincteric reflex remained significantly lower in both recovered and nonrecovered constipated and encopretic patients compared with controls. It was suggested that the underlying cause of chronic constipation is the decreased ability of the internal anal sphincter to relax with rectal distention, and the hypotonia of the anal canal is responsible for the encopresis. Abnormal anorectal functions were still Received November 8, 1983. Accepted June 25, 1984. Address requests for reprints to: V. Loening-Baucke, M.D., Department of Pediatrics, University of Iowa Hospitals and Clin- ics, Iowa City, Iowa 52242. This work was supported by grant MOl-RR-00059 from the General Clinical Research Center Program, Division of Research Resources, National Institutes of Health. The author thanks Mrs. Patricia Moore and Ms. Molly Wise for assistance. 0 1984 by the American Gastroenterological Association 0016-5065/84/$3.00 present years after cessation of treatment and recov- ery and put the recovered patient at risk for recur- rence of chronic constipation and encopresis. In a previous study (1) of chronically constipated and encopretic children it was demonstrated that the anal resting tone and values for the amplitudes of the reflex relaxation of the internal anal sphincter (rec- tosphincteric reflex, RSR) for rectal distention with 30 and 60 ml of air were statistically significantly lower than in control children. A month after recov- ery from chronic constipation and encopresis, the mean anal resting tone had normalized but the amplitudes of RSR remained low. The anal resting tone and the amplitudes of RSR remained lower in the 7 patients who did not recover compared with controls. We suggested that the basic problem in constipated and encopretic children may be an ab- normal internal anal sphincter, which is weaker and less responsive to rectal distention than in noncon- stipated children. The aim of the present investigation was to deter- mine whether decreased anal sphincter function was still present in these children years after resolution of severe constipation and encopresis. Materials and Methods The study population consisted of 52 children, aged 4-12 yr. Twenty control children, 16 boys and 4 girls, mean age 8.6 yr, were healthy and had no bowel com- plaints. Twelve patients, 6 boys and 6 girls, mean age 7.4 yr, suffered from chronic constipation but had no fecal soiling, and 20 patients, 10 boys and 10 girls, mean age 7.5 yr, suffered from chronic constipation and encopresis [soiling of the underpants with feces secondary to over- flow]. For operational purposes, constipation is defined here as the difficult passage of hard stools (2). The com- mon clinical history of the constipated children described a prolonged period of infrequent and abnormal stools persisting in all patients for at least 1 yr. Constipation Abbreviations used in this paper: RSR, rectosphincteric reflex.
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Related Documents
