Dyssynergic Defecation Concerning Proctalgia Fugax: An Observational Study

Introduction: There is no clarity about manometric findings in patients with proctalgia fugax; evidence shows different results. This study aims to evaluate dyssynergic defecation through anorectal manometry in Colombian patients in two gastroenterology centers in Bogotá, Colombia. Materials and methods: A cross-sectional descriptive observational study in adult patients with proctalgia fugax undergoing anorectal manometry and treated in two gastroenterology centers in Bogotá between 2018 and 2020. Results: 316 patients were included, predominantly women (65%), with a median age of 45.2 (range: 18-78; standard deviation [SD]: 28.3). Four percent of patients had hypertonicity, 50% were normotonic, and 46% were hypotonic. Regarding manometric parameters, 50% had normal pressure, and 46% had anal sphincter hypotonia; 76% had a normal voluntary contraction test. Dyssynergic defecation was documented in 5% of patients, and the most frequent was type I, followed by type III. A rectoanal inhibitory reflex was identified in all patients, 42% with altered sensory threshold and 70% with abnormal balloon expulsion. There was an agreement between the results of the anorectal manometry and the subjective report of the digital rectal exam by the head nurse who performed the procedure. Conclusions: The data obtained in the present study suggest that proctalgia is not related to the elevated and sustained basal contracture of the sphincter but neither to the alteration in voluntary contraction since most patients have typical values.

Introducción: Actualmente, no hay claridad acerca de los hallazgos manométricos en pacientes con proctalgia fugaz, y la evidencia muestra diferentes resultados. Se plantea como objetivo en el presente estudio evaluar la presencia de disinergia defecatoria con manometría anorrectal en pacientes colombianos en dos centros de gastroenterología en Bogotá, Colombia. Metodología: Estudio observacional descriptivo de corte transversal en pacientes adultos sometidos a manometría anorrectal con proctalgia fugaz y atendidos en dos centros de gastroenterología de la ciudad de Bogotá entre el 2018 y el 2020. Resultados: Se incluyó a 316 pacientes, predominantemente mujeres (65%), con mediana de edad 45,2 (rango: 18-78; desviación estándar [DE]: 28,3). El 4% de los pacientes presentaban hipertonicidad, el 50% eran normotónicos y el 46%, hipotónicos. En cuanto a parámetros manométricos, el 50% tenía presión normal y el 46%, hipotonía de esfínter anal. El 76% tuvo una prueba de contracción voluntaria normal. En 5% pacientes se documentó disinergia defecatoria, y la más frecuente fue el tipo I, seguido del tipo III. En todos los pacientes se identificó reflejo recto anal inhibitorio, 42% con alteración en umbral sensitivo y 70% con expulsión de balón anormal, y hubo concordancia entre los resultados de la manometría anorrectal y el reporte subjetivo del tacto rectal de la jefe de enfermería que realizó el procedimiento. Conclusiones: Los datos obtenidos en el presente estudio sugieren que la proctalgia no está relacionada con la contractura basal elevada y sostenida del esfínter, pero tampoco con la alteración en la contracción voluntaria, ya que la mayoría de los pacientes presentan valores normales.

Prevalence and predictors of functional evacuation disorder in patients with chronic constipation

Background: Functional evacuation disorder (FED) is the second most common cause of functional constipation (FC) after constipation-predominant irritable bowel syndrome. However, the data on FED is relatively scanty in our region. Hence, the present study was performed to evaluate the demographics of FED and to find out the predictors of FED in patients with chronic constipation. Methods: A total of 134 patients with chronic constipation diagnosed according to the Rome IV criteria who were referred for high-resolution anorectal manometry (HRAM) were retrospectively enrolled in the present study. All FC patients who underwent HRAM were asked to fill a questionnaire and underwent anorectal manometry and were submitted to the balloon expulsion test (BET). Results: The mean age of patients was 43.09 ± 9.32 years old, with a total of 76 (54%) males. The most common symptom was straining during defecation (87%) followed by incomplete evacuation (86%). The prevalence of FED, diagnosed by HRAM and by the BET was 39%. Patients with FED had a significantly higher percentage of straining and sensation of anorectal blockade compared with those without FED (96 versus 82%; p < 0.01; 81 versus 44%; p < 0.001, respectively). On the multivariate regression analysis, straining > 30 minutes (odds ratio [OR] = 3.63; p = 0.03), maximum squeeze pressure (OR = 1.05; p < 0.001), and balloon volume at maximal sensation (OR = 1.06; p < 0.001) were found to be significant independent predictors of FED. Conclusion: Prolonged straining and sensation of anorectal blockade were significant indicators of FED in patients with chronic constipation. (AU)

Normal Values and Associated Factors in Highresolution Anorectal Manometry in Healthy Vietnamese Adults / Valores normais e fatores associados na manometria anorretal de alta resolução em adultos vietnamitas saudáveis

Abstract Introduction The present study aims to identify normal high-resolution anorectal manometry (HRAM) values and related factors in healthy Vietnamese adults. Methods The present cross-sectional study was conducted at the Viet Duc hospital, Hanoi, Vietnam, during April and May 2019. Healthy volunteers were recruited to participate in the study. Anorectal measurement values from the digestive tract, including pressure, were recorded. Results A total of 76 healthy volunteers were recruited. The mean functional anal canal length was 4.2 ± 0.5 cm, while the mean anal high-pressure zone length was 3.4 ± 0.5 cm. Themean defecation index was 1.4 ± 0.8, with values ranging from 0.3 to 5.0. The mean threshold volume to elicit the rectoanal inhibitory reflex (RAIR) was 18.1 mL. The mean rectal sensation values were 32.4mL, 81.6mL, and 159 mL for first sensation, desire to defecate, and urge to defecate, respectively. Dyssynergic patterns occurred in ~ 50% of the study participants and included mainly types I (27.6%) and III (14.6%). There were significant differences between male and female patients in terms of maximum anal squeeze pressure, maximum anal cough pressure, maximum anal strain pressure, maximum rectal cough pressure, and maximum rectal strain pressure (all p<0.01). Conclusions The present study establishes normal HRAM values in healthy Vietnamese adults, particularly regarding normal values of anorectal pressure and rectal sensation. Further studies that include larger sample sizes should be conducted to further confirm the constants and their relationships.

Resumo Introdução O presente estudo tem como objetivo identificar valores normais de manometria anorretal de alta resolução e fatores relacionados em adultos vietnamitas saudáveis. Métodos O presente estudo transversal foi conduzido no hospital Viet Duc, Hanói, Vietnã, durante abril e maio de 2019. Voluntários saudáveis foram recrutados para participar do estudo. Valores de medição anorretal, incluindo pressão do trato digestivo, foram registrados. Resultados Um total de 76 voluntários saudáveis foram recrutados. O comprimento funcional médio do canal anal foi de 4,2 ± 0,5 cm, enquanto o comprimento médio da zona anal de alta pressão foi de 3,4 ± 0,5 cm. O índice médio de defecação foi de 1,4 ± 0,8, com valores variando de 0,3 a 5,0. O volume limite médio para eliciar o reflexo inibitório retoanal (RAIR, sigla em inglês) foi de 18,1 mL. Os valores médios da sensação retal foram 32,4mL, 81,6mL e 159 mL para a primeira sensação, o desejo de defecar e a urgência de defecar, respectivamente. Os padrões dissinérgicos ocorreram em aproximadamente 50% dos participantes do estudo e incluíram principalmente os tipos I (27,6%) e III (14,6%). Houve diferenças significativas entre homens e mulheres na pressão de compressão anal máxima, pressão de tosse anal máxima, pressão de distensão anal máxima, pressão de tosse retal máxima e pressão de distensão retal máxima (todos p<0,01). Conclusões O presente estudo estabelece valores normais de HRAM em adultos vietnamitas saudáveis, particularmente no que diz respeito aos valores normais de pressão anorretal e sensação retal. Mais estudos que incluam tamanhos de amostra maiores devemser realizados a fim de confirmar melhor as constantes e suas relações.

Improvement of neurogenic bowel dysfunction after spinal cord injury using functional magnetic stimulation based on anorectal manometry / 国际生物医学工程杂志

Objective:To explore the effect of functional magnetic stimulation(FMS) on the intestinal function of patients with neurogenic bowel dysfunction (NBD) after spinal cord injury using anorectal manometry technology.Methods:36 NBD patients were divided into FMS group and control group by random number table method. Patients in the control group received conventional treatment, including diet adjustment, abdominal massage, and pelvic floor muscle training. Patients in the FMS group received FMS treatment on the basis of conventional treatment. Using 3D high-resolution anorectal manometry and neurogenic intestinal dysfunction score, the intestinal function of the two groups of patients before and after the treatment were evaluated.Results:After receiving conventional treatment + FMS treatment, the high-pressure belt length, anal systolic pressure, rectal pressure, rectal-anal pressure difference, initial sensory threshold, bowel sensation threshold, maximum tolerance threshold, rectal compliance of the patients in the FMS group received were better than those before the treatment (all P<0.05). After receiving conventional treatment, only the rectal-anal pressure difference, initial sensory threshold and maximum tolerance threshold of the patients in the control group were significantly improved (all P<0.05). The improvement of the FMS group on the length of the high-pressure belt, anal systolic pressure, rectal pressure, and initial sensory threshold was significantly better than those of the control group (all P<0.05). Conclusions:The implementation of FMS therapy on the basis of conventional treatment can better improve the intestinal motility and intestinal sensation of the patients with NBD. The 3D high-resolution anorectal manometry technique can be used to quantitatively evaluate the intestinal function of NBD patients.

Cómo realizar e interpretar una manometría anorrectal de alta resolución / How to perform and interpret high resolution anorectal manometry

Resumen La manometría anorrectal es la técnica más utilizada para evaluar la función anorrectal y así detectar las anormalidades funcionales del esfínter anal y de coordinación anorrectal. En nuestro laboratorio de fisiología realizamos aproximadamente 15 estudios de manometría anorrectal de alta resolución a la semana, por lo que consideramos que es de vital importancia realizarlo de forma adecuada y tener una correcta interpretación. Mediante este artículo deseamos compartir nuestro protocolo de realización de manometría anorrectal de alta resolución con base en la literatura más relevante.

Abstract Anorectal manometry is the most commonly used technique to evaluate anorectal functioning and coordination and detect functional abnormalities of the anal sphincter. In our physiology laboratory we perform approximately 15 high resolution anorectal manometry studies each week. We consider that proper performance and correct interpretation are vitally important. We want to share our high resolution anorectal manometry protocol based on the most relevant literature through this article.

Actualización con la clasificación de Londres en la interpretación de la manometría anorrectal de alta resolución / Update of high-resolution anorectal manometry interpretation using the London classification

Resumen La manometría anorrectal de alta resolución es una prueba diagnóstica utilizada para los trastornos motores y sensitivos anorrectales. Consta de una medición del tono basal y de contracción anal; también valora la maniobra de pujo, reflejo rectoanal inhibitorio (RIAR) y parámetros sensitivos rectales. La interpretación convencional de la manometría anorrectal se enfoca en describir aisladamente la región anatómica disfuncional. Sin embargo, con la clasificación de Londres se busca estandarizar el informe de estos resultados, agrupándolos en trastornos mayores, menores y hallazgos no concluyentes, similar a la clasificación de Chicago para trastornos motores esofágicos.

Abstract High resolution anorectal manometry is a diagnostic test, used for anorectal motor and sensory disorders. It consists of measurement of basal tone, anal contraction and squeeze, the rectoanal inhibitory reflex (RAIR), and rectal sensory parameters. The conventional interpretation of anorectal manometry focuses on describing the dysfunctional anatomical region in isolation. However, the London classification seeks to standardize the report of these results, grouping them into major, minor and inconclusive findings in a manner similar to the Chicago classification for esophageal motor disorders.

Morphological characteristic of anal canal in patients with dyssynergic defecation and its correlation with anorectal manometry / 中华胃肠外科杂志

Objective@#To evaluate the diagnostic value of three-dimensional endoanal ultrasound (3D-EAUS) for dyssynergic defecation (DD).@*Methods@#A case-control study was performed to retrospectively collectclinical data of 46 DD patients, including 16 males and 30 females with median age of 51 (20 to 70) years, at Nanjing Hospital of Chinese Medicine from February 2012 to April 2015.All the patients met the diagnostic criteria of functional constipation of Rome III. The paradoxical contraction of puborectalis (PR) muscle was found by both rectal examination and anorectal manometry. In the same period,45 healthy volunteers, including 22 males and 23 females with median age of 48 (21 to 72) years, without pelvic operation history, and with normal defecation in recent 6 months, were enrolled as the control group. No significant differences were observed in age and gender between two groups (both P>0.05). Cleveland constipation score of DD group was higher than that of control group [15(8-24) vs. 5(1-9), t=15.720, P<0.001]. 3D-EAUS examination was performed in all the subjects. Thickness and length of internal anal sphincter (IAS) (anterior side and posterior side), thickness of PR muscle, length of external anal sphincter (EAS) plus PR muscle, and puborectalis angle were measured and compared by using student t test between two groups. Correlation between these ultrasound parameters and anorectal manometry was examined by Pearson correlation analysis.@*Results@#Both male and female in the DD group had the greater thickness of IAS, as compared to those in the control group [male: (1.7±0.5) mm vs.(1.5±0.2) mm, t=2.516, P=0.016; female: (1.9±0.4) mm vs.(1.6±0.5) mm, t=2.034,P=0.047]. No significant differences between the two groups were observed with respect to the posterior length of IAS, length of EAS plus PR muscle, and thickness of PR muscle (all P>0.05). Compared to the control group, male in the DD group had smaller puborectalis angle during straining [(87.0±3.6)° vs. (90.5±1.8)°,t=3.502,P=0.002];female in the DD group had smaller puborectalis angle both in resting and straining [resting:(86.5±3.8)° vs. (90.1±2.1)°,t=4.047, P<0.001;straining: (84.1±4.5)° vs. (90.2±2.3)°, t=5.938, P<0.001]. Correlation analysis showed that anterior length of IAS was positively correlated with anal resting pressure (r=0.321, P=0.030); the length of EAS plus PR muscle was positively correlated with anal squeeze pressure (r=0.415, P=0.004). There were no correlations between the thickness and the posterior length of IAS and the anal resting pressure, or between the thickness of PR muscle and the anal squeeze pressure (all P>0.05).@*Conclusions@#The 3D-EAUS can accurately assess the morphological features of anal canal in DD patients. There is a certain positive correlation between 3D-EAUS and anorectal manometry.

Effectiveness of biofeedback training among rectal cancer patients: a randomized controlled trial / 中国实用护理杂志

Objective@#To evaluate the effect of biofeedback training on bowl function among rectal cancer patients with chemoradiotherapy and temporary enterostomy.@*Methods@#Using randomized controlled trial design, 109 rectal cancer patients were randomly divided into three groups, the first blank control group, the second group pelvic floor muscle exercise group, the third group biofeedback group. High resolution anorectal manometry was used for 6 longitudinal traces in 16 months. Data of bowel function were collected by Memorial Sloan Kettering Cancer Center (MSKCC) Bowel Function Instrument.@*Results@#The main effect of the change of five indicators, anal resting pressure, rectal resting pressure, maximum squeeze pressure, maximum squeeze time and high pressure zone, was time. The other four indicators, rectal volume at first senory, rectal volume at sense of convenience, maximal tolerable rectal volume and rectal compliance, among patients of biofeedback group were (32.71±5.00) ml, (74.26±8.30) ml, (188.40±12.68) ml, (5.69±1.18) ml/kPa and (68.09±6.38). The rectal volume at first senory, rectal volume at sense of convenience, maximal tolerable rectal volume and rectal compliance, among patients of biofeedback group were significant higher than blank control group and pelvic floor muscle exercise group (F=3.589-26.826, P<0.05).@*Conclusion@#The biofeedback could significantly improve the sensory indicators of patients with middle and low rectal cancer. High-resolution anorectal manometry could effectively evaluate the effect of biofeedback training in patients with middle and low rectal cancer.

Long-term efficacy analysis of laparoscopic-assisted anorectoplasty for high and middle imperforate anus / 中华胃肠外科杂志

Objective@#To explore the long-term efficacy of laparoscopic-assisted anorectoplasty and conventional anorectoplasty in the treatment of children with high and middle anal atresia.@*Methods@#A retrospective cohort study was used. Inclusion criteria: (1) children with high and middle anal atresia; (2) complicated with rectourethral or rectovesical fistula; (3) complete follow-up data. Exclusion criteria: (1) complicated with 21-trisomy; (2) cerebral palsy and other mentaldisabilities; (3) Currarino syndrome; (4) FG syndrome. Clinical data of 88 patients with middle and high anal atresia, who complicated with rectourethral fistula or rectovesical fistula, and underwent anoplasty at Department of Pediatric Surgery, the First Affiliated Hospital of Zhengzhou University from January 2009 to June 2014 were enrolled in the study and analyzed. There were 24 cases with middle atresia and 64 cases with high atresia. All the cases were divided into 2 groups based on the operative method: laparoscopic group (laparoscopic-assisted anorectoplasty, 49 cases), pena group (posterior sagittal anorectoplasty, 39 cases). The demographic features of two groups were comparable. There were no statistically significant differences in gender, age, body mass, classification of anomaly types and sacral ratio (all P>0.05). Student t test and Chi square tests were used to compare the surgical conditions (operative time, postoperative hospital stay and complications), anal function (Kelly score), constipation (Krickenbeck constipation score) and anorectal pressure.@*Results@#Children of both groups all completed operation ssuccessfully. There were no statistically significant differences between laparoscopic group and pena group in the operative time [(120±31) minutes vs. (112±23) minutes, t=1.343, P=0.091] and postoperative hospital stay [(7.1±2.3) days vs. (10.7±3.3) days, t=6.021, P=1.000]. Complications were more common in the pena group [16.3% (8/49) vs. 35.9% (14/39), χ2=4.436, P=0.035]. The main complications in laparoscopic group were anal prolapse (8.2%, 4/49) and anal stenosis (6.2%, 3/49), while in pena group were anal stenosis (12.8%, 5/39) and perioperative perianal skin erosion (10.3%, 4/39). As for the anal function, the degree of feces, defecation control and sphincter contractility, the single scoring differences of Kelly scoring system were not statistically significant between the two groups, but the proportion of good function in the laparoscopic group was higher than that in the pena group [67.3% (8/49) vs. 38.5% (15/39), χ2=7.308, P=0.007]. Constipation occurred in 6 (12.2%) patients in the laparoscopic group, of whom 5 were improved by diet regulation and 1 required laxatives, while 9 (23.1%) patients developed constipation in the pena group, of whom 4 were improved by diet regulation and 5 required long-term laxatives. The difference of constipation ratio was not statistically significant (χ2=1.802, P=0.180). There were no cases of Krickenbeck constipation grade 3. Compared to the pena group, the laparoscopic group had higher anal resting pressure [(33.35±9.69) mmHg vs. (27.68±10.74) mmHg, t=2.599, P=0.011], higher dilating pressure [(9.00±5.61) mmHg vs.(6.51±3.24) mmHg, t=2.462, P=0.016], higher maximal squeeze pressure [(65.80±17.23) mmHg vs. (56.74±18.93) mmHg, t=2.389, P=0.019] and longer maximal contraction time [(21.16±5.02) seconds vs. (18.44±7.24) seconds, t=2.079, P=0.041]. The rectal resting pressure [(5.36±3.00) mmHg vs. (4.61±3.93) mmHg, t=1.015, P=0.312] was not statistically significantly different.@*Conclusions@#Compared with posterior sagittal anorectoplasty, laparoscopic-assisted anorectoplasty in the treatment of high and middle anal atresia has better long-term efficacy with less perioperative complications.

Value of rectoanal pressure gradient in seated position in evaluation of anorectal motility disorder in patients with constipation / 中华消化杂志

Objective To investigate the differences of anorectal manometry (ARM) parameters in different position (left lateral position and seated position) in patients with functional constipation (FC),and the value of rectoanal pressure gradient (RAPG) was assessed in seated position in the evaluation of anorectal motility disorder in patients with FC.Methods From March 2015 to July 2016,at Clinical Gastrointestinal Motility Center of Ningbo Yinzhou People's Hospital,66 consecutive patients with FC aged 18 to 75 who met Rome Ⅲ criteria were recruited.The questionnaires of patient assessment of constipation symptom (PAC-SYM)and patient assessment of constipation quality of life (PAC-QoL) were recorded.Patients randomly underwent ARM examination in left lateral or seated positions,and then followed by a balloon expulsion test (BET) in seated position.The differences of ARM parameters in different positions were compared.The correlation between ARM parameters and BET results,constipation symptoms and quality of life scores were analyzed.T-test,Spearman correlation analysis and Kappa coefficient were performed for statistical analysis.Results ARM parameters including rectal resting pressure,rectal defecation pressure and RAPG in seated position were both higher than those of left lateral position ((30.83 ±7.89) mmHg (1 mmHg =0.133 kPa) vs.(10.53 ± 3.94) mmHg,(78.86±22.25) mmHg vs.(54.92±21.26) mmHg,(17.53 ±27.40) mmHg vs.(-7.80 ±26.88) mmHg),and the differences were statistically significant (t =-21.10,-12.35 and-8.84,all P ＜ 0.01).However,there was no significant difference in anal-related pressure parameters (P ＞ 0.05).The RAPG in seated position was highly consistent with BET,with a maximum Kappa-value of 0.643,which was higher than the maxium Kappa-value of 0.349 in left lateral position.The optimal RAPG threshold of seated position was 10 mmHg,the sensitivity of RAPG in the prediction of BET was 85.71％ and the specificity was 79.17％.According to the optimal RAPG threshold in seated position,the patients were divided into high RAPG group and low RAPG group.The frequency of weekly spontaneous defecation of high RAPG group was higher than that of low RAPG group (2.88 ±2.16 vs.1.66 ±0.96),and the difference was statistically significant (t=2.65,P=0.01).The satisfaction score of PAC-QoL questionnaire of high RAPG group was lower than that of low RAPG group (2.05 ±0.55 vs.2.83 ±0.78),and the difference was statistically significant (t =-4.72,P ＜0.01).Conclusion It may be more reasonable to perform ARM in the seated position in FC patients,especially for the RAPG in seated position is better correlated with BET results,constipation symptoms and quality of life scores which may have more clinical value in the evaluation of anorectal motility disorder in FC patients.

Anorectal Manometry Versus Patient-Reported Outcome Measures as a Predictor of Maximal Treatment for Fecal Incontinence

PURPOSE: This study aims to establish the ability of patient-reported outcome measures (PROMs) and anorectal manometry (ARM) in predicting the need for surgery in patients with fecal incontinence (FI).METHODS: Between 2008 and 2015, PROMs data, including the Birmingham Bowel and Urinary Symptoms Questionnaire (BBUSQ), Short Form 36 (SF-36), Wexner Incontinence Score and ARM results, were prospectively collected from 276 patients presenting with FI. Spearman rank was used to assess correlations between specific PROMs questions and ARM assessments of sphincter motor function. Binomial regression analyses were performed to identify factors predictive of the need for surgery. Finally, receiver operating characteristic (ROC) curve analyses were performed to establish the utility of individual ARM and PROMs variables in predicting the need for surgical intervention in patients with FI.RESULTS: Two hundred twenty-eight patients (82.60%) were treated conservatively while 48 (17.39%) underwent surgery. On univariate analyses, all 4 domains of the BBUSQ, all 8 domains of the SF-36, and the Wexner Incontinence Score were significant predictors of surgery. Additionally, maximum resting pressure, 5-second squeeze endurance, threshold volume, and urge volume were significant. On ROC curve analyses, the only significant ARM measurement was the 5-second squeeze endurance. PROMs, such as the incontinence domain of the BBUSQ and five of the SF-36 domains, were identified as fair discriminators of the need for surgery.CONCLUSION: PROMs are reliable predictors of maximal treatment in patients with FI and can be readily used in primary care to aid surgical referrals and can be applied in hospital settings as an aid to guide surgical treatment decisions.

Pelvic floor function in women with stress urinary incontinence / 中华物理医学与康复杂志

Objective To evaluate any changes in overall pelvic floor function among women with stress urinary incontinence ( SUI) . Methods Twenty-five female SUI patients were recruited as the SUI group and twenty-three healthy female counterparts were selected as the control group. Pelvic organ prolapse quantifica-tion ( POP-Q) was performed with both groups. Ultrasonography was used to measure the position of the bladder neck, the posterior angle of the urethra, the urethra′s inclination angle and the size of the diaphragmatic hiatus for both groups at rest, during the Valsalva maneuver, as well as during the transition from resting to the Valsal-va maneuver. The strength and fatigue of type I and type II fibers in the pelvic muscles were evaluated electro-physiologically, and anorectal manometry was also performed with both groups. The significance of any relation-ship between these measurements and SUI was determined using multivariate logistic regression analysis. Results Eleven members of the SUI group showed phase I pelvic organ prolapse. Twelve were in phase II and 2 were in phase III. All of those incidences were significantly different from the control group. There were signifi-cant differences between the two groups in the average bladder neck position, urethral inclination angle, posterior urethra angle, descending distance of the bladder neck, and urethral rotation angle during the Valsalva maneu-ver. In the transition from resting to the Valsalva maneuver, significant differences were found only in the dis-tance of the bladder neck′s descent and the rotation angle of the urethra. The severity of pelvic organ prolapse, the descending distance of the bladder neck and the urethral rotation angle, as well as the bladder neck position and urethral angle during the Valsalva maneuver were the major risk factors associated with female SUI, and the correlation was statistically significant. Conclusion The greater the mobility of the bladder neck and urethra in female SUI patients, the more serious the prolapse. Prolapse, bladder neck mobility and urethral support all af-fect the overall functionality of the pelvic floor.

Consistency between symptoms and colorectoanal function tests in elderly patients with functional constipation / 中华全科医师杂志

Objective To analyze the consistency between constipated symptoms and the parameters of gastrointestinal transit time (GITT),anorectal manometry (ARM) in elderly patients with functional constipation.Methods Total 111 patients (54 males and 57 females) with an average age of (70.2±6.5) years,who met Rome Ⅲ criteria of functional constipation were enrolled from June 2010 to October 2012.After enrollment,patients took two-week diary,recording the spontaneous bowel movements per week,stool type of Bristol Stool Form,the frequency and severity of defecation straining,sensation of anorectal obstruction,manual maneuvers and sensation of incomplete evacuation.The GITT and ARM tests were performed,and the consistency between symptoms and test results were analyzed.Results Patients with symptoms of slow transit,defecation disorder and mixed symptoms were 19.8％ (22/111),16.2％ (18/ 111) and 59.5％ (66/111) respectively;and 4.5％ (5/111) patients had scattered symptoms.Based on results of GITT,slow transit subtype,defecation disorder subtype and mixed subtype were 54.1％ (59/109),1.8％ (2/ 109) and 29.4％ (32/109) respectively;and 14.7％ (16/109) patients were with normal transit time.ARM results showed that 38.0％ (41/109) of patients had dyssynergic defecation.The percentage of slow transit in GITT test showed no significant difference between patients with slow transit symptoms and mixed symptoms [50.0％ (11/22)vs.57.9％(33/57),x2=0.401,P=0.527].The consistency of predominant symptom with GITI subtype was low (κ=-0.013).The percentage of dyssynergic defecation detected with ARM showed no significant difference between patients with defecation disorder-predominant symptom and with mixed symptom [23.1％ (6/24)vs.38.2％ (21/55),x2=1.813,P=0.178].The consistency of defecation disorderpredominant symptom with dyssynergic defecation in ARM was low (κ=-0.019).Conclusion The mixed subtype symptoms are the most common presentations of elderly patients with functional constipation,and the consistency of predominant constipated symptoms with GITI,ARM test results is poor.

Normal values for solid state high resolution anorectal manometry in healthy adult volunteers / 中华内科杂志

Objective To explore the normal values for two-dimension solid state high resolution anorectal manometry (HRAM) in healthy adult volunteers.Methods The healthy adult volunteers were recruited by advertisement and underwent solid state HRAM in the left lateral position.Anorectal pressures and rectal sensation were recorded and analyzed.Results (1) A total of 126 Chinese healthy adult volunteers (male:50 cases (39.7％);age:(37.5 ± 14.2) years old) were recruited in this study.(2)Mean anal resting pressure (MERP) was (71.8 ± 17.3) mmHg (1 mmHg =0.133 kPa).Maximum anal resting pressure (MARP) was (79.3 ± 17.8) mmHg,Maximum anal squeeze pressure (MSP) was (178.7 ± 52.8) mmHg.Anal high pressure zone (HPZ) length was (3.4 ± 0.6) cm.During simulated evacuation,residual anal pressure (RAP) was (63.8 ±20.5) mmHg,and anal relaxation rate (ARR) was (37.0 ± 11.5) ％.Rectal threshold volume for first sensation (FST),desire to defecate (DDT),urgency to defecate (UDT) and maximum discomfort (MDT) was (47.4 ±10.0) ml,(84.5 ±18.2) ml,(125.8 ± 28.5) ml,and (175.5 ±36.1) ml,respectively.(3) Compared with female subjects,male subjects had higher MSP [(211.0 ± 50.7) mmHg vs (157.5 ± 42.5) mmHg],RAP [(71.6 ± 18.1) mmHg vs (58.8 ± 20.5) mmHg]and rectal MDT[(187.0 ±36.4) mmHg vs (168.0 ±34.1)mmHg],but lower ARR [(32.1 ±8.0)％ vs (40.2 ±12.3)％],all P＜0.01.(4) MERP,MARP,MSP and rectal MDT were higher in young group (≤ 40 years old),all P ＜ 0.05.Conclusions These observations provide normal values for two-dimension solid state HRAM,which have significant difference between genders and different age groups.

Changes of Pudendal Nerve Terminal Movement Latency and Anorectal Function in Rectal Prolapsed Patients / 中山大学学报(医学科学版)

[Objectives]To evaluate the change of anorectal function in patients with rectal prolapsed by water perfusion anorec?tal manometry and pelvic floor electromyography.[Methods]A total of 60 patients with rectal prolapsed were enrolled in this study, the analgesic parameters included resting sphincter pressures, squeeze sphincter pressures, length of the anal canal and rectal sensa?tion, the results were compared with the parameters of normal population. Twenty of which completed pelvic floor electromyography ex?amination, analyzed the changes of pudendal nerve terminal movement latency (PNTML).[Results]The resting sphincter pressures, squeeze sphincter pressures of patients were lower than the normal population;The length of anal canal was shortened;The first sensa?tion and the first defecation threshold were higher than those of normal people, There was no significant change in the maximum tolera?ble threshold of rectum;pudendal nerve terminal movement latency extended more than 2.6 ms.[Conclusions]Anal resting stool and function of contraction weakened in patients of rectal prolapse, decreased sensitivity of rectal, pudendal nerve terminal movement laten?cy extended.

Colorectal Perforation After Anorectal Manometry for Low Anterior Resection Syndrome

We experienced 3 cases of manometry-induced colon perforation. A 75-year-old man (case 1) underwent anorectal manometry (ARM) 3 years after radiotherapy for prostate cancer and a laparoscopic intersphincteric resection for rectal cancer. A 70-year-old man (case 2) underwent ARM 3 months after conventional neoadjuvant chemoradiotherapy and a laparoscopic low anterior resection for rectal cancer. A 78-year-old man (case 3) underwent ARM 2 months after a laparoscopic intersphincteric resection for rectal cancer. In all cases, a colon perforation with fecal peritonitis occurred. All were treated successfully using prompt and active operations and were discharged without any complications. ARM with a balloon, as a measure of rectal compliance, should be performed 2 months or longer after surgery. If a perforation occurs, prompt and active surgical intervention is necessary due to the high possibility of extensive fecal peritonitis.

Estudo descritivo dos exames de manometria anorretal realizados no laboratório de motilidade digestiva da Santa Casa de Misericórdia, Porto Alegre, Brasil / A descriptive study of anorectal manometry tests performed in the laboratory of digestive motility of Santa Casa de Misericórdia in Porto Alegre, Brazil

Introdução: A manometria anorretal é, atualmente, o padrão ouro, como método de diagnóstico laboratorial dos distúrbios evacuatórios. O objetivo do presente estudo é descrever uma experiência brasileira, da realização da manometria anorretal, valorizando-a como meio diagnóstico. Métodos: Estudo retrospectivo, com revisão dos laudos dos exames, no Laboratório de Motilidade Digestiva da Santa Casa de Misericórdia de Porto Alegre, Brasil. Foram incluídos os pacientes consecutivos, acima de 12 anos de idade, submetidos à manometria anorretal, entre março de 2003 e outubro de 2015. Resultados: No período, foram realizados 1319 exames, em pacientes com média de idade de 53,4±19,4 anos, sendo 70,7% do sexo feminino. A incontinência anal, com 62,4% dos exames, foi a principal indicação da manometria anorretal, a segunda foi constipação com 29,4% e por outros motivos em 8,2% dos pacientes. No período entre 2011 e 2015, houve um aumento significativo dos exames realizados por incontinência anal, em relação ao de 2003 até 2010. Conclusões: As duas principais indicações da manometria anorretal, no presente estudo e na literatura, são constipação e incontinência anal. O aumento significativo dos exames por incontinência anal, após 2011, sugere uma maior consciência dos médicos e pacientes em relação às possibilidades de diagnóstico e tratamento das disfunções evacuatórias. Este é o primeiro estudo brasileiro, que discute as indicações da manometria anorretal e as características dos pacientes encaminhados para o exame. Os autores sugerem a valorização da manometria anorretal como ferramenta de diagnóstico nas disfunções evacuatórias AU)

Introduction: Anorectal manometry is currently the gold standard for laboratory diagnosis of bowel disorders. The aim of the present study is to describe a Brazilian experience in performing anorectal manometry, valuing it as a diagnostic tool. Methods: A retrospective study, with review of test reports, in the Digestive Motility Laboratory of Santa Casa de Misericórdia, Porto Alegre, Brazil. We included consecutive patients, over 12 years of age, undergoing anorectal manometry from March 2003 to October 2015. Results: 1319 tests were performed in the studied period in patients with mean age of 53.4 ± 19.4, 70.7% of whom females. Anal incontinence, accounting for 62.4% of the tests, was the main indication for anorectal manometry, the second was constipation with 29.4%, and other reasons in 8.2% of the patients. In the 2011-2015 period there was a significant increase in the number of tests due to anal incontinence as compared to the 2003-2010 period. Conclusions: The two main indications for anorectal manometry in this study and in the literature are constipation and anal incontinence. The significant increase in the number of tests performed due to anal incontinence after 2011 suggests clinicians' and patients' greater awareness of the possibilities for diagnosis and treatment of bowel dysfunction. This is the first Brazilian study discussing the indications of anorectal manometry and the characteristics of the patients referred to the test. The authors suggest the use of anorectal manometry as a diagnostic tool in evacuation dysfunctions (AU)

Does Patient Position Influence the Results of Three-dimension High Resolution Ano-rectal Manometry?.

Aims: Anorectal manometry is the current gold standard to explore anorectal functional disorders. Recently, three-dimensional high-resolution anorectal manometry (3DHRAM) was developed. However, although procedures are usually performed in the left lateral decubitus position, anorectal symptoms usually occur in the erect or in the sitting position. Our aim was to prospectively compare the values obtained with 3DHRAM in the left lateral decubitus position versus the erect position. Study Design and Setting: A monocentric prospective study was conducted at a tertiary referral center, in the Department of Gastroenterology, Hôpital Nord, Marseille, France. Study Duration: Study was conducted from June 2013 to March 2014. Methodology: All patients referred to our center for 3DHRAM and endoanal ultrasonography to explore faecal incontinence or constipation were eligible. The 3DHRAM was successively performed by the same operator in the left lateral decubitus and then in the erect position. For each patient, the body mass index, the values of the KESS score or of the Wexner score were systematically rated. Results: Forty patients were included in this prospective study (20 with constipation, 20 with faecal incontinence). The median anal resting pressure was the only significantly different parameter between the left lateral decubitus and the erect position, both in patients suffering from constipation or from faecal incontinence (p=0.02 and p<0.001 respectively). All pressures values, as well as anismus diagnosis, were well correlated between the two positions, except the high-pressure zone, the sensation threshold and the need to defecate. Conclusion: In this study, only the median anal resting pressure was significantly different between the two positions. The good correlation between anal pressures values obtained in the two positions allows achieving 3DHRAM in the left lateral decubitus.

Analysis of anorectal function in cervical cancer patients with chronic pelvic radiation disease / 医学研究生学报

[Abstract ] Objective Pelvic radiation disease(PRD) is multiple injuries in more than one organ resulted by pelvic radio-therapy.Patients have the symptoms of frequent feces and fecal incontinence after the resection of small bowel lesion .Sugeries on PRD patients were mainly distal ileum and ilieocecal valve resections , while the most susceptible part of pelvic radiation injury is rectum . However , little research has been done concerning PRD patients′anorectal functions .This study was mainly to evaluate the anorectal function of cervical cancer patients with PRD in order to provide evidence for the therapy and prognosis of PRD . Methods Cervical cancer patients with PRD in need of small bowel resection who hospitalized in our department from January 2014 to January 2015 were collected as patient group , while people from outpatient physical exam group were selected as control group according to the exclusion criteria of hypertension , diabetes, constipation and unrelaxed pelvic floor syndrome .PDR group and control group were matched according to age.All subjects underwent colonoscopy and anorectal manometry .Rectal radiation injury was estimated on the basis of colonoscopy results.Anorectal manometry results of PRD group and control group were analysised statistically . Results PRD group and control group both included 20 women without stenosis or obstruction in rectum .Significant difference was found between PRD group and con-trol group in anal resting pressure (47.23 ±9.08 mmHg vs 58.25 ±9.24 mmHg, P<0.05), anal maximum squeezing pressure (47.23 ±9.08 mmHg vs 58.25 ±9.24 mmHg, P<0.01), anal distension pressure (23.30 ±12.49 mmHg vs 39.10 ±9.99 mmHg, P<0.01), rectal defecation pressure(22.85 ±16,69 mmHg vs 50.90 ±9.14 mmHg, P<0.01) and maximum tolerated rectal volume (112.85 ±51.34 mL vs 173.50 ±48.15 mL, P<0.01).There was no significant difference between the two groups as to the lenghth of functional sphincters(P=0.313),rectum initial threshold(P=0.416) and rectal defecation threshold(P=0.161). Conclusion Ionization radiation that injures PRD patients′internal anal sphincters and external anal sphincters also reduces maximum tolerated rec -tal volumes preoperatively .It′s necessary to assess the muscles and nerve functions of anorectum before intestinal surgery in order to make a proper operation plan which will improve PRD patients′life quality.

Can Anorectal Manometry Findings Predict Subsequent Late Gastrointestinal Radiation Toxicity in Prostate Cancer Patients? / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study is to investigate the influence of radiotherapy (RT) on anorectal function and radiation-induced toxicity in patients with prostate cancer. MATERIALS AND METHODS: Fifty-four patients who were treated with RT for prostate cancer (T1c-4N0-1M0) were evaluated. To assess the changes in anorectal function, two consecutive anorectal manometry readings were performed in patients, before and after 4-6 months of RT. Late gastrointestinal (GI) toxicity was defined as symptoms occurring more than 6 months after RT. The median radiation dose was 70.0 Gy (range, 66.0 to 74.0 Gy). Whole pelvis field RT was performed in 16 patients (29.6%). Grade of late radiation toxicity was defined in accordance to the severity of symptoms (Gulliford's scoring system). RESULTS: The median follow-up period was 60 months. Resting anal pressure (p=0.001), squeeze pressure (p or = 2) late toxicities. Elevated resting and squeeze external anal sphincter pressure prior to RT and large urge to defecate volumes after RT were associated with the occurrence of late GI toxicities. CONCLUSION: RT caused symptomatic anorectal dysfunction and resulted in a weakened anal sphincter. Increased urge to defecate volumes after RT were related to late GI toxicities. Elevated resting and squeeze anal sphincter pressure prior to RT rodcan be used to identify patients with an increased risk of late GI toxicities.ConclusionRT caused symptomatic anorectal dysfunction. An increased anal pressure prior to RT and urge to defecate volume after RT was related to an occurrence of late GI toxicities. Application of ARM for screening patients who have an elevated ASP prior to RT could be helpful in identifying patients with an increased risk of late GI toxicities.