Pattern Analysis of Defecography in Patients with Chronic Functional Constipation: Is It Predictable for the Responsiveness of Biofeedback Therapy?

PURPOSE: To determine if pattern analysis of defecography can predict the responsiveness of biofeedback therapy in patients with chronic functional constipation. MATERIALS AND METHODS: Over a two-year period, 104 patients with chronic functional constipation underwent defecography and biofeedback therapy. Two blinded readers analyzed the defecographic findings and classified them into six types; I = normal defecation, II = hypertonic lower anal sphincter (poor anal opening due to a persistent contraction of the lower anal sphincter), III = dyskinetic puborectal sling (inadequate laxity of the puborectal sling), IV = spastic pelvic floor syndrome (persistent contraction of both the puborectal sling and the lower anal sphincter), V = unclassified (including paradoxical contraction of the anal sphincter), VI = anatomical obstruction. In addition, the degree of rectal contraction during defecation was scored (grade 0 to 3). After biofeedback therapy, the differences in the defecography patterns or rectal contractions between the two groups, the responsive or non-responsive group, were analyzed. RESULTS: The defecograms revealed that the type IV of the spastic pelvic floor syndrome was most common (50 of 104 patients, 48%), followed by II (21/104, 20%), III (12/104, 11.5%), V (9/104, 9%) and VI (12/104, 11.5%). Biofeedback therapy showed a therapeutic response in 71 out of 104 patients (68%) but failed in 33 patients (32%). However, there were no significant differences in the defecographic pattern between the responsive and non-responsive groups (p=0.630). The defecograms revealed rectal contractions in 78 patients (75%) and moderate to vigorous contractions (more than grade 2) in 66 patients. Most of the biofeedback-responsive group showed rectal contractions (66 of 71 patients, 93%, p<0.001). CONCLUSION: In patients with chronic functional constipation, there was no significant difference in the morphological patterns of the defecogram between the responsive and non-responsive biofeedback groups. However, the presence of rectal contractions during defecation was strongly associated with the therapeutic response after biofeedback therapy.

The Value of Additional Videorecording on Defecography

PURPOSE: To determine the value of additional videorecording during defecography. MATERIALS AND METHODS:Ninety-nine consecutive patients (20 males, 79 females; mean age: 48 yrs) who between august 1996 and June 1997 had undergone defecography due to defecation difficulty were included in this study. In all patients, spotfilming(at rest, during squeezing, during straining) and videorecording during defecography were simultaneouslyperformed. Two radiologists retrospectively reviewed spot films and video images, analyzed discrepancies betweenthe two methods, and reached a consensus. RESULTS: In 52% of patients (51/99), the results of the twoexaminations were discrepant. The most common finding was anterior rectocele(n=33), followed by spastic pelvicfloor syndrome(n=16), rectal intussusception(n=5), posterior rectocele(n=3), mucosal prolapse(n=2), descendingperineal syndrome(n=2), and rectal prolapse(n=1). All findings except spastic pelvic floor syndrome were alsoshown by videorecording. CONCLUSIONS: Because videorecording during defecography showed additional findings in52% of patients, it is a necessary procedure for the diagnosis and management of patients with defecationdifficulty.

Comparison of Colonic Transit Time Findings Between Spastic Pelvic Floor Syndrome and Normal on defecogram

PURPOSE: To evaluate colonic transit time (CTT) in patients with spastic pelvic floor syndrome (SPFS)diagnosed by defecography and compare the findings with those of patients with normal defecography. MATERIALS AND METHODS: Over a recent 15-month period, 140 patients underwent both defecography and CTT test because of chronicidiopathic constipation. Of these, 54 with SPFS diagnosed by defecography and 49 controls with normal defecographywere included in our study. CTT testing involved the radiopaque marker method. Subjects ingested 24 markers at9:00AM on three consecutive days and a plain film of the abdomen was obtained on day 4. We calculated total andsegmental CTT, and compared CTT test findings in the two groups. RESULTS: Delayed total CTT was found in 35% ofpatients (19/54) with SPFS. Segmental CTT in the right, left and rectosigmoid colon was delayed in 19% (10/54),44% (24/54), and 31% of cases(17/54), respectively. Total CTT was delayed in 31% of patients(15/49) with normaldefecography. In this group, segmental CTT in the left colon was delayed in 39% of cases. CONCLUSION: There was nosignificant difference in CTT findings between the SPFS and normal groups on defecogram.