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Chronic Idiopathic Constipation
Published in Kevin W. Olden, Handbook of Functional Gastrointestinal Disorders, 2020
Anorectal manometry may provide useful information in some patients with severe constipation. The most useful parameters are rectal sensation and compliance, reflexive relaxation of the internal anal sphincter, and manometric patterns produced upon attempted expulsion of the apparatus (pseudodefecation). Satisfactory measurements of anal-sphincter pressures can be obtained with open-tipped perfused catheters, direct on-line pressure transducers, and air- or water-filled balloons of various sizes and configurations.
Severe functional constipation: Surgery and gastroenterologic collaboration
Published in Alejandra Vilanova-Sánchez, Marc A. Levitt, Pediatric Colorectal and Pelvic Reconstructive Surgery, 2020
Peter L. Lu, Desalegn Yacob, Carlo Di Lorenzo
The majority of children with functional constipation respond to conventional treatment with laxatives and behavioral modification. However, children with severe functional constipation refractory to conventional treatment often require specialized care from gastroenterologists and surgeons working in collaboration. Anorectal and colonic manometry testing can provide the medical team a better understanding of the physiological mechanisms contributing to a child's defecation problem and can be used to guide subsequent medical or surgical treatment. Anorectal manometry measures the neuromuscular function of the anus and rectum using a catheter placed through the anal canal into the rectum, and can be used to evaluate for the presence of Hirschsprung's disease, internal anal sphincter achalasia, and pelvic floor dyssynergia. Colonic manometry measures the neuromuscular function of the colon using a catheter placed in the lumen of the colon, and can be used to evaluate for the presence of colonic motor dysfunction, including colonic inertia and segmental colonic dysmotility.
Common gastrointestinal investigations and psychological concerns
Published in Simon R. Knowles, Laurie Keefer, Antonina A. Mikocka-Walus, Psychogastroenterology for Adults, 2019
Anorectal manometry helps to assess the function of the anorectal muscles which are important for normal defaecation. It is a useful test to investigate conditions such as faecal incontinence and constipation. Patients need to have an enema before the test to clean the lower bowel. A small, flexible catheter (approximately 20cm) with pressure censor is inserted into the anal canal and rectum. Pressure measurement is done during different phases: at rest, squeezing, and pushing.
Assessment of anal sphincter distensibility following the STARR procedure: a pilot study
Published in Acta Chirurgica Belgica, 2020
Charlotte Desprez, Chloé Melchior, Guillaume Gourcerol, Jean-Jacques Tuech, Estelle Houivet, Anne-Marie Leroi, Valérie Bridoux
The STARR (Stapled Trans-Anal Rectal Resection) procedure consists of a minimally invasive surgical correction of symptomatic rectocele or rectal intussusception [1] refractory to medical treatment. This surgery is associated with an improvement of obstructed defecation syndrome (ODS) in more than 70% of patients [2]. The STARR procedure involves prolonged anal dilatation with a circular anal dilator. Dilatation of the anal canal may contribute to the postoperative alteration of continence observed in approximately 20% of operated patients [2]. However, several studies have investigated anal sphincter function with anorectal manometry after this surgery and did not find any significant changes in the anorectal manometry parameters of patients [2]. Anorectal manometry is not the only available tool to evaluate anal function. The endoluminal functional lumen imaging probe (EndoFLIP®, Ireland) is a new technique for exploring anal canal distensibility during distension and may be superior to anorectal manometry for differentiating between impaired and normal anal sphincter function [3]. The objective of the present study was to determine the impact of the STARR procedure performed in continent patients with rectocele on anal distensibility using the new EndoFLIP® technique.
Long-Term Functional Outcome after Internal Delorme's Procedure for Obstructed Defecation Syndrome, and the Role of Postoperative Rehabilitation
Published in Journal of Investigative Surgery, 2018
C. A. Leo, P. Campennì, J. D. Hodgkinson, P. Rossitti, F. Digito, G. De Carli, L. D'Ambrosi, P. Carducci, L. Seriau, G. Terrosu
Between October 2006 and September 2013, 170 patients with a diagnosis of ODS underwent IDP. Male to female ratio was 18:152 (10.59%:89.41%). Median age was 60.41 yearsTABLE 2 (SD: ±13.27). A predominant preoperative reported symptom in 165 patients (97%) was feeling of incomplete evacuation. Sixty-three patients (37%) reported incomplete evacuation. Thirty-eight patients (22%) reported digitating via rectum or vagina to aid defecation. Eighty-five patients (50%) had tenesmus. Sixty-seven patients (38%) had a diagnosis of rectocele with mucosal prolapse. Fifty-nine (33%) had mucosal prolapse and rectal intussusception. Rectocele with mucosal prolapse and intussusception was found in 44 patients (24.8%). Of the 170 patients, 23.5% had perineal descent >4 cm. Twenty-six patients (15%) had a previous colorectal surgical procedure (including left/right hemicolectomy, hemorrhoidectomy, and hemorrhoid banding). Seventy patients (41%) had anorectal manometry studies within the normal range values. Fifty-one (30%) patients were found to have a low resting pressure, with normal other manometry pressures. Forty-nine patients (29%) had a significant alteration in rectal volumes tolerated. Results of this cohort are shown in Table 2.
Review of the international hypnosis literature
Published in American Journal of Clinical Hypnosis, 2023
Shelagh Freedman, Ian Wickramasekera
Anorectal manometry is a diagnostic test used with children to assess the neuromuscular function of the anorectum. A manometry catheter is inserted into the rectum through the anus. While the procedure is not considered painful, high levels of distress and anxiety have been reported by children undergoing the test, and their parents. A partially blinded randomized controlled pilot study was conducted with 32 children (4–18 years old; 15 in the hypnosis group). A very brief intervention with hypnosis was administered prior to the test, while the child was lying on the procedure bed. The hypnosis session lasted 1–3 minutes and involved progressive relaxation and mentally going to a “special place,” reference to the child’s wellbeing and comfort, and a post-hypnotic suggestion for them to think of their special place, which would provide comfort during the procedure. Prior to the insertion of the catheter, the distress in the children who participated in hypnosis was lower, as observed by the blinded and two non-blinded raters. Observed and reported levels of distress did not differ significantly between the groups during the procedure. Ninety-three percent of the parents and children in the hypnosis group reported that the hypnosis helped the child relax during the procedure. The authors conclude that this brief, and easy to incorporate, intervention reduces distress prior to the anorectal manometry and is positively perceived by both the parents and the children. Address for reprints: Desiree Baaleman, Department of Pediatric Gastroenterology, Emma Children’s Hospital, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands. E-Mail: [email protected]