Diagnostic Usefulness of Anorectal Physiologic Investigation in Patients with Chronic Constipation

Jo, Jae Sam; Park, Ung Chae

Abstract

BACKGROUND AND AIMS: The pathophysiology of chronic constipation is more complex than just simple disorders of the pelvic floor muscle or colon. This study was designed to assess the diagnostic usefulness of physiologic investigation in patients with chronic constipation and to analyze the characteristics of physiologic findings of obtained diagnosis.
METHODS
Anal manometry (n=82), cinedefecography (n=106), anal EMG/PNTML (pudendal nerve terminal motor latency; n=27) and colonic transit time study (n=35) were performed on the patients with chronic constipation. Physiologic findings of patients who recieved at least two items of physiologic tests (n=106, 68 females and 38 males) were retrospectively evaluated. Age matched control data (n=33) in anal manometry and sex matched control data (n=20) were selected from volunteers.
RESULTS
Patients were categorized as rectocele (Group I: n=36), nonrelaxing puborectalis syndrome (Group II: n=14), anal dyschezia (Group III: n=14), rectoanal intussusception (Group IV: n=8), encopresis (Group V: n=7) and others (n=27). In anal manometry, the patients with group III showed higher mean and maximum resting pressures (p<0.001) and higher mean squeeze pressures and maximal voluntary contraction (p<0.01) than the patients with other groups. In cinedefecography, patients with group II showed smaller anorectal angle at strain (p<0.001) and at dynamic change between rest and strain (p<0.05) than the patients with other groups. In neurologic study, mean value of PNTML for all patients was 2.35+/-0.44 (range, 1.66-3.66) msec. The value of PNTML was increased in proportion to the ages of patients (r=0.46, p=0.003).
CONCLUSIONS
These results suggest that anorectal physiologic studies are vital to the functional diagnosis for the patients with constipation. Current data provide the important diagnostic ramification, and can be used for clinical appraisal.