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Evaluation of the paradoxical sphincter contraction by a strain/squeeze index in constipated patients.
Dis Colon Rectum. 2005 Oct; 48(10):1923-9.DC

Abstract

PURPOSE

One finding in patients with constipation is the paradoxical puborectalis contraction, i.e. , activation of the sphincter muscles during straining instead of relaxation. The aims of this study were to evaluate the importance of needle placement in sphincter-electromyography and to evaluate a strain/squeeze index in constipated patients and control subjects.

METHODS

We investigated consecutively 194 constipated patients and 16 control subjects with integrated electromyography during straining and squeezing and calculated a strain/squeeze index. The examination was performed in the puborectalis and in the external anal sphincter muscle through hook-electrodes.

RESULTS

There was a strong correlation between indices in the puborectalis muscle and in the external anal sphincter muscle (r = 0.70-0.80, P < 0.001). Forty-seven patients (24 percent) had a mean index of greater than 50 compared with none in the control group (P = 0.01). Mean overall index in patients was 24 (range, 0-306) vs. 18 (range, 0-45) in controls (P = 0.12). Patients with an index greater than 50 had impaired rectal evacuation (P < 0.001), increased threshold for urge (P < 0.05), and tended to have fewer stools (P = 0.06).

CONCLUSION

Quantification of paradoxical contraction in the puborectalis and external anal sphincter with a strain/squeeze index differentiates patients in whom paradoxical activity may be a cause of constipation. An index above 50 may be of pathologic significance. Correlations between activity in the puborectalis and external anal sphincter muscle were strong which suggests that investigation in one of them is sufficient.

Authors+Show Affiliations

Department of Surgical Sciences, Section for Surgery, University Hospital, Uppsala, Sweden. urban.karlbom@akademiska.seNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16086218

Citation

Karlbom, Urban, et al. "Evaluation of the Paradoxical Sphincter Contraction By a Strain/squeeze Index in Constipated Patients." Diseases of the Colon and Rectum, vol. 48, no. 10, 2005, pp. 1923-9.
Karlbom U, Eeg-Olofsson KE, Graf W, et al. Evaluation of the paradoxical sphincter contraction by a strain/squeeze index in constipated patients. Dis Colon Rectum. 2005;48(10):1923-9.
Karlbom, U., Eeg-Olofsson, K. E., Graf, W., & Påhlman, L. (2005). Evaluation of the paradoxical sphincter contraction by a strain/squeeze index in constipated patients. Diseases of the Colon and Rectum, 48(10), 1923-9.
Karlbom U, et al. Evaluation of the Paradoxical Sphincter Contraction By a Strain/squeeze Index in Constipated Patients. Dis Colon Rectum. 2005;48(10):1923-9. PubMed PMID: 16086218.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of the paradoxical sphincter contraction by a strain/squeeze index in constipated patients. AU - Karlbom,Urban, AU - Eeg-Olofsson,Karin Edebol, AU - Graf,Wilhelm, AU - Påhlman,Lars, PY - 2005/8/9/pubmed PY - 2005/11/11/medline PY - 2005/8/9/entrez SP - 1923 EP - 9 JF - Diseases of the colon and rectum JO - Dis. Colon Rectum VL - 48 IS - 10 N2 - PURPOSE: One finding in patients with constipation is the paradoxical puborectalis contraction, i.e. , activation of the sphincter muscles during straining instead of relaxation. The aims of this study were to evaluate the importance of needle placement in sphincter-electromyography and to evaluate a strain/squeeze index in constipated patients and control subjects. METHODS: We investigated consecutively 194 constipated patients and 16 control subjects with integrated electromyography during straining and squeezing and calculated a strain/squeeze index. The examination was performed in the puborectalis and in the external anal sphincter muscle through hook-electrodes. RESULTS: There was a strong correlation between indices in the puborectalis muscle and in the external anal sphincter muscle (r = 0.70-0.80, P < 0.001). Forty-seven patients (24 percent) had a mean index of greater than 50 compared with none in the control group (P = 0.01). Mean overall index in patients was 24 (range, 0-306) vs. 18 (range, 0-45) in controls (P = 0.12). Patients with an index greater than 50 had impaired rectal evacuation (P < 0.001), increased threshold for urge (P < 0.05), and tended to have fewer stools (P = 0.06). CONCLUSION: Quantification of paradoxical contraction in the puborectalis and external anal sphincter with a strain/squeeze index differentiates patients in whom paradoxical activity may be a cause of constipation. An index above 50 may be of pathologic significance. Correlations between activity in the puborectalis and external anal sphincter muscle were strong which suggests that investigation in one of them is sufficient. SN - 0012-3706 UR - https://www.unboundmedicine.com/medline/citation/16086218/Evaluation_of_the_paradoxical_sphincter_contraction_by_a_strain/squeeze_index_in_constipated_patients_ L2 - http://link.springer.com/article/10.1007/s10350-005-0148-z DB - PRIME DP - Unbound Medicine ER -