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Obstructive defecation: a failure of rectoanal coordination.
Am J Gastroenterol 1998; 93(7):1042-50AJ

Abstract

OBJECTIVE

The pathophysiology of obstructive defecation is unclear. We investigated whether impaired rectoanal coordination causes obstructive defecation and if this dysfunction can be corrected by biofeedback therapy.

METHODS

We prospectively studied 25 healthy subjects and 35 consecutive patients with constipation (>1 year) with anorectal manometry and balloon expulsion test. Symptoms were assessed from diary cards. Patients found to have obstructive defecation were offered biofeedback therapy. After treatment, their defecation dynamics and symptoms were reassessed.

RESULTS

Eighteen patients had obstructive defecation and 17 had normal defecation dynamics (nonobstructive). Five normals (20%) exhibited obstructive pattern but only one failed to expel balloon. In the obstructive group, during straining, the intrarectal pressure and defecation index were lower (p < 0.05), and anal residual pressure was higher (p < 0.01) when compared with the nonobstructive group or normals. After biofeedback therapy, the intrarectal pressure and defecation index increased (p < 0.02) and anal residual pressure decreased (p < 0.001); stool frequency, degree of straining, and bowel satisfaction scores improved (p < 0.05); 67% stopped laxatives and 11 patients discontinued stooling with digitation.

CONCLUSION

Patients with obstructive defecation showed impaired rectal contraction, paradoxical anal contraction, or inadequate anal relaxation. These features suggest that rectoanal coordination was impaired. Biofeedback therapy rectified these pathophysiological disturbances and improved constipation.

Authors+Show Affiliations

Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

9672327

Citation

Rao, S S., et al. "Obstructive Defecation: a Failure of Rectoanal Coordination." The American Journal of Gastroenterology, vol. 93, no. 7, 1998, pp. 1042-50.
Rao SS, Welcher KD, Leistikow JS. Obstructive defecation: a failure of rectoanal coordination. Am J Gastroenterol. 1998;93(7):1042-50.
Rao, S. S., Welcher, K. D., & Leistikow, J. S. (1998). Obstructive defecation: a failure of rectoanal coordination. The American Journal of Gastroenterology, 93(7), pp. 1042-50.
Rao SS, Welcher KD, Leistikow JS. Obstructive Defecation: a Failure of Rectoanal Coordination. Am J Gastroenterol. 1998;93(7):1042-50. PubMed PMID: 9672327.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Obstructive defecation: a failure of rectoanal coordination. AU - Rao,S S, AU - Welcher,K D, AU - Leistikow,J S, PY - 1998/7/22/pubmed PY - 1998/7/22/medline PY - 1998/7/22/entrez SP - 1042 EP - 50 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 93 IS - 7 N2 - OBJECTIVE: The pathophysiology of obstructive defecation is unclear. We investigated whether impaired rectoanal coordination causes obstructive defecation and if this dysfunction can be corrected by biofeedback therapy. METHODS: We prospectively studied 25 healthy subjects and 35 consecutive patients with constipation (>1 year) with anorectal manometry and balloon expulsion test. Symptoms were assessed from diary cards. Patients found to have obstructive defecation were offered biofeedback therapy. After treatment, their defecation dynamics and symptoms were reassessed. RESULTS: Eighteen patients had obstructive defecation and 17 had normal defecation dynamics (nonobstructive). Five normals (20%) exhibited obstructive pattern but only one failed to expel balloon. In the obstructive group, during straining, the intrarectal pressure and defecation index were lower (p < 0.05), and anal residual pressure was higher (p < 0.01) when compared with the nonobstructive group or normals. After biofeedback therapy, the intrarectal pressure and defecation index increased (p < 0.02) and anal residual pressure decreased (p < 0.001); stool frequency, degree of straining, and bowel satisfaction scores improved (p < 0.05); 67% stopped laxatives and 11 patients discontinued stooling with digitation. CONCLUSION: Patients with obstructive defecation showed impaired rectal contraction, paradoxical anal contraction, or inadequate anal relaxation. These features suggest that rectoanal coordination was impaired. Biofeedback therapy rectified these pathophysiological disturbances and improved constipation. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/9672327/Obstructive_defecation:_a_failure_of_rectoanal_coordination_ L2 - http://Insights.ovid.com/pubmed?pmid=9672327 DB - PRIME DP - Unbound Medicine ER -