Obstructive defecation: a failure of rectoanal coordination

SSC Rao, KD Welcher, JS Leistikow - Official journal of the …, 1998 - journals.lww.com
SSC Rao, KD Welcher, JS Leistikow
Official journal of the American College of Gastroenterology| ACG, 1998journals.lww.com
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 …
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.
Lippincott Williams & Wilkins