Study Of Functional Constipation In Children With Anorectal Manometry

Background and ObjectiveConstipation is common symptoms of digestive tract in pediatrics. Clinical observations at home and abroad has indicated that the vast majority(about 95%) of constipation in childhood is functional constipation(FC). Functional constipation is the primary persistent constipation that non-systemic diseases or intestinal diseases caused and is also known as habitual constipation or simple constipation. It can be divided into slow transit constipation(STC) (Some studies indicate that it may belong to a motility disease), outlet obstruction constipation(OOC), mixed constipation(MIX). The latest functional gastrointestinal disorders RomeⅢcriteria in 2006 showed the incidence of FC in children was 0.3%～8.0%, accounting for 25% in digestion outpatient clinics of pediatric. This disease in children has a high incidence and lasts for a long time. Without the systemic treatment, almost 50% of children with constipation has been extended to the adult stage. However, because of the short-term conventional therapy does not work, parents have lost confidence in adherence to treatment and taken their own measures which is mainly alone stimulant cathartic to alleviate constipation. Effect is not so strong that functional constipation has become clinical problem which plagues physical and mental health of children.The anorectal manometry technology is rapidly developing a non-invasive method of examination in recent years. In early 1877 Growers had already reported the internal sphincter muscle of anus happens reflex relaxation while the rectum was dilated. Since then people had been observing related anorectal exercise again and again and found that testing anorectal resting pressure, dynamic pressure and reflex was able to know some anorectal capacity about control and judged anorectal function. In current the anorectal manometry technology in pediatrics is mainly used to assist to diagnosing anorectal diseases, evaluating the effect of surgery and drug, guiding biofeedback therapy.Study of anorectal dynamics of children with functional constipation by anorectal manometry, about which there is not many interrelated reports at home and abroad. The diagnostic criteria is relatively outdated and the number of cases is relatively fewer in previous research on functional constipation. Compared with the colonic transit test, anorectal manometry is easily implemented and non-invasive,therefore it easier for children to accept. First of all, the X-ray opaque markers are used to measure colonic transit index (TI) in order to distinguish between types of functional constipation.Then investigate differences of anorectal dynamics among the various types of functional constipation and between children with functional constipation and healthy children by anorectal manometry. At last experimental basis will be provided to assist Clinical classification of diagnosis and treatment about functional constipation.Methods In accordance with functional gastrointestinal disease RomeⅢcriteria, 25 children with functional constipation were enrolled in outpatient clinic and hospitalization. In the same period 10 children without gastrointestinal symptoms, healthy children of normal defecation were enrolled in the control group.The X-ray opaque markers(ROM)were used to measure colonic transit index (TI) in order to distinguish between types of functional constipation.Investigate differences of anorectal dynamics among the various types of functional constipation and between children with functional constipation and healthy children by anorectal manometry.ResultsSlow transit constipation (STC) and outlet obstruction constipation (OOC) were distinguished according to TI in the constipation groups and colonic transit index between the two groups had significant difference(t=12.22,P<0.01)。Children with mixed constipation were not founded in the test.The resting pressure of anal sphincter showed no significant difference between the constipation groups and the normal control group(P>0.05). The maximal systolic pressure of anal sphincter had no significant difference between the STC group and the normal control group(P>0.05). The maximal systolic pressure of anal sphincter was higher in the OOC group than the normal control group and had significant difference between the two groups(P<0.05). Minimal sensitive volume of rectum was larger and had significant difference between the constipation groups and the normal control group(P<0.05),so was maximal tolerated volume of rectum(P<0.05).There was no significant difference in the resting pressure of anal sphincter between the STC group and the OOC group(P>0.05). The maximal systolic pressure of anal sphincter was higher in the OOC group than the STC group and there was significant difference between the two groups(P<0.05). There was no significant difference in minimal sensitive and maximal tolerated volume of rectum between the two groups(P>0.05).ConclusionsThis study shows that there is obvious anorectal dynamic disorder and abnormal feel in children with functional constipation; Some differences exist in anorectal dynamic features between different types of functional constipation. Therefore anorectal manometry can be used to assist to diagnosing functional constipation and assist Clinical classification of diagnosis and treatment about functional constipation.The method of examination is non-invasive, easily implemented. However,it needs combination of children, so there should be an age limit and can be applicated in more than 4-year-old children.