Anorectal manometry with and without ketamine for evaluation of defecation disorders in children.

Introduction: Anorectal manometry (ARCM) provides valuable information in children with chronic constipation and fecal incontinence but may not be tolerated in the awake child. This study aimed to evaluate the effect of ketamine anesthesia on the assessment of anorectal function by manometry and to evaluate defecation dynamics and anal sphincter resting pressure in the context of pathophysiology of chronic functional (idiopathic) constipation and soiling in children.

Methods: This was a prospective study of children who were investigated for symptoms of chronic constipation and soiling between April 2001 and April 2004.

Pathophysiology of chronic childhood constipation: functional and morphological evaluation by anorectal manometry and endosonography and colonic transit study.

Background: Chronic idiopathic constipation (IC) is a common problem in children. We hypothesised that hypertonicity and overactivity of the internal anal sphincter (IAS) contributed to childhood IC.

Method: This was a prospective study of children who were admitted for investigation and treatment of chronic constipation at the gastrointestinal motility clinic in Guy's and St.

Transcutaneous needle-free injection of botulinum toxin: a novel treatment of childhood constipation and anal fissure.

Purpose: Constipation is a common problem in children, and when it becomes chronic fecal impaction, overflow soiling and megarectum may develop. Children with chronic idiopathic constipation (IC) may not respond to conventional treatments of laxatives, enemas, and toilet training. The aims of the study were to evaluate the long-term outcome of transcutaneous needle-free injection of botulinum toxin (TNFBT) into the external anal sphincter (EAS) and to assess the extent of the toxin penetration into the sphincter.

A new ultrasound scoring system for assessing the severity of constipation in children.

Purpose: Pelvic ultrasound (US) has been used in various different ways to assess severity of constipation. We evaluated the use of a new US scoring system to determine if there is any correlation between symptom severity and US findings.

Methods: Data were collected prospectively on all children attending the constipation clinic from January 2007 to July 2008.

Evaluation of outcome of anorectal anomaly in childhood: the role of anorectal manometry and endosonography.

The aim of this study was to evaluate role of anorectal manometry (ARM) and anal endosonography (ES) in assessment of the internal anal sphincter (IAS) quality on continence outcome following repair of anorectal anomalies (ARA). We devised a scoring system to evaluate the quality of the IAS based on ARM and ES and correlated the scores with clinical outcome, using a modified Wingfield score (MWS) for faecal continence. We also assessed the implication of megarectum and neuropathy on faecal continence.

Constipation and incontinence in childhood: two sides of the same coin?

Perspective on the paper by Loening‐Baucke ()

Botulinum toxin, a new treatment modality for chronic idiopathic constipation in children: long-term follow-up of a double-blind randomized trial.

Background: Myectomy of the internal anal sphincter (IAS) has been performed on some children after failure of medical treatment to treat idiopathic constipation. The aim of this study was to compare botulinum toxin injection with myectomy of the IAS in the treatment of chronic idiopathic constipation and soiling in children.

Methods: This was a double-blind randomized trial.

Outcome of excision of megarectum in children with anorectal malformation.

Background/purpose: Megarectum in association with anorectal malformation contributes to chronic constipation and fecal incontinence. Resection of megarectum in anorectal malformation improves bowel function, but neuropathy and poor sphincter quality may affect the outcome of fecal continence adversely. The aim of this study was to evaluate the benefits of resection of megarectum in anorectal malformation and to ascertain the impact of anal sphincter quality and neuropathy on the outcome.

Constipation in children.

Introduction: Prevalence of chronic constipation has been estimated at 1-5% of children in the UK and USA, most of whom have no obvious aetiological factors. A third of children with chronic constipation continue to have problems beyond puberty. Half of children with chronic faecal impaction and soiling have experienced an episode of painful defecation, and many children with chronic constipation exhibit withholding behaviour.

Role of anal dilatation in treatment of idiopathic constipation in children: long-term follow-up of a double-blind randomized controlled study.

Constipation in childhood is a common symptom, with an estimated incidence between 0.3% and 8%. Most of the evidence for the current management of constipation and fecal soiling in children is based on reports of nonrandomized retrospective trials.

Thickening of the internal anal sphincter in idiopathic constipation in children.

Thickening of the internal anal sphincter (IAS) is observed in chronic idiopathic constipation (IC) and solitary rectal ulcer syndrome (SRUS), where it has been correlated with the presence and severity of rectal intussusception. Alternatively, thickened IAS may be a feature of the obstructed megarectum in a similar way to the hypertrophy of bladder neck seen in dyssynergic bladders. The aim of this study was to investigate the significance of thickening of the IAS in children with chronic IC and to determine any association between the thickened IAS and anorectal manometry findings and patient's symptoms.

Management of childhood constipation.

The effective management of constipation in childhood requires an understanding of the ways that the physical and psychological factors interact. The early difficulty with defecation that leads to pain, fear, and refusal to use the pot or lavatory often progresses to the formation of vicious cycles of increasing faecal retention as the rectum increases in capacity and the experience of passing large, hard stools is repeated. There is increasing distress as overflow faecal incontinence compounds the problem for the older child.

Investigations for incontinence and constipation after surgery for Hirschsprung's disease in children.

Surgery for Hirschsprung's disease is associated with high rate of morbidity, in the form of either constipation or incontinence or a combination of the two. This study investigates the mechanisms responsible for incontinence and/or constipation following the pull-through operation for Hirschsprung's disease. There were 19 children (15 boys and 4 girls), who at the time of study; 16 had undergone Duhamel, 1 Rehbein, and 2 Soave operation.

Evaluation of dysfunction following reconstruction of an anorectal anomaly.

To evaluate the utility of anorectal manometry (ARM) and magnetic resonance imaging (MRI) with an endocoil in the assessment of dysfunction in children with repaired anorectal anomalies (ARA), 15 patients aged 1 to 15 years with repaired ARAs and chronic faecal incontinence or constipation were prospectively recruited. They underwent clinical assessment using a modified Wingfield score (MWS). ARM and MRI with an endocoil and conventional external coil were carried out.

Constipation in epidermolysis bullosa: successful treatment with a liquid fiber-containing formula.

In epidermolysis bullosa (EB), chronic constipation, painful defecation, and fecal impaction frequently contribute to malnutrition and growth failure. Standard treatments for constipation, such as increased intake of conventional dietary fiber and fluids and/or the use of laxatives and stool softeners, are largely unsuccessful. We evaluated by questionnaire the use of a fiber-containing liquid formula (Enrich) in 20 chronically constipated children with dystrophic EB.

Writing and marking examinations for paediatrics.

Examinations are an essential element of medical education, which generates vehement debate but unfortunately a relative lack of rigorous critical analysis. There appears to be a background anxiety that research findings that might suggest an examination has been less than fair will lead to endless arguments with candidates who have failed that examination. It is a major responsibility of all those involved in examining to seek evidence of the fairness, reliability, and validity of the methods and the organisation of the tests.

The clinical value of solid marker transit studies in childhood constipation and soiling.

Assessment of constipation in childhood is difficult, particularly when the presenting symptom is spurious diarrhoea or faecal incontinence. We have therefore assessed the clinical usefulness, reliability and acceptability of a solid marker transit technique in 52 patients with constipation (median age 8.0 years; range 2-13.

Anorectal function of children with neurological problems. II: cerebral palsy.

In response to the frequent complaint of difficulties with defecation experienced by children with cerebral palsy, 34 children (13 girls and 21 boys, mean age 10 years) with cerebral palsy were investigated by questionnaire and anorectal manometry. 24 enuretic children served as controls for the anorectal manometry. Constipation affected 26 of 29, defecation distress eight and faecal incontinence 16 of the index children, but incontinence was mild in most cases.

Anorectal function of children with neurological problems. I: Spina bifida.

Anorectal function was assessed with anorectal manometry in 45 children with spina bifida (21 girls and 24 boys, mean age 11 1/2 years). 24 enuretic children served as controls. The pressure in the first and second centimeters of the anal canal was lower among index children than controls and also lower among those with high spinal lesions compared with those with low lesions.