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Original Articles
The pattern of bowel dysfunction in patients with rectal cancer following the multimodal treatment: anorectal manometric measurements at before and after chemoradiation therapy, and postoperative 1 year
Ri Na Yoo, Bong-Hyeon Kye, HyungJin Kim, Gun Kim, Hyeon-Min Cho
Ann Coloproctol. 2023;39(1):32-40.   Published online March 11, 2022
DOI: https://doi.org/10.3393/ac.2021.00696.0099
  • 3,394 View
  • 154 Download
  • 3 Web of Science
  • 2 Citations
Graphical AbstractGraphical Abstract AbstractAbstract PDF
Purpose
Bowel dysfunction commonly occurs in patients with locally advanced rectal cancer treated with a multimodal approach of chemoradiation therapy (CRT) combined with sphincter-preserving rectal resection. This study investigated the decline in anorectal function using sequential anorectal manometric measurements obtained before and after the multimodal treatment as well as at a 1-year follow-up.
Methods
This was a retrospective cohort study conducted in a single center. The study population consisted of patients with locally advanced mid- to low rectal cancer who received the preoperative CRT followed by sphincter-preserving surgery from 2012 to 2016. The anorectal manometric value measured after each treatment modality was compared to demonstrate the degree of decline in anorectal function. A generalized linear model of repeated measures was performed using the manometric values measured pre- and post-CRT, and at 12 months postoperatively.
Results
Overall, 100 patients with 3 consecutive manometric data were included in the final analysis. In the overall cohort study, the mean resting and maximal squeezing pressures showed insignificant decrement post-neoadjuvant CRT. At a 1-year postoperative follow-up, the maximal squeezing pressure significantly decreased. The maximal rectal sensory threshold demonstrated significant reduction consecutively after each following treatment (P<0.001).
Conclusion
The short-term effect of neoadjuvant CRT on the anal sphincters was relatively trivial. The following sphincter-saving surgery resulted in a profound disruption of the anorectal function. Patients with rectal cancer should be consulted on the consequence of multimodal treatment.

Citations

Citations to this article as recorded by  
  • Beyond survival: a comprehensive review of quality of life in rectal cancer patients
    Won Beom Jung
    Annals of Coloproctology.2024; 40(6): 527.     CrossRef
  • Unveiling the profound advantages of total neoadjuvant therapy in rectal cancer: a trailblazing exploration
    Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim, Donghyoun Lee, Chinock Cheong
    Annals of Surgical Treatment and Research.2023; 105(6): 341.     CrossRef
Benign proctology,Surgical technique
Minimal Lateral Internal Sphincterotomy (LIS): Is It Enough to Cut Less Than the Conventional Tailored LIS?
Keun-Hee Lee, Keehoon Hyun, Seo-Gue Yoon, Jong-Kyun Lee
Ann Coloproctol. 2021;37(5):275-280.   Published online July 9, 2021
DOI: https://doi.org/10.3393/ac.2020.00976.0139
  • 11,516 View
  • 180 Download
  • 7 Web of Science
  • 8 Citations
AbstractAbstract PDF
Purpose
Anal fissure is a common anorectal condition, yet its pathogenesis remains unclear. Lateral internal sphincterotomy (LIS) is the gold standard treatment for chronic anal fissures that do not respond to conservative treatment; however, it has a risk of anal incontinence. We believe that fibrosis of the internal anal sphincter is an important factor in the pathogenesis of chronic anal fissure. In this study, we describe the minimal LIS method, a minimally invasive method where only the fibrotic portion of the internal anal sphincter is cut. We also describe the outcomes of this method.
Methods
We performed a retrospective review of 468 patients (270 male and 198 female) who underwent minimal LIS for chronic anal fissure in 2017 at Seoul Song Do Hospital. We analyzed the patients’ clinical characteristics, manometry data, complications, and outcomes of minimal LIS. The outcomes of the surgery were assessed via questionnaires during the postoperative outpatient visits, beginning 2 weeks postoperatively.
Results
The overall complication rate was 4.0% (19 patients). Delayed healing occurred in 14 patients (3.0%), perianal abscess was present in 3 patients (0.6%), and gas incontinence occurred in 2 patients (0.4%). All complications were improved with conservative treatment. Recurrence, defined as the recurrence of anal fissure more than 4 weeks after healing, was present in 6 patients (1.3%).
Conclusion
Minimal LIS is a safe and effective treatment option for patients with chronic anal fissure. Postoperative complications, especially incontinence and recurrence, are rare.

Citations

Citations to this article as recorded by  
  • Management of Hemorrhoids and Anal Fissures
    Oladapo Akinmoladun, William Oh
    Surgical Clinics of North America.2024; 104(3): 473.     CrossRef
  • Anal Fissure and Its Treatments: A Historical Review
    Cristiana Riboni, Lucio Selvaggi, Francesco Cantarella, Mauro Podda, Salvatore Bracchitta, Vinicio Mosca, Angelo Cosenza, Vincenzo Cosenza, Francesco Selvaggi, Bruno Nardo, Francesco Pata
    Journal of Clinical Medicine.2024; 13(13): 3930.     CrossRef
  • Botulinum toxin injection versus lateral internal sphincterotomy for chronic anal fissure: a meta-analysis of randomized control trials
    Ali Bonyad, Reza Hossein Zadeh, Setareh Asgari, Fatemeh Eghbal, Pardis Hajhosseini, Hani Ghadri, Niloofar Deravi, Reza Shah Hosseini, Mahdyieh Naziri, Rasoul Hossein Zadeh, Yaser khakpour, Sina Seyedipour
    Langenbeck's Archives of Surgery.2024;[Epub]     CrossRef
  • Modern trends and priority in treatment of chronic anal fissure
    S. A. Aliev, E. S. Aliev
    Grekov's Bulletin of Surgery.2024; 183(4): 77.     CrossRef
  • New Findings at the Internal Anal Sphincter on Cadaveric Dissection and Review of Sphincter-Related Surgery in a Newer Prospective
    Aswini Kumar Pujahari
    Indian Journal of Surgery.2023; 85(3): 585.     CrossRef
  • Long-term Efficacy and Safety of Controlled Manual Anal Dilatation in the Treatment of Chronic Anal Fissures: A Single-center Observational Study
    Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Shigenori Ota, Kei Ohara, Mitsuhiro Inagaki, Yusuke Saitoh, Masanori Murakami
    Journal of the Anus, Rectum and Colon.2023; 7(4): 250.     CrossRef
  • The Association of Coloproctology of Great Britain and Ireland guideline on the management of anal fissure
    Katie L. R. Cross, Steven R. Brown, Jos Kleijnen, James Bunce, Melanie Paul, Sophie Pilkington, Oliver Warren, Oliver Jones, Jon Lund, Henry J. Goss, Michael Stanton, Tatenda Marunda, Artaza Gilani, L. Wee Sing Ngu, Philip Tozer
    Colorectal Disease.2023; 25(12): 2423.     CrossRef
  • Is It a Refractory Disease?- Fecal Incontinence; beyond Medication
    Chungyeop Lee, Jong Lyul Lee
    The Ewha Medical Journal.2022;[Epub]     CrossRef
Benign proctology
Analyzing the Role of Anal Sphincter Pressure in Rectocele Formation
Süleyman Büyükaşık, Mehmet Abdussamet Bozkurt, Selin Kapan, Halil Alis
Ann Coloproctol. 2020;36(5):330-334.   Published online March 16, 2020
DOI: https://doi.org/10.3393/ac.2019.09.15
  • 3,700 View
  • 125 Download
  • 3 Web of Science
  • 3 Citations
AbstractAbstract PDF
Purpose
Constipation is a common entity in society with various factors in the etiology. In this study, we evaluated the role of anal sphincter pressure of patients who refer to surgery clinic with complaint of constipation.
Methods
Sixty patients who refer to surgery clinic with complaint of constipation and were diagnosed with constipation due to Rome III criteria between July 2010 and September 2014. These patients were evaluated with defecography and were divided into 2 groups based on presence of rectocele. Both groups’ anal sphincter pressures were evaluated using anal manometry and findings were compared.
Results
The patients with rectocele and without rectocele using defecography were inspected with anal manometry regarding resting tone pressure, squeeze pressure, maximum squeeze pressure and simulated defecation response pressure, first sensation volume, urge sensation volume, and maximum tolerable volume. Results were compared and no significant difference was found regarding groups with rectocele and without rectocele (P > 0.05).
Conclusion
We have proved the hypothesis arguing that increased sphincter pressures do not play a role in the formation of rectocele by inducing an obstruction and the formation of dilation in proximal bowel, and demonstrated that the presence of rectocele is not dependent on an increase in sphincter pressures.

Citations

Citations to this article as recorded by  
  • A possible physiological mechanism of rectocele formation in women
    Ge Sun, Robbert J. de Haas, Monika Trzpis, Paul M. A. Broens
    Abdominal Radiology.2023; 48(4): 1203.     CrossRef
  • Colonic pseudo-obstruction in a patient with dyssynergic defecation: A case report
    Yejun Jeong, Yongjae Kim, Wonhyun Kim, Seoyeon Park, Su-Jin Shin, Eun Jung Park
    International Journal of Surgery Case Reports.2022; 98: 107524.     CrossRef
  • Treatment of Hemorrhoid in Unusual Condition-Pregnancy
    Hyo Seon Ryu
    The Ewha Medical Journal.2022;[Epub]     CrossRef
Anorectal Manometry Versus Patient-Reported Outcome Measures as a Predictor of Maximal Treatment for Fecal Incontinence
Lisa Ramage, Shengyang Qiu, Zhu Yeap, Constantinos Simillis, Christos Kontovounisios, Paris Tekkis, Emile Tan
Ann Coloproctol. 2019;35(6):319-326.   Published online December 31, 2019
DOI: https://doi.org/10.3393/ac.2018.10.16
  • 3,721 View
  • 67 Download
  • 4 Web of Science
  • 6 Citations
AbstractAbstract PDF
Purpose
This study aims to establish the ability of patient-reported outcome measures (PROMs) and anorectal manometry (ARM) in predicting the need for surgery in patients with fecal incontinence (FI).
Methods
Between 2008 and 2015, PROMs data, including the Birmingham Bowel and Urinary Symptoms Questionnaire (BBUSQ), Short Form 36 (SF-36), Wexner Incontinence Score and ARM results, were prospectively collected from 276 patients presenting with FI. Spearman rank was used to assess correlations between specific PROMs questions and ARM assessments of sphincter motor function. Binomial regression analyses were performed to identify factors predictive of the need for surgery. Finally, receiver operating characteristic (ROC) curve analyses were performed to establish the utility of individual ARM and PROMs variables in predicting the need for surgical intervention in patients with FI.
Results
Two hundred twenty-eight patients (82.60%) were treated conservatively while 48 (17.39%) underwent surgery. On univariate analyses, all 4 domains of the BBUSQ, all 8 domains of the SF-36, and the Wexner Incontinence Score were significant predictors of surgery. Additionally, maximum resting pressure, 5-second squeeze endurance, threshold volume, and urge volume were significant. On ROC curve analyses, the only significant ARM measurement was the 5-second squeeze endurance. PROMs, such as the incontinence domain of the BBUSQ and five of the SF-36 domains, were identified as fair discriminators of the need for surgery.
Conclusion
PROMs are reliable predictors of maximal treatment in patients with FI and can be readily used in primary care to aid surgical referrals and can be applied in hospital settings as an aid to guide surgical treatment decisions.

Citations

Citations to this article as recorded by  
  • Correlation of Digital Rectal Examination and Anorectal Manometry with Patient-Reported Outcomes Among Women with Fecal Incontinence
    Alayne Markland, Mary Ackenbom, Uduak Andy, Ben Carper, Eric Jelovsek, Douglas Luchristt, Shawn Menefee, Rebecca Rogers, Vivian Sung, Donna Mazloomdoost, Maria Gantz
    International Urogynecology Journal.2024; 35(12): 2367.     CrossRef
  • Pelvic floor investigations for anal incontinence: Are they useful to predict outcomes from conservative treatment?
    Karina Cuinas, Linda Ferrari, Carlene Igbedioh, Deepa Solanki, Andrew Williams, Alexis Schizas, Alison Hainsworth
    Neurourology and Urodynamics.2023; 42(5): 1122.     CrossRef
  • Anorectal dysfunction in multiple sclerosis patients: A pilot study on the effect of an individualized rehabilitation approach
    Martina Kovari, Jan Stovicek, Jakub Novak, Michaela Havlickova, Sarka Mala, Andrew Busch, Pavel Kolar, Alena Kobesova
    NeuroRehabilitation.2022; 50(1): 89.     CrossRef
  • Postpartum fecal incontinence. State of the problem
    D.R. Markaryan, A.M. Lukyanov, T.N. Garmanova, M.A. Agapov, V.A. Kubyshkin
    Khirurgiya. Zhurnal im. N.I. Pirogova.2022; (6): 127.     CrossRef
  • Functional outcomes after sphincter-preserving surgeries for low-lying rectal cancer: A review
    Eun Jung Park, Seung Hyuk Baik
    Precision and Future Medicine.2021; 5(4): 164.     CrossRef
  • Usefulness of Patient-Reported Outcome Measures and Anorectal Physiologic Tests in Predicting Clinical Outcome for Fecal Incontinence
    Chang-Nam Kim
    Annals of Coloproctology.2019; 35(6): 289.     CrossRef
Case Report
Colorectal Perforation After Anorectal Manometry for Low Anterior Resection Syndrome
Kyung Ha Lee, Ji Yeon Kim, Young Hoon Sul
Ann Coloproctol. 2017;33(4):146-149.   Published online August 31, 2017
DOI: https://doi.org/10.3393/ac.2017.33.4.146
  • 4,618 View
  • 75 Download
  • 6 Web of Science
  • 5 Citations
AbstractAbstract PDF

We experienced 3 cases of manometry-induced colon perforation. A 75-year-old man (case 1) underwent anorectal manometry (ARM) 3 years after radiotherapy for prostate cancer and a laparoscopic intersphincteric resection for rectal cancer. A 70-year-old man (case 2) underwent ARM 3 months after conventional neoadjuvant chemoradiotherapy and a laparoscopic low anterior resection for rectal cancer. A 78-year-old man (case 3) underwent ARM 2 months after a laparoscopic intersphincteric resection for rectal cancer. In all cases, a colon perforation with fecal peritonitis occurred. All were treated successfully using prompt and active operations and were discharged without any complications. ARM with a balloon, as a measure of rectal compliance, should be performed 2 months or longer after surgery. If a perforation occurs, prompt and active surgical intervention is necessary due to the high possibility of extensive fecal peritonitis.

Citations

Citations to this article as recorded by  
  • Effect of low anterior resection syndrome on quality of life in colorectal cancer patients: A retrospective observational study
    Dong-Ai Jin, Fang-Ping Gu, Tao-Li Meng, Xuan-Xuan Zhang
    World Journal of Gastrointestinal Surgery.2023; 15(10): 2123.     CrossRef
  • Functional anorectal studies in patients with low anterior resection syndrome
    Ssu‐Chi Chen, Kaori Futaba, Wing Wa Leung, Cherry Wong, Tony Mak, Simon Ng, Hans Gregersen
    Neurogastroenterology & Motility.2022;[Epub]     CrossRef
  • Variation in rectoanal inhibitory reflex after laparoscopic intersphincteric resection for ultralow rectal cancer
    Bin Zhang, Ke Zhao, Yu‐Juan Zhao, Shu‐Hui Yin, Guang‐Zuan Zhuo, Yong Zhao, Jian‐Hua Ding
    Colorectal Disease.2021; 23(2): 424.     CrossRef
  • Broken beer bottle as a cause of sigmoid perforation: A summary of causes and predictors in the management of traumatic and non-traumatic colorectal perforation
    Christian German Ospina-Pérez, Ana Milena Álvarez-Acuña, Lina María López-Álvarez, Rosa María Ospina-Pérez, Ivan David Lozada-Martínez, Sabrina Rahman
    International Journal of Surgery Case Reports.2021; 85: 106261.     CrossRef
  • Assessment of defecation function after sphincter-saving resection for mid to low rectal cancer: A cross-sectional study
    Bao-Jia Luo, Mei-Chun Zheng, Yang Xia, Zhu Ying, Jian-Hong Peng, Li-Ren Li, Zhi-Zhong Pan, Hui-Ying Qin
    European Journal of Oncology Nursing.2021; 55: 102059.     CrossRef
Original Articles
Usefulness of Anorectal Manometry for Diagnosing Continence Problems After a Low Anterior Resection
Audrius Dulskas, Narimantas E. Samalavicius
Ann Coloproctol. 2016;32(3):101-104.   Published online June 30, 2016
DOI: https://doi.org/10.3393/ac.2016.32.3.101
  • 4,155 View
  • 50 Download
  • 17 Web of Science
  • 18 Citations
AbstractAbstract PDF
Purpose

For several decades, the low anterior resection (LAR) with total mesorectal excision (TME) has been the gold standard for treating patients with rectal cancer. Up to 90% of patients undergoing sphincter-preserving surgery will have changes in bowel habits, so-called 'anterior resection syndrome.' This study examined patients' continence after a LAR for the treatment of rectal cancer.

Methods

This prospective study was performed between September 2014 and August 2015 at the National Cancer Institute and included 30 patients who underwent anorectal manometry preoperatively and at 3 and 4 months after a LAR, but 10 were excluded from further evaluation for various reasons. Wexner score was recorded preoperatively and 4 months after LAR (1 month after ileostomy repair).

Results

Postoperatively, 70% of patients complained of some degree of soiling (incontinence to liquid stool), and 30% experienced urgent defecation. Four months after surgery, these symptoms had somewhat abated. The anal resting pressure and the maximum squeezing pressure did not change significantly. Rectal capacity and compliance were reduced in all patients. The majority of patients demonstrated manometric anorectal changes and clinical anorectal function disorders during the first 4 months after surgery. The Wexner scores and the manometric findings showed no correlation.

Conclusion

Many patients undergoing a LAR with TME for the treatment of rectal cancer experience some degree of incontinence postoperatively. Anorectal manometry may be used as an additional tool for evaluating problems with continence after a LAR. No correlation between the Wexner score and the manometric findings was observed.

Citations

Citations to this article as recorded by  
  • Long-term Survival and Functional Outcomes of Laparoscopic Surgery for Clinical Stage I Ultra-low Rectal Cancers Located Within 5 cm of the Anal Verge
    Masaaki Ito, Yuichiro Tsukada, Jun Watanabe, Yosuke Fukunaga, Yasumitsu Hirano, Kazuhiro Sakamoto, Hiroki Hamamoto, Masanori Yoshimitsu, Hisanaga Horie, Nobuhisa Matsuhashi, Yoshiaki Kuriu, Shuntaro Nagai, Madoka Hamada, Shinichi Yoshioka, Shinobu Ohnuma,
    Annals of Surgery.2025; 281(2): 304.     CrossRef
  • Long term persistence and risk factors for anorectal symptoms following low anterior resection for rectal cancer
    E. Koifman, M. Armoni, Y. Gorelik, A. Harbi, Y. Streltsin, S. D. Duek, R. Brun, Y. Mazor
    BMC Gastroenterology.2024;[Epub]     CrossRef
  • Effect of neoadjuvant chemoradiation on anorectal function assessed with anorectal manometry: A systematic review and meta-analysis
    Pamela Milito, Guglielmo Niccolò Piozzi, Mohammad Iqbal Hussain, Tommaso A. Dragani, Luca Sorrentino, Maurizio Cosimelli, Marcello Guaglio, Luigi Battaglia
    Tumori Journal.2024; 110(4): 284.     CrossRef
  • Low anterior resection syndrome
    Matthew C. Hernandez, Paul Wong, Kurt Melstrom
    Journal of Surgical Oncology.2023; 127(8): 1271.     CrossRef
  • Effects of neoadjuvant radiochemotherapy for anorectal function in locally advanced rectal cancer patients: a study protocol for a prospective, observational, controlled, multicentre study
    Jie Shi, Yi-Kan Cheng, Fang He, Jian Zheng, Yun-Long Wang, Xiang-Bo Wan, Hong-Cheng Lin, Xin-Juan Fan
    BMC Cancer.2023;[Epub]     CrossRef
  • Should anorectal manometry be routine before stoma reversal in patients after an intersphincteric resection?
    Mufaddal Kazi, Bhushan Jajoo, Jitender Rohila, Sayali Dohale, Chaitali Nashikkar, Rajesh Sainani, Prajesh Bhuta, Ashwin Desouza, Avanish Saklani
    Colorectal Disease.2023; 25(8): 1638.     CrossRef
  • Optimizing the Utility of Anorectal Manometry for Diagnosis and Therapy: A Roundtable Review and Recommendations
    Satish S.C. Rao, Nitin K. Ahuja, Adil E. Bharucha, Darren M. Brenner, William D. Chey, Jill K. Deutsch, David C. Kunkel, Baharak Moshiree, Leila Neshatian, Robert M. Reveille, Gregory S. Sayuk, Jordan M. Shapiro, Eric D. Shah, Kyle Staller, Steven D. Wexn
    Clinical Gastroenterology and Hepatology.2023; 21(11): 2727.     CrossRef
  • Clinical impact of the triple‐layered circular stapler for reducing the anastomotic leakage in rectal cancer surgery: Porcine model and multicenter retrospective cohort analysis
    Ryota Nakanishi, Yoshiaki Fujimoto, Masahiko Sugiyama, Yuichi Hisamatsu, Tomonori Nakanoko, Koji Ando, Mitsuhiko Ota, Yasue Kimura, Eiji Oki, Tomoharu Yoshizumi
    Annals of Gastroenterological Surgery.2022; 6(2): 256.     CrossRef
  • Troubles de la motricité anorectale : troubles fonctionnels de la défécation et incontinence fécale
    C. Desprez, V. Bridoux, A.-M. Leroi
    Journal de Chirurgie Viscérale.2022; 159(1): S46.     CrossRef
  • Disorders of anorectal motility: Functional defecation disorders and fecal incontinence
    C. Desprez, V. Bridoux, A.-M. Leroi
    Journal of Visceral Surgery.2022; 159(1): S40.     CrossRef
  • Long-Term Anorectal Manometry Outcomes After Laparoscopic and Transanal Total Mesorectal Excision
    Ana López-Sánchez, Antonio Morandeira-Rivas, Carlos Moreno-Sanz, Francisco Javier Cortina-Oliva, Marina Manzanera-Díaz, Jhonny David Gonzales-Aguilar
    Journal of Laparoendoscopic & Advanced Surgical Techniques.2021; 31(4): 395.     CrossRef
  • Assessment of defecation function after sphincter-saving resection for mid to low rectal cancer: A cross-sectional study
    Bao-Jia Luo, Mei-Chun Zheng, Yang Xia, Zhu Ying, Jian-Hong Peng, Li-Ren Li, Zhi-Zhong Pan, Hui-Ying Qin
    European Journal of Oncology Nursing.2021; 55: 102059.     CrossRef
  • Functional outcomes after sphincter-preserving surgeries for low-lying rectal cancer: A review
    Eun Jung Park, Seung Hyuk Baik
    Precision and Future Medicine.2021; 5(4): 164.     CrossRef
  • Predictors of permanent stoma creation in patients with mid or low rectal cancer: results of a multicentre cohort study with preoperative evaluation of anal function
    S. Kim, M. H. Kim, J. H. Oh, S.‐Y. Jeong, K. J. Park, H.‐K. Oh, D.‐W. Kim, S.‐B. Kang
    Colorectal Disease.2020; 22(4): 399.     CrossRef
  • Preoperative incremental maximum squeeze pressure as a predictor of fecal incontinence after very low anterior resection for low rectal cancer
    Masatoshi Kochi, Hiroyuki Egi, Tomohiro Adachi, Yuji Takakura, Shoichiro Mukai, Kazuhiro Taguchi, Ikki Nakashima, Yusuke Sumi, Shintaro Akabane, Koki Sato, Hisaaki Yoshinaka, Minoru Hattori, Hideki Ohdan
    Surgery Today.2020; 50(5): 516.     CrossRef
  • Manometric assessment of anorectal function after transanal total mesorectal excision
    M. X. Bjoern, S. K. Perdawood
    Techniques in Coloproctology.2020; 24(3): 231.     CrossRef
  • Postoperative Bowel Function After Anal Sphincter-Preserving Rectal Cancer Surgery: Risks Factors, Diagnostic Modalities, and Management
    Chris George Cura Pales, Sanghyun An, Jan Paolo Cruz, Kwangmin Kim, Youngwan Kim
    Annals of Coloproctology.2019; 35(4): 160.     CrossRef
  • Effectiveness of Pelvic Floor Rehabilitation for Bowel Dysfunction After Intersphincteric Resection for Lower Rectal Cancer
    Hideaki Nishigori, Masayuki Ishii, Yujiro Kokado, Kouji Fujimoto, Hiroshi Higashiyama
    World Journal of Surgery.2018; 42(10): 3415.     CrossRef
Biofeedback Therapy Before Ileostomy Closure in Patients Undergoing Sphincter-Saving Surgery for Rectal Cancer: A Pilot Study
Jeong-Ki Kim, Byeong Geon Jeon, Yoon Suk Song, Mi Sun Seo, Yoon-Hye Kwon, JI Won Park, Seung-Bum Ryoo, Seung-Yong Jeong, Kyu Joo Park
Ann Coloproctol. 2015;31(4):138-143.   Published online August 31, 2015
DOI: https://doi.org/10.3393/ac.2015.31.4.138
  • 4,595 View
  • 66 Download
  • 13 Web of Science
  • 12 Citations
AbstractAbstract PDF
Purpose

This study prospectively investigated the effects of biofeedback therapy on objective anorectal function and subjective bowel function in patients after sphincter-saving surgery for rectal cancer.

Methods

Sixteen patients who underwent an ileostomy were randomized into two groups, one receiving conservative management with the Kegel maneuver and the other receiving active biofeedback before ileostomy closure. Among them, 12 patients (mean age, 57.5 years; range, 38 to 69 years; 6 patients in each group) completed the study. Conservative management included lifestyle modifications, Kegel exercises, and medication. Patients were evaluated at baseline and at 1, 3, 6, and 12 months after ileostomy closure by using anal manometry, modified Wexner Incontinence Scores (WISs), and fecal incontinence quality of life (FI-QoL) scores.

Results

Before the ileostomy closure, the groups did not differ in baseline clinical characteristics or resting manometric parameters. After 12 months of follow-up, the biofeedback group demonstrated a statistically significant improvement in the mean maximum squeezing pressure (from 146.3 to 178.9, P = 0.002). However, no beneficial effect on the WIS was noted for biofeedback compared to conservative management alone. Overall, the FI-QoL scores were increased significantly in both groups after ileostomy closure (P = 0.006), but did not differ significantly between the two groups.

Conclusion

Although the biofeedback therapy group demonstrated a statistically significant improvement in the maximum squeezing pressure, significant improvements in the WISs and the FI-QoL scores over time were noted in both groups. The study was terminated early because no therapeutic benefit of biofeedback had been demonstrated.

Citations

Citations to this article as recorded by  
  • The effectiveness of physiotherapy interventions on fecal incontinence and quality of life following colorectal surgery: a systematic review and meta-analysis of randomized controlled trials
    Ming Yan Pun, Pak Ho Leung, Tsz Ching Chan, Chunn Pang, Kin Hei Chan, Priya Kannan
    Supportive Care in Cancer.2024;[Epub]     CrossRef
  • Application of pelvic floor rehabilitation in patients with colorectal cancer: a scoping review
    Lu Zhou, Changkun Zhong, Yuanyuan Su, Zhengyang Zhang, Ling Wang
    Techniques in Coloproctology.2024;[Epub]     CrossRef
  • Effectiveness of Pelvic Floor Muscle Training for Patients Following Low Anterior Resection
    Young Man Kim, Eui Geum Oh
    Journal of Wound, Ostomy & Continence Nursing.2023; 50(2): 142.     CrossRef
  • ILEOSTIM trial: a study protocol to evaluate the effectiveness of efferent loop stimulation before ileostomy reversal
    N. Blanco, I. Oliva, P. Tejedor, E. Pastor, A. Alvarellos, C. Pastor, J. Baixauli, J. Arredondo
    Techniques in Coloproctology.2023; 27(12): 1251.     CrossRef
  • Low anterior resection syndrome
    Seung‐Bum Ryoo
    Annals of Gastroenterological Surgery.2023; 7(5): 719.     CrossRef
  • Efficacy of Pelvic Floor Muscle Training for Postoperative Patients With Rectal Cancer: A Systematic Review and Meta-Analysis
    Yuki Nakashima, Kenichi Fudeyasu, Yuki Kataoka, Shunsuke Taito, Takashi Ariie, Yukio Mikami
    Cureus.2023;[Epub]     CrossRef
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    Sigmar Stelzner, Juliane Kupsch, Sören Torge Mees
    Der Chirurg.2021; 92(7): 612.     CrossRef
  • Anterior resection syndrome: a randomized clinical trial of a 5-HT3 receptor antagonist (ramosetron) in male patients with rectal cancer
    S -B Ryoo, J W Park, D W Lee, M A Lee, Y -H Kwon, M J Kim, S H Moon, S -Y Jeong, K J Park
    British Journal of Surgery.2021; 108(6): 644.     CrossRef
  • Investigating Risk Factors for Complications after Ileostomy Reversal in Low Anterior Rectal Resection Patients: An Observational Study
    Mateusz Rubinkiewicz, Jan Witowski, Michał Wysocki, Magdalena Pisarska, Stanisław Kłęk, Andrzej Budzyński, Michał Pędziwiatr
    Journal of Clinical Medicine.2019; 8(10): 1567.     CrossRef
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    Weidong Wang, Fang Wang, Feng Fan, Ana Cristina Sedas, Jian Wang
    International Journal of Behavioral Medicine.2017; 24(2): 191.     CrossRef
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    An Liu, Chenggang Huang, Jia Xu, Xuehong Cai
    Cancer Medicine.2016; 5(9): 2417.     CrossRef
  • Biofeedback Therapy After Sphincter-Preservation Surgery for the Treatment of Rectal Cancer
    Ik Yong Kim
    Annals of Coloproctology.2015; 31(4): 119.     CrossRef
Correlation of Histopathology With Anorectal Manometry Following Stapled Hemorrhoidopexy
Young Ki Hong, Yoon Jung Choi, Jung Gu Kang
Ann Coloproctol. 2013;29(5):198-204.   Published online October 31, 2013
DOI: https://doi.org/10.3393/ac.2013.29.5.198
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AbstractAbstract PDF
Purpose

The removal of smooth muscle during stapled hemorrhoidopexy raises concerns regarding its effects on postoperative anorectal function. The purpose of this study was to evaluate the correlation between the amount of muscle removed and changes in anorectal manometry following stapled hemorrhoidopexy.

Methods

Patients with symptomatic II, III, or IV degree hemorrhoids that underwent stapled hemorrhoidopexy between January 2008 and May 2011 were included in this study. Anorectal manometry was performed preoperatively and at three months postoperatively. The resected doughnuts were examined histologically, and the thicknesses of muscle fibers were evaluated.

Results

Eighty-five patients (34 males) with a median age of 47 years were included. Muscularis propria fibers were identified in 63 of 85 pathologic specimens (74.1%). The median thickness of the muscle fibers was 1.58 ± 1.21 mm (0 to 4.5 mm). The mean resting pressure decreased by approximately 7 mmHg after operation in the 85 patients (P = 0.019). In patients with muscle incorporation, there was a significant difference in mean resting pressure (P = 0.041). In the analysis of the correlation of the difference in anorectal manometry results ([the result of postsurgical anorectal manometry] - [the result of presurgical anorectal manometry]) to the thickness of muscle fibers, no significant differences were seen. No patients presented with fecal incontinence.

Conclusion

Although the incidence of fecal incontinence is very low, muscle incorporation in the resected doughnuts following stapled hemorrhoidopexy may affect anorectal pressure. Therefore, surgeons should endeavor to minimize internal sphincter injury during stapled hemorrhoidopexy.

Citations

Citations to this article as recorded by  
  • The prevalence of incontinence after excisional hemorrhoidectomy and stapled hemorrhoidopexy: A systematic review and meta-analysis
    James Z. Jin, Velia Men, Praharsh Bahl, Harshitha Penneru, Robin Yang, Niket Shah, Andrew G. Hill
    Surgery.2025; 180: 109139.     CrossRef
  • Anatomical Anal Stenosis after PPH: Insights from a Retrospective Study and Rat Model
    Chia-Cheng Wen, Shih-Ming Huang, Yi-Wen Wang
    International Journal of Molecular Sciences.2024; 25(6): 3543.     CrossRef
  • Evaluation of Clinical Manifestations of Hemorrhoidal Disease, Carried Out Surgeries and Prolapsed Anorectal Tissues: Associations with ABO Blood Groups of Patients
    Inese Fišere, Valērija Groma, Šimons Svirskis, Estere Strautmane, Andris Gardovskis
    Journal of Clinical Medicine.2023; 12(15): 5119.     CrossRef
  • Association of Muscle Fibers with Histopathology in Doughnut Specimens Following Stapled Hemorrhoidopexy and Their Impacts on Postoperative Outcomes
    Chetty Y. V. Narayanaswamy, M. R. Sreevathsa, G. Akhil Chowdari, Koteshwara Rao
    The Surgery Journal.2022; 08(03): e199.     CrossRef
  • Anorectal Functional Outcomes Following Doppler-Guided Transanal Hemorrhoidal Dearterialization: Evidence from Vietnam
    Le Manh Cuong, Vu Nam, Tran Thai Ha, Tran Thu Ha, Tran Quang Hung, Do Van Loi, Tran Manh Hung, Nguyen Van Son, Vu Duy Kien
    Advances in Therapy.2020; 37(3): 1136.     CrossRef
  • Post-surgical fecal incontinence
    Filippo Pucciani
    Updates in Surgery.2018; 70(4): 477.     CrossRef
  • Magnetic resonance imaging and endorectal ultrasound for diagnosis of rectal lesions
    Franciszek Burdan, Iwona Sudol-Szopinska, Elzbieta Staroslawska, Malgorzata Kolodziejczak, Robert Klepacz, Agnieszka Mocarska, Marek Caban, Iwonna Zelazowska-Cieslinska, Justyna Szumilo
    European Journal of Medical Research.2015;[Epub]     CrossRef
  • Histopathology and Physiological Alterations After Procedure for Prolapsed Hemorrhoids
    Do Sun Kim
    Annals of Coloproctology.2013; 29(5): 179.     CrossRef
An Analysis of Factors Associated with Increased Perineal Descent in Women
Jina Chang, Soon Sup Chung
J Korean Soc Coloproctol. 2012;28(4):195-200.   Published online August 31, 2012
DOI: https://doi.org/10.3393/jksc.2012.28.4.195
  • 6,139 View
  • 59 Download
  • 10 Citations
AbstractAbstract PDF
Purpose

Treatment of descending perineal syndrome is focused on personal etiology and on improving symptoms. However, the etiology of increased perineal descent (PD) is unclear. Therefore, the aim of the present study was to evaluate factors associated with increased resting and dynamic PD in women.

Methods

From January 2004 to August 2010, defecographic findings in 201 female patients were reviewed retrospectively. Patient's age, surgical history, manometric results and defecographic findings were compared with resting and dynamic PD.

Results

Age (P < 0.01), number of vaginal deliveries (P < 0.01) and resting anorectal angle (P < 0.01) were correlated with increased resting PD. Also, findings of rectoceles (P < 0.05) and intussusceptions (P < 0.05) were significantly correlated with increased resting PD. On the other hand, increased dynamic PD was correlated with age (P < 0.05), resting anal pressure (P < 0.01) and sigmoidoceles (P < 0.05). No significant correlation existed between non-relaxing puborectalis, history of pelvic surgery and increased PD. Also, no significant differences in PD according to the symptoms were observed.

Conclusion

Increased number of vaginal deliveries and increased resting rectoanal angle are associated with increased resting PD whereas increased resting anal pressure is correlated with increased dynamic PD. Older age correlates with both resting and dynamic PD. Defecographic findings, such as rectoceles and intussusceptions, are associated with resting PD, and sigmoidoceles correlated with dynamic PD. These results can serve as foundational research for understanding the pathophysiology and causes of increasing PD in women better and for finding a fundamental method of treatment.

Citations

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  • Evaluation of Perineal Descent Measurements on Pelvic Floor Imaging
    Isabelle M. A. van Gruting, Kirsten Kluivers, Aleksandra Stankiewicz, Joanna IntHout, Kim W. M. van Delft, Ranee Thakar, Abdul H. Sultan
    Journal of Clinical Medicine.2025; 14(2): 548.     CrossRef
  • Imaging and clinical assessment of functional defecatory disorders with emphasis on defecography
    Neeraj Lalwani, Rania Farouk El Sayed, Amita Kamath, Sara Lewis, Hina Arif, Victoria Chernyak
    Abdominal Radiology.2021; 46(4): 1323.     CrossRef
  • Consensus Definitions and Interpretation Templates for Fluoroscopic Imaging of Defecatory Pelvic Floor Disorders
    Ian Paquette, David Rosman, Rania El Sayed, Tracy Hull, Ervin Kocjancic, Lieschen Quiroz, Susan Palmer, Abbas Shobeiri, Milena Weinstein, Gaurav Khatri, Liliana Bordeianou
    Diseases of the Colon & Rectum.2021; 64(1): 31.     CrossRef
  • Consensus Definitions and Interpretation Templates for Fluoroscopic Imaging of Defecatory Pelvic Floor Disorders Proceedings of the Consensus Meeting of the Pelvic Floor Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdom
    Ian Paquette, David Rosman, Rania El Sayed, Tracy Hull, Ervin Kocjancic, Lieschen Quiroz, Susan Palmer, Abbas Shobeiri, Milena Weinstein, Gaurav Khatri, Liliana Bordeianou
    Female Pelvic Medicine & Reconstructive Surgery.2021; 27(1): e1.     CrossRef
  • Consensus Definitions and Interpretation Templates for Fluoroscopic Imaging of Defecatory Pelvic Floor Disorders
    Ian Paquette, David Rosman, Rania El Sayed, Tracy Hull, Ervin Kocjancic, Lieschen Quiroz, Susan Palmer, Abbas Shobeiri, Milena Weinstein, Gaurav Khatri, Liliana Bordeianou
    Techniques in Coloproctology.2021; 25(1): 3.     CrossRef
  • Descending Perineum Associated With Pelvic Organ Prolapse Treated by Sacral Colpoperineopexy and Retrorectal Mesh Fixation: Preliminary Results
    Aude Nessi, Aminata Kane, Etienne Vincens, Delphine Salet-Lizée, Karine Lepigeon, Richard Villet
    Frontiers in Surgery.2018;[Epub]     CrossRef
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    Zaid Chaudhry, Christopher Tarnay
    International Urogynecology Journal.2016; 27(8): 1149.     CrossRef
  • Correlation Between Echodefecography and 3-Dimensional Vaginal Ultrasonography in the Detection of Perineal Descent in Women With Constipation Symptoms
    Sthela M. Murad-Regadas, Francisco Sergio Pinheiro Regadas, Lusmar V. Rodrigues, Adjra da Silva Vilarinho, Guilherme Buchen, Livia Olinda Borges, Lara B. Veras, Mariana Murad da Cruz
    Diseases of the Colon & Rectum.2016; 59(12): 1191.     CrossRef
  • Descending perineum syndrome: new perspectives
    F. Pucciani
    Techniques in Coloproctology.2015; 19(8): 443.     CrossRef
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    F. Pucciani
    Techniques in Coloproctology.2015; 19(12): 713.     CrossRef
Effects of Age and Sex on Anorectal Manometry.
Heo, Seung Chul , Kang, Sung Bum , Park, Kyu Joo , Park, Jae Gahb
J Korean Soc Coloproctol. 2009;25(5):285-293.
DOI: https://doi.org/10.3393/jksc.2009.25.5.285
  • 46,169 View
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  • 2 Citations
AbstractAbstract PDF
PURPOSE
This study was performed to evaluate the effects of age and sex on anorectal manometry.
METHODS
Seventy-four consecutive patients who underwent surgery for sigmoid colon cancer and who had neither anal disorders nor colonic obstruction were included in this study. There were 45 men and 29 women, and the mean age was 58.6. Pressure measurements used both the rapid and the station pull-through (RPT and SPT) methods, and volume measurements used a balloon-tipped catheter. Three pressure indices (vector volume, maximal pressure, and mean pressure), three sphincter length indices (sphincter length, high pressure zone [HPZ] length, and maximal pressure position), and three volume indices (minimal sensory volume, maximal tolerance volume, and rectoanal inhibitory reflex) were analyzed.
RESULTS
Squeezing pressures were higher in men than in women, especially in the RPT method, while resting pressures were not different. Sphincter length and HPZ length were not different between the sexes, but the maximal pressure position was farther from the anal verge in men. Rectal volume indices were not different between the sexes. The resting and squeezing pressures decreased linearly with aging in men, but not in women. The differences in squeezing pressures between men and women were evident in their forties and fifties, but decreased gradually with aging, with no differences being observed in their seventies. With aging, the minimal sensory volume increased in women, and the maximal tolerance volume increased in men.
CONCLUSION
Anal canal pressures and volume indices are influenced by sex, age, and measurement method. Therefore, sex, age, and measurement method must be considered in the evaluation and application of anorectal manometry.

Citations

Citations to this article as recorded by  
  • Comparison between a new electronic bidet and conventional sitz baths: a manometric evaluation of the anal resting pressure in normal healthy volunteers
    S.-B. Ryoo, H.-K. Oh, E. C. Han, Y. S. Song, M. S. Seo, E. K. Choe, S. H. Moon, K. J. Park
    Techniques in Coloproctology.2015; 19(9): 535.     CrossRef
  • Anorectal manometric parameters are influenced by gender and age in subjects with normal bowel function
    Hyang Ran Lee, Seok-Byung Lim, Jeong Yun Park
    International Journal of Colorectal Disease.2014; 29(11): 1393.     CrossRef
Evaluation of Anal Continence Function by Advanced Anal Manometric Parameters.
Seong, Moo Kyung , Kim, Keun Young , Yoo, Young Bum
J Korean Soc Coloproctol. 2009;25(1):20-25.
DOI: https://doi.org/10.3393/jksc.2009.25.1.20
  • 1,650 View
  • 9 Download
  • 2 Citations
AbstractAbstract PDF
PURPOSE
Anal manometry is one of the most commonly used tests to evaluate fecal continence function. Advanced pressure parameters of the tests, such as fatigue rate index (FRI), resting rectoanal pressure gradient (RPG), cough index (CI), and radial asymmetry (RA) are recently devised to make up the inaccuracy of conventional parameters, but without solid verification. The object of this study is to investigate such parameters including conventional ones in incontinent patients compared with those in controls and to determine the significance of each parameter.
METHODS
Forty-four patients with anal incontinence and 42 controls were studied. We examined conventional pressure parameters (mean resting pressure [MRP], maximum squeeze pressure [MXSP]) and advanced parameters (RPG, FRI, CI, RA), and compare those parameters with normal controls. Multiple logistic regression analysis and receiver operating characteristic curve analyses were also performed.
RESULTS
No difference was detected in demographic factors between the two groups. Basic manometric parameters were significantly different between the two groups (MRP, 31.1+/-20.7 mmHg vs. 41.4+/-18.6 mmHg, P=0.0170; MXSP, 203.1+/-84.3 mmHg vs. 258.5+/-105.9 mmHg, P=0.0086). Among advanced parameters, RPG and FRI were significantly different (2.83+/-1.54 vs. 4.08+/-1.53, P=0.0003; 9+/-21.6 sec vs. 75.6+/-12.1 sec, P=0.0333), but CI and RA were not so different (0.74+/-0.45 vs. 0.61+/-0.33, P=0.1326; 22.7+/-7.0% vs. 21.1+/-7.6%, P=0.3244). Only RPG was significant in multiple logistic regression analysis (P=0.019). Areas under ROC curves were 0.65 for MRP, 0.65 for MXSP, 0.82 for RPG, and 0.73 for FRI.
CONCLUSION
Among anal manometric pressure parameters, RPG and FRI as advanced parameters are more accurate than any other parameters in detecting fecal incontinence.

Citations

Citations to this article as recorded by  
  • Anorectal manometric parameters are influenced by gender and age in subjects with normal bowel function
    Hyang Ran Lee, Seok-Byung Lim, Jeong Yun Park
    International Journal of Colorectal Disease.2014; 29(11): 1393.     CrossRef
  • Determinant of Anal Resting Pressure Gradient in Association With Continence Function
    Moo-Kyung Seong, Ung-Chae Park, Sung-Il Jung
    Journal of Neurogastroenterology and Motility.2011; 17(3): 300.     CrossRef
Case Report
Rectal Perforation after Anorectal Manometry Following Preoperative Chemoradiotherapy and Low Anterior Resection: Report of a Cases.
Jeong, Woon Kyung , Chung, Tae Sung , Lim, Sang Woo , Park, Ji Won , Lim, Seok Byung , Choi, Hyo Seong , Jeong, Seung Yong
J Korean Soc Coloproctol. 2008;24(4):298-301.
DOI: https://doi.org/10.3393/jksc.2008.24.4.298
  • 1,979 View
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  • 3 Citations
AbstractAbstract PDF
Anorectal manometry is widely used to evaluate anorectal function. Few reports have described complications resulting from this procedure. A 47-year-old male underwent preoperative chemoradiotherapy and a low anterior resection for rectal cancer. The patient underwent anorectal manometry at postoperative 8 months. A rectal perforation was diagnosed shortly thereafter. The patient was initially managed conservatively using percutaneous drainage and parenteral antibiotics and then discharged on day 60 after the event. One month later, a colo-cutaneous fistula and expanding abdominal fasciitis developed. The patient underwent surgical exploration, drainage, resection of the rectum including the fistula, and redo-coloanal anastomosis with a diverting ileostomy. The patient discharged without complications on postoperative day 25. Anorectal manometry should be performed with particular care in patients who have undergone radiotherapy and anastomosis at the rectum.

Citations

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  • Habit training versus habit training with direct visual biofeedback in adults with chronic constipation: study protocol for a randomised controlled trial
    Christine Norton, Anton Emmanuel, Natasha Stevens, S. Mark Scott, Ugo Grossi, Sybil Bannister, Sandra Eldridge, James M. Mason, Charles H. Knowles
    Trials.2017;[Epub]     CrossRef
  • Colorectal Perforation After Anorectal Manometry for Low Anterior Resection Syndrome
    Kyung Ha Lee, Ji Yeon Kim, Young Hoon Sul
    Annals of Coloproctology.2017; 33(4): 146.     CrossRef
  • Perforación rectal tras manometría anorrectal sin enfermedad rectal previa: una complicación excepcional resuelta con tratamiento médico
    Jorge Antonio Núñez Otero, Mariano Gómez Rubio, Ángel R. Durán Aguado, José L. Martínez Albares
    Gastroenterología y Hepatología.2013; 36(9): 577.     CrossRef
Original Articles
Role of Anorectal Physiologic Studies for the Diagnosis and Treatment of Non- relaxing Puborectalis Syndrome.
Kim, Nam Hyuk , Hwang, Yong Hee , Choi, Kun Phil
J Korean Soc Coloproctol. 2003;19(4):221-228.
  • 1,067 View
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AbstractAbstract PDF
PURPOSE
To assess the effectiveness of cinedefecography (CD), anal electromyography (EMG), and anal manometry (ARM) for the diagnosis of non-relaxing puborectalis syndrome (NRPR) and to compare the outcomes for patients after biofeedback therapy (BF).
METHODS
The clinical criteria used in this study for NRPR included straining, incomplete evacuation, tenesmus, and the need for enemas, suppositories, or digitation. Patients who satisfied the clinical criteria were evaluated by use of anorectal physiology tests: CD, EMG, and ARM. The EMG criteria included failure to achieve a significant decrease in the electrical activity of the puborectalis (PR) during attempted evacuation. The ARM criteria included failure to achieve a significant decrease in intra-anal pressure during attempted evacuation. The CD criteria included either paradoxical contraction or failure of the PR to relax together with incomplete evacuation. Other possible etiologies for incomplete evacuation, such as rectal intussusception or rectocele, were excluded in all cases. Fifty-eight constipated patients diagnosed as having NRPR by at least one of anorectal physiolosic tests had more than one BF session. The outcomes for fifty-one patients (mean age, 44.8 years; male-to-female ratio, 22:29) were reported as either improved or unimproved at a mean follow-up of 12.7 (range, 2~30) months. The sensitivities, the specificities, and the positive and negative predictive values for the CD, EMG, and ARM diagnoses of NRPR were calculated to assess the diagnostic accuracy of each test and to identify predictors associated with the outcome of BF.
RESULTS
The sensitivities of EMG, CD, and ARM were 96%, 89%, and 85%, respectively (P>0.05). The positive predictive values of the three tests were 63% for EMG, 52% for ARM, and 51% for CD (P>0.05). The negative predictive values of the three tests were 90% for EMG, 43% for ARM, and 25% for CD (P<0.05). The specificities of the three tests were 38% for EMG, 13% for ARM, and 2% for CD (P<0.05). The positive predictive values the two-study-positive groups and the three-study-positive group were 63% for the EMG- and ARM-positive group, 61% for the CD- and EMG-positive group, 51% for the CD- and ARM-positive group, and 61% for the three-study- positive group (P>0.05).
CONCLUSIONS
A combination of the CD and the EMG tests is suggested for the diagnosis of NRPR.
Measurement of External Anal Sphincter Function by Fatigue Rate Index.
Seong, Moo Kyung , Yoo, Young Bum
J Korean Soc Coloproctol. 2002;18(3):184-189.
  • 1,029 View
  • 19 Download
AbstractAbstract PDF
PURPOSE
Fatigue rate index (FRI) is one of relatively unknown parameters of anal manometry. It was devised to assess sustained voluntary contractibility of external anal sphincter muscle. We designed this study to determine the predictability of FRI in evaluating patients with symptoms of fecal incontinence.
METHODS
Consecutive male patients with fecal incontinence, those with prolapsed hemorrhoids but without any kind of incontinence symptom, and male healthy volunteers who have no anal symptom were grouped as A, B, C. Anal manometric parameters including FRI were measured and compared statistically among them.
RESULTS
All subjects were 84. Group A 27, Group B 33, and Group C 24. Their ages were 33.33+/-2.91 (mean SE), 39.27+/-2.80, and 50.81+/-4.33, respectively. Mean resting pressures (mmHg) were 78.11 6.56 for group A, 81.18+/-7.19 for group B, and 57.81+/-7.80 for group C. Maximum resting pressures (mmHg) were 98.67+/-9.69, 100.82+/-8.49, 78.13+/-10.26. Mean squeeze pressures (mmHg) were 229.11+/-18.72, 248.18+/-23.03, 156.94+/-17.89. Maximum squeeze pressures (mmHg) were 286.50+/-33.76, 298.59+/-27.83, 187.38+/-21.08. Resting radial asymmetries (%) were 18.85+/-2.81, 19.85+/-2.31, 28.70+/-4.79. Squeeze radial asymmetries were 15.73+/-2.90, 16.29+/-1.96, 16.47+/-2.95. Fatigue rates were 0.90+/-0.21, 1.17+/-0.15, 1.38+/-0.40. Fatigue rate indices (min.) were 3.76+/-0.41, 2.63+/-0.20, 1.94+/-0.26, respectively. Differences between group A and group C were statistically significant in mean squeeze pressure (P=0.0093), maximum squeeze pressure (P= 0.0190) and FRI (P=0.0008). Those between group B and group C were significant also in mean squeeze pressure (P=0.005), maximum squeeze pressure (P=0.0051), and FRI (P=0.0396). Multiple logistic regression analysis revealed that independently significant parameters were age (P= 0.002) and FRI (P=0.007). Cut-off point of FRI for incontinence with maximum sensitivity and specificity was 2.4min. by ROC (receiver operating characteristics) analysis.
CONCLUSION
FRI is a meaningful parameter in predicting fecal incontinence, which can be used in assessment of sphincter function and future treatment protocols.
Manometric Investigation of Anorectal Dysfunction in Patients with Progressive Systemic Sclerosis.
Choi, Hong Jo , Lim, Hyun Sung , Park, Ki Jae , Chung, Won Tae , Lee, Sung Won
J Korean Soc Coloproctol. 2002;18(2):83-88.
  • 1,038 View
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AbstractAbstract PDF
PURPOSE
The aim of this study was to investigate the anorectal function in patients with progressive systemic sclerosis (PSS), thus to define the clinical role of anorectal manometry in the earlier diagnosis of anorectal involvement of PSS.
METHODS
Seventeen consecutive patients (all females) with PSS were evaluated with anorectal manometry by the stationary pullthrough technique using the 8-channel hydraulic capillary infusion system for anorectal function. Functional parameters of the manometry were compared between patients with PSS and 20 normal control subjects, matched for age and sex.
RESULTS
The mean resting pressure over the high pressure zone (HPZ) in patients with PSS was significantly lower than that in the control group (70.8 3.4 mmHg vs. 81.5 3.2 mmHg: P=0.046). The HPZ in patients with PSS was also significantly reduced compared with that in the control (1.5 0.1 cm vs. 2.5 0.1 cm: P=0002). The rectoanal inhibitory reflex (RAIR) was detected in only 10 patients (59%) in the PSS group, but was present in all except one (95%) in the control (P=0.022). More interestingly, RAIR in patients with PSS responded at a higher volume of the air insufflated than that in the control (74% vs. 30% at 20 cc, 21% vs. 30% at 30 cc, and 0% vs. 40% at 50 cc, respectively: P=0.031). Other functional parameters, including maximal squeeze pressure, minimal sensory and maximal tolerable volume of the rectum, and rectal compliance were not significantly different between two groups.
CONCLUSIONS
Anorectal involvement reflected by the anorectal manometric dysfunction may be rather an earlier event in patients with PSS. An awareness to perform an anorectal manometric study in every case of PSS may be necessary for earlier subclinical detection of anorectal involvement by the disease.

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