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Journal of the Korean Society of Coloproctology 2000;16(4):231-238.
A Role of Anorectal Physiologic Study for the Diagnosis of Chronic Constipation.
Kim, Seung Han , Hwang, Yong Hee , Choi, Kun Phil
Department of Surgery, Seoul Adventist Hospital, Seoul, Korea.
Abstract
To assess the role of anorectal physiologic study for the diagnosis of chronic idiopathic constipation.
METHODS
A retrospective study of 81 constipated patients (23 male, 58 female) of mean age 48 16.6 (16~83) years who had no abnormalities in colonoscopy, barium enema, and rectal exam was done. 81 patients underwent defecography and cine-defecography, of which 66 patients underwent anal manometry, 52 patients underwent colonic transit time study (CTT), and 27 patients underwent anal plug electromyography (EMG).
RESULTS
Nonrelaxing puborectalis syndrome (NRPR), rectocele, rectal intussusception, anal dyschezia, and sigmoidocele were observed in 27 (33.3%), 26 (32.1%), 14 (17.3%), 3 (3.7%), and 2 (2.5%) of the patients, respectively. Normal cinedefecography finding was observed in 21 (25.9%) patients. More than one abnormal finding was found in 11 (13.6%) patients. Abnormal findings included colonic inertia in 6 (11.5%) patients and pelvic outlet obstruction in 2 (3.8%) patients. Normal colon transit time was observed in 44 (84.6%) patients. Anal hypertonia was observed in 23 (34.8%) patients by anal monometry, of which 3 patients were diagnosed with anal dyschezia in cinedefecography. 13 (48.1%) patients were diagnosed with NRPR in anal plug EMG. The correlation rate between cinedefecography/EMG, defecography/CTT, and CTT/EMG were 81.5%, 61.5%, and 51.9% respectively in the diagnosis of NRPR. Sensitivities of the three tests were 72.7% for cinedefecography, 66.7% for EMG, and 7.7% for CTT in diagnosing NRPR (p<0.05). Positive predictive values of the three tests were 80% for anal plug EMG, 72.7% for cinedefecography, and 50% for CTT in the diagnosis of NRPR.
CONCLUSIONS
Defecography and EMG were complements each of the other in diagnosis of pelvic outlet obstruction especially NRPR, but CTT has no role.
Key Words: Constipation; Defecography; Colon transit time; Electromyography; Non-relaxing puborectalis syndrome


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