Obstructive defecation

A failure of rectoanal coordination

Satish Sanku Chander Rao, Kimberly D. Welcher, Jennifer S. Leistikow

Research output: Contribution to journalArticle

228 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1042-1050
Number of pages9
JournalAmerican Journal of Gastroenterology
Volume93
Issue number7
DOIs
StatePublished - Jul 1 1998
Externally publishedYes

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Defecation
Pressure
Constipation
Therapeutics
Laxatives
Manometry
Healthy Volunteers
Biofeedback (Psychology)

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Obstructive defecation : A failure of rectoanal coordination. / Rao, Satish Sanku Chander; Welcher, Kimberly D.; Leistikow, Jennifer S.

In: American Journal of Gastroenterology, Vol. 93, No. 7, 01.07.1998, p. 1042-1050.

Research output: Contribution to journalArticle

Rao, Satish Sanku Chander ; Welcher, Kimberly D. ; Leistikow, Jennifer S. / Obstructive defecation : A failure of rectoanal coordination. In: American Journal of Gastroenterology. 1998 ; Vol. 93, No. 7. pp. 1042-1050.
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