Review
Pediatrics
Ilan J. N. Koppen, Marc A. Benninga
Summary: Defecation is a complex physiological process relying on intricate mechanisms involving the autonomic and somatic nervous system, pelvic floor muscles, and anal sphincter complex. Anorectal dysfunction can lead to constipation, a bothersome disorder that significantly impacts the daily lives of children and their families. This review focuses on different mechanisms underlying anorectal dysfunction and specific treatment options for improving defecation dynamics in children with functional constipation.
FRONTIERS IN PEDIATRICS
(2022)
Article
Medicine, General & Internal
Samuel Tanner, Ahson Chaudhry, Navneet Goraya, Rohan Badlani, Asad Jehangir, Dariush Shahsavari, Zubair Malik, Henry P. Parkman
Summary: In patients with chronic constipation, about 22% have dyssynergic defecation (DD), about 55% have slow transit constipation (STC), and 13% have both DD and STC. There were no specific symptoms differentiating STC from DD, but patients with STC and DD reported more severe constipation symptoms.
JOURNAL OF CLINICAL MEDICINE
(2021)
Article
Gastroenterology & Hepatology
Yuemei Xu, Xiaoping Li, Feizhen Xia, Feng Xu, Jiande D. Z. Chen
Summary: The modified adaptive biofeedback (ABF) training significantly improves constipation-related symptoms and is superior to conventional fixed biofeedback (FBF) training for dyssynergic defecation.
DIGESTIVE DISEASES AND SCIENCES
(2022)
Review
Pharmacology & Pharmacy
Ching-Yu Chu, Yu-Chi Su, Pei-Chun Hsieh, Yu-Ching Lin
Summary: Dyssynergic defecation (DD) is commonly associated with chronic constipation. This study aimed to evaluate the effectiveness of botulinum neurotoxin (BoNT) in treating DD through a systematic review and meta-analysis. The results showed that BoNT injection provided short-term symptom improvement in DD patients, but the effect decreased after 12 months. BoNT injection was not significantly different from surgery in terms of effectiveness, complications, and symptom recurrence, but it carried a higher risk of fecal incontinence compared to biofeedback therapy.
Article
Radiology, Nuclear Medicine & Medical Imaging
Pimpapon Thanaracthanon, Kewalee Sasiwimonphan, Angkana Sunthornram, Mukesh G. Harisinghani, Thitinan Chulroek
Summary: This retrospective study aimed to evaluate the diagnostic performance of MR defecographic findings in the diagnosis of dyssynergic defecation (DD). The results showed significant differences in several parameters between the DD and non-DD groups, including anorectal angle (ARA) and M line at rest, defecation, and change between 2 phases, anal canal width, prominent puborectalis muscle, and abnormal evacuation. Multivariate logistic regression revealed that M line at defecation and ARA at defecation were significant findings in differentiating between DD and non-DD. The study concludes that MR defecography has high diagnostic performance in DD diagnosis. Rating: 8 out of 10.
ABDOMINAL RADIOLOGY
(2023)
Review
Gastroenterology & Hepatology
Anahita Sadeghi, Elham Akbarpour, Fatemeh Majidirad, Serhat Bor, Mojgan Forootan, Mohammad-Reza Hadian, Peyman Adibi
Summary: About one-third of chronically constipated patients suffer from an evacuation disorder known as dyssynergic defecation, where the coordination between abdominal and pelvic floor muscles is disrupted. The etiology of this condition is still unknown, but diagnostic methods such as anorectal manometry, balloon expulsion test, and imaging techniques like magnetic resonance or conventional defecography are necessary. Biofeedback therapy is considered as one of the most effective and safe treatments for dyssynergic defecation. This article provides an overview of the condition and its diagnosis and management.
TURKISH JOURNAL OF GASTROENTEROLOGY
(2023)
Article
Gastroenterology & Hepatology
Borko Nojkov, Jason R. Baker, William D. Chey, Richard Saad, Lydia Watts, Moira Armstrong, Kristen Collins, Gabrielle Ezell, Cari Phillips, Stacy Menees
Summary: This study examines the impact of age and gender on anorectal function testing characteristics, symptoms burden, and quality of life (QoL) in patients with chronic constipation (CC). It found that men and patients older than 60 are more likely to have dyssynergic defecation, while women and patients younger than 60 experience worse constipation symptoms and QoL.
DIGESTIVE DISEASES AND SCIENCES
(2023)
Review
Gastroenterology & Hepatology
Alexandra R. Ortengren, Resham A. Ramkissoon, William D. Chey, Jason R. Baker, Kyle Staller, Johanna Iturrino, Eric D. Shah
Summary: A systematic review and meta-analysis showed that anorectal manometry has good diagnostic accuracy for detecting dyssynergic defecation, especially when three consecutive simulated defecation attempts are performed. However, measuring anorectal pressures to identify complex dyssynergic patterns did not improve real-world diagnostic accuracy estimates. Future iterations of the consensus protocol may improve diagnostic accuracy.
NEUROGASTROENTEROLOGY AND MOTILITY
(2021)
Article
Medicine, General & Internal
Justin Y. van Oostendorp, Pieter van Hagen, Grietje J. H. van der Mijnsbrugge, Ingrid J. M. Han-Geurts
Summary: Anorectal manometry measurements show significant interrater variability. New techniques like 3D high-resolution anorectal manometry (3D-HRAM) have the potential to improve diagnostic accuracy and understanding of defecation disorders. However, the extent of interrater variability in 3D-HRAM is still unknown.
Article
Gastroenterology & Hepatology
Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Kei Ohara, Mitsuhiro Inagaki, Masanori Murakami
Summary: Rectosigmoid accumulation of markers can differentiate DD from slow transit constipation. However, non-rectosigmoid accumulation does not exclude the presence of DD.
JOURNAL OF NEUROGASTROENTEROLOGY AND MOTILITY
(2021)
Review
Gastroenterology & Hepatology
Jenneke Kalkdijk, Paul Broens, Richard ten Broek, Joost van der Heijden, Monika Trzpis, Jean Pierre Pierie, Bastiaan Klarenbeek
Summary: The prevalence of functional constipation and dyssynergic defecation is higher in patients with hemorrhoids compared to controls. Anal pressures are also significantly higher in patients with hemorrhoids. Rubber band ligation does not reduce these pressures.
EUROPEAN JOURNAL OF GASTROENTEROLOGY & HEPATOLOGY
(2022)
Article
Gastroenterology & Hepatology
Nilay Ozkutuk, Ismet Eser, Serhat Bor
Summary: Biofeedback has a positive effect on reducing constipation severity, improving quality of life, and anorectal physiology in patients with dyssynergic defecation, showing its effectiveness in therapy for this condition.
TURKISH JOURNAL OF GASTROENTEROLOGY
(2021)
Article
Anesthesiology
Y. Launey, B. Painvin, A. Roquilly, C. Dahyot-Fizelier, S. Lasocki, C. Rousseau, D. Frasca, A. Gacouin, P. Seguin
Summary: Delayed defecation is common in intensive care patients and is associated with factors such as the use of laxatives, duration of ventilation, and enteral nutrition within 48 hours of admission. This delay can lead to longer intensive care stays, but does not impact mortality.
Article
Gastroenterology & Hepatology
Derya Ari, Oemer Oeztuerk, Yasemin Oezin, Ilyas Tenlik, Ferhat Bacaksiz, Volkan Goekbulut, Mustafa Kaplan, Ismail Hakki Kalkan, Meral Akdogan
Summary: Biofeedback therapy (BFT) is an effective treatment for solitary rectal ulcer (SRU) patients with dyssynergic defecation (DD) who do not respond to conventional treatments. BFT enhances the healing of ulcers in SRU patients by restoring coordination of the pelvic floor.
DIGESTIVE DISEASES
(2022)
Article
Gastroenterology & Hepatology
Henry P. Parkman, Emily Sharkey, Richard W. McCallum, William L. Hasler, Kenneth L. Koch, Irene Sarosiek, Thomas L. Abell, Braden Kuo, Robert J. Shulman, Madhusudan Grover, Gianrico Farrugia, Ron Schey, James Tonascia, Frank Hamilton, Pankaj J. Pasricha
Summary: In patients with symptoms of gastroparesis, about one-third of the patients have concurrent severe constipation and delayed colonic transit. The severity of constipation is associated with the severity of gastroparesis symptoms and the presence of irritable bowel syndrome, but not with delayed gastric emptying.
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
(2022)
