ISG Winter Meeting 2016

First Prize Clinical Oral

Lillian Barry

Oral (111)

Can symptoms predict findings of High Resolution Ano-refectal Manometry?


L Barry1, L Quinlivan1, G Elfasi2, M Farman2, J McCarthy2 & M Buckley1&2


1. GI Function Clinical Measurement Laboratory, Mercy University Hospital, Cork 2. Department of Gastroenterology, Mercy University Hospital, Cork


Constipation is a common problem thought to affect up to 27% of the general population. The health care costs of constipation are significant as evidenced by the hundreds of million euros spent yearly on laxatives alone. Despite the high prevalence of constipation the management of these patients can vary widely.


HRAM not only allows for measurement of anorectal sphincter function but also allows for a better understanding of the dynamic processes of defecation. Poor toileting behaviour and inappropriate recruitment of pelvic floor muscle is a significant factor on the pathophysiology of constipation.


We retrospectively reviewed HRAM tracings of 80 (64F) consecutive patients attending our GI Function Laboratory between October 2015 and Sept 2016. 23 of these patients (19F) presented primarily with features of constipation. We analysed the pattern of simulated defecation as per Rao classification of dyssynergic defecation.


23 of 80 patients who attended our laboratory for HRAM were classified as presenting with symptoms of Constipation. 82.6% were female (mean age 48 +/-17yrs). The predominant symptom in these patients was incomplete evacuation (47.8%). The remaining 52.2% of patients had non-specific constipation without predominant pelvic floor/anorectal symptoms. 40% were categorised with HRAM patterns revealing Rao Type IV Defecatory Dyssynergia, 10% RaoType I, 20% Rao Type II & 20% Rao Type III. 10% of patients with symptoms of incomplete evacuation had a normal defecatory pattern on HRAM. In those patients with constipation who did not complain primarily of incomplete evacuation (52.2%- disparate symptoms) 33% were classified as Rao Type IV, 25% Rao Type II, 16.6% Rao Type I & 16.6% Rao Type III. One patient had a normal defecatory pattern (4.4%) and one had a large rectal prolapse and Rao was not classified.


In all patients with constipation we found that defecatory dyssynergia is a common finding. Symptoms of incomplete evacuation alone do not solely predict obstructed defecation. In those with disparate symptoms of constipation such as abdominal pain, infrequent bowel movements & pain on defecation defecatory dyssynergia is very common and it is unclear if this is a primary or secondary phenomenon in these patients.