HRAM highlights the prevalence of defecatory dyssynergia
Barry L1, Quinlivan L1, McCarthy J2 & Buckley M1&2
GI Function Laboratory, Mercy University Hospital, Cork Department of Gastroenterology, Mercy University Hospital, Cork
Defecatory Disorders are a common problem in the community; the advent of HRAM not only allows for measurement of anorectal sphincter function but also allows for a better understanding of the dynamic processes of defecation. Biofeedback has been identified as an appropriate treatment in those who suffer from defecatory disorders, HRAM may allow for better selection of patients for this intervention.
We aim to investigatate the incidence of defecatory dyssynergia amoung patients attending a large teriary lower GI Physiological laboratory
We retrospectively reviewed HRAM tracings of 29 consecutive patients attending our GI Function Laboratory between October 2015 and January 2016. Patterns of simulated defecation were analysed and classified as per Rao classification of dyssynergic defecation.
Faecal Incontinence 23 of the 29 (79.4%) patients had symptoms of Faecal Incontinence (FI) (79.3% F). Mean ano-rectal resting pressure 75.7mmHg+/- 27.47mmHg. 17% of FI patients were reported with hypotensive resting pressure. Mean ano-rectal squeeze pressure 131.84mmHg+/-46.6mmHg. Hypotensive Squeeze was reported in 48% of those with FI. HRAM pressure topography plots of simulated defecation were reviewed and were assigned a Rao classification. Constipation 6 of 29 (20.6%) patients presented with constipation (66% female). Mean ano-rectal resting pressure 80.45mmHg+/-17.18mmHg. All patients with constipation were reported with normal ano-rectal resting pressure. Mean ano-rectal squeeze pressure 173.3mmHg+/-55.65mmHg
89.6% of patients presenting with faecal incontinence show evidence dyssynergic defecation. 100% patients presenting with constipation show evidence of dyssynergic defecation. Disordered defecation is a common finding among patients presenting with either Faecal Incontinence or Constipation. These patients may benefit from embarking on a biofeedback programme.