Abstract
Defecatory disorders in children, including chronic constipation (CC) and fecal incontinence (FI), are common conditions worldwide and have a significant impact on children, their families, and the healthcare system. Anorectal manometry (ARM) and high-resolution anorectal manometry (HRAM) are relatively novel tools for the assessment of anal sphincter function and rectal sensation and have contributed significantly to improving the understanding of the anorectum as a functional unit. ARM has been recognized as the investigation of choice for adults with symptoms of defecation disorders, including fecal incontinence (FI), evacuation difficulties, and constipation. Although it is the gold standard tool in adults, it has yet to be formally accepted as a standardized diagnostic tool in the pediatric age, with limited knowledge regarding indications, protocol, and normal values. ARM/HRAM is slowly becoming recognized among pediatricians, but given that there are currently no agreed guidelines there is a risk that will lead to diversity in practice. The British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN)-Motility Working Group (MWG) therefore has taken the opportunity to provide guidance on the use of ARM/HRAM in children with CC and/or FI.
Highlights
Chronic constipation (CC) with or without fecal incontinence (FI) is a common condition in children with a worldwide prevalence of up to 29.6%.1-6 It has a significant impact on children, their families, and healthcare systems
The concept of performing anorectal manometry to gain pathophysiological information was firstly acknowledged by Gowers in 1887.69 Since we have progressed greatly in terms of experience and technical advances; especially with adults
There remains controversy, confusion, and lack of understanding as to when and how high-resolution anorectal manometry (HRAM) should be performed in children
Summary
Chronic constipation (CC) with or without fecal incontinence (FI) is a common condition in children with a worldwide prevalence of up to 29.6%.1-6 It has a significant impact on children, their families, and healthcare systems. Chronic constipation (CC) with or without fecal incontinence (FI) is a common condition in children with a worldwide prevalence of up to 29.6%.1-6. It has a significant impact on children, their families, and healthcare systems. Typically CC is managed in outpatient and community clinics, children with CC are increasingly presenting to emergency departments (ED).[7] FI is distressing and is associated with poor quality of life (QoL), reduced school attendance, and social interaction.[8,9] Children with CC report a worse QoL compared with children affected by IBD and gastroesophageal reflux (GORD).[10] Most of the published guidelines are directed toward the management of functional constipation and provide a framework and general guidance.,[11,12] but there remains wide variation in the use of diagnostic tools and management strategies for children with CC with or without FI
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