Abstract
Symptoms such as a feeling of incomplete evacuation, straining, absence of the call to stool, anal blockage, or digitation suggest the presence a functional defecation disorder. As symptoms do not distinguish between patients with and without functional defecation disorder, Rome IV criteria recommend that this disorder is diagnosed when two of three tests are positive: balloon expulsion test (BET), anorectal manometry (ARM), and defecography. However, previous studies have demonstrated that the agreement among these tests is limited. In this issue of Neurogastroenterology and Motility, Sharma et al tested the hypothesis that conducting the ARM in a seated position would increase the diagnostic accuracy of the test in discriminating between patients with normal and prolonged BET. This minireview discusses the current knowledge on the role of the techniques to diagnose defecation disorder and the potential role of the ARM in a seated position.
Highlights
Chronic constipation is a heterogeneous condition characterized by unsatisfactory defecation related to either infrequent or difficult passing of stools, or both
As symptoms do not distinguish between patients with and without functional defecation diosrder, Rome IV criteria recommend that this disorder is diagnosed when two of three tests are positive: balloon expulsion test (BET), anorectal manometry (ARM) and defecography
Previous studies have demonstrated that the agreement among these tests is limited. In this issue of Neurogastroenterology and Motility, Sharma et al tested the hypothesis that conducting the ARM in a seated position would increase the diagnostic accuracy of the test in discriminating between patients with normal and prolonged BET
Summary
Chronic constipation is a heterogeneous condition characterized by unsatisfactory defecation related to either infrequent or difficult passing of stools, or both. Chronic constipation can present as functional constipation or irritable bowel syndrome with constipation (IBS-C), where the presence of abdominal pain related to change in the frequency and/or consistency of bowel movements differentiates IBS-C from functional constipation, but with a recognized large overlap between the two groups[4] In both conditions, symptoms such as a feeling of incomplete evacuation, straining, absence of the call to stool, anal blockage or digitation suggest a defecation disorder. Alterations in the behavioural component are often unspecific (i.e. they can be found in normally defecating healthy subjects) and their appraisal may vary depending on the subject’s degree of participation in their assessment[7] Structural alterations such as a rectocele, rectal prolapse, or rectal intussusception may be present but their causal role in the symptoms experienced is debated 8. A patient’s dissatisfaction with their bowel habits may well be a result of a combination of objective and subjective components, both an evident dysfunction in the defecation process along with a patient’s perception of what normal defecation should be[9, 10]
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