T1146 Effect of Rectal Distension On Bladder Function

Abstract

Background: Colonic manometry is a diagnostic test frequently used in the evaluation of children with defecation disorders unresponsive to medical and behavioral management. The standard protocol in pediatrics consists of a study that lasts approximately 4 hours. Given the wide physiologic variations in colonic motility throughout the day, longer observation might detect clinically relevant information. Aim: To determine whether prolonged colonic motility measurement results in treatment modifications in children with defecation disorders. Methods: A water perfused and a solid state colonic catheter with recording sites positioned at the same level were simultaneously placed using colonoscopy in 13 children (6 boys, median age 9 yrs, range 3-16 yrs) presenting with severe defecation disorders. The tip of the catheters was placed in the cecum in 11 patients and in the transverse colon in two. First, a “standard test” was performed with at least 1 hr fasting, 1 hr postprandial and 1 hr post-bisacodyl provocation recording. After this portion of the test was completed, recordings continued until the next day using the solid state, ambulatory technique. Results: Colonic manometry was performed in 10 children with intractable constipation, in one child with fecal incontinence and in two children with symptoms of pseudo-obstruction. Based on the short duration recordings, normal motility in the entire colon was found in 6/13 children. In 3/13 children normal motility was only found in the proximal segment with abnormalities limited to the dilated distal colon. Other patients showed low amplitude contractions (n=2) consistent with myopathy and colonic inertia with lack of contractions throughout the entire colon (n=2). The 24-hours recording results mostly agreed with the short recordings but revealed more information in 2 patients. In one patient with normal motility in the standard short recording, an excessive frequency of HAPCs was noted in the prolonged study, possibly contributing to the fecal incontinence. In another patient, standard recordings showed colonic activity only in the most proximal part of the colon but the 24 hour study showed normal motility over a larger portion of the colon. These findings did not, however, change treatment recommendations. Conclusion: Prolonged colonic measurement provides more information regarding colonic motor function and allows detection of motor events missed by the standard short manometry study with provocation. Further studies are necessary to evaluate the clinical relevance of this information.