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Background The treatment for functional constipation (FC) generally relies on the classification by clinical symptoms, but whether the classification by clinical symptoms is consistent with that by colorectal and anal function examinations still remains unclear. Objective To examine the consistency between FC classification by clinical symptoms and colorectal and anal functional examinations. Methods Forty FC outpatients and inpatients completing colorectal and anal functional examinations in Department of Gastroenterology, Hebei General Hospital from January 2018 to August 2021 were enrolled in this retrospective study. Symptoms were acquired for classifying FC by use of a questionnaire survey, including the frequency of spontaneous defecation per week, shape and type of stool assessed using the Bristol Stool Scale, difficulty in defecation, sense of anorectal blockage during defecation, requirement for manual assistance in defecation, and the frequency and degree of feeling of incomplete evacuation. And the results detected by examinations, including anorectal manometry (ARM) , defecography and gastrointestinal transit time (GITT) were also used for FC classification. The consistency of FC classification by symptoms and the three examinations was assessed. Results The FC classification by symptoms was as follows: slow transit constipation (STC) 〔27.5% (11/40) 〕, defecation disorder constipation〔20.0% (8/40) 〕, mixed constipation〔37.5% (15/40) 〕, and normal-transit constipation (NTC) 〔15.0% (6/40) 〕. FC classified by ARM included defecation disorder constipation〔80.0% (32/40) 〕and NTC〔20.0% (8/40) 〕, and by defecography also only included defecation disorder constipation〔67.5% (27/40) 〕 and NTC 〔32.5% (13/40) 〕. By GITT, FC classification contained three types: STC〔20.0% (8/40) 〕, defecation disorder constipation 〔15.0% (6/40) 〕, and NTC〔65.0% (26/40) 〕. The weighted Kappa test indicated that the FC classification by symptoms was not consistent with that by ARM, defecography or GITT (Kappa=-0.123, P=0.502; Kappa=-0.040, P=0.794; Kappa=-0.140, P=0.215) , and there was no overall consistency between FC classification by symptoms and the three examinations (Kappa=-0.005, P=0.944) . Conclusion Mixed constipation was the major type of FC classified by symptoms, while defecation disorder constipation was the major type of FC classified by the three examinations. As there are differences between clinical symptom classification and examination classification, FC should be diagnosed based on both clinical symptoms and examination results, accompanied with the individualized analysis.

Objective To explore the effect of preoperative high-resolution anorectal manometry-assisted pelvic floor muscle exercises on anal function recovery in children with tethered cord syndrome. Methods Totally 68 cases of patients with tethered cord syndrome were divided into a study group (n=38) and a control group(n=38). The high-resolution anorectal manometry was performed preoperatively for evaluation of functions of the anal canal. The control group received routine nursing and health education, and the study group received an intervention of exercise for strengthening levator ani muscles. The results of anorectal pressure measurement were analyzed during postoperative follow-up, and the recovery of anal function was compared between two groups. Results There was no significant difference in anal canal resting pressure and maximum anal squeeze pressure between two groups before surgery(P＞0. 05). After a three-month follow-up, better outcomes of anal canal resting pressure, rectal sensitivity test and maximum anal squeeze pressure were measured in the study group compared with that in the control group (P＜0. 05). Conclusion Based on the evaluation results of preoperative anorectal pressure measurement, targeted pelvic floor muscle exercises can help children with anal function recovery. (目的 探讨高分辨率肛门直肠测压技术指导下的提肛训练在儿童脊髓栓系综合征患儿术后肛管功能恢复中的应用效果。方法 68例脊髓栓系综合症行手术治疗的患儿分为试验组38例和对照组30例。采用高分辨率多通道胃肠功能检测系统对脊髓栓系患儿术前的肛管功能进行评估。对照组接受常规护理和健康宣教, 试验组由护士根据测压结果给予盆底肌肉功能锻炼为主的提肛训练。术后随访患儿肛门直肠测压结果并分析, 比较两组患儿术后肛管功能的恢复情况。结果 术前两组肛管静息压、肛管最大收缩压比较, 差异无统计学意义(P＞0. 05)。术后3个月后门诊随访, 试验组患儿肛管静息压力明显高于对照组, 直肠敏感性、肛管最大收缩压监测结果试验组要明显优于对照组, 差异有统计学意义(P＜0. 05)。结论 结合患儿术前肛门直肠测压的评估结果, 有针对性地开展术后提肛训练, 有助于患儿肛门功能的恢复。)

Objective To explore the relationship between spinal cord dysplasia and congenital complex anorectal malformations (ARMs) and how they affect the defecatory function in children. Methods We retrospectively analyzed the clinical data of 148 children undergoing staged surgeries for complex ARMs between October, 2012 and February, 2017. According to the findings by lumbosacral magnetic resonance imaging (MRI), the children were divided into normal spinal cord group and abnormal spinal cord development group to analyze the distribution of spinal cord dysplasia in different types of ARMs and the impact of anomalies in spinal cord development on the development of the perianal muscles, anorectal manometry, and the defecatory function. Results Of the 148 children, 34 (23.0%) showed anomalies in spinal cord development, including steatosis of the terminal filament in 21 (61.8%) cases, intraspinal lipoma in 7 (20.6%) cases, syringomyelia in 1 (2.9%) case, intraspinal cystic lesion in 3 (8.8%) cases, and mixed spinal cord anomaly in 2 (5.9%) cases. We classified AMRs into different types according to Krickenbeck international classification, and abnormal spinal cord development was found in 20.0% (1/5) of the patients with rectal stenosis, 25.0% (5/20) of the patients with rectal atresia, 20.0% (1/5) of the patients with perineal fistula, 22.2% (8/36) of the patients with rectobulbar fistula, 18.2% (6/33) of the patients with rectoprostatic fistula, 25.0% (1/4) of the patients with rectovesical fistula, 24.2% (8/33) of the patients with vestibular fistula, 66.7%(2/3) of the patients with rectovaginal fistula, and 22.2% (2/9) of the patients with cloaca; No significant difference was found in the incidences of abnormal spinal cord development among the 9 groups (P=0.874). A total of 145 patients were evaluated for perianal muscle development during the surgery, and 26 patients had excellent, 105 had good, and 14 had poor development; the development of perianal muscles differed significantly between the children with normal and those with abnormal spinal cord development (P=0.005). Forty-four patients received anorectal manometry, which Showing no significant difference in resting anal pressure between the children with normal and abnormal spinal cord development (35.0±14.8 vs 27.9±14.3 mmHg, P=0.268); the positivity rate of rectoanal inhibitory reflex (RAIR) was lower in normal spinal cord group than in spinal cord dysplasia group (45.9% vs 71.4%), but the difference was not statistically significant (P=0.412). Follow-up of the patients for defecatory function assessment using the modified Rintal scale showed no significant difference in the constituent ratios of defecatory function between the 2 groups (P=0.416). Conclusion Spinal cord dysplasia is associated with perianal muscle development in children with complex ARMs, for whom routine lumbosacral MRI should be performed to detect the presence of spinal cord dysplasia.

The effects of postural factors on defecation in patients with rectocele were observed on the basis of " defecography" and "anorectal manometry". Methods The study was conducted through a self controlled trial. A total of 35 patients with rectocele were recruited, and the stool typing of Bristol was collected. Anorectal manometry was performed at each time of squatting and sitting. According to the patient's condition, made " simulation contrast agent" to enema and defecography was per formed at each time of squatting and sitting. Results The squatting group patients' initial defecation threshold and maximum sensory threshold were lower than those in sitting group patients(P<0. 05). The resting phase anorectal angle degree and the defecation phase anorectal angle degree in squatting group were higher than those in sitting group(P<0. 05). The resting phase and the defecation phase's degree of rectocele were lower than those in sitting group(P<0. 05). The resting phase and the defecation phase' s degree of perineum descent in squatting group were higher than those in sitting group(P<0. 05). Conclusion During defecation, squatting is more likely to produce defecation reflex than sitting position, with greater anorectal angle degree, lower deep of recto cele and greater degree of perineal descent,so as to improve defecation difficulty. [ABSTRACT FROM AUTHOR]

Objective: To explore the long-term efficacy of laparoscopic-assisted anorectoplasty and conventional anorectoplasty in the treatment of children with high and middle anal atresia. Methods: A retrospective cohort study was used. Inclusion criteria: (1) children with high and middle anal atresia; (2) complicated with rectourethral or rectovesical fistula; (3) complete follow-up data. Exclusion criteria: (1) complicated with 21-trisomy; (2) cerebral palsy and other mentaldisabilities; (3) Currarino syndrome; (4) FG syndrome. Clinical data of 88 patients with middle and high anal atresia, who complicated with rectourethral fistula or rectovesical fistula, and underwent anoplasty at Department of Pediatric Surgery, the First Affiliated Hospital of Zhengzhou University from January 2009 to June 2014 were enrolled in the study and analyzed. There were 24 cases with middle atresia and 64 cases with high atresia. All the cases were divided into 2 groups based on the operative method: laparoscopic group (laparoscopic-assisted anorectoplasty, 49 cases), pena group (posterior sagittal anorectoplasty, 39 cases). The demographic features of two groups were comparable. There were no statistically significant differences in gender, age, body mass, classification of anomaly types and sacral ratio (all P >0.05). Student t test and Chi square tests were used to compare the surgical conditions (operative time, postoperative hospital stay and complications), anal function (Kelly score), constipation (Krickenbeck constipation score) and anorectal pressure. Results: Children of both groups all completed operation ssuccessfully. There were no statistically significant differences between laparoscopic group and pena group in the operative time [(120±31) minutes vs. (112±23) minutes, t =1.343, P =0.091] and postoperative hospital stay [(7.1±2.3) days vs. (10.7±3.3) days, t =6.021, P =1.000]. Complications were more common in the pena group [16.3% (8/49) vs. 35.9% (14/39), χ(2)=4.436, P =0.035]. The main complications in laparoscopic group were anal prolapse (8.2%, 4/49) and anal stenosis (6.2%, 3/49), while in pena group were anal stenosis (12.8%, 5/39) and perioperative perianal skin erosion (10.3%, 4/39). As for the anal function, the degree of feces, defecation control and sphincter contractility, the single scoring differences of Kelly scoring system were not statistically significant between the two groups, but the proportion of good function in the laparoscopic group was higher than that in the pena group [67.3% (8/49) vs. 38.5% (15/39), χ(2)=7.308, P =0.007]. Constipation occurred in 6 (12.2%) patients in the laparoscopic group, of whom 5 were improved by diet regulation and 1 required laxatives, while 9 (23.1%) patients developed constipation in the pena group, of whom 4 were improved by diet regulation and 5 required long-term laxatives. The difference of constipation ratio was not statistically significant (χ(2)=1.802, P= 0.180). There were no cases of Krickenbeck constipation grade 3. Compared to the pena group, the laparoscopic group had higher anal resting pressure [(33.35±9.69) mmHg vs. (27.68±10.74) mmHg, t= 2.599, P =0.011], higher dilating pressure [(9.00±5.61) mmHg vs.(6.51±3.24) mmHg, t= 2.462, P =0.016], higher maximal squeeze pressure [(65.80±17.23) mmHg vs. (56.74±18.93) mmHg, t =2.389, P =0.019] and longer maximal contraction time [(21.16±5.02) seconds vs. (18.44±7.24) seconds, t =2.079, P =0.041]. The rectal resting pressure [(5.36±3.00) mmHg vs. (4.61±3.93) mmHg, t =1.015, P =0.312] was not statistically significantly different. Conclusions: Compared with posterior sagittal anorectoplasty, laparoscopic-assisted anorectoplasty in the treatment of high and middle anal atresia has better long-term efficacy with less perioperative complications.

Objective: To evaluate the diagnostic value of three-dimensional endoanal ultrasound (3D-EAUS) for dyssynergic defecation (DD). Methods: A case-control study was performed to retrospectively collectclinical data of 46 DD patients, including 16 males and 30 females with median age of 51 (20 to 70) years, at Nanjing Hospital of Chinese Medicine from February 2012 to April 2015.All the patients met the diagnostic criteria of functional constipation of Rome III. The paradoxical contraction of puborectalis (PR) muscle was found by both rectal examination and anorectal manometry. In the same period,45 healthy volunteers, including 22 males and 23 females with median age of 48 (21 to 72) years, without pelvic operation history, and with normal defecation in recent 6 months, were enrolled as the control group. No significant differences were observed in age and gender between two groups (both P >0.05). Cleveland constipation score of DD group was higher than that of control group [15(8-24) vs. 5(1-9), t =15.720, P <0.001]. 3D-EAUS examination was performed in all the subjects. Thickness and length of internal anal sphincter (IAS) (anterior side and posterior side), thickness of PR muscle, length of external anal sphincter (EAS) plus PR muscle, and puborectalis angle were measured and compared by using student t test between two groups. Correlation between these ultrasound parameters and anorectal manometry was examined by Pearson correlation analysis. Results: Both male and female in the DD group had the greater thickness of IAS, as compared to those in the control group [male: (1.7±0.5) mm vs.(1.5±0.2) mm, t =2.516, P =0.016; female: (1.9±0.4) mm vs.(1.6±0.5) mm, t =2.034, P =0.047]. No significant differences between the two groups were observed with respect to the posterior length of IAS, length of EAS plus PR muscle, and thickness of PR muscle (all P >0.05). Compared to the control group, male in the DD group had smaller puborectalis angle during straining [(87.0±3.6)° vs. (90.5±1.8)°, t =3.502, P =0.002];female in the DD group had smaller puborectalis angle both in resting and straining [resting:(86.5±3.8)° vs. (90.1±2.1)°, t =4.047, P <0.001;straining: (84.1±4.5)° vs. (90.2±2.3)°, t= 5.938, P <0.001]. Correlation analysis showed that anterior length of IAS was positively correlated with anal resting pressure ( r =0.321, P =0.030); the length of EAS plus PR muscle was positively correlated with anal squeeze pressure ( r =0.415, P =0.004). There were no correlations between the thickness and the posterior length of IAS and the anal resting pressure, or between the thickness of PR muscle and the anal squeeze pressure (all P >0.05). Conclusions: The 3D-EAUS can accurately assess the morphological features of anal canal in DD patients. There is a certain positive correlation between 3D-EAUS and anorectal manometry.