Anorectal Manometry in Pediatric Colorectal Surgical Care

TL;DR

This study examines the use of anorectal manometry in diagnosing and managing defecation disorders in children, showing it is effective and well-tolerated.

Contribution

This is the first study to describe multi-year experience using a portable anorectal manometry device in pediatric patients.

Findings

72% of patients had dyssynergic defecation patterns, with 67.6% experiencing fecal soiling before treatment.

Pelvic rehabilitation led to continence in 79.5% of patients with fecal soiling who completed therapy.

Anorectal manometry was well-tolerated with no major complications reported.

Abstract

Background: Pediatric colorectal specialists care for patients with a variety of defecation disorders. Anorectal (AR) manometry testing is a valuable tool in the diagnosis and management of these children. This paper provides a summary of AR manometry techniques and applications as well as a review of AR manometry findings in pediatric patients with severe defecation disorders referred to a pediatric colorectal center. This is the first study describing multi-year experience using a portable AR manometry device in pediatric patients. Methods: An electronic medical record review was performed (1/2018 to 12/2023) of pediatric patients with defecation disorders who had AR manometry testing. Demographics, diagnostic findings, and outcomes are described. Key Results: A total of 297 unique patients (56.9% male, n = 169) had AR manometry testing. Of these, 72% (n = 188) had dyssynergic defecation patterns, of which 67.6% (n = 127) had fecal soiling prior to treatment. Pelvic rehabilitation (PR) was administered to 35.4% (n = 105) of all patients. A total of 79.5% (n = 58) of the 73 patients that had fecal soiling at initial presentation and completed PR with physical therapy and a bowel management program were continent after therapy. AR manometry was well tolerated, with no major complications. Conclusions: AR manometry is a simple test that can help guide the management of pediatric colorectal surgical patients with defecation disorders. As a secondary finding, PR is a useful treatment for patients with dyssynergic stooling.

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