ANORECTAL ASYNCHRONISM - CLINICAL AND MAN OMETRIC FINDINGS AND TREATMENT

Objectives: Anorectal asynchronism is a frequent and unrecognized caus e of terminal constipation. The aim of this study was to describe clin ical and instrumental findings, and results of biofeed-back therapy. M ethods: From 1987 to 1991, 18 patients with anorectal asynchronism wer e studied then treated by biofeedback training. Results: We found high rates of pelvic and perineal trauma (77.7%), of psychogenic factors ( 6.5%), of urinary incontinence (27.8%). The manometrical study confirm ed puborectalis paradoxical contraction during defecation straining, a nd all the patients could not expel a rectal balloon containing 50 mi of air; non-specific manometrical abnormality was found in 44.5% patie nts, Excessive stamp of puborectalis muscle was always found at defeco graphy; 77.7% of the patients had incomplete rectal evacuation, and 61 .1% had an associated pelvic floor disorder. Biofeedback training was successful, and 88.9% of the patients were cured by 5 or 6 sessions. T here was no predictive parameter in our study, but recovery rate seeme d to be lower for patients from 45 to 55 years old. Conclusion: The di agnosis of the anorectal asynchronism is easily made with manometry an d defecography. Treatment with biofeedback gives very good results in almost all patients.