Role of manometry, defecography and anal endosonography in the evaluation of colorectal disorders

OBJECTIVE: altered motility or anatomy of the rectum, anus and perineal flo or may lead to symptoms which are unresponsive to routine therapeutic appro aches. These disturbances usually lead to constipation, fecal incontinence, or both. Different tests and techniques for evaluating anorectal and perin eal disorders, developed in the last two decades, make a better understandi ng of these disorders possible. This study was designed to evaluate the dia gnostic benefits of combining manometry, defecography and anal endosonograp hy in the assessment of patients with anorectal disorders. METHODS: twenty-five children with constipation (with or without soiling), incontinence and/or prolapse underwent anal manometry, defecography and ana l endosonography. Group A consisted of 9 children with fecal incontinence, group B consisted of 10 children with constipation with soiling, and group C comprised 6 children with constipation without soiling. RESULTS: in group A resting incontinence was associated with a hypotonic ex ternal sphincter in 4 out of 9 patients, 2 of whom had internal anal sphinc ter thinning. In group B resting incontinence was associated with a hypoton ic external sphincter in 8 out of 10 patients, 6 of whom had internal anal sphincter thinning. In group C these associations were not seen in any of t he patients. CONCLUSIONS: barium enema is not sufficient for an accurate diagnosis of an orectal disorders. No single test is capable of revealing the type of disea se. Anal manometry, defecography and endosonography are complementary proce dures in the assessment of this group of disorders. This new approach will improve our knowledge of the pathogenesis of these disorders in children. H owever, further studies are needed to obtain conclusive evidence.