Boer, H.K.H. de (2014) Functional defecation disorder. Kunnen m. puborectalis en m. sphincter ani externus onafhankelijk van elkaar (dis)functioneren bij patiënten met een functional defecation disorder? thesis, Medicine.
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Abstract
Backgrounds: Functional defecation disorder (FDD) is common (it underlies about half of the cases of functional constipation) and, left untreated, can lead to serious complications such as fecal incontinence. Rome III-classification of FDD distinguishes dyssynergic defecation and inadequate defecatory propulsion, which can be further subdivided according to a classification proposed by Rao et al. Both classifications are based on the idea that m. puborectalis and m. sphincter ani externus behave as one functional unit during (attempted) defecation. Methods: Anorectal function tests (including anorectal pressure profile and defecometry test) were performed in 124 adult patients suffering from FDD. All patients were also asked to complete a questionnaire regarding medical history and current defecatory symptoms. Of the 124 patients, 97 were of female gender. Median age was 57 years (range 18-81 years). Results: Defecometry test revealed that m. puborectalis muscle and m. sphincter ani externus do not consistently contribute equally to FDD. In fact, three main groups can be identified: congruent FDD (in which both muscles dysfunction in more or less equal proportion; n = 105), puborectalis-dominated FDD (n = 9) and anal sphincter-dominated FDD (n = 10); all three causing similar symptoms. Defecatory propulsive force (increase in intrarectal pressure during attempted defecation) is more strongly correlated to pressure increase at the level of the m. puborectalis (ρ = 0,794) than to pressure increase at the level of the m. sphincter ani externus (ρ = 0,488). Conclusions: M. puborectalis and m. sphincter ani externus do not, by definition, behave as a functional unit in patients suffering from FDD and may thus differ in degree of dyssynergia. This understanding questions the reliability of the single probe EMG-devices currently used for both diagnosing and treating FDD. Furthermore, it can be concluded that an isolated abnormality in anorectal angle impedes defecation more than isolated anal sphincter contraction.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Broens, Dr. P.M.A. and Anorectaal Functiecentrum, Afd. Chirurgie |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:05 |
| Last Modified: | 25 Jun 2020 11:05 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2529 |
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