Abstract
Studies of colonic and rectal motility in children with constipation and encopresis have given conflicting results; the role of small intestinal motility has not been investigated. We studied mouth-to-colon transit time, colon transit time and the rectoanal reflex in 9 patients (2F, 7M age 8.8 ± .5 yr) with eneopresis. All had significant fecal retention by an x-ray scoring system (Barr et al. Clin Pediatr 18:674) compared to age-matched sibling controls (p < .05). Enemas were given to reduce the score to normal prior to study. Mouth-to-colon transit time was measured by rise in breath H2 after ingestion of lactulose; colon transit time by passage of 50% of ingested radio-opaque markers and anorectal manometry by an 8-lumen perfused catheter. RESULTS: There was no difference in mouth-to-colon transit time between patients and controls (105 ± 9 vs. 107 ± 18 min). Based on colon transit time, patients fell into 2 groups; in one group (4/9) transit was similar to controls (2.4 ± .4 vs. 2.6 ± .6 d) while in the other (5/9) it was prolonged (>5 d). There were no differences between these 2 groups for resting sphincter pressure (95 ± 14 vs. 85 ± 11 mmHg) or anal sphincter length (2.9 ± .4 vs. 2.6 ± .4 cm). An inhibitory reflex in the proximal anal sphincter was present in all patients. 7/9 patients had a delayed (>5 sec) contractile reflex in the distal anal sphincter following proximal relaxation.
CONCLUSIONS: (1) Children with constipation and encopresis have normal small intestinal transit time. (2) They are a diverse group with variable disorders of colonic motility. (3) Disordered external sphincter function may be an important mechanism in encopresis.
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Fliek, J., Taubman, B., Boyle, J. et al. 650 DIFFERING PATTERNS OF INTESTINAL MOTILITY IN CHILDREN WITH CHRONIC CONSTIPATION AND ENCOPRESIS. Pediatr Res 19, 219 (1985). https://doi.org/10.1203/00006450-198504000-00680
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DOI: https://doi.org/10.1203/00006450-198504000-00680