title: Idiopathic constipation in childhood is associated with thickening of the internal anal sphincter.
abstract: This study was undertaken to search for a rational basis for the use of anal dilatation and internal sphincterotomy as the treatment for chronic intractable constipation in children. Sixteen children, age 5 months to 13 years, who had constipation resistant to conservative treatment were compared with 39 age-matched controls. History and current symptoms were assessed using a standard questionnaire. Internal and external and sphincter morphology was assessed on clinical examination and by anal endosonography, using a 10-MHz rotating endoprobe to provide accurate measurement of the various components of the anal canal. The control group showed a linear correlation between the thickness of the internal anal sphincter and both age and weight, increasing from 0.4 mm in infancy to 0.9 mm in adolescence. Children who had constipation displayed significant thickening of the internal sphincter (range, 0.5 to 1.9 mm, P = .005) which was independent of the length of the history (P = .103). There was no difference in the morphology of the external anal sphincters between the groups. The finding of a hypertrophied internal anal sphincter could provide a rational basis for anal dilatation and internal sphincterotomy as treatment for idiopathic constipation.
authors.affiliation: Department of Paediatric Surgery, Institute of Child Health and Great Ormond Street Children's Hospital, London, England.
authors.forename: G P
authors.initials: GP
authors.lastname: Hosie
authors.forename: L
authors.initials: L
authors.lastname: Spitz
mesh_terms: D000293:Adolescent; D001003:Anal Canal / Q000473:pathology*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000209:etiology* / Q000601:surgery; D019160:Endosonography; D006801:Humans; D007223:Infant