title: The diameter of the rectum on ultrasonography as a diagnostic tool for constipation in children with dysfunctional voiding.
abstract: OBJECTIVE
  We proved the accuracy of the transverse diameter of the rectum on ultrasonography as an additional parameter for diagnosing constipation in children with lower urinary tract dysfunction.
  
  
  METHODS
  The diameter of the rectum on bladder ultrasonography in a constipated group of patients with dysfunctional voiding was compared to this diameter in a control group of patients with a normal defecation pattern. A total of 49 children were included. Group 1 consisted of 23 patients with a positive history of dysfunctional voiding and, according to pediatric gastroenterological practice, constipation. Control group 2 consisted of 26 patients without lower urinary tract dysfunction and a normal defecation pattern. In each group a defecation questionnaire was administered and physical examination of the abdomen was done. In all patients a 7.5 MHz probe was used to measure the transverse diameter of the rectum behind the bladder on ultrasonography. The probe was applied on the abdominal skin approximately 2 cm above the symphysis. Measurement was performed with a filled bladder at an angle of about 15 degrees downward from the transverse plane.
  
  
  RESULTS
  In constipated group 1 the mean diameter of the rectum was 4.9 cm (95% CI 4.4 to 5.3). In the control group the mean diameter of the rectum was 2.1 cm (95% CI 1.8 to 2.4). In group 1 the diameter of the rectum was significantly larger than in group 2 (p < 0.001). None of the patients had a sensation to defecate during the investigation. There was no significant difference in age between the 2 groups (p = 0.20) and no significant difference between them in the period between the last time that stool was passed prior to the time of rectal measurement (p = 0.16).
  
  
  CONCLUSIONS
  The transverse diameter of the rectum measured by lower abdominal ultrasound provides an additional accurate parameter with which to diagnose constipation in patients with nonneurogenic bladder-sphincter dyssynergia.
authors.affiliation: University Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Aart J
authors.initials: AJ
authors.lastname: Klijn
authors.forename: Marino
authors.initials: M
authors.lastname: Asselman
authors.forename: Marianne A W
authors.initials: MA
authors.lastname: Vijverberg
authors.forename: Pieter
authors.initials: P
authors.lastname: Dik
authors.forename: Tom P V M
authors.initials: TP
authors.lastname: de Jong
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D012007:Rectum / Q000000981:diagnostic imaging* / Q000473:pathology*; D014463:Ultrasonography; D014555:Urination Disorders / Q000150:complications*