title: The constipated child: is there a correlation between symptoms and manometric findings?
abstract: OBJECTIVE
  The aim of our study was to evaluate patients referred for care of chronic constipation. We compared results of the anorectal manometry studies with a patient/guardian questionnaire about the patients' constipation.
  
  
  METHODS
  From patients seen for constipation in the department of pediatric gastroenterology, 123 were prospectively enrolled and they completed symptom questionnaires. These patients already were treated with stool softeners, either by the referring primary care physician or by the referring gastroenterologist. Anorectal manometry was performed per standard protocol.
  
  
  RESULTS
  Of the 123 patients enrolled in the study, 57.7% were male. Patient age ranged from 0.2 to 17.8 years, and the mean age was 7.5 years. The average duration of constipation was 4.84 years. The average number of stools per week was 3.6. Average time spent in the defecation process was 13.3 minutes. The incidence of hematochezia was 30%. Delayed passage of meconium was reported in 45 of 99 patients (45.5%). Significant correlation was found between frequency of soiling and threshold for rectoanal inhibitory reflex (P = 0.029). The volume of first urge also was positively correlated with frequency of soiling (P = 0.034). There was significant correlation of withholding behavior and the maximum volume tolerated (P = 0.020). The presence of blood in stool was inversely correlated with the maximum volume tolerated (P = 0.004). No correlation was found between severity of complaints and the presence of paradoxical puborectalis contraction. Of the patients, 90.5% had paradoxical puborectalis contraction.
  
  
  CONCLUSIONS
  Significant correlation was found between frequency of soiling and rectoanal inhibitory reflex, as well as soiling and volume of first urge. There was correlation between withholding behaviors and maximum volume tolerated. The presence of blood inversely correlated with maximum volume tolerated. Anorectal manometry continues to provide additional new information and to assist in managing patients with this common chronic pediatric affliction.
authors.affiliation: Department of Pediatric Gastroenterology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA. feinbel1@ccf.org
authors.forename: Lisa
authors.initials: L
authors.lastname: Feinberg
authors.forename: Lori
authors.initials: L
authors.lastname: Mahajan
authors.forename: Rita
authors.initials: R
authors.lastname: Steffen
mesh_terms: D000293:Adolescent; D001003:Anal Canal / Q000503:physiopathology; D001004:Anus Diseases / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003248:Constipation / Q000503:physiopathology*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007258:Informed Consent; D008297:Male; D008365:Manometry / Q000379:methods*; D010287:Parent-Child Relations; D012002:Rectal Diseases / Q000453:epidemiology; D012007:Rectum / Q000503:physiopathology; D011795:Surveys and Questionnaires