title: Colon manometry proves that perception of the urge to defecate is present in children with functional constipation who deny sensation.
abstract: OBJECTIVE
  Children with functional constipation often state an inability to sense an urge to defecate and/or inability to feel incontinence. We used colon manometry to assess whether there was a sensory abnormality in patients who denied sensation.
  
  
  METHODS
  A physician observed all of the colon manometries in the preceding 20 years, and included behavioral observations in the procedure reports. We reviewed the charts of these patients.
  
  
  RESULTS
  Of 150 subjects with normal manometry and a diagnosis of functional constipation, 56 volunteered that they had no urge to defecate or complained of abdominal pain. For all who denied sensation, the first high-amplitude propagating colonic contraction (HAPC) was associated with retentive posturing and facial grimaces. When queried, all reported they felt nothing. The examiner explained the HAPC was causing pain, and informed the child that the pain would resolve if they defecated. With subsequent HAPCs, every patient acknowledged an urge to defecate and successfully defecated. Most agreed that a similar pain sensation was present daily, but was misinterpreted to be abdominal pain.
  
  
  CONCLUSIONS
  Colon manometry may be useful not only for objective findings to discriminate neuromuscular disease from functional symptoms but also to understand psychological issues and aid in helping the child and family understand the maladaptive behaviors in functional constipation.
authors.affiliation: Department of Pediatrics, Louisiana State University Health Sciences Center, Children's Hospital of New Orleans, New Orleans, LA 70118, USA.
authors.forename: Carrie
authors.initials: C
authors.lastname: Firestone Baum
authors.forename: Anub
authors.initials: A
authors.lastname: John
authors.forename: Kavitha
authors.initials: K
authors.lastname: Srinivasan
authors.forename: Prince
authors.initials: P
authors.lastname: Harrison
authors.forename: Andrew
authors.initials: A
authors.lastname: Kolomensky
authors.forename: Javier
authors.initials: J
authors.lastname: Monagas
authors.forename: Jose
authors.initials: J
authors.lastname: Cocjin
authors.forename: Paul E
authors.initials: PE
authors.lastname: Hyman
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000502:physiology / Q000503:physiopathology; D003248:Constipation / Q000503:physiopathology / Q000523:psychology; D003672:Defecation; D005145:Face; D005242:Fecal Incontinence; D005260:Female; D005769:Gastrointestinal Motility; D005772:Gastrointestinal Transit; D006801:Humans; D007223:Infant; D008297:Male; D008365:Manometry / Q000379:methods*; D009119:Muscle Contraction; D010465:Perception; D012677:Sensation; D012678:Sensation Disorders / Q000503:physiopathology; D055815:Young Adult