title: The value of fluoroscopic defecography in the diagnostic and therapeutic management of defecation disorders in children.
abstract: BACKGROUND
  Defecography is a study to assess anorectal function during evacuation.
  
  
  OBJECTIVE
  To investigate the value of fluoroscopic defecography in directing diagnostic and therapeutic management in children with defecation disorders.
  
  
  METHODS
  We reviewed all fluoroscopic defecography studies performed (2003-2009) in children with defecation problems and normal anorectal motility studies. Results were classified into three groups: (1) normal pelvic floor function; (2) pelvic floor dyssynergia, including incomplete relaxation of pelvic musculature, inconsistent change in anorectal angle and incomplete voluntary evacuation; (3) structural abnormality, including excessive pelvic floor descent with an intra-rectal intussusception, rectocele or rectal prolapse.
  
  
  RESULTS
  We included 18 patients (13 boys, median age 9.1 years). Indication for fluoroscopic defecography was chronic constipation in 56%, fecal incontinence in 22% and rectal prolapse in 22%. Defecography showed pelvic floor dyssynergia in 9 children (50%), a structural abnormality in 4 (22%) and normal pelvic floor function in 5 (28%). In 12 children (67%) the outcome of fluoroscopic defecography directly influenced therapeutic management. After defecography 4 children (22%) were referred for anorectal biofeedback treatment, 4 children (22%) for surgery, 2 children (11%) for additional MR defecography, and 1 child to the psychology department, and medication was changed in 1 child. In 6 children (33%) the result did not change the management. In 9 children (75%) the change of management was successful.
  
  
  CONCLUSIONS
  Fluoroscopic defecography can be a useful tool in understanding the pathophysiology and it may provide information that impacts management of children with refractory defecation disorders.
authors.affiliation: Division of Pediatric Gastroenterology, Nationwide Children's Hospital, Columbus, OH, USA, s.m.mugie@amc.nl.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Mugie
authors.forename: D Gregory
authors.initials: DG
authors.lastname: Bates
authors.forename: Jaya B
authors.initials: JB
authors.lastname: Punati
authors.forename: Marc A
authors.initials: MA
authors.lastname: Benninga
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Lorenzo
authors.forename: Hayat M
authors.initials: HM
authors.lastname: Mousa
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000000981:diagnostic imaging* / Q000628:therapy; D019841:Defecography / Q000379:methods*; D005242:Fecal Incontinence / Q000000981:diagnostic imaging* / Q000628:therapy; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008365:Manometry; D011829:Radiation Dosage; D012005:Rectal Prolapse / Q000000981:diagnostic imaging* / Q000628:therapy; D012189:Retrospective Studies