title: Dyssynergic defecation may play an important role in postoperative Hirschsprung's disease patients with severe persistent constipation: analysis of a case series.
abstract: BACKGROUND
  After surgery for Hirschsprung's disease (HD) the majority of patients have satisfactory clinical outcomes. Nevertheless, a substantial number of patients remain who suffer from severe persistent constipation. Current consensus attributes these complaints to the hallmarks of HD. In non-HD patients a cause for severe constipation is dyssynergic defecation.
  
  
  METHODS
  Retrospectively, we reviewed the medical records of ten postoperative HD patients with severe persistent constipation who had undergone extensive anorectal function tests to diagnose the reason for the constipation. We analyzed the results of these tests.
  
  
  RESULTS
  During the last three years, ten postoperative HD patients with severe persistent constipation were given extensive anorectal function tests. All ten patients were diagnosed with dyssynergic defecation. The ages at the time of diagnosis ranged from 7 to 19years with a median age of 12years. Signs of an enlarged rectum were seen in all ten patients, with a maximum measured value of 845mL.
  
  
  CONCLUSIONS
  Patients with HD may also suffer from dyssynergic defecation. It is important to consider this possibility when dealing with severe persistent constipation in postoperative HD patients. Viable options for treating dyssynergic defecation are available that could prevent irreversible long-term complications.
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: r.j.meinds@umcg.nl.
authors.forename: Rob J
authors.initials: RJ
authors.lastname: Meinds
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Maura C
authors.initials: MC
authors.lastname: Eggink
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Erik
authors.initials: E
authors.lastname: Heineman
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, University Medical Center Groningen, Groningen, The Netherlands; Department of Surgery, Anorectal Physiology Laboratory, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Paul M A
authors.initials: PM
authors.lastname: Broens
mesh_terms: D000293:Adolescent; D001003:Anal Canal / Q000503:physiopathology; D001259:Ataxia / Q000209:etiology / Q000503:physiopathology*; D002648:Child; D003248:Constipation / Q000209:etiology / Q000503:physiopathology*; D003672:Defecation / Q000502:physiology; D019841:Defecography; D005260:Female; D006627:Hirschsprung Disease / Q000150:complications* / Q000601:surgery; D006801:Humans; D008297:Male; D008365:Manometry; D012007:Rectum / Q000503:physiopathology; D012189:Retrospective Studies; D055815:Young Adult
keywords: Anismus; Congenital megacolon; Dyssynergic defecation; Hirschsprung's disease; Pelvic floor dyssynergia