Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Cirurgia e Anatomia, Divisão de Coloproctologia, Ribeirão Preto, SP, Brasil.
Arq Gastroenterol. 2020 Jul-Sep;57(3):306-310. doi: 10.1590/S0004-2803.202000000-56.
Evacuation disorders are prevalent in the adult population, and a significant portion of cases may originate from pelvic floor muscle dysfunctions. Anorectal manometry (ARM) is an important diagnostic tool and can guide conservative treatment.
To evaluate the prevalence of pelvic dysfunction in patients with evacuation disorders through clinical and manometric findings and to evaluate, using the same findings, whether there are published protocols that could be guided by anorectal manometry.
A retrospective analysis of a prospective database of 278 anorectal manometries performed for the investigation of evacuation disorders in patients seen at the anorectal physiology outpatient clinic of Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto between January 2015 to June 2019 was conducted. The following parameters were calculated: resting pressure (RP), squeeze pressure (SP), high-pressure zone (HPZ), rectal sensitivity (RS) and rectal capacity (RC). The pressure measurements and manometric plots were reviewed to determine the diagnosis and to propose potential pelvic physical therapy procedures. Analysis of variance (ANOVA) and Fisher's exact test were used to compare the continuous variables and to evaluate the equality of variances between groups of patients with fecal incontinence (FI) and chronic constipation (CC). Results with a significance level lower than 0.05 (P-value <0.05) were considered statistically significant. Statistical analysis was performed using IBM® SPSS® Statistics version 20.
The mean age of the sample was 45±22 years, with a predominance of females (64.4%) and economically inactive (72.7%) patients. The indications for exam performance were FI (65.8%) and CC (34.2%). Patients with FI had lower RP (41.9 mmHg x 67.6 mmHg; P<0.001), SP (85.4 mmHg x 116.0 mmHg; P<0.001), HPZ (1.49 cm x 2.42 cm; P<0.001), RS (57.9 mL x 71.5 mL; P=0.044) and RC (146.2 mL x 195.5 mL; P<0.001) compared to those of patients with CC. For patients with FI, the main diagnosis was the absence of a functional anal canal (49.7%). For patients with CC, the main diagnosis was outflow tract obstruction (54.7%). For patients with FI, the main protocol involved a combination of anorectal biofeedback (aBF) with tibial nerve stimulation (TNS) (57.9%). For patients with CC, the most indicated protocol was aBF combined with TNS and rectal balloon training (RBT) (54.7%).
There was a high prevalence of pelvic floor changes in patients with evacuation disorders. There was a high potential for performing pelvic floor physical therapy based on the clinical and manometric findings.
排便障碍在成年人群中很常见，其中很大一部分可能源于盆底肌肉功能障碍。肛肠测压（ARM）是一种重要的诊断工具，可以指导保守治疗。
通过临床和测压结果评估排便障碍患者中盆底功能障碍的患病率，并评估是否存在可以通过肛肠测压指导的已发表方案。
对 2015 年 1 月至 2019 年 6 月期间在里贝朗普雷图医学院附属医院肛肠生理门诊就诊的因排便障碍而接受 ARM 检查的 278 例患者的前瞻性数据库进行回顾性分析。计算以下参数：静息压（RP）、收缩压（SP）、高压区（HPZ）、直肠感觉（RS）和直肠容量（RC）。对压力测量和测压图进行分析，以确定诊断并提出潜在的盆底物理治疗方案。采用方差分析（ANOVA）和 Fisher 确切检验比较失禁（FI）和慢性便秘（CC）患者的连续变量，并评估组间方差的均衡性。具有低于 0.05 显著水平（P 值 <0.05）的结果被认为具有统计学意义。统计分析使用 IBM® SPSS® Statistics 版本 20 进行。
样本的平均年龄为 45±22 岁，女性（64.4%）和非经济活动（72.7%）患者居多。检查的指征是 FI（65.8%）和 CC（34.2%）。FI 患者的 RP（41.9mmHg×67.6mmHg；P<0.001）、SP（85.4mmHg×116.0mmHg；P<0.001）、HPZ（1.49cm×2.42cm；P<0.001）、RS（57.9mL×71.5mL；P=0.044）和 RC（146.2mL×195.5mL；P<0.001）均低于 CC 患者。FI 患者的主要诊断是功能性肛管缺失（49.7%）。CC 患者的主要诊断是出口梗阻（54.7%）。FI 患者的主要方案涉及肛肠生物反馈（aBF）联合胫神经刺激（TNS）（57.9%）。CC 患者最适用的方案是 aBF 联合 TNS 和直肠球囊训练（RBT）（54.7%）。
排便障碍患者中盆底改变的患病率较高。基于临床和测压结果，进行盆底物理治疗的潜力较大。
