Comparison of the sonographic features of the abdominal ...



Simultaneous urodynamic and anorectcal manometry studies in children: Insights into the relationship between the lower gastrointestinal and lower urinary tracts.

Ambartsumyan L, Siddiqui A, Bauer S, Nurko S: Neurogastroenterol Motil. 2016; 28(6):924-933 doi:10.1111/nmo.12794

Ann Dunbar PT, DPT, MS, WCS

September 13, 2017

Introduction

Adults and children with lower urinary tract dysfunction (LUT) have increased prevalence of fecal incontinence (FI) and functional constipation (FC) and children with FI and FC have higher prevalence of LUT symptoms.

Limited data exists on physiological interaction between LUT and anorectum in children with bowel and bladder disorders (BBD). Research on adults suggest an interaction exists but no studies have examined dynamic interaction between anorectum and bladder.

Primary Aim: “ a) to observe the effect of rectal distention on parameters of LUT function, and b) to observe the effect of bladder filling and voiding on parameters of anorectal function.”

Study Design: Observational

Methods:

Subject Selection: children four and older, fully potty trained, who were scheduled to have Urodynamic studies (UDS) to evaluate voiding dysfunction were recruited to undergo simultaneous UDT and anorectal manometery (ARM). Tracings from both were viewed on one screen.

Study protocol comprised of 3 phases: 1) Standard UDS 2) Standard ARM 3) Second UDS in presence of constant rectal balloon inflation (see article for details of procedures).

Results

Patient Population Ten children (3 male and 7 female) age range 7 to 12, with mean age 113.7 months ±18.7, all had LUT dysfunction with the following sx: UI (n=7), urgency (n=2), frequency (n=3), and/or dysuria (n=1), recurrent UTIs (n=4).

Bowel dysfunction: amongst the 10 subjects, 9 children met criteria for Rome III for FC (at least 2 of the following over previous 3 months: fewer than 3 BMs/wk, straining, lumpy or hard stools). Six children had FI related to stool retention. Treatment for the FC included osmotics (n=8) and stimulant laxatives (n = 2). Tenth subject had hx of recurrent UTIs, had no FI, never on any bowel regimen, reported 4 to 5 BMs/wk (Bristol scale 2-3).

Urodynamic Parameters: Bladder Volumes and Post Void Residual: no significant difference in total bladder volume with filling and percent of bladder volume filled for the expected bladder capacity (EBC) with and without rectal distension (RD). Bladder Capacity: in 5/10 with normal bladder capacity, RD decreased bladder capacity but only 2 of those dropped to small range; in 5/10 with small bladder capacity the capacity did not changes with RD. Sensation: no significant differences in volume of first sensation and % bladder volume filling at first sensation w/ and w/o RD. Bladder Pressure and Compliance Characteristics During Bladder Fill & Void: see Table 3; only significant findings were decline in bladder pressures in 3rd quartile with RD (P ................
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