Factors Correlated to HRARM Findings in Chronic Constipation

In patients with chronic constipation, the most common form of anorectal dysfunction is Type 1 dyssynergic defecation.

SAN ANTONIO — In patients with chronic constipation, the most common form of anorectal dysfunction is Type 1 dyssynergic defecation (DD). Additionally, sex and age distribution differs between the DD subtypes seen in normal, high-resolution, anorectal manometry (HRARM) populations, although the between-group symptom profile is largely the same, according to research presented at the ACG Annual Scientific Meeting, held October 25 to 30, 2019, in San Antonio, Texas.

HRARM is used to evaluate chronic constipation by assessing anorectal sensory and motor dysfunction, but not much is known about the patient factors associated with manometric diagnoses of DD and its subtypes I to IV. The current study was designed to characterize HRARM abnormalities in patients with chronic constipation and to correlate patient demographic factors and symptoms with the HRARM-identified abnormalities. Consecutive patients evaluated at the author’s center for chronic constipation (N=170) were given bowel-related symptom questionnaires, HRARM was performed using ManoScan, and the data were analyzed using ManoView software.

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Of the total 170 participants, 63 had Type 1 DD, 24 had Type 2, 16 had Type 3, 17 had Type 4, and 50 had a non-dyssynergic pattern of defecation. Participants with Type 3 DD were younger (P =.02), with a higher body mass index (P =.07), while patients with Type 1 DD were older (P =.02). Participants with Type 1 DD or Type 2 DD were also more likely to be men (P =.02), and in fact, most men (29 of 36, 81%) had either Type 1 or Type 2 DD. Participants with Type 1 DD less frequently had ≤2 bowel movements per week (P =.02). A trend toward difference was seen in several other symptoms, such as improvements in abdominal discomfort with bowel movement (P =.15) and the sensation of blockage (P =.13). Participants with Type 2 and Type 4 DD had lower intrarectal pressure (P <.001) compared with Type 1 DD, Type 3 DD, and non-DD participants.

Study investigators concluded, “Age and sex distribution differed between the dyssynergic defecation subtypes and normal HRARM populations. However, the symptom profile between these groups is largely the same. Thus, HRARM remains an important tool in differentiating dyssynergic defecation from other causes of chronic constipation.”


Tanner S, Vachhani H, Jehangir A, Malik Z, Parkman H. Relationship of patient factors to high resolution anorectal manometry findings in chronic constipation. Presented at: ACG Annual Scientific Meeting; October 25-30, 2019; San Antonio, TX. Abstract #P2166