Constipation is one of the most commonly encountered gastrointestinal complaints in clinical practice – a recent review reported the prevalence of North American chronic constipation at 10-15%. Constipation is a symptom-based disorder of heterogeneous pathophysiology and management guidelines have universally recommended that patients with typical constipation related complaints and no alarm features be treated empirically with dietary/lifestyle interventions and laxative therapy. However, almost half of constipation sufferers are not completely satisfied with their current treatment. This appears to be of particular relevance to patients with dyssynergic defecation as randomized trials have found that those patients are unlikely to improve with laxative therapies yet enjoy response rates of up to 80% with physical therapy and biofeedback training. In such patients, specialized testing including anorectal manometry and balloon expulsion testing can accurately identify patients with dyssynergic defecation. Unfortunately, this testing is embarrassing, invasive, and expensive. Further, these tests require specialized personnel to perform and interpret the procedure and are for that reason, are not available in most clinical practices.
Researchers at the University of Michigan have developed basic, office-based tools to simplify the task of diagnosing dyssynergic defecation. They have designed a glove-based device outfitted with pressure sensors to allow the collection of data identical to that yielded by laboratory-based anorectal manometry. In addition, they have also developed an inexpensive, disposable rectal balloon for office based balloon expulsion testing. These office-based tools will allow clinicians to accurately diagnose patients with dyssynergic defecation and in so doing, move the current treatment paradigm for chronic constipation from one that is based solely upon symptoms to one that is founded upon the identification and appropriate treatment of specific abnormalities in physiology.
Applications and Advantages
- Chronic constipation management
- Simple office tools
- Measurement-based diagnosis