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Khirurgii

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Year 2011 Vol. 19 No 2

HYPOTHESIS

LEVIN M.D., DEGTYAROV I.G.

PERSPECTIVES OF THE FUNCTIONAL CONSTIPATION TREATMENT IN CHILDREN

Here we offer a hypothesis of the disease, based on literature review as well as our analysis of 280 pediatric patients with functional constipation, who were examined at the Byelorussian Pediatric Surgical Center. Primary delay of defecation leads to enlargement of fecal masses. This in turn makes it difficult to have a normal bowel movement and causes further delay of defecation which leads to further increase in fecal mass and so on. If this vicious cycle is not broken within first several weeks of symptoms, rectum will become stretched. Earlier we described methods of precise evaluation of the size of rectum and differentiation among 3 degrees of puborectal muscle tone weakening. The muscle responsible for anal elevation during defecation fails to open anal canal. Gradually, pelvic floor muscles become more and more rigid. As a result, there is disproportion between large width of fecal masses and decreased ability of the anal canal to pass fecal masses. Chronic intestinal impaction promotes development of colitis and irritable bowel syndrome. Treatment has to take in consideration decreases opening of the rectum and restoration of the ability of anal canal to pass fecal masses. Methods of treatment (conventional therapy, anal stretching, sphincterometry of the inner sphincter, botuline toxin injection, biofeedback-therapy and sacral nerve electro stimulation) and their duration must be chosen base on the megacolon degree and symptoms of anal canal damage).

Keywords: functional constipation, pathological physiology, anal canal, megacolon, megarectum, children, irritable bowel syndrome, treatment
p. 113 – 124 of the original issue
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