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Colon Manometry Proves That Perception of the Urge to Defecate Is Present in Children With Functional Constipation Who Deny Sensation

Firestone Baum, Carrie*; John, Anub*; Srinivasan, Kavitha*; Harrison, Prince*; Kolomensky, Andrew*; Monagas, Javier*; Cocjin, Jose; Hyman, Paul E.*

Journal of Pediatric Gastroenterology & Nutrition: January 2013 - Volume 56 - Issue 1 - p 19–22
doi: 10.1097/MPG.0b013e31826f2740
Original Articles: Gastroenterology

Background and Objective: Children with functional constipation often state an inability to sense an urge to defecate and/or inability to feel incontinence. We used colon manometry to assess whether there was a sensory abnormality in patients who denied sensation.

Methods: A physician observed all of the colon manometries in the preceding 20 years, and included behavioral observations in the procedure reports. We reviewed the charts of these patients.

Results: Of 150 subjects with normal manometry and a diagnosis of functional constipation, 56 volunteered that they had no urge to defecate or complained of abdominal pain. For all who denied sensation, the first high-amplitude propagating colonic contraction (HAPC) was associated with retentive posturing and facial grimaces. When queried, all reported they felt nothing. The examiner explained the HAPC was causing pain, and informed the child that the pain would resolve if they defecated. With subsequent HAPCs, every patient acknowledged an urge to defecate and successfully defecated. Most agreed that a similar pain sensation was present daily, but was misinterpreted to be abdominal pain.

Conclusions: Colon manometry may be useful not only for objective findings to discriminate neuromuscular disease from functional symptoms but also to understand psychological issues and aid in helping the child and family understand the maladaptive behaviors in functional constipation.

*Department of Pediatrics, Louisiana State University Health Sciences Center, Children's Hospital of New Orleans, New Orleans, LA

Department of Pediatrics, University of Missouri-Kansas City, Children's Mercy Hospital, Kansas City, MO.

Address correspondence and reprint requests to Paul E. Hyman, MD, Children's Hospital of New Orleans, Division of Pediatric Gastroenterology, Hepatology and Nutrition, 200 Henry Clay Ave, New Orleans, LA 70118 (e-mail:

Received 22 March, 2012

Accepted 27 July, 2012

The authors report no conflicts of interest.

Copyright 2013 by ESPGHAN and NASPGHAN