Variation of the anal resting pressure induced by postexpiratory apnea effort in patients with constipation secondary to dyskinesia of the pelvic floor / Variação da pressão anal de repouso induzida pela apneia pos-esforço expiratorio em portadores de constipação secundaria a discinesia do assoalho pelvico

AUTOR(ES)
DATA DE PUBLICAÇÃO

2009

RESUMO

Intestinal constipation - a common symptom in the general population -, is more frequent in women. It may be secondary to improper diet or organic or functional disturbances, such as dyskinesia of the pelvic floor. This is basically characterized by the absence of relaxation or paradoxical contraction of the pelvic floor and the anal sphincter during evacuation. The aim of this study was to analyze, by manometric data, the anal pressure variation at rest, during evacuation effort by using the Valsalva maneuver and forced postexpiratory apnea in subjects with secondary constipation due to dyskinesia of the pelvic floor. Twenty-one patients (19 females - 90.4%) with mean age of 47.5 years old (23-72) were studied. The diagnosis was performed using anorectal manometry, with a catheter containing eight channels disposed at the axial axis, measuring the proximal (1) and distal (2) portions of the anal orifice. In order to diagnose dyskinesia of the pelvic floor, it was considered the elevation of the pressure values in relation to the resting with the evacuation effort. The Agachan score was used for clinical evaluation of the constipation. The variables studied were: mean anal pressure of the anal orifice for twenty seconds at rest (R) to the effort of evacuation using Valsalva (V) maneuver and to the evacuation effort during apnea after forced expiration (A), as well as the area under the curve of the manometric tracing at the moments V and A. The analysis of the mean values of the anal pressure variation at rest evidenced difference between proximal and distal channels (p= 0.007), independent of the moment and tendency to difference at the moments V and A (p= 0.06). The mean of values of the area under the manometric tracing curve showed difference between the moments V and A (p= 0.0008), either at the proximal portion or at the distal portion of the anal orifice. The conclusion is that the evacuation effort associated with postexpiratory apnea, when compared with the evacuation effort associated with the Valsalva maneuver, provides lower elevation of the anal pressure at rest by the parameter area under curve

ASSUNTO(S)

constipation manometry constipação manometria

ACESSO AO ARTIGO

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