The Role of Anorectal Manometry in Pediatric Chronic Refractory Constipation

NCT ID: NCT07291661

Last Updated: 2025-12-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

54 participants

Study Classification

INTERVENTIONAL

Study Start Date

2026-01-01

Study Completion Date

2027-12-31

Brief Summary

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This research protocol outlines a two-year descriptive cross-sectional study to investigate the role of high-resolution anorectal manometry (HRAM) in children aged 4-18 years with chronic refractory constipation.The study plans to enroll 54 patients at Ain Shams University Specialized Hospital . The study aims to identify different patterns of anorectal dysfunction (like dyssynergic defecation or rectal hyposensitivity) using standardized international protocols. A key goal is to determine if these manometry findings can directly guide specific management strategies, such as biofeedback therapy for dyssynergia or botulinum toxin injections for anal hypertension. improving outcomes for children who do not respond to standard constipation therapies.

Detailed Description

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Structural and functional abnormalities of the anorectum or pelvic floor have been observed in constipated children with or without fecal incontinence. Childhood functional constipation accounts for about 95% of cases, while organic causes are less than 5%.

Organic causes include Hirschsprung disease, anorectal malformations, neuromuscular disorders and metabolic causes. Functional constipation can be caused by paradoxical contraction or insufficient relaxation of the pelvic floor muscles, and/or inadequate rectal propulsive forces during defecation. According to the Rome IV criteria, functional constipation is defined separately for infants and toddlers (\<4 years) and for children (≥ 4 years).

Anorectal manometry (ARM) is an objective tool used to measure pressure and sensation in the anorectum at rest, during squeezing, and during simulated evacuation. three dimensional high resolution anorectal manometry (3D-HRAM) employs an array of 256 sensors, offering a more detailed assessment of anorectal anatomy and function.

Anorectal manometry is used for the evaluation of chronic constipation by checking rectoanal coordination and rectal sensitivity, and helps exclude structural disorders. It evaluates fecal incontinence by analyzing sphincter function and rectal sensation, identifies sphincter hypertension in functional anorectal pain, and provides preoperative baseline data before surgeries affecting continence or defecation.

Treatment of childhood constipation includes both nonpharmacological approaches (education, dietary modifications, behavioral strategies, biofeedback, and pelvic floor physiotherapy) and pharmacological options (osmotic and stimulant laxatives, probiotics as well as newer medications such as prucalopride and lubiprostone). For children with persistent constipation transanal irrigation, botulinum toxin injections, neuromodulation, and surgical procedures may be considered.

Conditions

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Refractory Constipation Fecal Incontinence in Children

Keywords

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Anorectal manometry Functional constipation Pediatric chronic refractory constipation Fecal incontinence Biofeedback therapy Botox injection

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

A descriptive cross-sectional study
Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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High resolution anorectal manometry using multiuse water perfused catheter

Solar™ GI High Resolution Anorectal Manometry with multiuse water perfused catheter

Group Type OTHER

High resolution anorectal manometry using a multiuse water perfused catheter

Intervention Type DEVICE

According to the international anorectal physiology working group recommendations(8):

Stabilization: A 3-minute period after catheter insertion to allow anal tone to return to baseline.

* Rest: Measures basal anal tone over 60 seconds.
* Squeeze: Records anal pressure during voluntary contraction. Three 5-second squeezes are performed.
* Long Squeeze: Evaluates anal pressure and fatigue during a single sustained 30-second contraction.
* Cough: Assesses reflex anal pressure changes during two single coughs.
* Push: Measures pressure changes during simulated defecation. Three 15-second pushes are performed.
* RAIR (Rectoanal Inhibitory Reflex): Tests reflex anal relaxation after rapid rectal balloon distension, starting with at least 30 mL.

Rectal Sensory Test: Measures rectal sensitivity by recording balloon volumes at three thresholds: first constant sensation, desire to defecate, and maximum tolerated volumes.

· Balloon Expulsion: time required to expel the balloon.

Interventions

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High resolution anorectal manometry using a multiuse water perfused catheter

According to the international anorectal physiology working group recommendations(8):

Stabilization: A 3-minute period after catheter insertion to allow anal tone to return to baseline.

* Rest: Measures basal anal tone over 60 seconds.
* Squeeze: Records anal pressure during voluntary contraction. Three 5-second squeezes are performed.
* Long Squeeze: Evaluates anal pressure and fatigue during a single sustained 30-second contraction.
* Cough: Assesses reflex anal pressure changes during two single coughs.
* Push: Measures pressure changes during simulated defecation. Three 15-second pushes are performed.
* RAIR (Rectoanal Inhibitory Reflex): Tests reflex anal relaxation after rapid rectal balloon distension, starting with at least 30 mL.

Rectal Sensory Test: Measures rectal sensitivity by recording balloon volumes at three thresholds: first constant sensation, desire to defecate, and maximum tolerated volumes.

· Balloon Expulsion: time required to expel the balloon.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

1. Children and adolescents aged from 4 to 18 years.
2. Participants who have chronic refractory constipation either functional or organic with or without fecal incontinence.
3. Cooperative patients.

Exclusion Criteria

1. Children aged less than 4 years old.
2. Uncooperative patients.
3. Children with anal fissures or any painful conditions that interfere with the procedure.
Minimum Eligible Age

4 Years

Maximum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Assiut University

OTHER

Sponsor Role lead

Responsible Party

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Yasser Mohamed Abd Elaal Ahmed

Doctor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Naglaa H. Ibrahim, Professor

Role: STUDY_DIRECTOR

Assiut University- Faculty of medicine

Naglaa S. Mohamed, A. professor

Role: STUDY_CHAIR

Assiut University- Faculty of medicine

Rehab I. Hassan, Lecturer

Role: STUDY_CHAIR

Assiut University- Faculty of medicine

Locations

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Assiut University-faculty of medicine

Asyut, , Egypt

Site Status

Countries

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Egypt

Central Contacts

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Yasser M. Abd Elaal, Master

Role: CONTACT

Phone: +201021356722

Email: [email protected]

Nagla H. Ibrahim, Professor

Role: CONTACT

Phone: +20111187223

References

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Poojari VS, Mirani S, Shetty NS, Shah I. Evaluation of constipation in children using high-resolution anorectal manometry. Trop Doct. 2021 Oct;51(4):527-531. doi: 10.1177/00494755211030362. Epub 2021 Jul 16.

Reference Type BACKGROUND
PMID: 34270377 (View on PubMed)

Rao SSC, Tetangco EP. Anorectal Disorders: An Update. J Clin Gastroenterol. 2020 Aug;54(7):606-613. doi: 10.1097/MCG.0000000000001348.

Reference Type BACKGROUND
PMID: 32692116 (View on PubMed)

Carrington EV, Scott SM, Bharucha A, Mion F, Remes-Troche JM, Malcolm A, Heinrich H, Fox M, Rao SS; International Anorectal Physiology Working Group and the International Working Group for Disorders of Gastrointestinal Motility and Function. Expert consensus document: Advances in the evaluation of anorectal function. Nat Rev Gastroenterol Hepatol. 2018 May;15(5):309-323. doi: 10.1038/nrgastro.2018.27. Epub 2018 Apr 11.

Reference Type BACKGROUND
PMID: 29636555 (View on PubMed)

Koppen IJN, Vriesman MH, Saps M, Rajindrajith S, Shi X, van Etten-Jamaludin FS, Di Lorenzo C, Benninga MA, Tabbers MM. Prevalence of Functional Defecation Disorders in Children: A Systematic Review and Meta-Analysis. J Pediatr. 2018 Jul;198:121-130.e6. doi: 10.1016/j.jpeds.2018.02.029. Epub 2018 Apr 12.

Reference Type BACKGROUND
PMID: 29656863 (View on PubMed)

Other Identifiers

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Anorectal manometry

Identifier Type: -

Identifier Source: org_study_id