Anal incontinence and chronic constipation are two diametrically opposite symptoms affecting the anal sphincter. The first is the involuntary loss of stool as a result of the inability of the anal muscles to contract and therefore to remain closed, while the second is characterized by a difficulty to evacuate. To diagnose and treat these two disorders, which significantly affect the daily lives of those who suffer, Humanitas can use rectal manometry, a method of diagnosis but also rehabilitation. The biofeedback with anorectal manometry has been shown to bring considerable benefit in 70% of cases of both expulsive constipation and anal incontinence. We talked about it with Professor Enrico Corazziari and with Dr. Elisa Carlani, specialists in Gastroenterology at Humanitas, whose department is headed by Professor Alberto Malesci.
Intestinal transit times
It begins with a slowing down of the transit that usually manifests itself with a reduced frequency in the going of the body and a weakening or absence of the stimulus to evacuate. To determine whether intestinal transit times are normal or pathological, an x-ray of the abdomen can be taken to calculate the time of passage of the fecal content through the intestine and identify where the slowdown occurs. This passage is sometimes the first true diagnosis of chronic constipation, at the basis of which there may be several mechanisms: on one side a slowdown in the time of passage of the fecal content through an intestine that contracts less or less, on the other side a defect in the ability to coordinate the force exerted with the muscles of the abdomen with the release of the muscles at the level of the anus, such a defect that ends up hindering the expulsion of the faeces.
Constipation, the importance of understanding the motivations
When the constipation problem lies in a slower time of passage of the fecal content, the use of pharmacological therapy will be used: laxatives, enterokinetics or secretagogues can be used to speed up the transit as well as other food measures can help. If, on the other hand, the problem lies in a lack of coordination, the muscles responsible for defecation must be physically rehabilitated. During normal conditions, in fact, the anus does not allow the unintentional release of stool because it has two muscle rings (sphincters) normally closed. When we feel the stimulus to go of body, the expulsion of the stool happens coordinating the contraction of the abdominal muscles, that determine an increase of the pressure that with force pushes the content of the intestine toward the exit, with the release of the sphincters of the anus that do not oppose more resistance to the transit of the stool. Many people lose the ability to coordinate the contraction of abdominal muscles with the release of the anal sphincters and therefore suffer from a form of constipation that is distinguished by the difficulty of expulsion of the stool. The characteristic symptoms are manifested during the act of defecation and are an example: an effort followed by little or no emission of stool, a sense of anal blockage and the use of fingers to facilitate the passage of the stool.
The involuntary loss of stool, anal incontinence, occurs instead following the loss, by the muscles of the anal sphincters, of the ability to contract and thus to remain closed. A relatively frequent disorder with increasing age.
An anorectal manometry for diagnosis
The diagnosis and treatment of these defects of muscle contraction is carried out with an easy and risk-free examination: anorectal manometry. Biofeedback with anorectal manometry has been shown to be of considerable benefit in 70% of cases of both expulsive constipation and anal incontinence. The procedure consists of measuring the force and time of contraction and release of the anal sphincters by introducing a plastic tube a few millimetres in size into the anus with a latex balloon placed at the end, while the patient lies on the bed. This examination, which lasts 10-15 minutes, allows the diagnosis of expulsive constipation or incontinence to be made. Like all muscles also the anal ones can be rehabilitated to improve their ability to inhibit or contract in a temporally coordinated way with the stimulus to go of body. The technique of anorectal manometry is also used for the rehabilitation of muscle coordination of both expulsive constipation and anal incontinence, and allows the patient to see on a monitor the representation of contractions and releases of the anal sphincters. In this way, the patient learns to contract or release or to modulate the muscles at the right time, under the guidance of an operator. In the case of expulsive constipation, the patient learns to coordinate the abdominal and anal sphincter muscles by looking directly at the monitor at the phases of contraction and release of their own muscles. In the case of anal incontinence, on the other hand, the patient practices contracting the muscles of the anus guided by a rehabilitator and observing the effects of the exercise directly on the monitor.