ArticleActa gastroenterologica Latinoamericana
[Identification of the Different Subtypes of Dyssynergic Defecation: A Descriptive Study in a Tertiary Care Hospital].
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Abstract
Introduction: Dyssynergic defecation is a functional disorder characterized by a lack of coordination between abdominal contractions and the relaxation of the anal sphincter, leading to chronic constipation. The main symptoms include a sensation of incomplete evacuation and excessive defecatory effort. Diagnosis requires excluding organic causes and evaluating alarm symptoms through digital rectal examination, high-resolution anorectal manometry, and balloon expulsion tests. Dyssynergic defecation is classified into four subtypes based on the manometric mechanisms involved. Objective: To describe the clinical and manometric characteristics of patients suspected of having dyssynergic defecation and estimate the proportions of the different subtypes. Materials and methods: Observational, descriptive, and retrospective study of 170 patients over 18 years of age diagnosed with dyssynergic defecation, evaluated at Hospital de Clínicas José de San Martín. High-resolution anorectal manometry was performed with a 12- circumferentially-oriented pressure sensors catheter and a balloon expulsion test. Manometric patterns were classified into four subtypes based on defecatory effort and sphincter relaxation. Results: The average age was 59.3 years (SD 15.7), and 80.6% of the patients were women. The distribution of the subtypes was as follows: type I (31.2%), type II (17%), type III (22.9%), and type IV (28.8%). No significant differences were found in age distribution (p = 0.558). Type IV dyssynergia had the highest proportion of women (95.9%, p = 0.015). The presence of symptoms such as incomplete evacuation, defecatory effort, and digitations varied between subtypes, but no statistically significant differences were found. Conclusion: The study confirms the clinical and manometric heterogeneity of patients with dyssynergic defecation. While some subtypes show a higher association with certain symptoms, the lack of significant differences suggests that other factors might influence the clinical presentation. High-resolution anorectal manometry remains key in the evaluation and classification of dyssynergic defecation.
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