| dc.description.abstract | Introduction: Anorectal anomalies (ARA) are a range of congenital conditions ranging
from a slight malposition of the anus to complex anomalies of the hindgut and urogenital
organ. Despite advanced surgical and treatment modalities, voluntary bowel control is poor
following surgical care with high rates of faecal incontinence (FI), and also constipation
after all grades of reconstructive surgery. The main aim was to determine the impact that FI
and constipation has on psychosocial functioning in the context of ARA in comparison to
patients with idiopathic constipation (IC) and healthy controls. We also investigated the
pathophysiological mechanisms that might contribute to poor bowel function in patients with
ARA.
Methods: Study comprised 52 patients (19 females; range 11-43 years) with ARA, 46 (13
females; range 11-31 years) IC and 51 healthy controls (26 females; range 11-42 years).
Constipation and FI were evaluated using KESS and Vaizey scores respectively (a higher
score indicating greater symptom severity). Psychometric tests included: Gastrointestinal
Quality of Life Index, Children's Depression Inventory/Beck Depression Inventory, General
Health Questionnaire-28, State-Trait Anxiety Inventory/Children, Pennebaker Inventory of
Limbic Languidness, Big Five Inventory, Level of Hopefulness, Cognitive Emotion
Regulation Questionnaire and Weinberger Attitude Inventory. Physiological investigations
were undertaken in 32 adults, presenting with a history of previous surgery for ARA and
urge FI. Physiological assessment included: anal manometry; rectal sensation (balloon
distension); pudendal nerve function (motor latencies); endo-anal ultrasound; colonic transit
and proctography.
Results: Significantly higher KESS scores were found in patients with IC (<0.0001)
compared to ARA and healthy controls and significantly higher Vaizey scores found in - 3
4
patients with ARA (<0.0001) and IC (0.0002) compared to healthy controls. Poorer
GIQOL scores were found in patients with IC compared to healthy controls (p<0.001) and
ARA compared to healthy controls (p<0.01). There was a significant relationship between
poor quality of life and high KESS scores in ARA and IC (p = 0.003) and high Vaizey
Incontinence scores (p = 0.02). Patients with ARA did not have higher psychiatric morbidity
in comparison to IC and healthy controls. Personality traits and level of hopefulness
appeared the same across the three groups. IC significantly put less emphasis on their
general physical health (p<0.0001) in comparison to ARA and healthy controls. ARA
significantly used more ‘positive reappraisal’ and ‘putting into perspective’ as their main
coping mechanism compared to healthy controls. Anorectal physiology was abnormal in all
subjects with ARA, involving multiple mechanisms. Anal resting tone and squeeze
increments were attenuated in 23/32 and 17/32 patients respectively. Both anal sphincters
were deficient on endosonography in the majority of patients with ARA. Evidence of
pudendal neuropathy in 11/13 (85%) patients studied. Rectal sensation and emptying was
abnormal in 17/22 (77%) and 9/14 patients (64%) respectively. Eight out of 17 patients had
delayed colonic transit (47%).
Conclusions: Symptoms of FI and constipation are major determinants for poor quality of
life in patients with ARA. Contrary to our expectations, they share similar bowel and
psychosocial functioning to patients with IC. Adolescents with ARA and IC had minimal
psychiatric morbidity, yet experience condition-specific psychosocial problems affecting
their daily life. The chronic nature of the patient’s problem appeared to have stimulated
psychologically protective factors such as positive coping strategies. While the structural
integrity of the anal sphincters is the major factor contributing to continence, this study
confirms that extra-sphincteric mechanisms, particularly rectal sensory function, may be
equally important. | en_US |
