Prevalence of Functional Defecation Disorder among Patients with Functional Constipation: Experience from a Tertiary Care Hospital in India

Abstract

Aims: To study the manometry findings and its association with clinical symptoms in patients with functional constipation (FC) and prevalence of Functional defecation disorder (FDD) among them. Study Design:  Prospective observational study. Place and Duration of Study: Patients from the department of Gastroenterology, Apollo Main Hospital Chennai between March 2020 to October 2021. Methodology: Consecutive patients with FC between age 18-70 years presenting to our institute and undergoing anorectal manometry (ARM) and balloon expulsion test (BET) were enrolled. Patients with mechanical obstruction or severe cardiopulmonary co-morbidities were excluded. Patients with abnormal ARM and absent BET were diagnosed as FDD and were classified into dyssynergic defecation (DD) I-IV according to Rao’s classification. Results: 75 patients (M:F-39:36) were enrolled. Mean age and mean duration of constipation was 44.59 (±13.89) years and 3.32(±2.87) years, respectively. Common symptoms were sensation of incomplete evacuation (67%), use of manual manoeuvres (55%) and excessive straining (53%). 69.2% males (27/39) had a FDD compared to 44.4% females (16/36) which was statistically significant (P = .037). 83% (20/24) of the patients presenting with sensation of blockage/obstruction had a FDD while 17% (4/24) had a normal manometry study which was statistically significant (P = .002). No other symptoms could predict an abnormal finding in manometry. Conclusion: This study is aimed to describe the clinical and anorectal manometry profile of patients with FC. A large number of patients with FC had FDD. Male patients and those presenting with symptom of sensation of obstruction/blockage were more likely to have FDD.