Korean J Gastroenterol.  2003 Jun;41(6):456-464.

Manometric Classification of Pelvic Floor Dyssynergia and Its Clinical Significance in Patients with Constipation

Affiliations
  • 1Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. sjm5675@amc.seoul.kr
  • 2Department of Internal Medicine, Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea.

Abstract

BACKGROUND/AIMS: The pathophysiology of pelvic floor dyssynergia (PFD) is unclear and heterogenous. The PFD patient could be classified according to several manometric patterns. However, its clinical significance is not known. The aims of this study were to classify PFD patients according to manometric patterns and to evaluate its clinical meaning including response to biofeedback therapy. METHODS: Seventy patients (M:F 21:49, mean age 51+/-18) with PFD who fulfilled Rome criteria were examined with anorectal manometry. These patients were classified into 4 groups according to manometric patterns. The types were defined as follows: Type 1, adequate propulsive force with paradoxical anal contraction (n=49); type II, inadequate propulsive force with inappropriate anal contraction (n=3); type III, adequate propulsive force with failure to relax (n=13); type IV, inadequate propulsive force with failure to relax (n=5). We compared the clinical findings, parameters of manometry, and responses to biofeedback therapy of the 4 groups. RESULTS: Clinical findings including subjective symptoms were not different among the 4 groups. On anorectal manometry, squeezing pressure was low in type II and type IV compared to type I and type III (p<0.05). Only forty patients underwent biofeedback therapy, and there was no difference in the biofeedback response rate among the 4 groups. CONCLUSIONS: Pelvic floor dyssynergia could be classified into four groups according to manometric patterns. However, the significance of this classification system is dubious because clinical features including responses to biofeedback therapy are not different among groups.

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