Physiotherapy in the Сomplex Rehabilitation of Children with Anorectal Malformations: Systematic Review

Medical rehabilitation is an integral part of the treatment for surgical patients. Regarding pediatric patients with anorectal malformations, the success of the result of surgical treatment is mainly a correctly selected rehabilitation program, including methods of individual physiotherapy. Disturbances of intestinal transit, such as chronic constipation and anal incontinence, according to the world literature, occur in the study group in up to 30% of cases. According to the social significance of constipation and anal incontinence, the psychological aspects, the disabling component, children with anorectal malformations need early and long-term rehabilitation, adapted to their needs. At the moment, there are regulatory documents describing the principles of medical rehabilitation of children, its main characteristics, however, there are no protocols for the use of physiotherapy methods regarding the manifestations of colon transit disorders. Aim. Analysis of modern literature data on physiotherapeutic methods of rehabilitation of children with anorectal malformations. Material and methods. After determining the research criteria, a basic literature review using Web of Science, PubMed, electronic library was conducted, as a result 186 articles were selected that met the search criteria. After the initial assessment, 10 full-text articles were accepted for the analysis. Results. We have assessed the opportunity and mechanisms of the therapeutic action of sacral stimulation and tibial neuromodulation, the effect of various types of currents and a high-intensity magnetic field on the muscles of the complex, studied the possibility and results of using biofeedback therapy in children with colon transit disorders after operations on the anorectal body area in 421 children in 10 studies. Conclusion. Based on the results of scientific research, a range of physiotherapy methods have been established that are effective in relation to rehabilitation measures in children with anorectal malformations.

Bowel transit studies in children: evidence base, role and practicalities

Constipation is common in children and adults with varied worldwide prevalence. The majority of children have functional constipation as defined by Rome clinical criteria and respond favourably to standard medical therapy; up to one-third can develop difficult-to-treat constipation requiring investigation and specialist treatment. Colon function tests aim to assess the neuromuscular integrity, the movement of faeces across the colon and evaluate/predict response to the therapy. The ‘ideal’ test should be practical, non-invasive, widely available and cost-effective. None of the available diagnostic tools is designed to provide a comprehensive assessment of colon function and clinicians often have to combine more than one test to answer different questions. In this review, we aim to assess the strengths and limitations of the commonly available diagnostic investigations (radiopaque marker studies, scintigraphy, wireless motility capsule and colonic manometry) used to assess colon transit in children and to provide guidance on the most appropriate test for particular clinical settings.

A Novel Noninvasive Method for Quantitative Detection of Colonic Dysmotility Using Real-Time Ultrasonography

<b><i>Introduction:</i></b> Colonic motility disorders are a frequent clinical problem caused by various drugs and diseases. However, the etiology of colonic dysmotility is often unclear due to the lack of in vivo methods, including rapid dynamic assessment. <b><i>Objectives:</i></b> The aim of this study was to establish a novel quantitative method to objectively assess colonic motility using ultrasonography. <b><i>Methods:</i></b> We applied echocardiographic speckle tracking-based strain imaging to analyze murine colonic motility. A trace line was placed on the boundary between the proximal wall of the colon and the inner cavity to analyze colonic wall displacement and strain rate. Locomotion activities of the colonic wall were used to quantify colonic motility via ultrasonography. <b><i>Results:</i></b> We found that ultrasonography can quantitatively detect a decrease in colonic motility induced by loperamide, an antidiarrheal drug. These quantitative data were consistent with the imaging findings of colonic peristalsis and colon transit time. Additionally, ultrasonography also revealed changes in colonic motility over short intervals. Furthermore, we have shown that ultrasonography can quantitatively and noninvasively detect colonic dysmotility and hypervascularity of the colonic wall in colitis mice. <b><i>Conclusions:</i></b> These findings suggest that ultrasonography is a useful in vivo method for objectively monitoring changes in colonic motility caused by drugs and diseases.

Novel Bionics Assessment of Anorectal Mechanosensory Physiology

Biomechatronics (bionics) is an applied science that creates interdisciplinary bonds between biology and engineering. The lower gastrointestinal (GI) tract is difficult to study but has gained interest in recent decades from a bionics point of view. Ingestible capsules that record physiological variables during GI transit have been developed and used for detailed analysis of colon transit and motility. Recently, a simulated stool named Fecobionics was developed. It has the consistency and shape of normal stool. Fecobionics records a variety of parameters including pressures, bending, and shape changes. It has been used to study defecation patterns in large animals and humans, including patients with symptoms of obstructed defecation and fecal incontinence. Recently, it was applied in a canine colon model where it revealed patterns consistent with shallow waves originating from slow waves generated by the interstitial Cells of Cajal. Novel analysis such as the “rear-front” pressure diagram and quantification of defecation indices has been developed for Fecobionics. GI research has traditionally been based on experimental approaches. Mathematical modeling is a unique way to deal with the complexity. This paper describes the Fecobionics technology, related mechano-physiological modeling analyses, and outlines perspectives for future applications.

Dyssynergic patterns of defecation in constipated adolescents and young adults with anorectal malformations

We aimed to evaluate the etiologies of constipation in patients with anorectal malformations having a good prognosis for bowel control but a high risk of constipation. We included twenty-five patients from the Odense university hospital in Denmark. Patients were subjected to colon transit time examination and high resolution anorectal manometry (HRAM). The median age was 18 (14–24) and 48% (12/25) were females. Fifty-two % (13/25) of patients were diagnosed with constipation. Types of anorectal malformation were perineal fistula (9/25), rectovestibular fistula (8/25), rectourethral bulbar fistula (5/25) and no fistula (3/25). No difference in neither total colon transit time nor segmental colon transit times were found based on the presence of constipation. Only four of the constipated patients fulfilled criteria for dyssynergic defecation with a dyssynergic pattern at HRAM and prolonged colon transit time. A Type I dyssynergic pattern was dominant in constipated patients (7/13). A Dyssynergic defecation pattern was due to isolated contraction of puborectalis muscle in 9 out of 13constipated patients. We found a dyssynergic pattern during attempted defecation in patients with anorectal malformations disregarded the presence of constipation. In the majority of constipated patients an isolated contraction of the puborectalis muscle was visualized with HRAM.