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Diagnosis of constipation does not correlate with trans-abdominal ultrasound of rectal distention
Matthew D. Mason, M.D., Christina B. Ching, M.D., Douglass B. Clayton, M.D., John C. Thomas, M.D., John C. Pope, IV, M.D., Mark C. Adams, M.D., John W. Brock, III, M.D., Stacy T. Tanaka, M.D..
Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.

BACKGROUND:
Ultrasound (US) has been shown to be a reliable method to assess constipation in an outpatient constipation clinic. We hypothesize that trans-abdominal ultrasound assessing rectal distention would correlate with assessment of constipation on a validated dysfunctional elimination questionnaire.
METHODS:
At our institution, families of toilet-trained patients seen in the outpatient Pediatric Urology clinic are asked to prospectively fill out the Vancouver Nonneurogenic Lower Urinary Tract Dysfunction/Dysfunctional Elimination Syndrome (NLUTD/DES) questionnaire. Three questions from this questionnaire specifically address bowel function. Patients undergoing trans-abdominal US of the bladder also have stool burden scored 0-10 as per a previously published tool from the pediatric gastroenterology literature. Clinic records for June 2013 were reviewed for 100 patients that had a complete questionnaire and US stool evaluation, comparing the symptoms of constipation by questionnaire with US score by both linear regression analysis and mean US score for patients with specific symptoms.
RESULTS:
Linear regression analysis showed no correlation of US stool height to patient reported frequency of bowel movement (p = 0.69), hard stools (p = 0.52), or fecal incontinence (p = 0.44). Table 1 shows US results for patients with worse constipation symptoms, none of whom had significantly higher US scores.
Table 1
# of patientsmean US score (0-10)p-value (t-test)
BM every 2 or fewer days932.80.19
BM every 3 or more days93.7
Hard stool half the time or less942.80.31
Hard stool more than half the time83.5
Bowel accidents less than 1/week872.80.63
Bowel accidents at least 1/week153.0

CONCLUSIONS:
US examination has previously been shown to correlate with symptom severity for children with chronic constipation in a constipation clinic setting. However, in a Pediatric Urology outpatient clinic setting at our institution, US examination did not correlate with patient reported symptoms.


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