Objective Assessing the presence of pelvic dyssynergia on high-resolution anorectal manometry
(HR-ARM) in children with lower urinary tract symptoms (LUTS).
Methods HR-ARM has been performed on children with LUTS aged ≥ 5 years. Children were categorized
according to LUTS into non-monosymptomatic enuresis, monosymptomatic enuresis, and
isolated urinary with daytime urination. The evaluation of the urinary symptoms was
carried out with the help of a structured questionnaire and a voiding diary. HR-ARM
was performed according to the London protocol. According to Rao´s classification,
pelvic dyssynergia was classified as Type I dyssynergia, II, III, and IV. Functional
constipation (FC) was assessed using the Rome IV criteria.
Results Forty children with a mean age of 9.33 ± 2.66 years, 22 (55%) were male, underwent
HR-ARM. Twenty (50%) patients suffered from constipation. Twenty-eight children (70%)
had pelvic dyssynergia, with Type I dyssynergia being the most common. Among children
with pelvic dyssynergia, seventeen (60,7%) had non-monosymptomatic enuresis (p=0.04).
Patients with dyssynergia had a higher intrarectal expulsion pressure, with a median
54.15(IC 45.88 – 66.23) × 28.05 (IC 25.98 – 36.53); p< 0.001. In addition, they had
a lesser anal relaxation during straining, with a median -10.35 (IC -28.82 – 9,15) × 36.6
(IC 22.85 – 50); p< 0.001.
Conclusion The presence of pelvic dyssynergia is associated with the simultaneous presence of
daytime and nocturnal symptoms, hence non-monosymptomatic enuresis. This could indicate
that the presence of pelvic incoordination is more common in more severe cases of
LUTS.
