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PURPOSE: This study was designed to compare routine clinical examination and d efecography in the diagnosis of rectal intussusception in constipated patients a nd study relationships between rectal intussusception and symptoms. METHODS: A t otal of 127 consecutive patients with functional constipation were examined in t he left-lateral position with rectal palpation and rectoscopy according to a pr otocol. An overall clinical judgment was made if the patient had intussusception , unclear finding, or no intussusception. Defecography was performed without kno wledge of the results of the clinical evaluation. Symptomduration varied between 0.5 to 60 (median, 10) years. All patients fulfilled a bowel questionnaire and all had a full physiologic workup. RESULTS: A diagnosis by digital examination ( P = 0.002) and by rectoscopy (P = 0.002) as well as the overall judgment (P = 0. 0002) was clearly related to a longer intussusception as measured by defecograph y. Five of six intraanal intussusceptions were correctly assessed by clinical examinat ion,whereas the correlation to defecographywas poor in the group with short intu ssusceptions. Neither clinical nor defecographic diagnosis of rectal intussuscep tion were related to the main symptoms of constipation but both were associated with a tendency toward lower anal resting pressures (P = 0.04 and P = 0.06) and an obtuse anorectal angle (during evacuation, P = 0.01 and P = 0.01). CONCLUSION S: There is no clear relationship between rectal intussusception and constipatio n. However, intussusception is related to sphincter function and may be of clini cal relevance. A normal clinical examination will exclude most long intussuscept ions, whereas a positive finding needs further evaluation with defecography.
METHODS: A total study of 127 consecutive patients with functional constipation were examined in t he An overall clinical judgment was made if the patient had intussusception, unclear finding, or no intussusception. Defecography was performed without kno wledge of the results of the clinical evaluation. Symptomduration varied All patients fulfilled a bowel questionnaire and all had a full physiologic work. RESULTS: A diagnosis by digital examination (P = 0.002) and by rectoscopy (P = 0.002) as well as the overall judgment (P = 0. 0002) was clearly related to a longer intuition as as measured by defecograph y. Five of six intraanal intussus ceptions were correctly evaluated by clinical examinat ion, while the correlation to defecography was poor in the group with short intu ssusceptions. both Neither clinical nor defecography was poor in the group with short intu ssusceptions. resting pressures (P = 0.04 and P = 0.06) and an obtuse anorectal angle (during evacuation, P = 0.01 and P = 0.01). CONCLUSION S: There is no clear relationship between rectal intussusception and constipatio n. However, intussusception is related to s normalinclude function and may be of clini cal relevance. A normal clinical examination will exclude most long intussuscept ions, while a positive finding needs further evaluation with defecography.