Date of Award

3-1996

Degree Type

Thesis

Degree Name

Doctor of Philosophy (PhD)

Department

Biomedical Sciences

Supervisor

J. Huizinga

Abstract

This thesis examines the sensitivity and specificity of manometry and defecography assessments; the relationship between function and symptoms; and the relationship between age and parity and patient assessments.

The manometry assessments of 72 incontinent and 50 constipated female patients were compared to 86 healthy volunteers using discriminant function and classification analysis (DFA). The defecography assesssments of a subset of these patients, 21 incontinent and 25 constipated, were compared to 22 healthy female volunteers. These data were used to examine the factors age, parity, severity of symptoms and rectal wall morphology on function.

The results show that the variables of total squeeze pressure and resting pressure have a sensitivity of 79% for the incontinent patients and 32% for the constipated patients. The specificity was 87%. The manometry variables resting pressure, squeeze pressures, volume to urgency were significantly different in the patient groups. Aging was a significant factor for lower resting pressures and increased parity was a significant factor for lower squeeze pressures in the patient groups.

The sensitivity of the combination of the defecography variables, lift and strain angles and junction levdls, was 90% for the incontinent patients and 88% for the constipated patients. The specificity was 95%. The defecography variables were not significantly different in the patient groups. Rest and lift angles were significantly wider with increased age and parity.

Neither the defecography and manometry variables nor rectal wall morphology changes were associated with varying severity of either constipation or incontinence.

The manometry and defecography assessments are presented in graphs, which may enhance the dinical usefulness of the assessments by demonstrating the difference between patient values and healthy controls. The manometry data are also presented in an index which makes areas of specific impairment more obvious.

DFA of the manomeby and defecography variables provides probability rates which may be useful in predicting patient outcomes. The discriminant scores from the analysis of the defecography and manometry variables can be used to develop a continuum from health to incontinence.

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