{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 16, Ep 2 of 3: Dyssynergia and Slow-Transit Constipation","html":"","width":"100%","height":180,"duration":704,"description":"Episode two covers the constipation phenotypes that need more than pharmacology: defecatory disorders diagnosed on anorectal manometry and balloon expulsion and treated with biofeedback, and slow-transit constipation documented on a marker or capsule study. The organizing discipline is to decide the mechanism before the next drug, because escalating laxatives in unrecognized outlet dysfunction produces overflow and urgency without relief. The central pitfall runs the whole episode: unrecognized outlet dysfunction falsifies the transit study and sends the wrong patient to colectomy, so check the outlet before you cut the colon. Testing thresholds, the two-of-three diagnostic rule, and precise colectomy criteria throughout.\n \nTopics covered\n\nDeciding phenotype before the next drug\nDyssynergic defecation mechanism and rectal exam clue\nBalloon expulsion screening test\nAnorectal manometry parameters and the rectoanal inhibitory reflex\nDefecography and structural lesions\nTwo-of-three diagnostic rule and biofeedback\nSlow-transit constipation and transit studies\nSubtotal colectomy indications and disqualifiers\n \n \nKey decisions\n\nAfter empiric therapy fails, the first decision is which phenotype the patient has, not which drug comes next, because more laxative in outlet dysfunction produces urgency and overflow around a still-closed sphincter.\nBalloon expulsion is the first-line screen: a rectal balloon is inflated with fifty milliliters of warm water and failure to expel within sixty seconds is abnormal and supports a defecatory disorder.\nAnorectal manometry reads resting pressure, squeeze pressure, the push maneuver (dyssynergia is a paradoxical rise in anal pressure), and the rectoanal inhibitory reflex, whose absence is the hallmark of Hirschsprung disease.\nThe diagnosis of a defecatory disorder requires at least two of three positive studies among manometry, defecography, and balloon expulsion, because a paradoxical contraction on manometry alone is too soft....","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}