@article{10.37349/edd.2025.100596,
abstract = {Aim: Functional defecatory disorder (FDD) is associated with impaired defecation not only due to abnormalities in recto-anal coordination, but also due to abnormalities in anal tone and rectal sensation. This study aimed to characterize the spectrum of anorectal motor and sensory abnormalities in patients with FDD using the London classification. Methods: In this single-center prospective study, 100 consecutive patients fulfilling Rome IV criteria for FDD were included. Secondary causes of constipation were excluded. High-resolution anorectal manometry, rectal sensory testing, and a balloon expulsion test were performed as per the International Anorectal Physiology Working Group (IAPWG) protocol. Patients were classified using the London classification, which identifies multiple subtypes of anorectal dysfunction. Results: The median age was 34 years (range: 18–78), with 64% males and 36% females. Among the cohort, 85% had abnormal expulsion with dyssynergia, while 15% had abnormal expulsion with poor propulsion and dyssynergia. Anal hypotension with normal contractility was seen in 9%, while 4% had anal normotension with hypocontractility. Rectal hyposensitivity and borderline rectal hyposensitivity were noted in 4% and 5% of patients, respectively. Conclusions: This study highlights that dyssynergic defecation is frequently accompanied by additional anorectal dysfunctions. Applying the London classification enhances the recognition of coexisting abnormalities, which may have therapeutic implications. Future research should investigate whether addressing these additional dysfunctions improves treatment outcomes in FDD.},
author = {Benny, Stephan and Jaleel, Rajeeb and Choudhury, Ashis Kumar and Dutta, Amit Kumar and Mathews, Noble Varghese},
doi = {10.37349/edd.2025.100596},
journal = {Exploration of Digestive Diseases},
elocation-id = {100596},
title = {Multiple abnormalities of anorectal physiology co-exist with dyssynergia in patients with functional defecatory disorder—an observational study based on the London classification},
url = {https://www.explorationpub.com/Journals/edd/Article/100596},
volume = {4},
year = {2025}
}