BackgroundWhether patients with defecatory disorders (DDs) with favorable response to a footstool have distinctive anorectal pressure characteristics is unknown. We aimed to identify the clinical phenotype and anorectal pressure profile of patients with DDs who benefit from a footstool.MethodsThis is a retrospective review of patients with high resolution anorectal manometry (HR‐ARM) and balloon expulsion test (BET) from a tertiary referral center. BET was repeated with a 7‐inch‐high footstool in those who failed it after 120 s. Data were compared among groups with respect to BET results.Key ResultsOf the 667 patients with DDs, a total of 251 (38%) had failed BET. A footstool corrected BET in 41 (16%) of those with failed BET. Gender‐specific differences were noted in anorectal pressures, among patients with and without normal BET, revealing gender‐based nuances in pathophysiology of DDs. Comparing patients who passed BET with footstool with those who did not, the presence of optimal stool consistency, with reduced instances of loose stools and decreased reliance on laxatives were significant. Additionally, in women who benefited from a footstool, lower anal pressures at rest and simulated defecation were observed. Independent factors associated with a successful BET with a footstool in women included age <50, Bristol 3 or 4 stool consistency, lower anal resting pressure and higher rectoanal pressure gradient.Conclusion & InferencesIdentification of distinctive clinical and anorectal phenotype of patients who benefited from a footstool could provide insight into the factors influencing the efficacy of footstool utilization and allow for an individualized treatment approach in patients with DDs.

中文翻译：

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使用脚凳可改善某些排便障碍患者的直肠球囊排出情况

背景 对脚凳有良好反应的排便障碍 (DD) 患者是否具有独特的肛门直肠压力特征尚不清楚。我们的目的是确定受益于脚凳的 DD 患者的临床表型和肛门直肠压力特征。方法这是对来自三级转诊中心的高分辨率肛门直肠测压 (HR-ARM) 和球囊排出测试 (BET) 的患者进行回顾性评价。对于 120 秒后失败的人，用 7 英寸高的脚凳重复 BET。比较各组之间 BET 结果的数据。 主要结果 在 667 名 DD 患者中，共有 251 名 (38%) BET 失败。脚凳为 41 名 (16%) BET 失败者纠正了 BET。在 BET 正常和不正常的患者中，肛门直肠压力存在性别差异，揭示了 DD 病理生理学中基于性别的细微差别。将使用脚凳通过 BET 的患者与未通过 BET 的患者进行比较，发现最佳粪便稠度、稀便次数减少以及对泻药的依赖减少，这一点非常显着。此外，在受益于脚凳的女性中，观察到在休息和模拟排便时肛门压力较低。与女性使用脚凳成功进行 BET 相关的独立因素包括年龄 <50 岁、布里斯托尔 3 或 4 粪便稠度、较低的肛门静息压力和较高的直肠压力梯度。结论与推论识别受益于脚凳的患者的独特临床和肛门直肠表型可以深入了解影响脚凳使用效果的因素，并为 DD 患者提供个性化的治疗方法。