Objectives: A subgroup of children with functional constipation (FC) is unresponsive to conventional treatment. Abnormal rectal function due to increased distensibility (compliance) might be an underlying mechanism of therapy resistant FC. We hypothesize that rectal compliance is normal in patients who are successfully recovered from FC (RC). Methods: Using the barostat, a pressure-controlled intermittent distension protocol was performed in FC patients, RC subjects free of symptoms for at least 4 years, and healthy volunteers (HV). Rectal compliance was calculated using a non-linear mixed-effect model for volume-pressure curves. Results: Forty-seven FC patients, median (range) age of 12 (11-17) years, and 20 RC subjects, 15 (11-18) years, were studied and compared to 22 HV, 14 (8-16) years. The median (5th–95th percentile) rectal compliance in HV was 16 (12-20) ml/mmHg. FC patients had a median rectal compliance of 25 (13-47) ml/mmHg and RC 20 (12-35) ml/mmHg, which was significantly higher compared to HV (p<0.001 and p=0.003). RC had lower rectal compliance when compared to FC (p=0.02). Forty-five percent of RC subjects had a rectal compliance above the upper limit of normal (>95th percentile of HV), which was significantly less compared to 75% of FC patients (p=0.02). Conclusion: While rectal compliance in recovered subjects is lower when compared to constipated adolescents, almost half of the recovered subjects showed an increased rectal compliance. The role of rectal compliance in therapy resistant functional constipation seems limited, because recovery is possible despite an increased rectal compliance.
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