Unraveling Intractable Functional Constipation: Manometries Are Still the Gold Standard

Unraveling Intractable Functional Constipation: Manometries Are Still the Gold Standard 1024 680 Natalie Wilson
Close up color photo of little boy holding hands on his belly

Cine-MRI recordings can’t replace colonic manometries when assessing motility among children with functional constipation, but they may offer additional information. And conducting both MRIs and manometries simultaneously is feasible.

While functional constipation (FC) is common in childhood, and most children who experience it respond well to behavioral interventions or treatment with laxatives, some children continue to experience problems, such as fecal incontinence. Others may have difficult-to-manage motility disorders that require additional testing.

The “gold standard” of this testing is a colonic manometry. Physicians insert a catheter into a child’s colon through the rectum under sedation or general anesthesia to record the pressure of the colon wall and determine if a child is experiencing normal colonic motility patterns, which are present in FC, or if a child has a neuromuscular disorder.

“A colonic manometry is a very established test,” says Carlo Di Lorenzo, MD, chief of the Division of Gastroenterology, Hepatology and Nutrition and director of the Motility Center at Nationwide Children’s Hospital, where he holds the Robert F. and Edgar T. Wolfe Foundation Endowed Chair in Pediatric Gastroenterology. “But it’s a big deal. It requires general anesthesia, catheter placement and at least six hours in the hospital. And while Nationwide Children’s offers it, very few places do.”

Dr. Di Lorenzo and his team conducted a preliminary study, published in European Radiology Experimental, to explore whether cine magnetic resonance imaging (MRI) could be a noninvasive alternative. The technique, which shows changes in the diameter of the colon wall over time at a given position, had shown promise in adults but had not been studied in children with FC.

To compare the two tests, the team administered bisacodyl to participants to stimulate their colons, then collected both MRI and manometry readings simultaneously for about 30 minutes. Over the course of a year, all children with FC aged 12-to-18 years who were scheduled to undergo colonic manometry recordings at the Motility Center at Nationwide Children’s were invited to participate. Twelve patients initially joined; however, six of them withdrew due to premature catheter dislodgement or issues tolerating either test.

Among the six patients who completed both tests, results differed. Colonic manometry showed a total of 11 high-amplitude propagated contractions (HAPCs), the colonic activity responsible for bowel movements, for three patients, but corresponding cine-MRI recordings showed high colonic activity during two HAPCs and minimal activity during seven HAPCs. The MRI did not record two HAPCs, yet in two of the three patients with absent HAPCs on their manometry recordings, the MRI showed colonic activity.

“We hoped an MRI would capture the same events as the manometry, but that wasn’t really the case,” says Dr. Di Lorenzo, who is also a member of the physician team in the Center for Colorectal and Pelvic Reconstruction (CCPR) at Nationwide Children’s. “But this preliminary study shows you can use MRI to measure certain movements of the colon. There might be some data we aren’t capturing with colonic manometry that we can capture with an MRI, and we may learn that additional data is just as important in assessing colon activity.”

“One is not a substitute for the other,” he adds, “but they might be complimentary techniques.”



Vriesman MH, de Jonge CS, Kuizenga-Wessel S, Adler B, Menys A, Nederveen AJ, Benninga MA, Di Lorenzo C.  Simultaneous assessment of colon motility in children with functional constipation by cine-MRI and colonic manometry: a feasibility studyEuropean Radiology Experimental. 2021;(5):8.

Image credit: Adobe Stock

About the author

Marketing Strategist, Research Communications

Natalie is a passionate and enthusiastic writer working to highlight the groundbreaking research of the incredible faculty and staff across Nationwide Children's Hospital and the Abigail Wexner Research Institute. Her work at Nationwide Children's marries her past interests and experiences with her passion for helping children thrive and a long-held scientific curiosity that dates back to competing in the Jefferson Lab Science Bowl in middle school. Natalie holds a bachelor’s degree in sociology from Wake Forest University, as well as minors in women's, gender & sexuality studies and interdisciplinary writing. As an undergraduate student, Natalie studied writing and journalism, engaged with anthropological and sociological research with a focus on race and ethnic relations, served as executive editor for the student newspaper, the Old Gold & Black, and gained marketing experience as an intern for a nonprofit entrepreneurial incubator, Winston Starts, as well as by working for Wake Forest University School of Law Office of Communication and Public Relations and its Innocence and Justice Clinic.