结肠传输时间测定和直肠肛管测压在儿童便秘中的意义

目的　小儿便秘的病理生理基础目前尚不清楚,该文对结肠传输时间和直肠肛管测压在儿童便秘 中应用的意义进行初步探讨。方法　对28例便秘儿童(便秘组)和43例正常儿童(对照组)进行全胃肠传输时间 (TGITT)、左半结肠传输时间(LCTT)、右半结肠传输时间(RCTT)和直肠乙状结肠传输时间(RSTT)测定和直肠肛 管向量测压(包括肛管压力、向量容积和对称指数)。根据结肠传输时间是否超过对照组均值加两个标准差将28 例便秘儿童分为传输时间正常型便秘组和传输时间延长型便秘组。结果　便秘组儿童TGITT、LCTT和RSTT较对 照组均显著延长(92±56hvs29±8h,17±13hvs7±4h,62±29hvs13±6h)(P均<0.01),肛管最大收缩压显 著升高(216±44mmHgvs190±38mmHg)(P<0.05),对称指数显著降低(0.71±0.06vs0.84±0.08)(P< 0.05),两组RCTT正常。传输时间正常型便秘组和传输时间延长型便秘组儿童肛管最大压力、向量容积和对称指 数差异无显著意义。结论　便秘儿童的结肠传输功能和/或直肠肛管动力存在不同程度异常;无论结肠传输时间 正常与否,所有便秘患儿均应进行直肠肛管测压检查。     

Megarectum in constipation.

BACKGROUND: Faecal impaction is frequently observed in children with chronic constipation. The term megarectum is often used to describe this finding. AIM: To evaluate rectal functioning and rectal measures in constipated children with a filled rectum, in order to define the terms faecal impaction, enlarged rectum, and megarectum. METHODS: All children underwent radiological investigation, colonic transit time study, anorectal manometry, and rectal volume and rectal wall compliance measurements. Patients with faecal impaction were compared with controls, who had an empty rectum on digital rectal examination. RESULTS: A total of 31 patients and six controls were included in the study. The mean duration of complaints was 4.2 years and all had faecal incontinence. The colonic transit times in the patients showed a distinct delay in the rectosigmoid segment. Anorectal manometry was not significantly different between patients and controls. The rectal width in patients was 0.68 and in controls 0.52 with an upper limit of 0.61. The pressure-volume curve in patients showed significant less relaxation at a distension of 50 ml. The slope of the curve (corresponding with rectal wall compliance) was comparable for patients and controls. CONCLUSIONS: We suggest that faecal impaction is a filled rectum found on digital rectal examination; an enlarged rectum is defined by a rectopelvic ratio greater than 0.61; and megarectum is defined in those with significant abnormalities found with anorectal manometry, pressure-volume curves, or rectal compliance investigation. A diminished relaxation of the rectum on rectal distension could be the first sign of megarectum in children with chronic constipation.     

Megarectum in constipation

BACKGROUND—Faecal impaction is frequently observed in children with chronic constipation. The term megarectum is often used to describe this finding.AIM—To evaluate rectal functioning and rectal measures in constipated children with a filled rectum, in order to define the terms faecal impaction, enlarged rectum, and megarectum.METHODS—All children underwent radiological investigation, colonic transit time study, anorectal manometry, and rectal volume and rectal wall compliance measurements. Patients with faecal impaction were compared with controls, who had an empty rectum on digital rectal examination.RESULTS—A total of 31 patients and six controls were included in the study. The mean duration of complaints was 4.2 years and all had faecal incontinence. The colonic transit times in the patients showed a distinct delay in the rectosigmoid segment. Anorectal manometry was not significantly different between patients and controls. The rectal width in patients was 0.68 and in controls 0.52 with an upper limit of 0.61. The pressure-volume curve in patients showed significant less relaxation at a distension of 50 ml. The slope of the curve (corresponding with rectal wall compliance) was comparable for patients and controls.CONCLUSIONS—We suggest that faecal impaction is a filled rectum found on digital rectal examination; an enlarged rectum is defined by a rectopelvic ratio greater than 0.61; and megarectum is defined in those with significant abnormalities found with anorectal manometry, pressure-volume curves, or rectal compliance investigation. A diminished relaxation of the rectum on rectal distension could be the first sign of megarectum in children with chronic constipation.     

便秘患儿的胃肠传输时间测定及其意义

目的　初步测定正常中国儿童的胃肠传输时间并探讨胃肠传输时间对小儿便秘的病因、诊断和分型的意义。方法　研究对象分为对照组和便秘组。对照组 3 3例 ,男 2 1例 ,女 12例 ,平均年龄 5岁。便秘组 2 5例 ,男 15例 ,女 10例 ,平均年龄 7岁 ,均符合Benninga的便秘诊断标准。应用简化的不透X线标记物追踪法 ,即多次口服标记物一次摄片法测定正常和便秘儿童的全胃肠传输时间 (Totalgastrointestinaltransittime,TGITT)和节段性结肠传输时间 ,包括 :右半结肠传输时间 (Rightcolonictransittime ,RCTT) ;左半结肠传输时间 (Leftcolonictransittime ,LCTT)和直肠乙状结肠传输时间(Rectosigmoidcolonictransittime ,RSTT) ;部分患儿联合应用X线排便造影 ,探讨便秘的诊断和分型 ;结果　正常儿童的TGITT ,RCTT ,LCTT和RSTT分别为 2 8 7± 7 7小时、7 5± 3 2小时、6 5± 3 8小时和 13 4± 5 6小时 ;便秘组的TGITT ,LCTT和RSTT较对照组明显延长 (92 2± 5 5 5小时vs 2 8 7± 7 7小时 ,P <0 0 0 1;16 9± 12 6小时vs 6 5± 3 8小时 ,P <0 0 1;和 61 5± 2 9 0小时vs 13 4± 5 6小时 ,P <0 0 0 1)。RCTT无显著变化。X线排便造影显示直肠前突、会阴下降综合征和耻骨直肠肌痉挛综合征各 1例。结论　首次     

Total and segmental colonic transit time and anorectal manometry in children with chronic idiopathic constipation

BACKGROUND: Constipation is a frequent symptom in pediatric clinical practice, although the underlying pathogenesis is not fully understood. Estimating the colonic transit time may help identify subgroups of patients with different physiopathologic mechanisms. METHODS: Thirty children with normal bowel habits and 38 children with chronic idiopathic constipation, aged 2 to 14 years, were studied. The total and segmental colonic transit times were estimated by administering multiple radiopaque markers for 6 days and performing a single abdominal radiograph on day 7. Anorectal function was evaluated using manometry with an Arhan probe. RESULTS: The observed upper reference values were 19.02 hours for the right colon, 19 hours for the left colon, 32 hours for the rectosigmoid colon, and 45.7 hours for the total colon. Fifty percent of the children with chronic idiopathic constipation had colonic transit times within reference values, whereas 37% had left colonic and rectosigmoid delays and 13% had global delay in all colonic segments (colonic inertia). Paradoxic anal contraction was observed in 64% of the constipated children with distal delay but in none of the subjects with colonic inertia. CONCLUSIONS: Estimating colonic transit time is a simple and noninvasive technique for classifying patients with constipation. Colonic inertia may be a manifestation of global motility dysfunction. Children with delayed distal colonic transits are more likely to have abnormal defecation dynamics.     

Investigations for incontinence and constipation after surgery for Hirschsprung's disease in children

Surgery for Hirschsprung's disease is associated with high rate of morbidity, in the form of either constipation or incontinence or a combination of the two. This study investigates the mechanisms responsible for incontinence and/or constipation following the pull-through operation for Hirschsprung's disease. There were 19 children (15 boys and 4 girls), who at the time of study; 16 had undergone Duhamel, 1 Rehbein, and 2 Soave operation. We classified patients according to their symptoms into 3 groups: Group A was incontinent of faeces; Group B was constipated and incontinent of faeces, and Group C was constipated only. The median age at referral was 6 years, and the median period after operation was 5 years. All patients were investigated by intestinal transit study, endoanal sonography and anorectal manometry. Group A had normal or rapid transit study, as opposed to Groups B and C, who had delayed-transit study. On endoanal sonography, all children had an intact internal and an external anal sphincter, below the level of pull-through operation. The anorectal manometry showed a significantly lower resting anal pressure in the incontinent Group A as compared to the constipated children with or without incontinence in Group B or C (38 mmHg versus 57 or 66 mmHg respectively). The rectal pressure was also significantly higher in children in Group A as compared to those in Group B or C (71 mmHg versus 42 or 36 mmHg). The ratio of rectal/anal pressure was higher in incontinent children in Group A, as compared to constipated children in Group B or C. Therefore, constipation can be caused by high anal resting pressure and a weak rectal peristalsis, while faecal incontinence can be secondary to poor compliance and elevated rectal pressure in the presence of normal or low anal sphincter resting pressure. Aperients are the mainstay of treatment of constipation, however, children with incontinence are more difficult to treat. We did not attempt to define the pattern of nerve plexus because of poor results of revision operation for residual hypoganglionic segment and intestinal neuronal dysplasia. Treatment of these children can become more rational, if furnished with detailed functional studies. We advocate investigation of the anorectal function at an early stage in symptomatic children after surgery for Hirschsprung's disease, and less invasive treatment should be considered before embarking on major surgery.     

Treatment of chronic functional constipation in children by administration of vegetable fiber (Dicoman 5)

Chronic functional constipation is a common clinical disorder in pediatric age. Thirteen children with functional constipation were treated by administration of vegetable fibres together with a toilet training program, for two months. In each patient anorectal manometry showed presence of inhibitory anal reflex and diagnosis of constipation was confirmed by a prolonged gastrointestinal transit time measured by radio-opaque markers. In all patients there was a significant improvement in both stool frequency and intestinal transit time; furthermore, a normalization of anorectal motility variables was observed at rectal manometry. No changes in the blood levels of nutritional parameters were seen in any patient. It is concluded that vegetable fibres represent an effective treatment of functional chronic constipation in children.     

不同型别的功能性便秘患儿肛门直肠测压对照研究

目的探讨功能性便秘（FC）患儿与健康儿童肛门直肠动力学差异,为其临床分型诊断及治疗提供依据。方法采用功能性胃肠病罗马Ⅲ诊断标准,收集2008年1月至2009年1月在第四军医大学唐都医院儿科门诊及住院的FC患儿为FC组。选取同期无消化系统症状,平日排便正常的健康儿童为正常对照组。采用不透光X线硫酸钡条测定结肠传输指数（TI）,依据TI将FC组分为出口梗阻型（OOC）亚组、慢传输型（STC）亚组和混合型（MIX）亚组。通过肛门直肠测压法分析FC各亚组与正常对照组肛门直肠动力学差异。结果研究期间FC组纳入25例,其中STC亚组10例,OOC亚组15例,未发现MIX患儿;正常对照组纳入10名。FC组与正常对照组肛门括约肌静息压差异无统计学意义（P＞0.05）。STC亚组肛门括约肌最大收缩压与正常对照组差异无统计学意义（P＞0.05）,OOC亚组肛门括约肌最大收缩压显著高于正常对照组及STC亚组（P＜0.05）。FC组直肠最低敏感量及最大耐受量均显著高于正常对照组（P均＜0.05）。STC亚组与OOC亚组直肠最低敏感量及最大耐受量差异均无统计学意义（P均＞0.05）。结论FC患儿存在明显的肛门直肠动力和感觉异常;OOC和STC患儿的肛门直肠动力学存在差异。肛门直肠测压检查对协助诊断FC有一定价值。     

Gastrointestinal transit in children with chronic idiopathic constipation

Abstract  Chronic constipation in children is common and produces significant morbidity. Identification of the site of dysmotility in constipation may determine the cause and permit directed management. Scintigraphy differentiates constipated patients with anorectal hold-up from those with colonic slowing. Adults with colonic slowing demonstrate variation in the site of hold-up. However, in children with colonic slowing, variability in the site of hold-up has not been investigated. Purpose  The current study aimed to characterise colonic transit patterns in 64 children with chronic idiopathic constipation. Methods  Scintigraphic images were grouped visually by their transit patterns. Intra-observer variation was assessed. Scintigraphic data were analysed quantitatively. Results  Visual analysis of scintigraphy studies demonstrated normal transit (11/64), anorectal hold-up (7/64) and slow colonic transit (46/64). Transit characteristics in the slow transit group demonstrated three possible subgroups: pancolonic slowing (28/46), discrete hold-up in the transverse colon (10/46) and abnormal small and large bowel transit (8/46). Kappa testing demonstrated consistent characterisation (k = 0.79). Statistical analysis of scintigraphic data demonstrated highly significant differences from normal (P < 0.001) in the subgroups. Conclusion  Scintigraphy demonstrates three possible transit patterns in children with chronic constipation secondary to slow colonic transit.     

经肛巨结肠根治术后患儿的肛肠功能评价

目的：经肛门巨结肠一期根治术近期效果好,但术后患儿的肛肠功能目前尚不十分清楚。该文旨在评估患儿术后的排便模式,结肠和肛门括约肌功能。方法：对58例经肛门巨结肠根治术后半年以上儿童进行随访,随访时间为15.8 月 (6～24 月)。并进行排便功能问卷调查、钡灌肠、结肠传输时间和肛门直肠测压检查。33例正常儿童作为对照。结果：大多数随访患儿排便正常,无任何临床症状。４例出现稀便便频,9例污便,5例便秘,3例小肠结肠炎。钡灌肠结果显示大多数随访患儿结肠形态恢复良好。全部病例术后直肠肛管角（度）较对照组显著开大,有症状组较无症状组显著开大。58例随访患儿的平均全胃肠、左半结肠和右半结肠传输时间较术前显著缩短,与对照组相比差异无显著性意义。直肠肛管反射5例阳性。便秘组的肛管最大静息压和最大收缩压明显高于无症状组和对照组。污便组向量容积和对称指数较对照组显著降低。便秘组对称指数显著高于对照组。结论：经肛门巨结肠根治术后大多数患儿排便功能、结肠功能和括约肌功能良好。少数病例排便功能障碍可能与术后乙状结肠曲减少或消失、“新直肠”储便功能代偿不全和拖出结肠致直肠肛管角开大、肛门括约肌痉挛失弛缓有关。［中国当代儿科杂志,2007,9（3）：188-192］     

Comorbidities associated with constipation in children referred for colon manometry may mask functional diagnoses

BACKGROUND: In children with prolonged constipation of unclear pathogenesis or unresponsive to treatment, colon manometry can discriminate between functional fecal retention (FFR) and colon neuromuscular diseases. AIM: To identify the clinical features precipitating referral for colon manometry in children with functional constipation. METHOD: Retrospective medical record review of 173 constipated children (116 male, mean age 6.9 years, range 1-17 years) referred for colon manometry. RESULTS: Manometry was normal in 121 (70%). In those with normal manometry, FFR was identified in 96, irritable bowel syndrome (IBS) in 10, and functional constipation in 15. Of the 96 children FFR, 72 (76%) had comorbid conditions that might have interfered with the clinician's ability to diagnose FFR. Of 52 children with colon neuromuscular disease, only 12 (23%) had comorbid conditions (P < 0.001 compared with FFR). Of children more than 4 years, those with FFR were more likely to have fecal incontinence (44 of 62; 71%) than those with other functional disorders (2 of 19; 10%; P < 0.001) or neuromuscular disease (6 of 23; 26%; P < 0.001). CONCLUSIONS: Two thirds of children referred for colon manometry had normal studies and met criteria for a functional diagnosis. Three quarters of those with functional constipation had a comorbid condition that might alter the history sufficiently to obscure the diagnosis.     

Orocoecal Transit Time in Healthy and Constipated Children

ABSTRACT. Orocoecal transit time (OCTT), assessed by means of H₂ breath test after lactulose and/or after a semisolid standard meal, was studied in normal and constipated children. Both control subjects and patients with constipation showed a significantly longer OCTT after a standard meal than after lactulose ingestion ( p <0.01). Whereas the OCTT after lactulose did not differ in the two groups, the constipated patients had a significantly longer transit time after a standard meal when compared to controls ( p <0.05). No correlation was observed within each group between the OCTT after a standard meal or after lactulose ingestion ( r =-0.077; p >0.1). These findings suggest that 1) measurement of the transit of a standard meal instead of a lactulose solution may offer more direct insight into the role of small intestinal transit of food, both in physiological and pathological conditions, 2) gastrointestinal segments other than colon may play a role in chronic non organic constipation of childhood.     

Orocoecal transit time in healthy and constipated children

Orocoecal transit time (OCTT), assessed by means of H2 breath test after lactulose and/or after a semisolid standard meal, was studied in normal and constipated children. Both control subjects and patients with constipation showed a significantly longer OCTT after a standard meal than after lactulose ingestion (p less than 0.01). Whereas the OCTT after lactulose did not differ in the two groups, the constipated patients had a significantly longer transit time after a standard meal when compared to controls (p less than 0.05). No correlation was observed within each group between the OCTT after a standard meal or after lactulose ingestion (r = -0.077; p greater than 0.01). These findings suggest that 1) measurement of the transit of a standard meal instead of a lactulose solution may offer more direct insight into the role of small intestinal transit of food, both in physiological and pathological conditions, 2) gastrointestinal segments other than colon may play a role in chronic non organic constipation of childhood.     

Outcome of functional constipation in childhood: a 10-year follow-up study

OBJECTIVES: To assess the outcome of patients presenting with functional constipation in childhood during a 10-year period and to determine any risk factors for developing persistent constipation throughout adolescence and adulthood. PATIENTS AND METHODS: 72 children (mean age 4 years; 40 boys) referred for constipation were included in a longitudinal set of observations. Initial workup included segmental colonic transit time and anorectal manometry; 45 of the 72 patients could be reevaluated 10 to 12 years later. RESULTS: 21 of 45 patients (46%; 95% confidence interval 29% to 67%) remained constipated at follow-up. Encopresis and recurrent abdominal pain were present in 25% and 56% of patients, respectively. Patients with anorectal dyssynergia remained more frequently constipated at follow-up than the others: 61% versus 29% (P < .05). CONCLUSION: Almost 50% of patients presenting with constipation during childhood remained constipated on long-term follow-up. Anorectal dyssynergia is associated with a worse prognosis.     

以难治性便秘为主要表现的儿童结肠冗长症诊断及治疗进展CSCD

难治性便秘是指经保守治疗3个月无效的胃肠运动障碍性疾病,患儿常并发结肠冗长症。结肠冗长症表现为长期便秘和大量粪便潴留,进而造成肠道蠕动障碍,严重影响患儿生长发育及生活质量。通过灌肠造影可判断结肠定位及形态是否异常,结肠传输试验、肛门直肠测压、结肠测压、组织病理学检查可辅助诊断难治性便秘。目前,以难治性便秘为主要表现的结肠冗长症如长期保守治疗无效,应采取顺行节制性灌肠、骶神经刺激以及手术治疗。本文对以难治性便秘为主要表现的儿童结肠冗长症的诊断与治疗进展进行综述。     

Bowel imbrication in the management of anorectal anomalies

Four patients who had imbrication of their proximal rectum and distal sigmoid colon as part of the management of constipation following an anorectoplasty for an anorectal anomaly. Three children with an anorectal anomaly presented with constipation and marked dilation of the rectosigmoid portion of the large bowel; each had longitudinal imbrication of the dilated segment, via a left iliac fossa incision. The forth was born with a cloacal anomaly with associated colonic atresia. The small bowel was used to construct the anorectum following a redo anorectoplasty. Subsequently, the small bowel became ectatic, resulting in the patient developing persistent watery diarrhoea and severe perianal excoriation, which was managed with a 30 cm longitudinal imbrication of the distal bowel during an extensive laparotomy. All 4 have patients now have near normal bowel motions with minimal medication, after only a short hospital stay. Residual problematic dilatation of the rectosigmoid colon in patients with a high anorectal anomaly, in the presence of constipation, can be successfully managed by imbrication of the dilated segment, if carefully selected.     

Is posterior anal transfer a good treatment for vestibular anus?

Eleven females who had a posterior anal transfer (PAT) for a vestibular anus were reviewed in order to: (1) assess the long-term functional success of this operation clinically; (2) evaluate the anorectal manometry profile; and (3) assess defaecation by video proctography. The cosmetic appearance was excellent in all patients. Seven had a good result, 2 a fair result, and 2 a poor result when assessed clinically (Kelly score) in terms of constipation and soiling. The anorectal manometry profile remained within normal limits except in the 2 with a poor result who had diminished sensory awareness of stool in the rectum. PAT does not appear to damage the muscle-sphincter complex, and the children with a large rectum full of faeces seemed to behave like children with acquired megacolon and constipation. Video proctography showed normal defaecatory patterns in all patients. Patient selection is important for this procedure. When PAT was used as the initial treatment a good result was obtained; when it was used to relieve constipation following previous surgery the result was less satisfactory.     

Effects of herbal medicine Dai-Kenchu-to on anorectal function in children with severe constipation.

AIM: We administered the herbal medicine Dai-Kenchu-To (DKT) to children with severe chronic constipation or with severe constipation after surgery for anorectal malformations. We then objectively assessed the effect of DKT on anorectal function by manometric study in addition to using a clinical scoring system. PATIENTS AND METHODS: Ten children with severe chronic constipation and 5 children with severe constipation after surgery for anorectal malformations were assessed. These 15 children received 0.3 g/kg/day of DKT for periods ranging from 3 months to 1 year. We objectively assessed their bowel function, sphincter function and rectal reservoir function by anorectal manometry and clinical scoring. RESULTS: In 10 children with severe chronic constipation, the clinical score after administration of DKT (7.2 +/- 0.8) improved significantly compared with that before administration of DKT (4.6 +/- 2.9) (p < 0.02). The threshold sensation volume and the maximum tolerable volume after administration of DKT significantly (p < 0.05; p < 0.01) decreased (128 +/- 63 ml vs. 69 +/- 18 ml; 229 +/- 99 ml vs. 144 +/- 47 ml), and rectal compliance after administration of DKT also significantly (p < 0.05) decreased (12.4 +/- 10.9 ml/cmH(2)O vs. 4.7 +/- 3.9 ml/cmH(2)O). CONCLUSION: The present study demonstrated that DKT had a favorable clinical effect on severe constipation in children, and anorectal manometry showed an improvement in their rectal reservoir functions. It appears that the results were secondary to DKT-stimulated peristalsis of the intestine, which promoted regular bowel habits.     

Colonic diversion for intractable constipation in children: colonic manometry helps guide clinical decisions.

BACKGROUND: Colonic manometry helps discriminate functional and behavioral causes for childhood constipation from colonic neuromuscular disease. METHODS: Of 375 colonic manometries performed for clinical indications, 12 could not be interpreted because of chronic colonic dilation. Based on colonic manometries that showed either no contractions or an absence of the gastrocolonic response or an absence of high-amplitude propagating contractions, the authors recommended diverting colostomies or ileostomies in 12 chronically constipated children (mean age, 4 years; range, 2-14 years, 5 boys). Before study, medical treatment was ineffective in all children. These children had persistently dilated colons with pathologic diagnoses of intestinal neuronal dysplasia (n = 4), hypoganglionosis (n = 2), hollow visceral myopathy (n = 1), and normal (n = 5). RESULTS: Six to 30 months after diversion, the authors restudied all the children. Eleven of 12 diverted colons were no longer dilated. In two patients, abnormal motility involving the entire colon was unchanged from the initial study, small bowel motility was abnormal, and we recommended no further surgery. In two cases, the colon remained abnormal but small bowel motility was normal, and we recommended subtotal colectomy and ileoproctostomy. In four cases, the left colon remained abnormal, but the right colon was normal, and we recommended reanastomosis after left hemicolectomy. In four cases, motility in the diverted colons was normal, including a gastrocolonic response and high-amplitude propagating contractions, and the authors recommended reanastomosis. Defecation problems resolved in 10 of 12 when followed up 5 to 30 months after treatment. CONCLUSION: These data suggest that in some cases of intractable childhood constipation associated with colonic distention, temporary diversion improved colonic motility. Colonic manometry may be used to predict which patients will benefit from resection or reanastomosis.     

Chronic constipation in infants and children

Around 1 per cent of infants and children suffer from chronic constipation, and is usually accompanied by soiling of the underpants. In most, the cause is unknown, however, some recent studies show evidence for disturbed motility in the anorectal region. Thus, this entity appears to have a functional basis and may be properly labelled as chronic “functional” constipation. The diagnosis of chronic “functional” constipation in infants and children is made by excluding all other causes of chronic constipation. Important among these are hypothyroidism, Hirschsprung’s disease especially that with involvement of a short segment of the distal rectum, congenital, and other anomalies of the gastro-intestinal tract. Anorectal manometry is a useful test to rule out Hirschsprung’s disease. The treatment involves disimpaction of the rectum and colon from feces and maintaining flow of colonic contents. This is achieved by using enemas and by using fecal softeners. The fecal softeners are used for prolonged periods and then gradually weaned. Recovery rate is about 50 per cent during the first year. Some may need fecal softeners for many years.