Thickening of the Internal Anal Sphincter: Primary Cause or Secondary Effect of Constipation

Part of Pediatric Surgery Essentials 19 items

jpedsurg.org

Constipation is one of the most common abdominal symptoms in childhood. In many cases, no primary cause is found and the condition may be labelled as “idiopathic constipation”. Fortunately, most of these cases respond well to dietary manipulation and laxatives. However, some patients continue to suffer from severe refractory constipation without an obvious primary cause [1]. As pediatric surgeons, our main concern is to identify an unrecognized correctable surgical etiology. Among these overlooked potentially correctable surgical causes, internal anal sphincter (IAS) achalasia refers to failure of relaxation of the internal anal sphincter after rectal distension [2].

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Article · Oct 2023 · 1 min read

In brief

This article examines whether internal anal sphincter (IAS) thickening is a primary cause of refractory pediatric constipation or a secondary adaptive response. The discussion focuses on IAS achalasia as a potentially correctable surgical condition in children who fail conservative management with diet and laxatives.

Most childhood constipation is idiopathic and responds to dietary changes and laxatives.
Severe refractory constipation warrants evaluation for correctable surgical causes.
Internal anal sphincter achalasia—failure of sphincter relaxation—is an overlooked surgical etiology.
Pediatric surgeons must distinguish primary IAS pathology from secondary thickening due to chronic straining.
Identifying IAS achalasia may prevent unnecessary prolonged medical management in select cases.

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