Applicability of the London Classification to Characterize Defecation Disorders: a Retrospective Study in a Tertiary Care Center in Argentina

Abstract

Introduction. Chronic constipation and fecal incontinence are common functional pelvic floor disorders with a significant impact on quality of life. Although the London Classification standardizes anorectal manometric assessment, its application in Latin American populations is still limited.

Objectives. To characterize anorectal manometric profiles according to clinical indication (constipation, fecal incontinence, or coexisting symptoms), using the London Classification.

Materials and methods. A retrospective observational study was conducted on 413 adult patients who were evaluated using high-resolution anorectal manometry (Diversatek and ManoScan AR®) at a tertiary care center. Clinical, manometric, and sensory variables were classified according to the four domains of the London Classification and analyzed. ANOVA and chi-square tests were used for group comparisons.

Results. Patients with constipation had higher resting and voluntary contraction pressures of the anal canal, a higher prevalence of hypertonia and dyssynergia, and higher sensory thresholds. Patients with fecal incontinence presented hypotonia, hypocontractility, and altered coordination but not dyssynergia. Patients with coexisting symptoms exhibited mixed patterns. There were no significant differences in the prevalence of the inhibitory anal rectal reflex or rectal sensory disorders.

Conclusion. The London Classification allowed the identification of specific pathophysiological patterns based on clinical phenotypes. These findings suggest its usefulness as a standardized diagnostic tool, with clinical implications for more accurate and personalized evaluation of defecation disorders.