Overlooked and Undertreated: National Shortfalls in Anorectal Evaluation for Gastroparesis-Associated Constipation and Defecation Disorder

Why It Matters

Early physiologic assessment of anorectal function can curb costly acute care episodes for gastroparesis patients, highlighting a missed opportunity for more efficient, patient‑centered treatment.

Key Takeaways

• Only 1.4% diagnosed with defecatory disorder despite 30% constipation
• Anorectal manometry performed in just one‑third of diagnosed cases
• ARM linked to 30% fewer emergency department visits
• ARM reduced hospitalizations by 42% in matched cohort
• Pelvic floor therapies remain underutilized, under 4% receiving biofeedback

Pulse Analysis

Gastroparesis, a chronic delay in gastric emptying, frequently coexists with constipation, creating a therapeutic dilemma for gastroenterologists. While delayed gastric transit is well‑studied, the contribution of anorectal dysfunction—specifically defecation disorders—has received far less attention. The recent TriNetX analysis of nearly 300,000 U.S. patients revealed that almost 30% of those with gastroparesis also report constipation, yet only 1.4% receive a formal diagnosis of a defecatory disorder. This gap suggests that clinicians may overlook pelvic floor pathology, missing an opportunity to address a reversible cause of refractory constipation.

Anorectal manometry (ARM) offers objective measurement of sphincter pressure and coordination, guiding targeted pelvic floor therapy. In the matched cohort, patients who underwent ARM experienced a 30% reduction in emergency department visits and a 42% drop in hospital admissions, alongside fewer abdominal imaging studies. These findings underscore that physiologic assessment can streamline care pathways, preventing costly interventions such as nasogastric tube placement. Moreover, the modest uptake—only one‑third of diagnosed patients received ARM—highlights a systemic underuse of a diagnostic tool that directly influences resource utilization.

For health systems, integrating routine ARM into the work‑up of gastroparesis‑associated constipation could translate into measurable cost savings and improved patient outcomes. Gastroenterology practices should consider multidisciplinary collaboration with pelvic floor physical therapists and biofeedback specialists, especially when standard prokinetic regimens fail. Future research ought to explore longitudinal benefits of early ARM, including quality‑of‑life metrics and long‑term reduction in invasive nutrition support. By recognizing and treating defecatory disorders promptly, clinicians can close a critical care gap and deliver more comprehensive, value‑based gastrointestinal care.