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Source publication
Treatment of descending perineal syndrome is focused on personal etiology and on improving symptoms. However, the etiology of increased perineal descent (PD) is unclear. Therefore, the aim of the present study was to evaluate factors associated with increased resting and dynamic PD in women.
From January 2004 to August 2010, defecographic findings...
Context in source publication
Context 1
... analyzed factors that correlated with the resting phase of peri- neal descent in patients. Age, number of vaginal deliveries, and the size of the resting-phase anorectal angle showed significant correlations while the resting-phase or the squeezing-phase anal pressure did not have a statistically significant correlation (Table 3). Within the correlation analysis between the dynamic perineal descent and factors, age and anal pressure of the resting phase had a significant correlation (Table 4). ...
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Citations
... Pelvic floor descent is an abnormal caudal movement of the pelvic floor during defecation and is commonly associated with outlet obstruction. Although any of the three pelvic compartments (anterior, middle, or posterior) can be involved, more frequently it involves either all three compartments, or remains confined to the posterior compartment [35]. The caudal movement of each compartment is assessed by movement of a specific landmark in each compartment (bladder base in the anterior compartment, anterior cervix or fornix of vagina in the middle compartment, and anorectal junction in the posterior compartment) with respect to the pubococcygeal line [30]. ...
Functional defecation disorders (FDD) encompass causes of constipation associated with anorectal dysfunction, which include dyssynergia or inadequate defecatory propulsion. FDD are frequently encountered in clinical practice and may affect up to 33–50% of patients with chronic constipation. The etiology of FDD is unclear, however, it has been defined as an acquired, but subliminal behavioral disorder. Pathophysiologic mechanisms may include discoordination of rectoanal muscles, paradoxical contraction or insufficient relaxation of puborectalis and/or anal sphincter during defecation, and sluggish colonic transit. A combination of comprehensive clinical assessment, digital rectal examination and a battery of physiologic tests are needed to make an accurate diagnosis of FDD. Defecography may play a crucial role in the evaluation of FDD, especially when a balloon expulsion test (BET) and/or anorectal manometry (ARM) are equivocal or demonstrate contradictory results. In this review, we provide a thorough overview of the epidemiology, pathophysiology, diagnostic criteria, clinical and imaging evaluation, and treatment options for FDD, with an emphasis on available diagnostic imaging tools such as defecography and conventional fluoroscopic methods.
... They also found associated features between DPS and the female gender (96%), multiparity with vaginal delivery (55%) and with hysterectomy or vaginal cystocele and/or rectocele repair (74%). Chang et al. (19) found a statistically significant association between DPS, age and increasing number of vaginal deliveries, whereas surgical history did not have any impact. ...
Introduction and hypothesis: Descending Perineum Syndrome (DPS) is a coloproctologic disease and the best treatment for it is yet to be defined. DPS is frequently associated with pelvic organ prolapse (POP) and it is reasonable to postulate, that treatment of POP will also have an impact on DPS. We aimed to evaluate the subjective satisfaction and improvement of DPS for patients who have undergone a sacral colpoperineopexy associated with retrorectal mesh for concomitant POP.
Methods: This retrospective cohort study, conducted between February 2010 and May 2016 included all women who had undergone surgery to treat POP and DPS. Improvement of POP was assessed clinically and subjective satisfaction was assessed with a survey.
Results: Among the 37 operated patients, 31 responded to the questionnaire and 77.4% were satisfied with this surgical procedure. 94.6% were objectively cured for POP. There was a 60% improvement rate for constipation, 63.5 and 68% were cured or improved for ODS and the need for digital maneuvers respectively.
Conclusion: Sacral colpoperineopexy associated with retrorectal dorsal mesh appears to objectively and subjectively improve POP associated with DPS.
... In this way descending perineum overlaps with pelvic floor dyssynergia [2]. Older age is correlated with both dynamic and fixed descending perineum [3], and excessive perineal descent is found in 78 % of elderly patients with evacuation disorders [4]. The organic descent of the hypotonic pelvic floor combined with pudendal neuropathy explains the appearance of fecal incontinence. ...
... В таких случаях аноректальный угол увеличивается и опускается каудально по отношению к пубококцигеальной линии в значительно большей степени, чем в норме [1]. Причина СОП устанавливается в индивидуальном порядке, так как этиология его не известна [2]. Опущение промежности может наблюдаться в спокойном состоянии или только во время напряжения. ...
... Опущение промежности может наблюдаться в спокойном состоянии или только во время напряжения. С возрастом как выраженность, так и частота развития СОП увеличиваются [2]. «Золотым стандартом» для выявления СОП считается дефекография. ...
... Во-первых, это исследование сопряжено с большой дозой ионизирующей радиации, что недопустимо при обследовании детей и лиц детородного возраста. Во-вторых, измерение аноректального угла и степени смещения его по отношению к пубококцигеальной линии плохо воспроизводимо, а результаты существенно различаются в разных исследованиях, что свидетельствует о низкой точности оценки [2]. ...
Objective:
To propose a safer, simpler, and more exact method for the diagnosis of descending perineum syndrome (DPS).
Material and methods:
A total of 194 patients aged 5 days to 15 years were examined and divided into 2 groups: Group 1 consisted of 65 patients without anorectal anomalies (AA); Group 2 comprised 129 patients, including 66 children with functional constipation,
55 with AA and visible fistulas, who were preoperatively examined, and 8 patients with anorectal angle (ARA), who were postoperatively examined. All the patients underwent
irrigoscopy that was different from standard examination in the presence of X-ray CT contrast marker near the anus.
Results and conclusion:
DPS is caused by puborectalis muscle dysfunction. A method was proposed to evaluate the status of the puborectalis muscle from the distance between the position of the ARA and the marker near the anus. This not only promotes
an exacter estimate of DPS, but also allows refusal of defecography. The use of a barium enema with the minimum number of X-ray films decreases dose of ionizing radiation hazard and permits the use of this procedure not only in adults, but also in children with chronic constipation, fecal incontinence, and in AA for both pre- and postoperatively assessment of the causes of complications.
... Straining at stool, a sensation of incomplete evacuation and of anorectal obstruction/blockage, manual maneuvers to facilitate defecation, and loss of solid or liquid stool are mixed with vaginal symptoms (sensation of a bulge, heaviness) and urological symptoms (urinary incontinence, urgency, hesitancy, feeling of incomplete emptying). Several factors are associated with mobile or fixed DPS in women: aging, the number of vaginal deliveries and obesity [24]. All these conditions have a common denominator: impairment of the connective tissue network that envelops all organs of the pelvis and connects them loosely to the supportive pelvic musculature and pelvic bones. ...
The classical clinical profile of descending perineum syndrome (DPS) has been replaced by new pathophysiological, diagnostic, and therapeutic acquisitions. This paper will focus on trigger factors ranging from dyssynergic defecation to excessive straining, fecal incontinence against the backdrop of obstructed defecation, attendant rectal diseases, and therapy tailored to evolving stages of DPS.
Background:
Defecography is an established method of evaluating dynamic anorectal dysfunction, but conventional defecography does not allow for visualization of anatomic structures.
Objective:
The purpose of this study was to describe the use of dynamic 3-dimensional endovaginal ultrasonography for evaluating perineal descent in comparison with echodefecography (3-dimensional anorectal ultrasonography) and to study the relationship between perineal descent and symptoms and anatomic/functional abnormalities of the pelvic floor.
Design:
This was a prospective study.
Setting:
The study was conducted at a large university tertiary care hospital.
Patients:
Consecutive female patients were eligible if they had pelvic floor dysfunction, obstructed defecation symptoms, and a score >6 on the Cleveland Clinic Florida Constipation Scale.
Interventions:
Each patient underwent both echodefecography and dynamic 3-dimensional endovaginal ultrasonography to evaluate posterior pelvic floor dysfunction.
Main outcome measures:
Normal perineal descent was defined on echodefecography as puborectalis muscle displacement ≤2.5 cm; excessive perineal descent was defined as displacement >2.5 cm.
Results:
Of 61 women, 29 (48%) had normal perineal descent; 32 (52%) had excessive perineal descent. Endovaginal ultrasonography identified 27 of the 29 patients in the normal group as having anorectal junction displacement ≤1 cm (mean = 0.6 cm; range, 0.1-1.0 cm) and a mean anorectal junction position of 0.6 cm (range, 0-2.3 cm) above the symphysis pubis during the Valsalva maneuver and correctly identified 30 of the 32 patients in the excessive perineal descent group. The κ statistic showed almost perfect agreement (κ = 0.86) between the 2 methods for categorization into the normal and excessive perineal descent groups. Perineal descent was not related to fecal or urinary incontinence or anatomic and functional factors (sphincter defects, pubovisceral muscle defects, levator hiatus area, grade II or III rectocele, intussusception, or anismus).
Limitations:
The study did not include a control group without symptoms.
Conclusions:
Three-dimensional endovaginal ultrasonography is a reliable technique for assessment of perineal descent. Using this technique, excessive perineal descent can be defined as displacement of the anorectal junction >1 cm and/or its position below the symphysis pubis on Valsalva maneuver.
