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The aim of this study was to evaluate the clinical significance of perineal descent (PD) in pelvic outlet obstruction patients diagnosed by using defecography.
One hundred thirty-six patients with pelvic outlet obstruction (POO; median age 49 years) had more than one biofeedback session after defecography. Demographic finding, clinical bowel sympto...
Context in source publication
Context 1
... regard to fixed perineal descent, the older was the age (r = 0.33, P < 0.001) (Fig. 1), the larger was the diameter of the rec- tocele (r = 0.31, P < 0.01), and the more frequent was the num- ber of vaginal deliveries (r = 0.46, P < 0.001) (Fig. 2), the lon- ger was its length. The length of fixed perineal descent was lon- ger in patients showing symptoms of fecal incontinence than in patients showing symptoms of constipation (P < 0.05) ( Table 1). In addition, the anorectal angle at rest (r = 0.67, P < 0.001) (Fig. 3), the anorectal angle at squeeze (r = 0.62, P < 0.001), the ...Similar publications
Obstructed defecation is a common problem that adversely affects the quality of life for many patients. Known causes of obstructed defecation include pelvic dyssynergy, rectocele, rectal intussusception, enterocele, pelvic organ prolapse, and overt rectal prolapse. Management of this condition requires an understanding of urinary, defecatory, and s...
Background: Fecal incontinence is a difficult and debilitating problem with various nonsurgical and surgical modes
of treatment. Biofeedback is among the most considerable nonoperative strategies. This study is to review of the
short-term effectiveness of the use of biofeedback therapy in management of fecal incontinence.
Methods: A retrospective r...
Pelvic floor retraining is considered first line treatment for patients with faecal incontinence or obstructed defaecation. There is presently no data on the effect of a high-grade internal rectal prolapse on outcomes of pelvic floor retraining. The current study aimed to assess this influence.
120 consecutive patients were offered pelvic floor ret...
Citations
... Perineal descent has long been associated with chronic straining and constipation but is also found in those with AI and pudendal nerve neuropathy, which may be caused by chronic stretch and pressure forces on the pelvic floor. 48 ...
Obesity is increasing worldwide with significant healthcare implications. We searched PubMed/MEDLINE, Embase and Cochrane Library for articles registered until June 2020 to explore the relationship between obesity, urinary (UI) and anal incontinence (AI). Obesity is associated with low‐grade, systemic inflammation and pro‐inflammatory cytokine release, producing reactive oxygen species and oxidative stress (1). This alters collagen metabolism and, in combination with increased intraabdominal pressure, contributes to UI development. Whereas in AI, stool consistency may be a factor. Weight loss can reduce UI and should be a management focus, however effect on AI is less clear. Keywords: Obesity, Urinary incontinence, Anal incontinence.
... Rectocoele has traditionally been defined as an outpouching of the rectal wall on defaecation . A total of 17/41 studies defined a cut-off of rectocoele depth to establish the diagnosis: 2 cm (n=9) (Goh et al. 2000, Dvorkin et al. 2005, Baek et al. 2010, Vitton et al. 2011, Piloni et al. 2013, Li et al. 2015, Hassan et al. 2016, Martin-Martin et al. 2017); 2.5 cm (n=1) (Poncelet et al. 2017); 3 cm (n=4) (Siproudhis et al. 1993, Faucheron and Dubreuil 2000, Savoye-Collet et al. 2003; or 4 cm (n=3) (Nielsen et al. 1993, Kashyap et al. 2013, Palit et al. 2016. However, the approach adopted to calculate rectocoele size during maximum straining has been detailed in only 9 of these as: a) the 'maximum depth of the bulge beyond the expected and extrapolated line of the anterior rectal wall' ...
... , Murad-, Baek et al. 2010, Mohammed et al. 2010, Andrade et al. 2014, Palit et al. 2014, Palit et al. 2016, Poncelet et al. 2017). Among the 27/59 (46%) studies reporting its prevalence in CC, enterocoele affected a larger proportion of patients in studies describing the use of oral contrast (n=11) compared to those that did not (n=16) (20.4% [95%CI, 15.6-25.6] ...
... However, the evidence demonstrating this relationship is limited. The limited available data is generally from mix gender trials and has demonstrated no consistent link between the two and constipation [20][21][22]. The theory behind this relationship is that excessive straining results in an increase in perineal descent and stretch injury of the pudendal nerve [7,16]. ...
... This leads to the viscous cycle of reduced sensation and weakness in the pelvic floor which results in increased straining. A Korean study nicely demonstrated that perineal descent can increase with age and birth trauma and posterior compartment defects [22]. In other words, it alone may not be causative of constipation but may be a factor. ...
Purpose of Review
Defecatory dysfunction is infrequently considered a gynaecological problem. However, obstructed defecation (OD) more commonly affects women than men and is associated with pelvic floor dysfunction. Therefore, we set out to write a review from a urogynaecologists’ prospective focusing on OD as it relates to the pelvic floor.
Recent Findings
Literature on this topic remains sparse and the studies tend to have a low sample size. It is clear that OD is associated with pelvic floor dysfunction including urinary incontinence and structural dysfunction; however, it is less clear which is the primary pathology. Management of OD needs to be considered in treatment of pelvic floor dysfunctions.
Summary
OD effects 14% of the general population. Ninety percent of the patients with OD will have a rectocele, enterocele or even intussusception. The pathophysiology is multifactorial and still not fully comprehended. Aetiology of constipation is classified as primary or secondary. The former includes slow transit or normal constipation and defecation disorders. The latter includes constipation caused by medications, diet and medical conditions. The Rome IV criteria are used to define functional constipation globally. Defecation disorders of the pelvic floor are categorised as structural disorders, pudendal neuropathy and dyssynergic defecation. First-line management includes treating the primary causes, dietary modification and laxatives. We stress the importance of posture whilst defecating is of utmost importance. A full squatting position with a slight forward tilt results in the broadening of the anorectal angle thereby facilitating emptying. Biofeedback therapy is still considered first-line treatment for dyssynergic defecation. Finally, surgical management of advanced stage prolapse is often unavoidable but is not a cure of OD. The increasing use of translabial ultrasound as a diagnostic modality will hopefully help facilitate research in this area.
... 23 We found that descending perineum syndrome was more frequently observed in males, contrary to previous studies. 24,25 Although we lack an explanation, we hypothesize that it could be due to the fewer numbers of men in our study. ...
Background/aims:
Chronic constipation is a common gastrointestinal disorder diagnosed using Rome III criteria. Defecography is a radiographic method used to identify anatomic abnormalities of anorectum. The present study aimed to evaluate the defecographic findings in patients with severe idiopathic chronic constipation.
Methods:
One hundred patients, who complained of severe idiopathic chronic constipation with abnormal balloon expulsion test, underwent defecography after injection of barium. An analysis of radiographs was performed by an expert radiologist for the diagnosis of descending perineum syndrome, rectocele, enterocele, rectal ulcer, rectal prolapse, fecal residue of post defecation, and etc. Then, they were compared between the two sexes.
Results:
Normal defecography was only observed in two participants. Descending perineum syndrome was the most common abnormality (73.3%). The results showed that rectocele (80.8%) and descending perineum syndrome (69.2%) were most frequent in women. In males, descending perineum syndrome and rectal prolapse were more prevalent (87% and 43.5%, respectively). Compared with men, rectocele and rectal ulcer were more frequently observed in women (p<0.001, and p=0.04, respectively), while men were more affected by descending perineum syndrome (p=0.04). In total, women had a greater incidence of abnormal defecographic findings compared with men (p=0.02).
Conclusions:
Defecography can be performed to detect anatomic abnormalities in patients with severe idiopathic chronic constipation and abnormal balloon expulsion test. This technique can assist physicians in making the most suitable decision for surgical procedure.
... Степень опущения промежности измеряется в сантиметрах на рентгенограммах, выполненных во время дефекографии и определяется как каудальное смещение АРУ относительно пубококцигеальной линии. Если снижение АРУ наблюдается в состоянии покоя, это определяется как фиксированное опущение [10]. В легких случаях в начале заполнения прямой кишки контрастным веществом длина РНР равна нормальной длине анального канала. ...
... Рис.10. Больной 10 лет с функциональным запором и повреждением ПРМ. ...
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.
The aim of this study was to investigate the pathophysiology of functional constipation (FC) in the elderly. Material and methods: In the State Geriatric Center of Netanya (Israel), 37 patients at the age of 65-93 years with complaints of chronic constipation were examined. This main group did not include patients with tumors and cases after surgery on the rectum and colon. The results of a survey of 15 young people aged 11-17 years with no bowel disease were taken as a control group. A barium enema with a radiopaque marker near the anus was produced. A frontal radiography of the abdomen as well as an X-ray of the lateral projection of the anorectal zone were made after the administration of 100, 200 and 300 ml of barium. Results: In 6 (16%) cases, the width of the rectum was more than 5 cm - megarectum. The length of the anal canal was 2 times less than the minimum normal limit after the injection of 100 ml of barium. In 25 (68%) patients, the width of the rectum was normal and had a normal shape. The functioning anal canal length was shortened during the administration of barium. In 6 (16%) patients, the reason for constipation was high colonic tone. They had the anorectal parameters within the normal range. Conclusion: We found 3 types of FC in the elderly. In the structure of FC the cases of self-defined constipation (68%) are dominated, where there is no mechanical obstruction for defecation. The reason for the sense of constipation and incomplete emptying is due to the age-related weakness of the pelvic floor muscles. In 16% of patients, obstructive constipation with a megarectum and a fixed descending perineum syndrome was detected. This pathology originated in childhood or after anal fissures, and childbirth. In 16% of patients, the cause of constipation was a high tone of the colon, what can be the result of an irritable bowel syndrome, the formation of functional sphincters in the colon and diverticula of the sigmoid colon. An increase in the tone of the colon causes a slow transit constipation.
