PubMed · 6015321
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E Clarke. 1966-11-07. A program of bowel training.. https://pubmed.ncbi.nlm.nih.gov/6015321/
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OBJECTIVE: To identify the functional and anatomic outcomes in women who have surgery for pelvic organ prolapse with enterocele repair. METHODS: Fifty-four women had surgery for pelvic organ prolapse which included enterocele repair. Preoperative and postoperative examinations were done by a research nurse, including a pelvic examination using the International Continence Society staging system and standardized questionnaires about bowel function, sexual function, and prolapse symptoms. RESULTS: Fifty-four women had enterocele repairs as part of their surgery. Mean follow-up time was 16 months (range 6-29 months). Postoperatively five women were excluded from the analysis because of fluctuation in stage of prolapse over time. At the apex and posterior wall of the vagina, 33 women had stage 0 or I prolapse, and 16 had stage II prolapse. None had stage III or IV prolapse. Fifty-three percent of women had improvement in bowel function and 91% had improvement in vaginal prolapse symptoms. Functional outcomes were not significantly different in women with and without stage II prolapse at follow-up. CONCLUSION: Most women who had surgery for pelvic organ prolapse with enterocele repair reported improvement in vaginal prolapse symptoms. Functional outcomes did not differ significantly between women with stage 0 and I prolapse and women with stage II prolapse at the vaginal apex and posterior vaginal wall. This was an observational study and the lack of statistically significant findings could result from inadequate sample size; however, the observed differences were judged to be not clinically significant.
Knowledge of anorectal anatomy is essential for understanding the normal function of the anorectum. Its physiology is more complex, however. The maintenance of continence depends on several factors, and today clinicians have a better understanding of the usual sequence of events that leads to defecation. The extensive number of investigative techniques that have evolved have permitted better understanding of the disorders of the anal sphincters, rectum, and pelvic floor.
Defecation is a dynamic event, and although evacuation proctography does not simulate physiologic defecation exactly, it does provide maximal stress to the pelvic floor and image rectal emptying, both of which are required for the diagnosis of certain conditions: MR imaging studies are attractive in that no ionizing radiation is involved, but unless an evacuation study is performed, the features of anismus, trapping in a rectocele, and intussusception cannot be diagnosed. Because these are the main reasons for investigating difficult defecation, the fluoroscopic examination is the simplest and most reliable method. Endoanal ultrasound is an ideal screening examination for incontinence to show internal sphincter degeneration and tears of the internal or external sphincters. The diagnosis of external sphincter atrophy on ultrasound is not yet resolved, and this remains an important indication for endoanal MR imaging.