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PubMed1988

[A cause of terminal constipation: hypertonia of the striated pelvic muscle. Value of complementary studies].

The aim of this study was to define an other cause of idiopathic constipation with a mathematic automatic classification Fifty patients were studied by colonic transit time, anorectal manometry and defecography. Three classical causes were found: 12 patients had hypertonic upper anal pressure; 8 patients had abnormal rectonanal inhibitory reflex and 12 patients had anatomic conditions reducing stool frequencies Automatic mathematic classification coming from optimised bowls technic has led to the characterization of a new cause. Eight young women (mean age 33 years) with hypertonic striated pelvic muscles on straining were identified. Three items were significantly different: defect of sphincteric relaxation without high sphincteric pressure; closure or non opening anorectal angle, hypertonic levator ani on straining. There was a significant high frequency (p less than 0.05) of urinary disorders in this new group. All abnormalities occurred during defecation. This group can be studied with other methods: balloon expulsion, anal electromyography. Clinical identity with urinary pathology may be explained by common neurologic disorders of pelvic striated muscle innervation.

Adult↗
PubMed1987

[Contribution of radiology in the study of ileal reservoirs anastomosed to the anal canal].

Confection of an ileal reservoir anastomosed to anal canal is a seductive issue after total coloproctectomy. In this prospective study, early complications, mainly anastomotic fistulae, were effectively detected by routine enemas with water soluble media. These complications affected 14% of patients. Preliminary results of functional exploration of reservoirs by defecography showed that continence muscle barriers were apparently unaltered by the operation, that the content of reservoirs in J was satisfactory and that difficulties in exoneration frequently met with in reservoirs in S were due to architectural anomalies of these ileal pouches rather than a disturbance in pelvic muscles play. Radiologic analysis can establish perfection of surgical mounting and guide possible recovery operations.

Adolescent↗
PubMed1986

The pathogenesis and pathophysiology of rectal prolapse and solitary rectal ulcer syndrome.

Rectal prolapse and solitary rectal ulcer syndrome are both benign conditions affecting the rectum, mainly in women; prolapse tends to occur late in life, while solitary rectal ulcer syndrome has a predilection for the younger adult. Complete rectal prolapse probably starts as a mid-rectal intussusception, although a combination of this theory and the 'sliding hernia' theory has been proposed by Altemeier et al (1971). The pelvic floor weakness associated with prolapse, which gives rise to incontinence, is most likely due to a traction injury to the pudendal nerve. Anorectal manometry will indicate those incontinent patients likely to benefit from rectopexy. Abnormal descent of the perineum may be found in rectal prolapse and solitary rectal ulcer syndrome as well as descending perineum syndrome per se. The clinical features of these three conditions can overlap. Solitary rectal ulcer syndrome is essentially due to prolapse and traumatization of the rectal mucosa. Inappropriate puborectalis contraction, abnormal perineal descent, and overt rectal prolapse have all been cited as possible mechanisms of development of the condition. Defecography is the radiologic investigation of choice. Electromyography, as in rectal prolapse, may show evidence of pudendal nerve damage although incontinence is rare.

Adult↗
PubMed1987

[The urorectal syndrome caused by abdomen-levator incoordination in children].

We have studied thirty four children (mean age 6.6 years) with severe functional constipation, associated or not with encopresis. In twenty three cases the defecography showed a persistent anorectal angle due to failure of puborectalis sling relaxation during defecation straining. Voiding disorders, unknown to parents, but demonstrated by obstructive uroflowmetry, are also seen in nineteen of these children. Therefore is definite a true urorectal outlet obstruction syndrome by spastic pelvic floor mechanism. The exact etiologic factor of these functional abnormalities remains undefined. All children were managed by biofeedback training. A satisfactory result (with six months follow up), has obtained in fourteen cases.

Adolescent↗
PubMedDate not supplied

[Diagnostic explorations in constipation].

In 40 patients affected with ano-rectal diseases and presenting with severe constipation, the following tests have been performed: ano-rectal manometry, measurement of the sensitivity to rectal distention, study of intestinal transit time; also in some cases a defecography, double contrast barium enema, biopsies, neurological examination, and blood sugar. In 45% of the cases, the examinations enabled to specify the cause of the constipation and establish corresponding therapeutic indications.

Adult↗
PubMed1985

[Radiological and instrumental study of the colon in idiopathic constipation].

It has been demonstrated that it is not always possible to attribute to constipation a reduced colonic transit time as being evidenced by radiological studies using radiopaque markers. In fact, in constipated patients with a normal transit time, it was more reasonable to consider a recto-anal disorder as evidenced by defecography and manometry.

Anus Diseases↗
PubMed1984

The topography of ileoanal reservoirs in relation to evacuation patterns and clinical functions.

The clinical outcome following ileoanal pouch operations vary greatly. To understand the underlying mechanism 15 S-shaped reservoirs and one J-shaped were studied by defecography (evacuation pouchography). Efficient evacuation was noticed when the reservoir was placed deep in the pelvis with the outlet of the pouch on a level with the 5th sacral vertebra or coccyx, and when the efferent limb was short (less than or equal to 7 cm) and straight. When the pouch was placed higher up in the pelvis and when the efferent limb was long and angulated, evacuation was impaired. Patients with efficient evacuation all had excellent clinical functions with few (less than or equal to bowel movements in 24 hours and no leakage, but when the evacuation was impaired there was a tendency towards more frequent stooling and leakage.

Adult↗
PubMed1995

Functional colonic and anorectal disorders. Detecting and overcoming causes of constipation and fecal incontinence.

Evaluation of constipation and fecal incontinence begins with comprehensive history taking, which may include overcoming a significant psychosocial barrier. Before functional anorectal diseases can be controlled, the fundamental cause must be determined and any underlying disorder corrected. In constipation, a colonic or anorectal motility disorder is often the cause; about half of refractory cases are the result of obstructive defecation. In fecal incontinence, dysfunction of several anatomic or physiologic mechanisms may be the cause. Anorectal manometry is useful in assessment in both disorders. Other helpful tests are colonic-transit measurement in constipation and electrophysiologic tests and defecography in fecal incontinence. Treatment of constipation often includes dietary measures and use of laxatives or prokinetic agents; fecal incontinence may respond to bulking or antidiarrheal agents. In both disorders, some patients have responded to the recently described technique of neuromuscular conditioning with biofeedback. In some cases, surgical repair must be considered.

Constipation↗
PubMed1994

[Results of therapeutic management of vesico-urethral and anorectal disorders in 20 patients with cauda equina syndrome].

Twenty patients (7 females and 13 males) with cauda equina lesions (12 herniated lumbar disks, 4 tumours, and 4 compression fractures of the lumbar spine), were treated according to a standardized management of their urinary and digestive symptoms, after surgery. The bladder emptying inability was managed by Crédé manoeuver facilitated by appropriate drugs completed by self intermittent catheterization. The constipation was treated by non irritant osmotic laxatives, and defecation obtained by abdominal straining, was facilitated by a suppository. All the patients recovered a sphincteric autonomy, without invalidating incontinence. Within 3 to 6 months, eleven patients improved enough bladder emptying to stop drugs and self-catheterization. None presented urinary incontinence. Within the same time, 14 had a stool daily, but medical treatment of the constipation had to be carried on in all of the 20 patients. None of the patients had incontinence for the solid stools, but only the patients who improved (spontaneously or after biofeedback therapy) the voluntary anal sphincter contraction were continent for the gaz, and liquid stools. The intermittent self-catheterization release (a complete emptying of the bladder being achieved) was more frequent after tumor treatment than after herniated disk, or compressive fracture treatment; the same release happened in case of immediate management if compared with delayed management of the urinary symptoms. Adversely, the digestive recovering was not influenced by either the etiology of the cauda equina lesions or the therapeutic management delay. Defecography demonstrated anatomical disturbances of the rectoanal apparatus such as perineal descent and/or mucosal prolapse, which could be secondary to the abdominal straining necessary to complete bladder and rectum emptying.

Adult↗
PubMed1994

[The coronal anatomy of the pelvis at rest and under straining].

Twenty-five subjects with no pelvic floor dysfunctions at defecography were examined with direct coronal CT scans of the pelvis at rest and on straining. Three compartments with different characteristics were delimited by two planes-the anterior one being tangent to the ischiatic foramen and the posterior one to the ischial tuberosities. At rest, the average length of the levator ani muscle and the surface of the supralevator space were significantly lower posteriorly than in the other two compartments (48.3 mm +/- 7.9; 48.8 mm +/- 7; 42.6 mm +/- 9.4, p < 0.05 and 70.6 cm2 +/- 7.5; 66.9 cm2 +/- 11.2; 27.2 cm2 +/- 4.8, p < 0.01, respectively). On straining, maximum muscle lengthening occurred posteriorly, as indicated by similar average values (63.7 mm +/- 12.7; 63.3 mm +/- 9.5 and 60.5 mm +/- 14) and the corresponding increase (+12.5%) in the supralevator space occurred in the middle compartment (73.8 cm2 +/- 7.6; 75.3 cm2 +/- 11.6 and 30.2 cm2 +/- 5.2). To conclude, our method proved reliable enough (intra- and interobserver correlation index > 80%) and promising for future clinical applications and studies of pelvic floor dysfunctions.

Adult↗
PubMed1994

[Kohlrausch's plica (plica transversalis recti): localization, morphology, function].

The plica transversalis recti (K Kohlrausch's plica or Houston's valve) shows a preferential double (52%) rather than triple (38%) localization and is absent in as much as 16% of cases. It is alternatively found on the left and right sides, 3-4 and 8-9 cm from the anal margin respectively. Both its detection rate and radiographic features depend on the technique used as follows: (a) 92%, contour indentation and/or linear filling defect, 4 to 5 mm thick at barium enema studies; (b) 67%, the same as in (a) plus 1/3 narrowing of the maximum diameter at defecography; and (c) 90%, two opposite and overlapping folds at coronal CT. Evidence is given that neither organic nor functional anorectal conditions affect the radiographic appearance of the fold, its likely role being to fix the proximal margins during the expulsion of feces.

Adult↗
PubMedDate not supplied

[Diagnostic imaging in constipation].

Diagnostic imaging modalities play a key role in the definition of the possible causes of constipation. Barium Enema (BE), Defecography (DG), Intestinal Transit Time (ITT), Computed Axial Tomography (CT) and Magnetic Resonance (MR) are necessary diagnostic tools for the identification either of the possible organic causes of the disease or of the functional disorders. The ITT evaluation is the main investigation to look for functional colic constipation; this method is in fact able to distinguish between the hypertonic type (in which the fecal progression is slowed down to such an extent that radiopaque markers accumulate in the most proximal part of the colon) and the atonic one (characterized by a global slowing down with the markers distributed along the whole colon). DG gives very accurate dynamic documentation of the pathologic alteration of the rectum-anal conduit, as well as of the disease of the supporting and anchoring system and of the levator complex; this type of investigation allows the definition (characterisation) of the different types of the functional rectum-anal constipation. Even in this case TAC and RM can greatly contribute to the definition of the whole picture of the constipation.

Constipation↗
PubMedDate not supplied

[Functional ano-rectal disorders: associated defecographic findings and related symptoms].

We retrospectively analyzed our latest 564 defecographies to evaluate: the frequency of each single defecographic finding on the total number of patients and in the two sexes; the frequency of the finding as single disorder and in association with other anorectal disorders; the correlation between findings and symptoms. The most common disorders were anterior rectocele (54%), mucosal prolapse (53%), puborectalis muscle syndrome (15%), and intussusception (15%); this order is respected in women (70, 57, 17 and 16% of the study population) but differs in men (mucosal prolapse 42%, puborectalis muscle syndrome 18%, posterior rectocele 14%, and intussusception 14%). Intussusception and puborectalis muscle syndrome were identified as an isolated finding in many cases (55% and 43%, respectively). The most common associations are: posterior rectocele with anterior rectocele (58% of cases), anterior rectocele with mucosal prolapse and vice versa (63% and 64%), intussusception with anterior rectocele (52%), puborectalis muscle syndrome with mucosal prolapse (36%) and with anterior rectocele (49%) and descending perineum syndrome with anterior rectocele (81%) and with mucosal prolapse (70%). The low rate of association among some disorders should be mentioned too for example, mucosal prolapse is associated, with intussusception only in 10% of cases. Clinical-defecographic correlations are less apparent: if some symptoms are found to be more typical of some disorders, this correlation is not pathognomonic and the clinical picture is quite aspecific. We stress the value of a careful correlation between clinical-anamnestic and defecographic findings for the correct evaluation of these disorders.

Adult↗
PubMed1993

[Rectocele: a sign of the relaxed pelvic floor syndrome].

Routine physical examination, anorectal dynamics, electromyography of the pelvic floor, defecography and bowel transit were made in 45 patients with rectocele. The results showed that the disorder occurred mainly postpartum and always coexisted with other relaxed pelvic floor disorder. The patients had abnormal descent of pelvic floor, which was positively related to the depth of rectocele. Those with rectocele and spastic pelvic floor syndrome showed less descent of pelvic floor and depth of rectocele compared with those without SPFS. Thess suggest that the relationship between rectocele and descent of the pelvic floor is close. The maximum contraction pressure of the anal canal, the sensitive function, and the contractive function of the rectum were significantly decreased in the patients with rectocele, suggesting neurogenic damage.

Adult↗
PubMed1994

[Diagnostic strategy in constipation, including irritable bowel syndrome].

Constipation is not a disease but a symptom. Underlying causes include side effects of drugs, metabolic, endocrine, neurologic, psychiatric and intestinal diseases. Constipation is part of the so-called irritable bowel syndrome. The diagnosis is based on history, physical examination and a few laboratory tests. Second-line diagnostic procedures include endoscopy, colonic transit time and physiological investigations of the anorectum like anorectal manometry or defecography.

Adult↗
PubMedDate not supplied

Paradoxical contraction of pelvic floor muscles: clinical significance.

Paradoxical contraction of pelvic floor muscles during defecation straining has been said to be a cause of constipation and difficulty in passing feces. Nevertheless, controversies about its clinical significance still remained. Twenty patients with constipation and electromyographic evidence of paradoxical contraction of both puborectalis and external anal sphincter were investigated. An anorectal manometry performed in 17 confirmed the paradoxical contraction in 13 (76%). Electromyography revealed neurogenic signs in 11. Defecography demonstrated the paradoxical contraction in 6 only, but, together with barium enema and colon transit time, showed associated anorectal disorders in 9 patients. Twenty control patients were also studied. None had difficulty defecating. Nevertheless, 8 of them (40%) had paradoxical contraction. These observations suggest that paradoxical contraction of pelvic floor muscles may by asymptomatic and that another cause of emptying difficulties has always to be looked for.

Adult↗
PubMed1993

[Evaluation of anorectal motility].

Constipation and incontinence frequently lead to medical consultation. A careful history and a complete physical examination of both anus and rectum are required before performing anorectal motility tests, the most important of which are anorectal manometry coupled with electromyography of the external anal sphincter and defecography. The pathophysiologic origin of these symptoms can then be understood. This has led to the development of new therapies such as bio-feedback or corrective surgery.

Aged↗
PubMed1993

[Surgical treatment of supralevator rectocele. Value of transanal excision with automatic stapler and linear suture clips].

A retrospective review of 20 rectoceles performed over a four year period (1988-1991) was carried out. The major indication for repair was constipation and outlet obstruction. All patients were objectively quantified by standardized defecography and functional investigations. All patients were repaired via a trans-anal approach using a linear stapler. Sixteen patients were improved with a mean follow-up of 21.8 months.

Adult↗