Anal manometric predictors of significant rectocele in constipated patients

Abstract

The diagnosis of significant rectocele is currently made on the basis of cinedefecographic findings. Clinical examination alone will only allow assessment of the presence but not the significance of a rectocele. Therefore, the aim of this study was to determine if anal manometric findings can predict the significance of a rectocele. All patients with a diagnosis of constipation and rectocele confirmed on cinedefecography between 1992 and 1998 were retrospectively reviewed. Significant rectocele was defined as the presence of three of the following five parameters: rectocele >4 cm in diameter as measured during the evacuatory phase of cinedefecography, rectal and/or vaginal symptoms present for longer than 12 months, persistence of rectal or vaginal symptoms for at least four weeks, despite increased dietary fiber (up to 35 g/day), need for rectal and/or vaginal digitation or perineal support maneuvers for rectal evacuation. Statistical analysis was performed using the Mann-Whitney test and Fisher's exact test. A logistic regression model with stepwise selection was used to determine significant prognostic factors. A total of 305 patients (31 men) with rectocele, with a median age of 68 years (range, 12-89) were identified. Of these, 89 (29.2%) had significant rectoceles. There was no difference in the frequency of significant and non-significant rectoceles with respect to gender or age. However, patients with a significant rectocele compared to those with a non-significant rectocele had higher median first sensation volume (45 vs. 30 ml, p=0.0005), median capacity (160 vs. 120 ml, p<0.0001), and median compliance (10 vs. 8 ml H(2)O/mmHg, p=0.05). Calculations based on a logistic regression model determined that with a first sensation of 100 ml, a capacity of 400 ml, and a compliance of 50 ml/mmHg, the probability of a significant rectocele would be 85%. In conclusion, anal manometric findings may be useful in predicting significant rectocele in constipated patients.

Dynamic MR assessment of the anorectal angle and puborectalis muscle in pediatric patients with anismus: Technique and feasibility

“…They are particularly helpful for showing anatomic abnormalities such as rectocele, rectal intussusception, total rectal prolapse, and perineal descent. However, these abnormalities are seen mainly in adult patients (8) and are relatively uncommon in pediatric patients who present with anismus (9). The pubococcygeal line, which is traditionally used to define the level of the pelvic floor, may also be difficult to identify.…”

Age effects on anorectal pressure in anal continent women with lower urinary tract dysfunction

“…Rotholtz et al [19] revealed that a rectocele ≥4 cm in maximal diameter, as measured during an evacuatory effort during cinedefecography, had a higher first sensation volume, capacity, and compliance. We only looked for stage I and II rectoceles affecting the anorectal sphincter pressure.…”

The Impact of Stapled Transanal Rectal Resection on Anorectal Function in Patients with Obstructed Defecation Syndrome

“…The main parameters that were assessed included length of the anal canal (3,4 -3,8 cm), maximal anal resting pressure (56 -74 mmHg), maximal anal squeeze pressure (124 -162 mmHg), objective rectoanal inhibitory reflex(20 -40 mL), subjective rectal sensitivity threshold volume (defecation stimulus: 60 -100 mL), and maximum tolerable volume (threshold of evoked abdominal pain: 180 -250 mL). The balloon-expulsion test was performed at the end of the manometric study 26. …”