Analyzing the Role of Anal Sphincter Pressure in Rectocele Formation

Abstract

Constipation is a common entity in society with various factors in the etiology. In this study, we evaluated the role of anal sphincter pressure of patients who refer to surgery clinic with complaint of constipation. Methods: Sixty patients who refer to surgery clinic with complaint of constipation and were diagnosed with constipation due to Rome III criteria between July 2010 and September 2014. These patients were evaluated with defecography and were divided into two groups based on presence of rectocele. Both groups' anal sphincter pressures were evaluated using anal manometry and findings were compared. Results: The patients with rectocele and without rectocele using defecography were inspected with anal manometry regarding resting tone pressure, squeeze pressure, maximum squeeze pressure and simulated defecation response pressure, first sensation volume, urge sensation volume and maximum tolerable volume. Results were compared and no significant difference was found regarding groups with rectocele and without rectocele (P˃0.05). Conclusion: We have proved the hypothesis arguing that increased sphincter pressures do not play a role in the formation of rectocele by inducing an obstruction and the formation of dilation in proximal bowel, and demonstrated that the presence of rectocele is not dependent on an increase in sphincter pressures

A possible physiological mechanism of rectocele formation in women

“…They suggested that paradoxical sphincter contraction increases anal sphincter pressure during defecation [ 37 ], and that this may be a causative factor in rectocele formation [ 11 ]. Ambiguous outcomes regarding the contribution of anal pressure to rectocele development probably result from the fact that different studies measured pressures in different physiological conditions [ 11 , 14 , 15 ]. According to Buyukasik et al [ 14 ] and Yoshioka et al [ 15 ], anal sphincter resting pressure is not correlated to rectocele formation.…”

“…Ambiguous outcomes regarding the contribution of anal pressure to rectocele development probably result from the fact that different studies measured pressures in different physiological conditions [ 11 , 14 , 15 ]. According to Buyukasik et al [ 14 ] and Yoshioka et al [ 15 ], anal sphincter resting pressure is not correlated to rectocele formation. This is probably because they measured the pressure in the anal canal at rest with the rectum empty instead of filling the rectum until the patients were able to expel the balloon, as we did in our study.…”

“…Nevertheless, on account of the complexity and multifactorial nature of anorectal physiology, their impact on rectocele formation remains unclear. Some researchers proposed that rectocele formation during defecation was not correlated with anal sphincter pressure during rest [ 14 , 15 ]. Others reported that paradoxical anal sphincter contraction during defecation might be a risk factor for rectocele formation [ 11 , 12 , 18 ].…”

Colonic pseudo-obstruction in a patient with dyssynergic defecation: A case report

“…Dyssynergic defecation is the failure to complete a series of defecation processes. The defecation process occurs completely when the abdominal, rectal, pelvic floor, and anal sphincter muscles effectively coordinate [8] , [14] , [15] . One important aspect of childhood development is the acquisition of toileting skills and establishment of continence.…”

Treatment of Hemorrhoid in Unusual Condition-Pregnancy

“…The consumption of fiber and fluids positively affects costipation, which is one of the elements that contribute to the development of uterine fibroids during pregnancy. Constipation is a risk factor for long-term pelvic organ prolapse when combined with changes in anal sphincter pressure [20,21]. It is important to consume fresh fruits and vegetables on a regular basis [22].…”