Descending perineum syndrome: a review of the presentation, diagnosis, and management

Chaudhry, Zaid; Tarnay, Christopher M.

doi:10.1007/s00192-015-2889-0

Cited by 30 publications

(19 citation statements)

References 55 publications

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“…There can be complaints of anal bleeding, loss of mucus, perineal pruritus or pain. Sometimes digital maneuvers are required to pass stool ( 1 , 3 , 4 ) and severe cases are often associated with anal incontinence ( 1 , 4 , 5 ).…”

Section: Introductionmentioning

confidence: 99%

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Descending Perineum Associated With Pelvic Organ Prolapse Treated by Sacral Colpoperineopexy and Retrorectal Mesh Fixation: Preliminary Results

et al. 2018

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Introduction and hypothesis: Descending Perineum Syndrome (DPS) is a coloproctologic disease and the best treatment for it is yet to be defined. DPS is frequently associated with pelvic organ prolapse (POP) and it is reasonable to postulate, that treatment of POP will also have an impact on DPS. We aimed to evaluate the subjective satisfaction and improvement of DPS for patients who have undergone a sacral colpoperineopexy associated with retrorectal mesh for concomitant POP.Methods: This retrospective cohort study, conducted between February 2010 and May 2016 included all women who had undergone surgery to treat POP and DPS. Improvement of POP was assessed clinically and subjective satisfaction was assessed with a survey.Results: Among the 37 operated patients, 31 responded to the questionnaire and 77.4% were satisfied with this surgical procedure. 94.6% were objectively cured for POP. There was a 60% improvement rate for constipation, 63.5 and 68% were cured or improved for ODS and the need for digital maneuvers respectively.Conclusion: Sacral colpoperineopexy associated with retrorectal dorsal mesh appears to objectively and subjectively improve POP associated with DPS.

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Section: Introductionmentioning

confidence: 99%

“…First line therapy consists of dietary recommendations and use of laxatives (hydrophilic laxative or irritant suppository) to facilitate the rectal emptying ( 1 , 4 ). The second line would be biofeedback and pelviperineal physiotherapy, which aims to reinforce the muscle and prevents further damage.…”

Section: Introductionmentioning

confidence: 99%

Descending Perineum Associated With Pelvic Organ Prolapse Treated by Sacral Colpoperineopexy and Retrorectal Mesh Fixation: Preliminary Results

et al. 2018

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“…Chronic straining and constipation can lead to abnormal descent of more than 3.5 cm. This can lead to hypermobility and stretching of muscles and nerves resulting in functional loss [123].…”

Section: Pelvic Floor Descentmentioning

confidence: 99%

Common Tests for the Pelvic Floor

Thorsen

Roth

2021

The ASCRS Textbook of Colon and Rectal Surgery

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Disorders of anorectal function are common and have a significant impact on individual's quality of life.• Anal manometry allows assessment of anorectal motor and sensory function to delineate contributing factors leading to symptoms of obstructed defecation, anal pain, and fecal incontinence. • Ultrasound, fluoroscopic defecography, and MR defecography provide anatomic and dynamic assessment and the impact of anatomy on function in evaluating patients with fecal incontinence, obstructed defecation, and pelvic organ prolapse.

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“…Although not Food and Drug Administration (FDA)-approved, specialized commode seats and use of an artificial device–a polycarbonate plate with two separate holes for passing urine and stool and a built in hump which supports the perineum when sitting on a commode are available and have been suggested as ways to potentially alleviating symptoms. 60 The device together with biofeedback therapy may improve symptoms in about 50%. 52 At present, there is no consensus on a surgical procedure for the treatment of descending perineum syndrome.…”

Section: Descending Perineum Syndromementioning

confidence: 99%

“…Abdominal sacrocolpoperineopexy and obliteration of the posterior cul-de-sac, transvaginal reconstruction and anchoring of perineal body, and transanal stapling procedure have all been reported but their usefulness is limited by the small sample size. 60 …”

Section: Descending Perineum Syndromementioning

confidence: 99%

Update on the Pathophysiology and Management of Anorectal Disorders

Patcharatrakul

Rao

2018

Gut and Liver

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Anorectal disorders are common and present with overlapping symptoms. They include several disorders with both structural and functional dysfunction(s). Because symptoms alone are poor predictors of the underlying pathophysiology, a diagnosis should only be made after evaluating symptoms and physiologic and structural abnormalities. A detailed history, a thorough physical and digital rectal examination and a systematic evaluation with high resolution and/or high definition three-dimensional (3D) anorectal manometry, 3D anal ultrasonography, magnetic resonance defecography and neurophysiology tests are essential to correctly identify these conditions. These physiological and imaging tests play a key role in facilitating a precise diagnosis and in providing a better understanding of the pathophysiology and functional anatomy. In turn, this leads to better and more comprehensive management using medical, behavioral and surgical approaches. For example, patients presenting with difficult defecation may demonstrate dyssynergic defecation and will benefit from biofeedback therapy before considering surgical treatment of coexisting anomalies such as rectoceles or intussusception. Similarly, patients with significant rectal prolapse and pelvic floor dysfunction or patients with complex enteroceles and pelvic organ prolapse may benefit from combined behavioral and surgical approaches, including an open, laparoscopic, transabdominal or transanal, and/or robotic-assisted surgery. Here, we provide an update on the pathophysiology, diagnosis, and management of selected common anorectal disorders.

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Descending perineum syndrome: a review of the presentation, diagnosis, and management

Abstract: Knowledge of DPS is essential for the practicing pelvic reconstructive surgeon to make a timely diagnosis, avoid harmful treatments, and initiate therapy early on.

Cited by 30 publications

References 55 publications

Descending Perineum Associated With Pelvic Organ Prolapse Treated by Sacral Colpoperineopexy and Retrorectal Mesh Fixation: Preliminary Results

Descending Perineum Associated With Pelvic Organ Prolapse Treated by Sacral Colpoperineopexy and Retrorectal Mesh Fixation: Preliminary Results

Common Tests for the Pelvic Floor

Update on the Pathophysiology and Management of Anorectal Disorders

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