Descending Perineum Syndrome: Are Abdominal Hysterectomy and Bowel Habits Linked?

Abstract

Clinical evaluation and instrumental data suggested a possible link between fecal incontinence and abdominal hysterectomy in patients affected by descending perineum syndrome.

Descending perineum syndrome: new perspectives

“…DPS women with obstructed defecation have anal pressure values similar to those of the controls, whereas patients with fecal incontinence have lower anal pressure values than those with obstructed defecation and controls [9]. These data underline the progression of defective anal sphincter function which is significantly related to fecal incontinence.…”

“…Anorectal angle and pelvic floor descent values are significantly higher at rest and during evacuation (p \ 0.01) in DPS patients than in controls [9]. Rectocele and rectoanal intussusception may be detected, and some DPS patients have a poor anorectal angle opening at evacuation.…”

“…These data underline the progression of defective anal sphincter function which is significantly related to fecal incontinence. A significant impairment of the amplitude of maximal voluntary contraction may be detected in DPS women, independently from defecation disorders, when compared to controls (p \ 0.001) [9]. It is the obvious expression of the negative influence of pudendal neuropathy on external anal sphincter function.…”

“…Defecography images clarify the pathophysiology. A mobile descending perineum shows, at straining, a paradoxical puborectalis contraction that is simultaneous with excessive pelvic floor descent [5,9]. Obstructed dyssynergic defecation occurs, and the patient triggers a more exaggerated effort to evacuate, an effort which then worsens perineal descent.…”

“…The dyssynergic component plays a role in the early stages of the disease, inducing obstructed defecation. The organic descent of the hypotonic pelvic floor, combined with disease duration, advancing age, pudendal neuropathy, and sometimes uterine surgery, such as abdominal hysterectomy, explains the appearance of fecal incontinence [9,11,12]. Pudendal neuropathy is a pathophysiological sign of DPS.…”