Descending perineum syndrome: new perspectives

Pucciani, Filippo

doi:10.1007/s10151-015-1321-6

Cited by 15 publications

(19 citation statements)

References 46 publications

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“…42 Even with this ongoing debate, Pucciani suggests that urogynecological structures are implicated and thus pelvic organ prolapse may coexist with other physical exam findings associated with IPD. 43…”

Section: Pathophysiologymentioning

confidence: 99%

“…Urological symptoms include urinary complaints and vaginal symptoms including sensation of a bulge. 43…”

Section: Historymentioning

confidence: 99%

“…46 The anorectal angle may return very slowly to baseline or remain fixed. 43 Owing to the ability to identify multiple abnormalities within different pelvic compartments, dynamic proctography and cystocolpoproctography (DCP) has largely replaced defecography alone as the workup of choice for IPD. DCP combines vaginal opacification and voiding cystography and defecography to visualize multiple compartments of the pelvis.…”

Section: Defecographymentioning

confidence: 99%

“…55 Because of the associated urogynecological abnormalities, it is of benefit to seek a multidisciplinary approach including rehabilitative therapy. 43,56,57 Rehabilitative therapy including pelviperineal kinesiotherapy aimed at improving muscular tone and function at the levator ani muscles should be involved in treatment algorithms. Kinesiotherapy can improve pelvic floor muscle tone and coordination and contribute to positive outcomes in anorectal surgery.…”

Section: Biofeedbackmentioning

confidence: 99%

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Functional Disorders of Constipation: Paradoxical Puborectalis Contraction and Increased Perineal Descent

Payne

Grimm

2016

Clinics in Colon and Rectal Surgery

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Paradoxical puborectalis contraction (PPC) and increased perineal descent (IPD) are subclasses of obstructive defecation. Often these conditions coexist, which can make the evaluation, workup, and treatment difficult. After a thorough history and examination, workup begins with utilization of proven diagnostic modalities such as cinedefecography and anal manometry. Advancements in technology have increased the surgeon's diagnostic armamentarium. Biofeedback and pelvic floor therapy have proven efficacy for both conditions as first-line treatment. In circumstances where PPC is refractory to biofeedback therapy, botulinum toxin injection is recommended. Historically, pelvic floor repair has been met with suboptimal results. In IPD, surgical therapy now is directed toward the potentially attendant abnormalities such as rectoanal intussusception and rectal prolapse. When these associated abnormalities are not present, an ostomy should be considered in patients with IPD as well as medically refractory PPC.

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Section: Pathophysiologymentioning

confidence: 99%

“…Urological symptoms include urinary complaints and vaginal symptoms including sensation of a bulge. 43…”

Section: Historymentioning

confidence: 99%

Section: Defecographymentioning

confidence: 99%

Section: Biofeedbackmentioning

confidence: 99%

See 2 more Smart Citations

Functional Disorders of Constipation: Paradoxical Puborectalis Contraction and Increased Perineal Descent

Payne

Grimm

2016

Clinics in Colon and Rectal Surgery

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“…In parallel, excessive abdominal straining at stool evacuation causes progressive perineal descent: the recurrent straining against defecatory outlet obstruction impairs pelvic floor muscle tone until it disappears completely. In this way descending perineum overlaps with pelvic floor dyssynergia [2]. Older age is correlated with both dynamic and fixed descending perineum [3], and excessive perineal descent is found in 78 % of elderly patients with evacuation disorders [4].…”

mentioning

confidence: 95%

A theory of progression from obstructed defecation to fecal incontinence

Pucciani

2015

Tech Coloproctol

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Fecal disorders have a relevant social impact because they impair the quality of life of the patient and add to the cost of healthcare. In order to shed light on the pathophysiology of fecal disorders it is helpful to consider the progression of obstructed defecation to fecal incontinence which occurs in women without anal sphincter defects who have descending perineum syndrome.The overall prevalence of chronic constipation in the general population is about 15 %, and the most common subtype among women is obstructed defecation. Obstructed defecation occurs in 47.7 % of Italian patients affected by chronic constipation. Dyssynergia alone is present in young women (median age 38 ± 14 years), whereas dyssynergia plus structural diseases, such as rectocele, rectal intussusception, mucosal prolapse and perineal descent materialize in middle-aged women (median age 52 ± 14 years) [1]. Therefore there is no doubt that ageing is implicated in the evolution from functional to anatomic pelvic floor disorders. In parallel, excessive abdominal straining at stool evacuation causes progressive perineal descent: the recurrent straining against defecatory outlet obstruction impairs pelvic floor muscle tone until it disappears completely. In this way descending perineum overlaps with pelvic floor dyssynergia [2]. Older age is correlated with both dynamic and fixed descending perineum [3], and excessive perineal descent is found in 78 % of elderly patients with evacuation disorders [4]. The organic descent of the hypotonic pelvic floor combined with pudendal neuropathy explains the appearance of fecal incontinence. Perineal descent involves the anterior, middle and posterior pelviperineal areas in women. Uro-gynecological structures and proctologic segments are all implicated and thus pelvic organ prolapse may coexist with rectoanal intussusception, rectal prolapse and rectocele [5].Fecal incontinence is a physically and psychologically disabling condition which has a negative impact on the quality of life of the patient. The prevalence of fecal incontinence in community-dwelling women in the USA varies considerably depending on the population studied, ranging from 2.2 to 17 % of women housed in communities and up to almost half of all nursing home residents. Fecal incontinence is often related to several specific diseases, such as diabetes mellitus, dementia, irritable bowel syndrome, cerebrovascular disease, pelvic-anal surgery, traumatic sphincter lesions and post-partum incontinence. Even when excluding the presence of these cases, women over 65 years often have combined chronic constipation and fecal incontinence (32.7 % of constipated women) and women with anal incontinence have greater values of descending perineum measures than those without anal incontinence [6]. Therefore, these last epidemiological data support the hypothesis of a link between obstructed and fecal incontinence via descending perineum syndrome.Obstructed defecation can be caused by organic or functional diseases which are difficult to untangle. Mechanic...

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Anorectal Functional Anatomy

Pucciani

2020

High Resolution and High Definition Anorectal Manometry

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Descending perineum syndrome: new perspectives

Cited by 15 publications

References 46 publications

Functional Disorders of Constipation: Paradoxical Puborectalis Contraction and Increased Perineal Descent

Functional Disorders of Constipation: Paradoxical Puborectalis Contraction and Increased Perineal Descent

A theory of progression from obstructed defecation to fecal incontinence

Anorectal Functional Anatomy

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