Functional State of the Pelvic Floor Muscles in Patients With the Pelvic Prolapse

Abstract

The article analyzes the functional state (evacuation functions, continence) and innervation of the pelvic floor muscles in patients with rectocele and combination rectocele with internal rectal intussusception, with complaints of obstructive defecation. AIM. The study of the functional state of the pelvic floor muscles in patients with obstructive defecation syndrome (ODS). MATERIALS AND METHODS. The study included 224 women with complaints of obstructive defecation, without pelvic floor surgery. On physical examination, all patients were detected signs of rectocele. The average age - 49,9±15,0 years. 52 (23,2%) patients had complaints to the fecal incontinence of various components. Diagnostic algorithm: physical examination defecography, rectal functional study (high resolution manometry (HRAM), evacuation test, comprehensive sphincterometry, pudendal nerve study). RESULTS. Frequency of functional disorders of defecation (FDD) according to objective methods of study among patients with ODS is high and amounts to 64.7%. In this case, there are no differences in the frequency FDD in patients with a combination of rectocele and internal intussusception compared to patients with only rectocele. There were no correlation between the frequency of anal sphincter failure and FDD. We identified some patients with subclinical incontinence, without complaints but with reduced manometric values and anal sphincter contractility. We have proved the absence of correlation between the presence or absence of pelvic floor muscle innervations violations in the form of neuropathy n. pudendus and the presence or absence of FDD. CONCLUSION. FDD can cause unsatisfactory results of surgical treatment of patients with ODS, even after the restoration of the anatomic relationships due to complaints of evacuation violation. ODS diagnostic algorithm should include not only an assessment of evacuationfunction (HRAM and evacuation test), but also sphincterometry, to assess the content function.

MRI DEFECOGRAPHY IN PELVIC FLOOR DESCENT SYNDROME (review)

“…Чувствительность и специфичность комплексного ультразвукового исследования в выявлении патологических изменений составили: для ректоцеле 81% и 33%, соответственно, для инвагинации 60% и 91%, для энтероцеле 65% и 80% и для цистоцеле 65% и 84%, соответственно [20]. Аноректальная манометрия высокого разрешения разработана сравнительно недавно, используется для исследования аноректальных расстройств и для выявления ректальной инвагинации [24,25]. По данным Benezech A. и соавт., специфичность метода для диагностики ректальной инвагинации составила 100%, чувствительность -69,2%.…”