MR defecography for obstructed defecation syndrome

Thapar, Ravikumar B; Patankar, Roysuneel V; Kamat, Ritesh D.; Thapar, Radhika R; Chemburkar, Vipul

doi:10.4103/0971-3026.150134

Cited by 29 publications

(16 citation statements)

References 11 publications

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“…This was in concordance to a study done by Hetzer at al 34 in 2006. Similar results were observed by Ravi b thapar et al 29 which showed pelvic floor descent was grade 1 in 37.10% patients during defecation followed by grade 2 in 30.81% and grade 3 descent in 33.96% patients. We can conclude that the detection of pelvic floor descent was increased during defecation (92.68% 76/82) as compared from resting state (46.34% 38/82) and it was stastically significant (P 0.001).…”

supporting

confidence: 89%

A Descriptive Study of MR Defecography for Evaluation of Obstructed Defecation Syndrome

Bamboriya

Jaipal

Jakhar

2020

IJMBS

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Objective:-This study aims to ascertain the role of MR Defecography in the evaluation of obstructed defecation syndrome (ODS) with objective to describe spectrum of MR Defecography findings in obstructed defecation syndrome (ODS) and describe a number of reference lines and measurement points used to diagnose and grade pelvic floor disorders and Document the MRI appearance of disorders associated with ano-rectal dysfunction. MR Defecography demonstrated the profile of obstructed defecation syndrome on the basis of MR defecography and demonstrate its utility in simultaneous & objective evaluation of all three pelvic compartments. This diagnostic modalities provide a detailed pelvic floor anatomy and functional evaluation, as well as their respective abnormalities, making a precise diagnosis and provides valuable information on treatment planning & decrease chance of postoperative recurrence. Subjects and Methods: It was Cross-sectional and prospective (quantitative) hospital based descriptive type of observational study carried out at a tertiary hospital SMS hospital, jaipur. Chosen the patients diagnosed with ODS as per Rome criteria (III) whose colonoscopy or rectosigmoidoscopy, had been done to rule out other findings from Feb 2018 to September 2019.MR defecography (static and dynamic) with 3 T (PHILIPS INGENIA) MRI system having tunnel configuration. After written and informed consent, patient was positioned supine in MR machine gantry . Static imaging performed in the axial T1WI high resolution, axial, coronal and sagittal T2WI high resolution images at rest for anatomical evaluation. Following this,after ultrasound gel instilled in the patient’s rectum and intravaginaly ,dynamic imaging were taken in the midsagittal plane through the anal canal using a T2 weighted sequence. This sequence was ran for almost 2 min, while the patient performs various maneuvers (Kegel (squeeze), valsalva menuvere (strain), and defecation). MR defecography structurally and functionally evaluated in all 3 pelvic floor compartments and associated defects noted and grading of specific findings like organ specific prolapse, pelvic floor relaxiation and descent were measured. Results: In our study most common findings were pelvic floor descent and anorectal junction descent in 92.68% cases each followed by rectocele in 82.93% cases. Among the females, vaginal/uterine prolapse were observed in 65.31% cases. Least common findings were paradoxical contraction (8.54%) and sigmoidocele (0%). Significant difference was observed in MRI functional parameters in resting state and during defecation/maximal strain position, utilising HMO system for pelvic floor relaxation and descent, as significant difference (p <0.001S) was observed in all parameters including H line, M line, bladder base descent, cervical/vaginal and anorectal junction descent during resting state and during defecation/maximal strain position. Out of 82 conservative biofeedback therapy was given to 79.27 % patients, surgical management was done in (7.32%) and combination of both therapies was given in 13.41% of cases. Out of 82 patients 68.29% showed benefit from management and showed improvement on follow and 31.71% patients were not improved on follow up. Conclusion: As complete survey of the entire pelvis is necessary before surgical repair Magnetic resonance imaging permits evaluation of all three pelvic compartments and as we demonstrated in our study more than one compartment are frequently affected in obstructed defecation syndrome. Static MR Imaging can be also useful to identify the defects responsible for pelvic organ prolapse and stress urinary incontinence, and so help perform site specific repair in surgery, to avoid the high recurrence rates.Findings reported at dynamic MR imaging of the pelvic floor are valuable for selecting candidates for surgical treatment and for indicating the most appropriate surgical approach as detection rate of pathologies increased during defecation / maximal straning as concluded by our study.

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confidence: 89%

A Descriptive Study of MR Defecography for Evaluation of Obstructed Defecation Syndrome

Bamboriya

Jaipal

Jakhar

2020

IJMBS

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“…Symptoms include unsuccessful fecal evacuation attempts, excessive straining, pain, bleeding after defecation, and a sense of incomplete fecal evacuation, which is also an important cause of constipation. 18,19 The MODS is the most commonly used scoring system to evaluate the treatment strategy for ODS patients and to assess the percent and total change in ODS symptom score from baseline after intervention in short term and long-term follow-up trials of various intervals. A cut-off of nine for surgical intervention is preferred by many authors Our results showed that the combination therapy with milk of magnesia, liquid paraffin and sodium picosulphate reduced mean MODS score from 11.63 to 5.88 (51.44% reduction, p<0.012 vs baseline), indicating towards the role of Cremaffin plus in the medical management of ODS.…”

Section: Discussionmentioning

confidence: 99%

A prospective non-comparative study to assess the effectiveness and safety of combination laxative therapy containing milk of magnesia, liquid paraffin and sodium picosulphate (Cremaffin-Plus®) in the management of constipation in patients with anal fissure/hemorrhoids/obstructive defecation syndrome

Patankar

Mishra

2017

Int Surg J

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Background: Assess the effectiveness and safety of combination laxative therapy containing milk of magnesia, liquid paraffin and sodium picosulphate (Cremaffin-Plus®) in management of constipation, in patients with anal fissure/haemorrhoids/obstructive defecation syndrome (ODS). Methods: Patients visiting study site with complaints of constipation secondary to anal fissures/haemorrhoids/ODS, intended to receive combination laxative therapy (as per physicians' discretion), were enrolled. Primary objectives were to assess the change in number of bowel movements per day and stool consistency; secondary objectives were to assess change in straining, physician global efficacy assessment, quality of life (PAC-QOL score), Constipation Symptoms (CSS), Fecal Incontinence Score (FIS), Patient Assessment of Constipation Symptoms (PAC-SYM) score, along with the Modified Longo Score (MODS) for ODS from baseline to end of 4 weeks. Safety, tolerability and treatment adherence were also assessed. Results: About 32 patients (anal fissure:19, haemorrhoids:5, ODS:8) met inclusion criteria. Significant improvement in stool frequency was observed in all patients pooled together (p=0.016); group wise, statistical significance was noted in patients of anal fissures. Stool consistency was improved in all patients pooled together (p<0.001); group wise, significant improvement was seen in patients of anal fissure and ODS. There was a significant improvement in straining noted in all patients pooled together (p=0.002). Significant reduction (p<0.001) was noted in all the symptom scores (CSS, FIS, PAC-SYM and PAC-QOL) from baseline to 4 weeks in all patients. About 51.44% reduction in MODS score was noted in patients with ODS. Conclusions: Improvement in stool frequency, consistency and straining was noted in all patients with constipation (with fissure/haemorrhoids/ODS) treated with Cremaffin-plus for 4-weeks, improving the quality of life. All patients showed good therapy adherence with better safety and tolerability profile.

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“…Disadvantages include supine positioning, increased cost, patient reports of difficulty evacuating their rectum, and underreporting of abnormalities of the pelvic floor. 26,27 A study by Vitton et al reported a concordance rate of 55% for conventional defecography and dynamic MRI. 22 This may be due to the decreased rate of complete rectal emptying seen with MR (2%) compared with barium proctography (29%).…”

Section: Diagnostic Modalitiesmentioning

confidence: 99%

Functional Disorders: Rectoanal Intussusception

Blaker

Anandam

2016

Clinics in Colon and Rectal Surgery

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HistoryRectoanal intussusception (RI), also known as internal intussusception, occult rectal prolapse, intrarectal prolapse, and internal procidentia, is a telescoping of the rectal wall during fecal evacuation. 1 Allingham, in the late 1800s, first described what we label today as rectoanal intussusception as the third variety of procidentia recti in which "the upper part of the rectum descends through the lower part, but does not appear outside the anus." 2,3 He diagnosed this with physical exam and symptoms included "obstinate constipation unrelieved by purgatives; a sensation of burning and fullness in the bowel attended with tenesmus, straining, and difficulty in defecation with occasional discharges of blood and mucus." He postulated that the intussusception was caused by a redundant sigmoid or rectal mesentery. Treatment options at that time included cauterizing portions of the intussusception or a sort of rectopexy via a left lower quadrant incision in which a silk suture is passed through the mesentery and secured it to the abdominal wall. 3 Since its first description, advances have been made in the diagnosis and treatment of rectal intussusception. However, there are many unanswered questions and the best treatment option remains unclear. EtiologyThe pathophysiology and etiology of RI is not well elucidated. Existing theories of etiology fall along two general lines of thought: RI is a dynamic anomaly which may progress to rectal prolapse; or RI is secondary to other abnormalities of pelvic floor function. 1,2 Loose fixation of the rectum to the sacrum or connective tissue disorders may contribute to RI. 4 It is hypothesized that symptoms of obstructed defecation due to RI occur owing to the circular infolding of the rectal wall with subsequent occlusion of the rectal lumen.Several studies have examined whether RI progresses to rectal prolapse. Wijffels et al found a positive correlation between grade of prolapse and age, supporting this postulation. 5 However, other studies do not support this hypothesis. Choi et al found that only 1 in 26 patients treated with dietary therapy or biofeedback for large RI ( 10 mm) developed fullthickness rectal prolapse during 45 months of follow-up (range: 12-118 months). 1 Similarly, Mellgren et al studied 38 patients with rectal intussusception on defecography who were treated nonsurgically, and found that only 2 developed rectal prolapse during the follow-up period. 6 A much larger study of 1,014 women with fecal incontinence and/or obstructive defecation found that of the 26 patients with initial rectorectal intussusception, 1 progressed to external rectal AbstractRectoanal intussusception is an invagination of the rectal wall into the lumen of the rectum. Patients may present with constipation, incomplete evacuation, incontinence, or may be asymptomatic. Defecography has been the gold standard for detection. Magnetic resonance imaging defecography and dynamic anal endosonography are alternatives to conventional defecography. However, both methods are not as sens...

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MR defecography for obstructed defecation syndrome

Cited by 29 publications

References 11 publications

A Descriptive Study of MR Defecography for Evaluation of Obstructed Defecation Syndrome

A Descriptive Study of MR Defecography for Evaluation of Obstructed Defecation Syndrome

Functional Disorders: Rectoanal Intussusception

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