Posterior pelvic floor disorders and obstructed defecation syndrome: Clinical and therapeutic approach

Zbar, Andrew P.

doi:10.1007/s00261-012-9878-2

Cited by 16 publications

(9 citation statements)

References 55 publications

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“…At the end of evacuation, rectum is expected to be almost completely empty. [2][3][4] When evacuation is difficult and infrequent with or without a sense of incomplete evacuation it is called "constipation". Chronic constipation is a common health problem which significantly reduces the quality of life.…”

Section: Introductionmentioning

confidence: 99%

“…Obstructed defecation is responsible for the frustrating symptoms in half of the severely constipated patients who are refractory to conservative therapies. 3 Obstructed defecation means that the passage of stool has been opposed and there is an inadequate evacuation of fecal contents from rectum. Most of these patients complain about their need to apply digital support and excessive straining during defecation with repeated and prolonged attempts for evacuation.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Bamboriya

Jaipal

Jakhar

2020

IJMBS

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“…Thus, vaginography should be typically considered in the situation of continuous urinary incontinence in young female patients, especially when other diagnosis and imaging modalities have not established the etiology. More recently, in the same way as MRI, cystourethrography, peritoneography, or defecography, vaginography has been used in the diagnosis and evaluation of pelvic floor disorders (11,12). Some authors have also reported a method performed by ultrasonography consisting of the use of three-dimensional saline infusion vaginography as an adjunctive modality in the same indications (13).…”

Section: Answermentioning

confidence: 99%

What is your diagnosis?

Nohuz¹,

Stern-Veyrin²,

Drayi³

et al. 2015

J Turkish German Gynecol Assoc

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A 65-year-old-woman who complained of uncontrollable passage of gas and feces from the vagina without fever or abdominal pain was referred to the Obstetrics and Gynecology Department. She was in good health and had previously undergone total hysterectomy by laparotomy 20 years earlier for uterine leiomyomata. The symptoms began 5 months after an acute sigmoiditis and were accompanied by vulvovaginal burns and itching. She had undergone several gynecological examinations, which failed to identify the etiology. Rectosigmoidoscopy and magnetic resonance imaging (MRI) also failed to establish a diagnosis. A subsequent workup by vaginography resolved the etiological investigation (Figure 1, 2).

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“…The obstructed defecation syndrome (ODS) is the most frequent symptom related to the posterior compartment and may be sustained either by mechanical causes (e.g., rectal prolapse, rectal descent, rectal invagination, rectocele, enterocele) or by a functional disorder (puborectalis syndrome, dyssynergic defecation) [6,27]. Common symptoms of rectal prolapse include constipation, sensation of incomplete evacuation, fecal incontinence, and rectal ulceration with bleeding.…”

Section: Posterior Compartmentmentioning

confidence: 99%

MRI of the Pelvic Floor and MR Defecography

Maccioni

Alt

2018

IDKD Springer Series

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The female pelvic floor is a complex functional and anatomic system. It is composed of an active muscular component and a passive support system. Furthermore, it is topographically divided in three main functional and anatomic compartments: the anterior, supporting the bladder and urethra; the middle, supporting the vagina and uterus; and the posterior or anorectal compartment [1]. When the pelvic floor is damaged in its fascial, muscular, or neural components at the level of any of its three compartments, several pelvic floor dysfunctions or disorders (PFD) may arise [2]. As pelvic floor muscles and fasciae act like a unique functional entity, dysfunction of one compartment is commonly associated with various dysfunctions of the other compartments as well. Hence, a multidisciplinary team, often called a pelvic floor unit, is strongly recommended that includes urogynecologists, urologists, gastroenterologists, proctologists, physicians, radiologists, physiotherapists, and specialized nurses. Additionally, the correct diagnosis of the specific PFD and the identification of all associated disorders are mandatory for an effective conservative or surgical treatment. Dynamic MRI provides excellent morphological and functional display of the pelvic floor and is therefore additionally applied for a comprehensive overview of the pelvic floor and the entire pelvic structures. Evaluation is best done by performing a standardized MRI procedure and using a systemic approach to report the MRI findings [3]. To improve effective communication between the radiologist and the clinician, it is also relevant to understand the specific lesions underlying PFD and to explain the frequent association of disorders in different pelvic compartments. Functional Anatomy of the Pelvic Floor PathogenesisThe pelvic floor is an integrated system composed of an active component, the striated muscles, and a passive support system, the suspensory ligaments and fascial coverings, and is associated with an intricate neural network. It not only provides support for the pelvic viscera (bladder, bowel, uterus) but maintains their functioning, thanks to the combined action of the two major pelvic floor structures: the levator ani muscle (LAM), and the endopelvic fascia [1, 2, 4]. Levator Ani Muscle (LAM)The LAM has two main components: the iliococcygeus and pubococcygeus muscles. Various muscle subdivisions of the LAM are assigned to the medial portions of the pubococcygeus in order to reflect the attachments of the muscle to the Learning Objectives• To gain a basic knowledge on anatomy and pathophysiology of the pelvic floor unit • To get familiar with the recently published general recommendations for standardized imaging and reporting of pelvic floor disorder using MRI • To discuss how to apply these recommendations in case-based evaluations

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Posterior pelvic floor disorders and obstructed defecation syndrome: Clinical and therapeutic approach

Cited by 16 publications

References 55 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

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MRI of the Pelvic Floor and MR Defecography

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