Role of age, bowel function and parity on anorectocele pathogenesis according to cinedefecography and anal manometry evaluation

Abstract

Anorectocele is not correlated with parity, age, episiotomy, delivery of a large baby and anismus. It was more frequent in patients with severe constipation and less common in patients with anal hypotonia.

Influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions

“…However, rectocele grade II or grade III, rectal intussusception, rectocele grade II or III associated with rectal intussusception and occult sphincter injury were more prevalent in group II (P = 0.0432; P = 0.0028; P = 0.0178; P = 0.0001, respectively). The groups did not differ significantly with regard to anismus, anismus associated with rectocele grade II or III, or entero/ sigmoidocele grade III ( (8,14,15,17,20,27) . Thus, while some reports have correlated pelvic floor abnormalities with obstetric trauma (4,10,12,23) , others have failed to identify an association between the incidence of such dysfunctions and vaginal delivery (17,20,27) .…”

“…The groups did not differ significantly with regard to anismus, anismus associated with rectocele grade II or III, or entero/ sigmoidocele grade III ( (8,14,15,17,20,27) . Thus, while some reports have correlated pelvic floor abnormalities with obstetric trauma (4,10,12,23) , others have failed to identify an association between the incidence of such dysfunctions and vaginal delivery (17,20,27) . According to Dietz et al (6,7) true rectocele is a rectovaginal septum defect in younger nulliparous women, the prevalence and size of which appear to be associated with childbirth.…”

“…Because of differences in measurement techniques and anatomical landmarks, some authors describe rectocele as a descent of the rectal ampulla, quantified by correlation with the inferoposterior margin of the symphysis pubis (8,12) , while others consider rectocele a herniation of the anterior rectal wall into the posterior vagina, the size of which determines the grade of rectocele (2,3,9,13,15,17,19,20,23,27,29) . Using 3-DAUS, we identified isolated and associated posterior dysfunctions and determined rectocele size.…”

“…Different techniques and imaging methods have been used to evaluate pelvic floor dysfunctions in the anterior, middle and posterior compartment (2,3,7,8,9,12,14,15,16,17,18,19,20,24,25,27) . Because of differences in measurement techniques and anatomical landmarks, some authors describe rectocele as a descent of the rectal ampulla, quantified by correlation with the inferoposterior margin of the symphysis pubis (8,12) , while others consider rectocele a herniation of the anterior rectal wall into the posterior vagina, the size of which determines the grade of rectocele (2,3,9,13,15,17,19,20,23,27,29) .…”

“…Anatomical and functional changes of the pelvic floor (anterior compartment) have also been described (12,16,24,25) . However, the relation between vaginal delivery, age (post-menopause) and posterior pelvic floor dysfunctions involving obstructed defecation syndrome (ODS) is still a matter of controversy (8,14,17,19,27) . Pelvic floor dysfunctions are best evaluated with dynamic techniques such as magnetic resonance (9,15) and ultrasonography using endorectal (2,18,19) or transperineal (3,7) probes to view the anal canal and pelvis anatomy.…”