Statistical shape modeling of the pelvic floor to evaluate women with obstructed defecation symptoms

Routzong, Megan R.; Rostaminia, Ghazaleh; Bowen, Shaniel T.; Goldberg, Roger P.; Abramowitch, Steven D.

doi:10.1080/10255842.2020.1813281

Cited by 5 publications

(1 citation statement)

References 34 publications

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“…The fact that a patient-reported measure of ODS severity (frequency of incomplete emptying) is linearly correlated with specific dynamic ultrasound measures of rectal hypermobility and folding denotes the significance of this positive, linear relationship and the usefulness of dynamic ultrasound for evaluation of ODS. In addition, these results are consistent with prior studies that have confirmed associations between OD and pelvic floor relaxation 14 and have shown specific changes in pelvic architecture among ODS subjects (including increased levator plate descent, a widened anorectal angle, and a larger rectal area) at rest 12,13 and during defecation 19 and Valsalva. 20,21 These findings may have significant clinical implications for the evaluation and management of ODS in women.…”

Section: Discussionsupporting

confidence: 91%

Obstructed Defecation Symptom Severity and Degree of Rectal Hypermobility and Folding Detected by Dynamic Ultrasound

Routzong

Abramowitch

Chang

et al. 2021

Ultrasound Quarterly

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We used dynamic pelvic floor ultrasound to investigate the relationship between obstructed defecation symptom (ODS) severity and the degree of rectal hypermobility/folding. In this retrospective study, women who presented with ODS from October 2017 to January 2019 and underwent an interview, pelvic examination, and pelvic floor ultrasound were recruited. Patients were diagnosed with abdominal constipation, dyssynergia, or pelvic constipation. Pelvic constipation patients were categorized based on their reported frequency of incomplete emptying of stool (<50% or ≥50% of bowel movements) representing mild and severe ODS, respectively. Using dynamic ultrasound, rectal hypermobility was quantified via rectovaginal septum length at rest and Valsalva and its compression ratio, where shorter lengths and larger compression ratios are indicative of increased rectal hypermobility. One hundred twenty-one patients (41 with abdominal constipation, 7 with dyssynergia, and 73 with pelvic constipation) were included. Compression ratios were higher in women with severe versus mild ODS (17.36 ± 16.89 vs 36.38 ± 25.82, P = 0.0039). The risk of having severe symptoms was 4 times greater (odds ratio = 4.2, 95% confidence interval = 1.4 to 12.6, P = 0.01) among those with a high compression ratio (≥20%) after controlling for age, body mass index, and levator plate descent angle. Incomplete emptying was weakly, positively, linearly correlated with rectal hypermobility/folding (r = −0.2724, −0.3767 to 0.3922, and P = 0.0197, 0.0010, 0.0006, respectively). Women with more severe ODS experienced more rectal hypermobility/folding as measured via dynamic ultrasound-a cheaper, effective alternative to magnetic resonance defecography for evaluation of obstructed defecation.

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