The Syndrome of the Descending Perineum

270

Our simple method of defecography has proved to be more sensitive than clinical evaluation in the detection and description of defecation disorders. Among the different types of disorders, described on the basis of 144 abnormal defecograms, the most common are rectal intussusception (RI), intraanal rectal intussusception (IRI), external manually (EMRP) or spontaneously (ESRP) reducible prolapses, rectocele, and accentuation of the impression of the puborectalis sling (AIPR). Study of the mean values of the anorectal angle (ARA) (normal mean value = 92 degrees at rest) reveals an increase (p less than 0.05) in the ARA in IRI and ESRP and a decrease (p less than 0.05 at rest, p less than 0.001 at strain) in AIPR. The most striking observation is a highly significant increase (p less than 0.001) in the ARA associated with incontinence.

Section: Discussionmentioning

confidence: 67%

“…In the descending perineum syndrome [3], the muscle tone of the pelvic floor is diminished and obstructive constipation and sometimes tenesmus are present. When a straining effort is made, the pelvic floor rapidly descends 3-4 cm below the pubococcygeal line.…”

Section: Defecation Disordersmentioning

confidence: 99%

Defecography: II. Contribution to the diagnosis of defecation disorders

Mahieu

Pringot

Bodart

1984

270

“…Kerremans [5] showed that this mechanism could not be applied to the anorectal system because the internal anal sphincter is located below the level at which the intraabdominal pressure can affect the rectal walls -below the pelvic muscle floor. In 1966, this theory was modified by Parks et al [7] who proposed a flap-valve theory. According to this theory, the puborectalis sling produces an angle of about 90 ~ between the anal canal and lower rectum and, as a result of this angulation, the lower anterior rectal mucosa comes to lie as a flap over the upper end of the anal canal, effectively occluding it.…”

Section: Discussionmentioning

confidence: 99%

Defecography: I. Description of a new procedure and results in normal patients

Mahieu

Pringot

Bodart

1984

370

124

To solve frequently encountered clinical problems in the anorectal area, we have developed a simplified dynamic method of defecography. A radiopaque substance, the consistency of normal stools, is introduced into the rectum and the patient is then seated on a specially designed seat composed of superposed air chambers which, for technical reasons, are filled with water. The movements induced by evacuation of the rectum are recorded using 100-mm ampliphotography. After recording findings in 56 normal patients, we are able to define 5 criteria for "normal": increase in anorectal angulation, obliteration of the impression of the puborectal muscle, wide opening of the anal canal, total evacuation of the rectal contents, and normal resistance of the pelvic floor. The mean value of the anorectal angle (ARA) was 91.96 degrees (+/- 1.52 SEM) at rest and 136.76 degrees (+/- 1.51 SEM) during straining. The increase of ARA during straining is 44.8 degrees.

“…The level of the pelvic floor is defined as the distance between the anorectal junction and a line determined by the bony landmarks [9,10]. Thus, determination of the anal and the rectal axis is crucial in the quantitative analysis of radiological images.…”

mentioning

confidence: 99%

Intraobserver variation in the radiological measurement of the anorectal angle

Penninckx

Debruyne

Lestár

et al. 1991

Seven experts drew the rectal axes of 18 representative proctographic images on two occasions, with a 1-year interval, in order to assess intraobserver variation in the determination of the anorectal angle (ARA). Intraobserver variation (6%) and interobserver variation (17%) were smallest when the central rectal axis was used to determine the ARA. A strong relation was found between inter- and intraobserver variation (r = 0.77). Intraobserver variation tended to be rather small for pictures made during straining, but a relation with the magnitude of the ARA was not found. Although none of the seven experts could reproduce the rectal axes with less than or equal to 10% variation in all 18 pictures, redrawing of the central rectal axis delivered less than or equal to 10% variation in 86% of determinations. It is concluded that intraobserver variation is influenced by the expertise of the investigator, the method of analysis, and the anorectal configuration to be analyzed. Radiologic assessment of the ARA may yield reliable data on the dynamics of the anorectum if performed by a single investigator on x-ray films that allow confident analysis.