Rectocele is associated with paradoxical anal sphincter reaction

Abstract

Rectocele is a frequent finding in constipated patients. However, constipation is not always relieved by rectocele repair, which may be due to other overlooked reasons for constipation. The study was designed to investigate patients with rectocele, in order to elucidate concomitant colorectal disorders and their association with rectocele. One hundred and twelve female patients suffering from severe constipation and rectal emptying difficulties were investigated using defecography, electrophysiology, anorectal manometry and colon transit time. Fifty-six patients with rectocele demonstrated by defecography were compared with 56 patients without rectocele, but with other abnormal findings at defecography. The frequency of paradoxical anal sphincter reaction (PSR) was higher in patients with rectocele (60%) than in patients without rectocele (24%). The present study supports an association between rectocele and PSR. We suggest that constipated patients with a rectocele should be investigated thoroughly before rectocele repair is considered. Further studies on the effect of biofeedback training in patients with rectocele and PSR are indicated.

Transanal rectocele repair using EndoGIA: short–term results of a prospective study

“…Mean anal resting pressure was 77 mmHg (SD=7 mmHg) and mean squeeze pressure was 89 mmHg (SD=8 mmHg). No alteration of RAIR was reported; no sign of anismus was founded at balloon expulsion test [13][14][15][16][17][18]. Defecography showed presence and depth of rectocele barium trapping on postevacuation radiography in all cases; mean size of rectocele in these patients at defecography measurements (base x depth) was 4.8 cm x 4.3 cm (range: base, 3.5-6.5 cm; depth, 3-6 cm) ( Table 1).…”

“…Therefore, in order to elucidate concomitant colorectal disorders and their association, it is necessary to preoperatively investigate patients with symptomatic rectocele by means of defecography and manometry [13][14][15][16][17][18][19][20][21][22]. The main value of preoperative defecography is the objective demonstration of rectocele presence, size and involvement by means of barium trapping presence and depth on postevacuation radiography [32].…”

“…Mere descensus is not sufficient to induce obstruction symptoms, although it increases impaired defecation and pelvic discomfort and is directly accountable for the feeling of pelvic heaviness [28]. An important functional alteration involved in evacuatory difficulty is anismus; paradoxically reaction of puborectalis muscle is often associated with rectocele [17,18,[29][30][31].…”

Symptomatische Rektozele mit Outlet-Obstruction

“…Nadel-EMG des Beckenbodens), zur Verfügung. Mit diesem Verfahren lassen sich präoperativ Koordinationsstörungen des Beckenbodens im Sinne eines Anismus ausschließen [16,18,20]. In unserem Krankengut stellten wir eine signifikannte Erniedrigung des präoperativ bestimmten Sphinkterruhedrucks fest.…”

Symptomatische Rektozele mit Outlet-Obstruction II

“…B. Nadel-EMG des Beckenbodens). Mittels dieses Verfahrens lassen sich präoperativ Koordinationsstörungen des Beckenbodens im Sinne eines Anismus ausschließen[12,13,15].P. Prohm · T. Kuruc · N. WolfSymptomatischeRektozele mit OutletObstruction II.…”