The impact of anismus on the clinical outcome of rectocele repair

Dam, J. H. van; Schouten, W. R.; Ginai, Abida Z.; Huisman, Willem; Hop, Wim C. J.

doi:10.1007/s003840050053

Cited by 62 publications

(31 citation statements)

References 45 publications

(25 reference statements)

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“…In contrast, some studies have reported poor results after rectocele repair in patients with associated anismus (17) . In another series, no significant difference was observed (35) . Our patients were evaluated up to 6 months after clinical/biofeedback management and 3-6 months after surgery.…”

Section: Discussionmentioning

confidence: 83%

Management of patients with rectocele, multiple pelvic floor dysfunctions and obstructed defecation syndrome

Murad-Regadas

Regadas

Rodrigues

et al. 2012

Arq. Gastroenterol.

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-Context -Management of patients with obstructed defecation syndrome is still controversial. Objective -To analyze the efficacy of clinical, clinical treatment followed by biofeedback, and surgical treatment in patients with obstructed defecation, rectocele and multiple dysfunctions evaluated with echodefecography. Methods -The study included 103 females aged 26-84 years with obstructed defecation, grade-II/III rectocele and multiple dysfunctions on echodefecography. Patients were distributed into three treatment groups and constipation scores were assigned. Group I: 34 (33%) patients with significant improvement of symptoms through clinical management only. Group II: 14 (14%) with improvement through clinical treatment plus biofeedback. Group III: 55 (53%) referred to surgery due to treatment failure. Results -Group I: 20 (59%) patients had grade-II rectocele, 14 (41%) grade-III. Obstructed defecation syndrome was associated with intussusception (41%), mucosal prolapse (41%), anismus (29%), enterocele (9%) or 2 dysfunctions (23%). The average constipation score decreased significantly from 11 to 5. Group II: 11 (79%) grade-II rectocele, 3 (21%) grade-III, associa ted with intussusception (7%), mucosal prolapse (43%), anismus (71%) or 2 dysfunctions (29%). There was significant decrease in constipation score from 13 to 6. Group III: 8 (15%) grade-II rectocele, 47 (85%) grade-III, associated with intussusception (42%), mucosal prolapse (40%) or 2 dysfunctions (32%). The constipation score remained unchanged despite clinical treatment and biofeedback. Twenty-three underwent surgery had a significantly decrease in constipation score from 12 to 4. The remaining 32 (31%) patients which 22 refused surgery, 6 had low anal pressure and 4 had slow transit. Conclusions -Approximately 50% of patients with obstructed defecation, rectocele and multiple dysfunctions presented a satisfactory response to clinical treatment and/or biofeedback. Surgical repair was mainly required in patients with grade-III rectocele whose constipation scores remained high despite all efforts. HEADINGS -Rectocele. Constipation. Pelvic floor. Imaging, three-dimensional.None disclosure.

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Section: Discussionmentioning

confidence: 83%

Management of patients with rectocele, multiple pelvic floor dysfunctions and obstructed defecation syndrome

Murad-Regadas

Regadas

Rodrigues

et al. 2012

Arq. Gastroenterol.

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“…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).…”

Section: Methodsmentioning

confidence: 85%

“…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].…”

Section: Fig 5 Final Resultsmentioning

confidence: 99%

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

2005

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“…In this way one might postulate that the patient with a type 1 rectocele would have a long history of constipation and perhaps digitation. There might be no associated genital descensus, normal or relatively high anorectal pressures without a clinical history of incontinence and presumably an acceptable outcome of rectocele repair, however, performed depending upon one's views concerning the appropriateness of surgery for those cases associated with significant anismus [22,23]. This archetype would contrast with the patient with a type 2 rectocele who might present with clinical evidence of a rectocele in combination with some other form of genital prolapse or perhaps vault prolapse following hysterectomy [24,25,26].…”

Section: Resultsmentioning

confidence: 96%

Rectoanal inhibition and rectocele: physiology versus categorization

Beer-Gabel

Aslam

2001

Int J Colorectal Dis

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Some authors divide rectoceles into those with chronic evacuatory difficulty and normal genital position (type 1) and those with associated pelvic organ prolapse (type 2). This study assessed whether there are physiological differences between these two clinical rectocele types. Female patients were assessed by conventional anorectal manometry, vector manometry, parametric assessment of the rectoanal inhibitory reflex (RAIR), and defecography. Subjects included 33 volunteer controls without anorectal disease, 14 patients with type I rectocele, and 26 patients with type II rectocele. Significant differences were noted for resting pressure measurements (maximal resting anal pressure and vector volume) between rectocele types and between type I patients and controls. Significant differences were noted for squeeze parameters (maximal squeeze pressure and vector volume) only between rectocele types. There were minimal differences in parameters of the RAIR, with a reduced slope of inhibition in the proximal sphincter for both rectocele groups and a reduced maximal inhibitory pressure in the intermediate and distal sphincter of type 1 rectocele patients. There were no differences in transient excitation of the pressure wave during the RAIR reflex to account for pressure variations with no measured differences in rectocele depth (type 1, 2.87 +/- 0.7 cm; type 2, 2.84 +/- 1.4 cm) There are few physiological differences between the different clinical categories of rectocele patients based on the presence or absence of associated genital prolapse.

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The impact of anismus on the clinical outcome of rectocele repair

Cited by 62 publications

References 45 publications

Management of patients with rectocele, multiple pelvic floor dysfunctions and obstructed defecation syndrome

Management of patients with rectocele, multiple pelvic floor dysfunctions and obstructed defecation syndrome

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

Rectoanal inhibition and rectocele: physiology versus categorization

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