Techniques in Coloproctology

, Volume 5, Issue 3, pp 157–161

Associations of defecography and physiologic findings in male patients with rectocele

  • H. H. Chen
  • A. Iroatulam
  • O. Alabaz
  • E. G. Weiss
  • J. J. Nogueras
  • S. D. Wexner
ORIGINAL ARTICLE

DOI: 10.1007/s101510100018

Cite this article as:
Chen, H., Iroatulam, A., Alabaz, O. et al. Tech Coloproctol (2001) 5: 157. doi:10.1007/s101510100018

Abstract

This study evaluated the incidence and physiological findings in male patients with rectoceles. All defecographic studies were evaluated by a single colorectal surgeon. After diagnosis of rectocele in male patients, the patient's history, symptoms, and physiologic tests (anal manometry, pudendal nerve terminal motor latency [PNTML], assessment and electromyography [EMG]) were studied. A prominent rectocele was defined as one that did not empty during defecography and was associated with outlet obstructive syndrome. Forty (17%) rectoceles were diagnosed in 234 male patients with evacuatory disorders who underwent defecography. Rectoceles were anterior in 19 (48%) and posterior in 21 (52%) patients. The main complaint was constipation with difficult defecation in 33 (83%), followed by rectal pain in 5 (13%), rectal prolapse in 1 (3%), and incontinence in 1 (3%). Previous prostatic surgery had been performed in 16 (40%) patients. The mean age and duration of symptoms were 72.4 years (range, 30–88) and 10.3 years (range, 0.5–70), respectively. Excessive straining during evacuation was noted in 73%, unilateral or bilateral pudendal neuropathy in 24.5%, paradoxical puborectalis contraction in 49% and abnormal EMG in 11% of patients. Higher resting pressures with a mean 3.9 cm high pressure zone were noted in 29% of patients. The accompanying findings in defecography were, non-relaxing or partially relaxing puborectalis muscle (66%), perineal descent (65%), intussusception (23%), and sigmoidocele (15%). None of the patients underwent surgery for rectocele alone. In conclusion, rectocele is uncommon in males; it rarely appears as an isolated dysfunction as it is often associated with functional disorders of the pelvic floor. There is a frequent association between rectocele and prostatectomy. Clinical significance and therapeutic strategy remain unknown.

Key words Rectocele Males Defecography Evacuatory disorders Constipation 

Copyright information

© Springer-Verlag Italia 2001

Authors and Affiliations

  • H. H. Chen
    • 1
  • A. Iroatulam
    • 1
  • O. Alabaz
    • 1
  • E. G. Weiss
    • 1
  • J. J. Nogueras
    • 1
  • S. D. Wexner
    • 1
  1. 1.Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, Florida 33331, USAUS

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