International Journal of Colorectal Disease

, Volume 11, Issue 1, pp 1–9 | Cite as

Anterior rectocele and anorectal dysfunction

  • F. Pucciani
  • M. L. Rottoli
  • A. Bologna
  • M. Buri
  • F. Cianchi
  • P. Pagliai
  • C. Cortesini
Original Articles
Accepted:

Abstract

The two types of anterior rectocele, “distension” or Type 1 rectocele (T1R) and “displacement” or Type 2 rectocele (T2R), have different anatomical, clinical and therapeutic profiles. The aim of this study was to assess anorectal function in patients with distension or displacement rectocele. Three groups of female patients and one group of healthy female subjects were studied. Both the 10 Group 1 subjects, who had been diagnosed as having T1R, and the 10 Group 2 women who had been diagnosed as having T2R, were symptomatic for digital evacuation of the rectum. The 10 Group 3 females had complained of severe idiopathic constipation but had no defecatory disorders. The control group was made up of 10 healthy volunteers. All patients and controls underwent clinical evaluation, colonic transit time (CTT), computerized anorectal manometry (CAM), and defecography. Bowel movements and clinical evaluation were similar for both rectocele groups. In Group 1, CAM detected significantly higher anal pressure (P<0.05) and more impaired rectoanal inhibitory reflex (RAIR) (P<0.01) in comparison to the other patients and controls. In Group 2, the lowest anal pressure (P<0.001) was noted but RAIR was normal. Defecographic results, at rest and during evacuation, showed a significantly (P<0.001) higher anorectal angle and a more abnormal pelvic floor descent in Group 2 than in the other study groups and controls. Therefore, peculiar anorectal function was present in patients with anterior rectocele. A pelvic floor dyssynergia was noted in the distension rectocele group, while a fall of the pelvic floor was noted in the displacement rectocele group.

Keywords

Pelvic Floor Colonic Transit Time Anorectal Function Constipation Idiopathique Healthy Female Subject 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Les deux types de rectocèle antérieure, rectocèle par distension ou de type 1 (T1R) et rectocèle par déplacement ou type 2 (T2R) ont des profils anatomiques cliniques et thérapeutiques différents. Le but de cette étude était d'étudier la fonction anorectale chez des patientes avec des rectocèles par distension ou déplacement. Trois groupes de patientes de sexe féminin et un groupe de sujets témoins de sexe féminin ont été étudiés. Les 10 sujets du groupe 1 chez lesquels un diagnostic de rectocèle de type 1 avait été posé et les 10 patientes du groupe 2 porteuses d'une rectocèle de type T2R étaient symptomatiques et nécessitainet des manœuvres digitales pour évacuer le rectum. Les 10 patientes du groupe 3 se plaignaient d'une constipation idiopathique sévère mais n'avaient pas de troubles de la défécation. Le groupe contrôle était constitué de 10 femmes volontaires en bonne santé. L'ensemble des patients et des sujets contrôles ont été soumis à une évaluation clinique, à une détermination du temps de transit colique (CTT), une manométrie anorectale digitalisée (CAM) et une défécographic. Les exonérations et l'évaluation clinique étaient similaires dans les deux groupes de patientes porteuses de rectocèle. Dans le groupe 1, la manométrie a mis en évidence une pression anale significativement plus élevée (P<0.05) et une altération du réflexe rectoanal inhibiteur (RAIR) (P<0.01) en comparaison avec les autres patients et le groupe contrôle. Dans le groupe 2, la pression anale est nettement abaissée (P<0.001) mais le réflexe recto-anal inhibiteur était normal. La défécographie au repos et durant l'évacuation a montré un angle ano-rectal plus élevé (P<0.001) et une descente du plancher périnéal plus marquée dans le groupe 2 que dans les autres groupes étudiés et le groupe de contrôle. En conséquence, les patientes porteuses d'une rectocèle antérieure présentent une fonction ano-rectale particulière. Une dyssynergie du plancher pelvien est notée dans le groupe de rectocèle avec distension alors qu'une chute du plancher périnéal est mise en évidence dans le groupe de rectocèle avec déplacement.

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Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • F. Pucciani
    • 1
  • M. L. Rottoli
    • 2
  • A. Bologna
    • 1
  • M. Buri
    • 2
  • F. Cianchi
    • 1
  • P. Pagliai
    • 1
  • C. Cortesini
    • 1
  1. 1.Clinica Chirurgica 3Università degli Studi di FirenzeFirenzeItaly
  2. 2.Radiodiagnostica 1-Dipartimento Fisiopatologia ClinicaUniversità degli Studi di FirenzeFirenzeItaly

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