International Journal of Colorectal Disease

, Volume 24, Issue 10, pp 1227–1232 | Cite as

Types of pelvic floor dysfunctions in nulliparous, vaginal delivery, and cesarean section female patients with obstructed defecation syndrome identified by echodefecography

  • Sthela M. Murad-RegadasEmail author
  • Francisco Sérgio P. Regadas
  • Lusmar V. Rodrigues
  • Leticia Oliveira
  • Rosilma G. L. Barreto
  • Marcellus H. L. P. de Souza
  • Flavio Roberto S. Silva
Original Article



This study aims to show pelvic floor dysfunctions in women with obstructed defecation syndrome (ODS), comparing nulliparous to those with vaginal delivery or cesarean section using the echodefecography (ECD).

Materials and methods

Three hundred seventy female patients with ODS were reviewed retrospectively and were divided in Group I—105 nulliparous, Group II—165 had at least one vaginal delivery, and Group III—comprised of 100 patients delivered only by cesarean section. All patients had been submitted to ECD to identify pelvic floor dysfunctions.


No statistical significance was found between the groups with regard to anorectocele grade. Intussusception was identified in 40% from G I, 55.0% from G II, and 30.0% from G III, with statistical significance between Groups I and II. Intussusception was associated with significant anorectocele in 24.8%, 36.3%, and 18% patients from G I, II, and III, respectively. Anismus was identified in 39.0% from G I, 28.5% from G II, and 60% from G III, with statistical significance between Groups I and III. Anismus was associated with significant anorectocele in 22.8%, 15.7%, and 24% patients from G I, II, and III, respectively. Sigmoidocele/enterocele was identified in 7.6% from G I, 10.9% G II, and was associated with significant rectocele in 3.8% and 7.3% patients from G I and II, respectively.


The distribution of pelvic floor dysfunctions showed no specific pattern across the groups, suggesting the absence of a correlation between these dysfunctions and vaginal delivery.


Dynamic anal ultrasound Pelvic floor Defecatory dysfunction Rectocele Intussusception 


  1. 1.
    Porter WE, Steele A, Walsh P, Kohli N, Karram MM (1999) The anatomic and functional outcomes of defect-specific rectocele repairs. Am J Obstet gynecol 181:1353–1359PubMedCrossRefGoogle Scholar
  2. 2.
    Flet-Bersma RJF, Ma C (2001) Rectal prolapse, rectal intussusception, rectocele and solitary rectal ulcer syndrome. Gastroenterol Clin North Am 30:199–222CrossRefGoogle Scholar
  3. 3.
    Finco C, Luongo B, Sanvastano S, Polato F (2007) Selection criteria for surgery in patients with obstructed defecation, rectocele and anorectal prolapse. Chir Ital 59:513–520PubMedGoogle Scholar
  4. 4.
    Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernam A (2002) Pelvic organ prolapse in the women`s health initiative: gravity and gravidity. Am J Obstet Gynecol 186:1160–1166PubMedCrossRefGoogle Scholar
  5. 5.
    Dietz HP, Clarke B (2005) Prevalence of rectocele in young nulliparous women. Aust N Z J Obstet Gynaecol 45:391–394PubMedCrossRefGoogle Scholar
  6. 6.
    Renzi A, Izzo D, Di Sarno G et al (2006) Cinedefecographic findings in patients with obstructed defection syndrome. A study in 420 cases. Minerva Chir 61:493–499PubMedGoogle Scholar
  7. 7.
    Soares F A., Regadas FSP, Murad Regadas SM et al (2008) Role of age, bowel function and parity on anorectocele pathogenesis according to cinedefecography and anal manometry evaluation. Colorectal Disease (CDI-00299-2007 – submitted for publication)Google Scholar
  8. 8.
    Regadas FSP, Murad-Regadas SM, Wexner SD et al (2006) Anorectal three-dimensional endosonography and anal manometry in assessing anterior rectocele in women. A new pathogenesis concept and the basic surgical principle. Colorectal Dis 9:80–85CrossRefGoogle Scholar
  9. 9.
    Regadas FSP, Murad-Regadas SM, Lima DMR et al (2007) Anal canal anatomy showed by three-dimensional anorectal ultrasonography. Surg Endoscopy 21:2207–2211CrossRefGoogle Scholar
  10. 10.
    Agachan F, Chen T, Pfeiffer J, Reissman P, Wexner SD (1996) A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum 39:681–685PubMedCrossRefGoogle Scholar
  11. 11.
    Murad-Regadas SM, Regadas FSP, Rodrigues LV, Silva FR, Soares FA, Escalante RD (2008) A novel 3D dynamic anorectal ultrasonography technique (echodefecography) to assess obstructed defecation comparing with defecography. Surg Endosc 22:974PubMedCrossRefGoogle Scholar
  12. 12.
    Lienemann A, Anthuber C, Baron A et al (1997) Dynamic MR colpocystorectography assessing pelvic-floor descent. Eur Radiol 7:1309–1317PubMedCrossRefGoogle Scholar
  13. 13.
    Gufler H, Laubengerger J, De Gregorio G et al (1999) Pelvic floor descent: dynamic MR imaging using a half-fourier RARE sequence. J Magn Reson Imaging 9:378–383PubMedCrossRefGoogle Scholar
  14. 14.
    Kelvin FM, Maglinte DDT, Hale DS et al (2000) Female pelvic organ prolapse: a comparison of triphasic dynamic MR imaging and triphasic fluoroscopic cystocolopoproctography. Am J Roentgenol 174:81–88Google Scholar
  15. 15.
    Fielding JR (2002) Practical MR imaging of female pelvic floor weakness. RSNA. 22(2):295–304Google Scholar
  16. 16.
    Bolog N, Weishaupt D (2005) Dynamic MR imaging of outlet obstruction. Rom J Gastroenterol. 14(3):293–302PubMedGoogle Scholar
  17. 17.
    Barthet M, Portier F, Heyries L (2000) Dynamic anal endosonography may challenge defecography for assessing dynamic anorectal disorders: results of a prospective pilot study. Endoscopy 32(4):300–305PubMedCrossRefGoogle Scholar
  18. 18.
    Dietz HP, Haylen BT, Broome J (2001) Ultrasound in the quantification of female pelvic organ prolapse. Ultrasound Obstet Gynecol 18:511–514PubMedCrossRefGoogle Scholar
  19. 19.
    Beer-Gabel M, Teshler M, Schechtman E, Zbar AP (2004) Dynamic transperineal ultrasound vs. defecography in patients with evacuatory difficulty: a pilot study. Int J Colorectal Dis 19:60–67PubMedCrossRefGoogle Scholar
  20. 20.
    Van Outryve SM, Van Outryve MJ, De Winter BY, Pelckmans PA (2002) Is anorectal endosonography valuable in dyschesia? Gut 51(5):695–700PubMedCrossRefGoogle Scholar
  21. 21.
    Piloni V, Spazzafumo L (2005) Evacuation sonography. Tech Coloproctol 9:119–126PubMedCrossRefGoogle Scholar
  22. 22.
    Brusciano L, Limongelli P, Pescatori M et al (2007) Ultrasonographic patterns in patients with obstructed defaecation. Int J Colorectal Dis 22:969–977PubMedCrossRefGoogle Scholar
  23. 23.
    Murad-Regadas SM, Regadas FSP, Rodrigues LV et al (2006) A novel procedure to assess anismus using three-dimensional dynamic ultrasonography. Colorectal Dis 9:159–165CrossRefGoogle Scholar
  24. 24.
    Okamoto N, Maeda K, Kato R, Senga S, Sato H, Hosono R (2006) Dynamic pelvic three-dimensional computed tomography for investigation of pelvic abnormalities in patients with rectocele and rectal prolapse. J Gastroenterol 41:802–806 Defecography in normal volunteers: results and implications. Gut 30:1937-1949PubMedCrossRefGoogle Scholar
  25. 25.
    Shorvan PJ, McHugh S, Diamant NE, Somers S, Stevenson GW (1989) Defecography in normal volunteers: results and implications. Gut 30:1737–1749CrossRefGoogle Scholar
  26. 26.
    Van Tets WF, Kuipjers JH (1995) Internal rectal intussusception: fact or fancy? Dis Colon Rectum 38:1080–1083PubMedCrossRefGoogle Scholar
  27. 27.
    Agachan F, PfeiferJ WSD (1996) Defecography and proctography. Results of 744 patients. Dis Colon Rectum 39:899–905PubMedCrossRefGoogle Scholar
  28. 28.
    Thompson JR, Chen AH, Pettit PMD, Bridges MD (2002) Incidence of occult rectal prolapse in patients with clinical rectoceles and defecatory dysfunction. Am J Obstet Gynecol 187:1494–1500PubMedCrossRefGoogle Scholar
  29. 29.
    Freimanis MG, Wald A, Caruana B, Bauman DH (1991) Evacuation proctography in normal volunteers. Invest Roadiol 26:581–585CrossRefGoogle Scholar
  30. 30.
    Johanson C, Nilsson BY, Holmström B, Dolk A, Mellgren A (1992) Association between rectocele and paradoxical sphincter response. Dis Colon Rectum 35:503–509CrossRefGoogle Scholar
  31. 31.
    Siproudhis L, Dautreme S, Ropert A et al (1993) Dyschezia and rectocele—a marriage of convenience? Dis Colon Rectum 36:1030–1036PubMedCrossRefGoogle Scholar
  32. 32.
    Kaufman HS, Buller JL, Thompsom JR, Pan HK, De Meester SL, Genadry RR et al (2001) Dynamic pelvic magnetic resonance imaging and cystocolpoproctography alter surgical management of pelvic floor disorders. Dis Colon Rectum 44:1575–1584PubMedCrossRefGoogle Scholar
  33. 33.
    Tjandra JJ, Ooi BS, Tang CL, Dwyer P, Carey M (1999) Transanal reapir of rectocele corrects obstructed defecation if it is not associated with anismus. Dis Colon rectum 42:1544–1550PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Sthela M. Murad-Regadas
    • 1
    • 3
    • 4
    Email author
  • Francisco Sérgio P. Regadas
    • 1
  • Lusmar V. Rodrigues
    • 1
  • Leticia Oliveira
    • 1
  • Rosilma G. L. Barreto
    • 1
  • Marcellus H. L. P. de Souza
    • 2
  • Flavio Roberto S. Silva
    • 1
  1. 1.Department of Surgery, School of Medicine of the Federal University of Ceara, Clinic HospitalFederal University of CearaFortalezaBrazil
  2. 2.Department of PharmacologySchool of Medicine of the Federal University of CearáFortalezaCearáBrazil
  3. 3.FortalezaCearaBrazil
  4. 4.School of Medicine of the Federal University of Ceara-Brazil, São Carlos HospitalFortalezaBrazil

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