Skip to main content
SpringerLink
Log in

Association between rectocele and paradoxical sphincter response

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

Rectocele as well as paradoxical sphincter reaction may lead to rectal emptying difficulties and outlet obstruction. Forty-one patients with emptying disturbances and rectocele were investigated with defecography, anorectal manometry, colon transit time, and electromyography. Twenty-nine patients (71 percent) had concomitant paradoxical sphincter reaction, and 13 of these also had increased colon transit time. The functional results after surgical treatment of rectocele are not always satisfactory, probably because patients often have several causes for their emptying disturbances. It is emphasized that careful preoperative investigations are important before surgical treatment of rectocele in patients with emptying difficulties.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cummings JH, Jenkins DJ, Wiggins HS. Measurement of the mean transit time of dietary residue through the human gut. Gut 1976;17:210–6.

    PubMed  CAS  Google Scholar 

  2. Shouler P, Keighley MR. Changes in colorectal function in severe idiopathic chronic constipation. Gastroenterology 1986;90:414–20.

    PubMed  CAS  Google Scholar 

  3. Kamm MA, Hawley PR, Lennard-Jones JE. Outcome of colectomy for severe constipation. Gut 1988;29:969–73.

    PubMed  CAS  Google Scholar 

  4. Wasserman IF. Puborectalis syndrome. (Rectal stenosis due to anorectal spasm). Dis Colon Rectum 1964;7:87–98.

    PubMed  CAS  Google Scholar 

  5. Rutter KR, Riddell RH. The solitary ulcer of the rectum. Clin Gastroenterol 1975;4:505–30.

    PubMed  CAS  Google Scholar 

  6. Womack NR, Williams NS, Holmfield JH, Morrisson JF. Anorectal function in the solitary rectal ulcer syndrome. Dis Colon Rectum 1987;30:319–23.

    PubMed  CAS  Google Scholar 

  7. Kuijpers HC, Bleijenberg G. The spastic pelvic floor syndrome: a cause of constipation. Dis Colon Rectum 1985;28:669–72.

    PubMed  CAS  Google Scholar 

  8. Preston DM, Lennard-Jones JE. Anismus in chronic constipation. Dig Dis Sci 1985;30:413–8.

    Article  PubMed  CAS  Google Scholar 

  9. Mathers SE, Kempster PA, Swash M, Lees AJ. Constipation and paradoxical puborectalis contraction in anismus and Parkinson's disease: a dystonic phenomenon? J Neurol Neurosurg Psychiatry 1988;51:1503–7.

    Article  PubMed  CAS  Google Scholar 

  10. Kiff ES, Barnes PR, Swash M. Evidence of pudendal neuropathy in patients with perineal descent and chronic constipation. Gut 1984;25:1279–82.

    PubMed  CAS  Google Scholar 

  11. Snooks SJ, Nicholls RJ, Henry MM, Swash M. Electrophysiological and manometric assessment of the pelvic floor in the solitary rectal ulcer syndrome. Br J Surg 1985;72:131–3.

    PubMed  CAS  Google Scholar 

  12. Lubowski DZ, Swash M, Nicholls RJ, Henry MM. Increase in pudendal nerve terminal motor latency with defecation straining. Br J Surg 1988;75:1095–7.

    PubMed  CAS  Google Scholar 

  13. Redding MD. The relaxed perineum and anorectal disease. Dis Colon Rectum 1965;8:279–82.

    PubMed  CAS  Google Scholar 

  14. Pitchford CA. Rectocele: a cause of anorectal pathologic changes in women. Dis Colon Rectum 1967;10:464–6.

    PubMed  CAS  Google Scholar 

  15. Arnold MW, Stewart WR, Aguilar PS. Rectocele repair: four years' experience. Dis Colon Rectum 1990;33:684–7.

    PubMed  CAS  Google Scholar 

  16. Johansson C, Ihre T, Holmström B, Nordström E, Dolk A, Brodén G. A combined electromyographic and cineradiologic investigation in patients with defecation disorders. Dis Colon Rectum 1990;33:1009–13.

    PubMed  CAS  Google Scholar 

  17. Brodén B, Snellman B. Procidentia of the rectum studied with cineradiography: a contribution to the discussion of causative mechanism. Dis Colon Rectum 1968;11:330–47.

    PubMed  Google Scholar 

  18. Keighley MR, Shouler PJ. Abnormalities of colonic function in patients with rectal prolapse and faecal incontinence. Br J Surg 1984;71:892–5.

    PubMed  CAS  Google Scholar 

  19. Hinton JM, Lennard-Jones JE, Young AC. A new method for studying gut transit times using radioopaque markers. Gut 1969;10:842–7.

    PubMed  CAS  Google Scholar 

  20. Holmström B, Brodén G, Dolk A, Frenckner B. Increased anal resting pressure following the Ripstein operation: a contribution to continence? Dis Colon Rectum 1986;29:485–7.

    PubMed  Google Scholar 

  21. Brodén G, Dolk A, Holmström B. Recovery of the internal anal sphincter following rectopexy: a possible explanation for continence improvement. Int J Colorectal Dis 1988;3:23–8.

    Article  PubMed  Google Scholar 

  22. Frenckner B, Ihre T. Function of the anal sphincters in patients with intussusception of the rectum. Gut 1976;17:147–51.

    PubMed  CAS  Google Scholar 

  23. Neill ME, Swash M. Increased motor unit fibre density in the external anal sphincter muscle in anorectal incontinence: a single fibre EMG study. J Neurol Neurosurg Psychiatry 1980;43:343–7.

    PubMed  CAS  Google Scholar 

  24. Kiff ES, Swash M. Slowed conduction in the pudendal nerves in idiopathic (neurogenic) faecal incontinence. Br J Surg 1984;71:614–6.

    PubMed  CAS  Google Scholar 

  25. Jones PN, Lubowski DZ, Swash M, Henry MM. Is paradoxical contraction of puborectalis muscle of functional importance? Dis Colon Rectum 1987;30:667–70.

    PubMed  CAS  Google Scholar 

  26. Johansson C, Ihre T, Ahlbäck SO. Disturbances in the defecation mechanism with special reference to intussusception of the rectum (internal procidentia). Dis Colon Rectum 1985;28:920–4.

    PubMed  CAS  Google Scholar 

  27. Khubchandani IT, Sheets JA, Stasik JJ, Hakki AR. Endorectal repair of rectocele. Dis Colon Rectum 1983;26:792–6.

    PubMed  CAS  Google Scholar 

  28. Sehapayak S. Transrectal repair of rectocele: an extended armamentarium of colorectal surgeons. A report of 355 cases. Dis Colon Rectum 1985;28:422–33.

    PubMed  CAS  Google Scholar 

  29. Capps WF Jr. Rectoplasty and perineoplasty for the symptomatic rectocele: a report of fifty cases. Dis Colon Rectum 1975;18:234–44.

    Google Scholar 

  30. Zacharin RF. Pulsion enterocele: review of functional anatomy of the pelvic floor. Obstet Gynecol 1980;55:135–40.

    PubMed  CAS  Google Scholar 

  31. Kuhn RJP, Hollyock VE. Observations of the anatomy of the rectovaginal pouch and septum. Obstet Gynecol 1982;59:445–7.

    PubMed  CAS  Google Scholar 

  32. Block IR. Transrectal repair of rectocele using obliterative suture. Dis Colon Rectum 1986;29:707–11.

    PubMed  CAS  Google Scholar 

  33. Keighley MR, Shouler P. Outlet syndrome: is there a surgical option? J R Soc Med 1984;77:559–63.

    PubMed  CAS  Google Scholar 

  34. Johansson C, Nilsson BY, Holmström B, Dolk A. Is paradoxical sphincter reaction provoked by needle electrode electromyography? Dis Colon Rectum 1991;34:1109–12.

    Article  PubMed  CAS  Google Scholar 

  35. Snooks SJ, Barnes PR, Swash M, Henry MM. Damage to the innervation of the pelvic floor musculature in chronic constipation. Gastroenterology 1985;89:977–81.

    PubMed  CAS  Google Scholar 

  36. Dolk A, Brodén G, Holmström B, Johansson C, Nilsson BY. Slow transit of the colon associated with severe constipation after the Ripstein operation: a clinical and physiologic study. Dis Colon Rectum 1990;33:786–90.

    Article  PubMed  CAS  Google Scholar 

  37. Goligher JC, Hughes ES. Sensibility of the rectum and colon. Its role in the mechanism of anal continence. Lancet 1951;1:543–7.

    Article  PubMed  CAS  Google Scholar 

  38. Duthie HL. Defecation and the anal sphincters. Clin Gastroenterol 1982;11:621–31.

    PubMed  CAS  Google Scholar 

  39. Schiller LR. Fecal incontinence. Clin Gastroenterol 1986;15:687–704.

    PubMed  CAS  Google Scholar 

  40. Rogers J, Henry MM, Misiewicz JJ. Combined sensory and motor deficit in primary faecal incontinence. Gut 1988;29:5–9.

    PubMed  CAS  Google Scholar 

  41. Kamm MA, Lennard-Jones JE. Rectal mucosal electrosensory testing—evidence for a rectal sensory neuropathy in idiopathic constipation. Dis Colon Rectum 1990;33:419–23.

    PubMed  CAS  Google Scholar 

  42. Ihre T. Studies on anal function in continent and incontinent patients. Scand J Gastroenterol 1974;9:1–64.

    PubMed  Google Scholar 

  43. Barnes PR, Hawley PR, Preston DM, Lennard-Jones JE. Experience of posterior division of the puborectalis muscle in the management of severe constipation. Br J Surg 1985;72:475–7.

    PubMed  CAS  Google Scholar 

  44. Kamm MA, Hawley PR, Lennard-Jones JE. Lateral division of the puborectalis muscle in the management of severe constipation. Br J Surg 1988;75:661–3.

    PubMed  CAS  Google Scholar 

  45. Bleijenberg G, Kuijpers HC. Treatment of the spastic pelvic floor syndrome with biofeedback. Dis Colon Rectum 1987;30:108–11.

    PubMed  CAS  Google Scholar 

  46. Dolk A, Johansson C, Holmström B, Nilsson BY, Frosteil C. The effect of yoga on puborectalis paradox. Int J Colorectal Dis 1991;6:139–42.

    Article  PubMed  CAS  Google Scholar 

  47. Hallan RI, Melling J, Womack NR, Williams NS, Waldron DJ, Morrison JF. Treatment of anismus in intractable constipation with botulinum A toxin. Lancet 1988;2:714–6.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Karolinska Institutet at Danderyd Hospital, Sweden

    Claes Johansson M.D., Bo Holmström M.D., Anders Dolk M.D. & Anders Mellgren M.D.

  2. Department of Clinical Neurophysiology, Södersjukhuset, Stockholm, Sweden

    Bengt Yngve Nilsson M.D.

Authors
  1. Claes Johansson M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bengt Yngve Nilsson M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bo Holmström M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anders Dolk M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anders Mellgren M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Johansson, C., Nilsson, B.Y., Holmström, B. et al. Association between rectocele and paradoxical sphincter response. Dis Colon Rectum 35, 503–509 (1992). https://doi.org/10.1007/BF02049410

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02049410

Keywords

Search

Navigation