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Defecography in patients with anorectal disorders

Which findings are clinically relevant?

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

Abstract

To evaluate the results and clinical impact of defecography in patients with anorectal disorders, 100 results of defecographic examinations from 92 patients were reviewed. The defecographic results were screened for the anorectal angle, defined both at rest and during straining, perineal descent, and abnormalities of the rectal configuration during straining. Anal manometry, saline infusion test, rectal capacity measurement, and anal electromyography (EMG) were also performed. There was a significant difference (P<0.001) both at rest (22°) and during straining (12°) between the two anorectal angle measurements. Incontinent patients had a larger anorectal angle, both at rest and during straining, than continent patients (P<0.04), but with a large overlap. The anorectal angle was not influenced by gender or age. An abnormal rectal configuration was found in 62 defecographic examinations. From the 8 patients with rectopexy performed for a large rectocele or intussusception, incontinent patients with an intussusception had the best results. In four patients, anal EMG showed an increased activity of the external sphincter during straining. Two of these four patients had abnormal defecograhic results. No correlations were found between anorectal angle and the other function tests. In conclusion, the anorectal angle lacks clinical relevance. In patients with defecation problems, defecography may be indicated whenever other investigations (physical examination, anal manometry, anal EMG) have excluded local pathology or a spastic pelvic floor syndrome. In these situations, defecography could detect an intussusception, which could easily be treated with rectopexy.

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References

  1. Mahieu P, Pringet J, Bodart P. Defecography: I. Description of a new procedure and results in normal patients. Gastrointest Radiol 1984;9:247–51.

    CAS  PubMed  Google Scholar 

  2. Bartram CI, Turnbull GK, Lennard-Jones JE. Evacuation proctography: an investigation of rectal expulsion in 20 subjects without defecatory disturbances. Gastrointest Radiol 1988;13:72–80.

    CAS  PubMed  Google Scholar 

  3. Ekberg O, Nylander G, Fork FT. Defecography. Radiology 1985;155:45–8.

    CAS  PubMed  Google Scholar 

  4. Bartolo DC, Roe AM, Virjee J, Mortensen NJ. Evacuation proctography in obstructed defecation and rectal intussusception. Br J Surg 1985;72:S111–6.

    PubMed  Google Scholar 

  5. Read NW, Abouzekry L. Why do patients with faecal impaction have faecal incontinence? Gut 1986;27:283–7.

    CAS  PubMed  Google Scholar 

  6. Roe AM, Bartolo DC, Mortensen NY. Diagnosis and surgical management of intractable constipation. Br J Surg 1986;73:854–61.

    CAS  PubMed  Google Scholar 

  7. Skomorovski E, Hegedus V. Sex differences in anorectal angle and perineal descent. Gastrointest Radiol 1987;12:353–5.

    Google Scholar 

  8. Read NW, Harford WF, Schmulen AC, Read MG, Santa Ana C, Fordtran JS. A clinical study of patients with fecal incontinence and diarrhea. Gastroenterology 1979;76:747–56.

    CAS  PubMed  Google Scholar 

  9. McHugh SM, Diamond NE. Effect of age, gender and parity on anal canal pressures. Dig Dis Sci 1987;37:726–36.

    Google Scholar 

  10. Loening-Baucke V, Anuras S. Effects of age and sex on anorectal manometry. Am J Gastroenterology 1985;80:50–3.

    CAS  Google Scholar 

  11. Buchman P, Mogg GA, Alexander-Williams J, Allan RN, Keighley MR. Relationship of proctitis and rectal capacity in Crohn's disease. Gut 1980;21:137–40.

    Google Scholar 

  12. Womack NR, Morrison JF, Williams NS. Prospective study of the effects of postanal repair in neurogenic faecal incontinence. Br J Surg 1988;75:48–52.

    CAS  PubMed  Google Scholar 

  13. Preston DM, Lennard-Jones JE, Thomas BM. The balloon proctogram. Br J Surg 1984;71:29–32.

    CAS  PubMed  Google Scholar 

  14. Felt-Bersma RJF, Janssen JJ, Klinkenberg-Knol EC, Hoitsma HW, Meuwissen SG. Soiling: causes, anorectal function investigations and results of treatment. Int J Color Dis 1989;4:37–40.

    CAS  Google Scholar 

  15. Bartolo DC, Jarrat JA, Read MG, Donnelly TC, Read NW. The role of partial denervation of the puborectalis in idiopathic faecal incontinence. Br J Surg 1983;70:664–7.

    CAS  PubMed  Google Scholar 

  16. Kuypers HC, Strijk SP. Diagnosis of disturbances of continence and defecation. Dis Colon Rectum 1984;27:658–62.

    Google Scholar 

  17. Read NW, Bartolo DC, Read MG. Differences in anal function in patients with incontinence to solids and in patients with incontinence to liquids. Br J Surg 1984;71:39–42.

    CAS  PubMed  Google Scholar 

  18. Skomorovski E, Henrichsen S, Christiansen J, Hegedus V. Videodefecography combined with measurement of the anorectal angle and of perineal descent. Acta Radiol 1987;28:559–62.

    Article  Google Scholar 

  19. Bartolo DC, Read NW, Jarratt JA, Read MG, Donnelly TC, Johnson AG. Differences in anal sphincter function and clinical presentation in patients with pelvic floor descent. Gastroenterology 1983;85:68–75.

    CAS  PubMed  Google Scholar 

  20. Bannister JJ, Timms JM, Barfield LJ, Donnelly TC, Read NW. Physiological studies in young women with chronic constipation. Int J Color Dis 1986;1:175–82.

    CAS  Google Scholar 

  21. Bartolo DC, Roe AM, Virjee J, Mortenson NJ, Locke-Edmonds JC. An analysis of rectal morphology in obstructed defecation. Int J Color Dis 1988;3:17–22.

    CAS  Google Scholar 

  22. Mahieu P, Pringet J, Bodart P. Defecography: II. Contribution to the diagnosis of defecation disorders. Gastrointest Radiol 1984;9:253–61.

    CAS  PubMed  Google Scholar 

  23. Miller R, Bartolo DC, Locke-Edmunds JC, Mortensen NJ. Prospective study of conservative and operative treatment for faecal incontinence. Br J Surg 1988;75:101–5.

    CAS  PubMed  Google Scholar 

  24. Felt-Bersma RJ, Klinkenberg-Knol EC, Meuwissen SG. Investigation of anorectal function. Br J Surg 1988;75:53–5.

    CAS  PubMed  Google Scholar 

  25. Bannister JJ, Abouzekry L, Read NW. Effect of aging on anorectal function. Gut 1987;28:353–7.

    CAS  PubMed  Google Scholar 

  26. Touchais JY, Ducrotte P, Weber J, et al. Relationship between results of radiological pelvic floor study and anorectal manometry in patients consulting for constipation. Int J Color Dis 1988;3:53–8.

    CAS  Google Scholar 

  27. Keighley MR, Shouler P. Clinical and manometric features of the rectal ulcer syndrome. Dis Colon Rect 1984;27:507–12.

    CAS  Google Scholar 

  28. Shorvon PJ, McHugh F, Somers S, Stevenson GW. Defecographic findings in young healthy volunteers. Gut 1987;28:A1361.

    Google Scholar 

  29. Kuijpers HC, Schreve RH, ten Cate Hoedemakers H. Diagnosis of functional disorders of defecation causing the solitary rectal ulcer syndrome. Dis Colon Rectum 1986;29:126–9.

    CAS  PubMed  Google Scholar 

  30. Womack NR, Williams NS, Holmfield JH, Morrison JF. Pressure and prolapse-the cause of solitary rectal ulceration. Gut 1987;28:1228–33.

    CAS  PubMed  Google Scholar 

  31. Kuijpers HC, Bleijenberg MD. The spastic pelvic floor syndrome: a cause of constipation. Dis Col Rectum 1985;28:669–72.

    CAS  Google Scholar 

  32. Womack NR, Williams NS, Holmfield JH, Morrison JF, Simpkins KC. New methods for the dynamic assessment of anorectal function in constipation. Br J Surg 1985;72:994–8.

    CAS  PubMed  Google Scholar 

  33. Turnbull GK, Lennard-Jones JE, Bartram CI. Failure of rectal expulsion as a cause of constipation: why fibre and laxatives sometimes fail. Lancet 1986;1:767–9.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Departments of Gastroenterology and Radiology, Free University Hospital, Amsterdam, The Netherlands

    R. J. F. Felt-Bersma M.D., W. J. Luth M.D., J. J. W. M. Janssen M.B. & S. G. M. Meuwissen M.D., Ph.D.

Authors
  1. R. J. F. Felt-Bersma M.D.
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  2. W. J. Luth M.D.
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  3. J. J. W. M. Janssen M.B.
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  4. S. G. M. Meuwissen M.D., Ph.D.
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Additional information

Read in part at the meeting of the Dutch Society of Gastroenterology, Noordwijkerhout (The Netherlands), March 25 to 26, 1988.

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Felt-Bersma, R.J.F., Luth, W.J., Janssen, J.J.W.M. et al. Defecography in patients with anorectal disorders. Dis Colon Rectum 33, 277–284 (1990). https://doi.org/10.1007/BF02055468

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  • DOI: https://doi.org/10.1007/BF02055468

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