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Clinical Features and Associations of Descending Perineum Syndrome in 300 Adults with Constipation in Gastroenterology Referral Practice

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Abstract

Background

Outlet obstruction constipation accounts for about 30% of chronic constipation (CC) cases in a referral practice.

Aims

To assess the proportion of patients with CC diagnosed with descending perineum syndrome (DPS) by a single gastroenterologist and to compare clinical, radiological, and associated features in DPS compared to patients with constipation.

Methods

We conducted a review of records of 300 consecutive patients evaluated for constipation by a single gastroenterologist from 2007 to 2019, including medical, surgical, and obstetrics history, digital rectal examination, anorectal manometry, defecation proctography (available in 15/23 with DPS), treatment, and follow-up. DPS was defined as > 3 cm descent of anorectal junction on imaging or estimated perineal descent on rectal examination. Logistic regression with univariate and multivariate analysis compared factors associated with DPS to non-DPS patients.

Results

Twenty-three out of 300 (7.7%, all female) patients had DPS; these patients were older, had more births [including more vaginal deliveries (84.2% vs. 31.2% in non-DPS, p < 0.001)], more instrumental or traumatic vaginal deliveries, more hysterectomies, more rectoceles on proctography (86.7% vs. 28.6% non-DPS, p = 0.014), lower squeeze anal sphincter pressures (p < 0.001), and lower rectal sensation (p = 0.075) than non-DPS. On univariate logistic regression, history of vaginal delivery, hysterectomy, and Ehlers-Danlos syndrome increased the odds of developing DPS. Vaginal delivery was confirmed as a risk factor on multivariate analysis.

Conclusions

DPS accounts for almost 10% of tertiary referral patients presenting with constipation. DPS is associated with age, female gender, and number of vaginal (especially traumatic) deliveries.

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Acknowledgments

The authors thank Mrs. Cindy Stanislav for excellent secretarial assistance.

Funding

Michael Camilleri is supported by Grant R01-DK115950 from National Institutes of Health.

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Authors and Affiliations

  1. Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. S.W., Charlton Building, Rm. 8-110, Rochester, MN, 55905, USA

    Xiao Jing Wang, Victor Chedid, Priya Vijayvargiya & Michael Camilleri

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  1. Xiao Jing Wang
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  2. Victor Chedid
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  3. Priya Vijayvargiya
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  4. Michael Camilleri
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Contributions

Xiao Jing Wang performed medical records review and has the authorship of manuscript; Victor Chedid and Priya Vijayvargiya performed medical records review; and Michael Camilleri was the principal investigator, gastroenterologist to all patients evaluated, and senior author.

Corresponding author

Correspondence to Michael Camilleri.

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Conflict of interest

Michael Camilleri receives research support unrelated to this manuscript from Allergan and Takeda. The other authors have no conflicts of interest.

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Wang, X.J., Chedid, V., Vijayvargiya, P. et al. Clinical Features and Associations of Descending Perineum Syndrome in 300 Adults with Constipation in Gastroenterology Referral Practice. Dig Dis Sci 65, 3688–3695 (2020). https://doi.org/10.1007/s10620-020-06394-0

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  • DOI: https://doi.org/10.1007/s10620-020-06394-0

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