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Balloon expulsion test facilitates diagnosis of pelvic floor outlet obstruction due to nonrelaxing puborectalis muscle

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Diseases of the Colon & Rectum

Abstract

We compared balloon expulsion, defecography, colonic transit times, anal manometry, and electromyography in 21 patients with severe constipation. Defecography demonstrated nonrelaxation of the sphincter during straining in all patients. Only 12 patients were unable to expel a balloon. Colonic transit was normal (five) or showed rectosigmoid delay (seven). All 12 patients were offered biofeedback. The nine patients able to expel a balloon had normal colonic transit (six) or colonic inertia (two). Rectosigmoid delay was due to severe intussusception in one patient. Anal manometry and pudendal nerve latencies revealed no difference between those who could and those who could not expel a balloon. Balloon expulsion seems to be a more reliable way to diagnose pelvic floor outlet obstruction due to nonrelaxation of the puborectalis muscle. Nonrelaxation of the sphincter on defecography should be correlated with balloon expulsion and colonic transit studies.

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Authors and Affiliations

  1. Jewish Hospital of St. Louis, Washington University School of Medicine, St. Louis, Missouri

    James W. Fleshman M.D., Zeev Dreznik M.D., Edward Cohen M.D., Robert D. Fry M.D. & Ira J. Kodner M.D.

Authors
  1. James W. Fleshman M.D.
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  2. Zeev Dreznik M.D.
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  3. Edward Cohen M.D.
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  4. Robert D. Fry M.D.
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  5. Ira J. Kodner M.D.
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Additional information

Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, April 29 to May 4, 1990.

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Fleshman, J.W., Dreznik, Z., Cohen, E. et al. Balloon expulsion test facilitates diagnosis of pelvic floor outlet obstruction due to nonrelaxing puborectalis muscle. Dis Colon Rectum 35, 1019–1025 (1992). https://doi.org/10.1007/BF02252990

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  • DOI: https://doi.org/10.1007/BF02252990

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