Predictive Capability of Anorectal Physiologic Tests for Unfavorable Outcomes Following Biofeedback Therapy in Dyssynergic Defecation

The purpose of this study is to evaluate the predictive capability of anorectal physiologic tests for unfavorable outcomes prior to the initiation of biofeedback therapy in patients with dyssynergic defecation. We analyzed a total of 80 consecutive patients who received biofeedback therapy for chronic idiopathic functional constipation with dyssynergic defecation. After classifying the patients into two groups (responders and non-responders), univariate and multivariate analyses were performed to determine the predictors associated with the responsiveness to biofeedback therapy. Of the 80 patients, 63 (78.7%) responded to biofeedback therapy and 17 (21.3%) did not. On univariate analysis, the inability to evacuate an intrarectal balloon (P=0.028), higher rectal volume for first, urgent, and maximal sensation (P=0.023, P=0.008, P=0.007, respectively), and increased anorectal angle during squeeze (P=0.020) were associated with poor outcomes. On multivariate analysis, the inability to evacuate an intrarectal balloon (P=0.018) and increased anorectal angle during squeeze (P=0.029) were both found to be independently associated with a lack of response to biofeedback therapy. Our data show that the two anorectal physiologic test factors are associated with poor response to biofeedback therapy for patients with dyssynergic defecation. These findings may assist physicians in predicting the responsiveness to therapy for this patient population.

Defecographic Findings of Rectal Intussusception / 대한소화관운동학회지

OBJECTIVES: To analyze the findings of rectal intussusception and to find the other accompanied functional anorectal diseases. MATERIALS AND METHODS: We analyzed defecograms in 25 patients with rectal intussusception among 77 patients taken with obstructed defecatory symptom. Females were 16 (64%), males were 9 (36%), and the mean age was 55 years old. The changes of anorectal angle (ARA) and movement of anorectal junction were measured, and the morphologic changes of rectal wall during defecation were analyzed. RESULTS: ARAs measured by central axis method (CAM), the mean angles were 114.6, 102.2, and 119.8 degree, respectively in resting, squeezing, and straining period. By posterior wall methods (PWM), those were 86.7, 72.0, 93.3 degree. The differences of ARA between resting and straining period were 5.2, 6.6 degree, respectively by CAM and PWM. The mean descent of anorectal junction during defecation was 0.83 cm. The most frequent finding associated with rectal intussusception was rectocele (12 cases;48%). The other accompanied findings were 9 spastic pelvic floor syndrome (36%) and 4 fecal incontinence (16%). Total 18 patients out of 25 patients were accompanied with other functional anorectal diseases (72%). CONCLUSIONS: Recognition of rectal intussusception with accompanied diseases would be important for the proper treatment planning.

Defecographic Findings of Rectal Intussusception / 대한소화관운동학회지

OBJECTIVES: To analyze the findings of rectal intussusception and to find the other accompanied functional anorectal diseases. MATERIALS AND METHODS: We analyzed defecograms in 25 patients with rectal intussusception among 77 patients taken with obstructed defecatory symptom. Females were 16 (64%), males were 9 (36%), and the mean age was 55 years old. The changes of anorectal angle (ARA) and movement of anorectal junction were measured, and the morphologic changes of rectal wall during defecation were analyzed. RESULTS: ARAs measured by central axis method (CAM), the mean angles were 114.6, 102.2, and 119.8 degree, respectively in resting, squeezing, and straining period. By posterior wall methods (PWM), those were 86.7, 72.0, 93.3 degree. The differences of ARA between resting and straining period were 5.2, 6.6 degree, respectively by CAM and PWM. The mean descent of anorectal junction during defecation was 0.83 cm. The most frequent finding associated with rectal intussusception was rectocele (12 cases;48%). The other accompanied findings were 9 spastic pelvic floor syndrome (36%) and 4 fecal incontinence (16%). Total 18 patients out of 25 patients were accompanied with other functional anorectal diseases (72%). CONCLUSIONS: Recognition of rectal intussusception with accompanied diseases would be important for the proper treatment planning.

The comparison of the defecation physiology between postpartum and postoperative women by defecogram and pudendal nerve terminal motor latency / 대한산부인과학회잡지

OBJECTIVE: To understand the difference of defecation physiology between postpartum and postoperative women. METHODS: Between July 1998 to April 1999, we performed defecogram and pudendal nerve motor latency to 31 women, who were 8 postoperative women, 9 post cesarean-section state women, and 14 normal vaginal delivery-state women. RESULTS: According to the defecogram results, only squeezing angles of the anorectal angle were significantly increased(96.0 vs 72.3, 74.9 degree) in normal vaginal delivery-state women compared to post cesarean-section state and postoperative women, but rest and evacuation angles were not. And to pudendal nerve latency, there were no statistically significant difference. CONCLUSION: We concluded that the pudendal plexus was damaged during labor, therefore its ability to control puborectalis muscle was damaged. So, the anorectal angles of squeezing of postpartum women were significantly increased, compared to those of post cesarean section women or postoperative women.