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Measurements of pelvic floor dyssynergia: which test result matters?
Dis Colon Rectum 2011; 54(1):60-5DC

Abstract

PURPOSE

Failure to expel a 60-mL balloon on manometry and abnormal relaxation of anal sphincter on electromyographic testing are frequently used to diagnose pelvic floor dyssynergia. However, the relationship between these 2 test results and their relationship to defecography is poorly characterized. We aimed to describe this relationship and create a predictive model for pelvic floor dyssynergia on defecography.

METHODS

From March 2008 to April 2010 consecutive patients with symptoms suggestive of functional constipation were evaluated at our Pelvic Floor Disorders Center 125 and the results of their workups were collected prospectively. Sixty-three patients with pelvic floor dyssynergia on defecography were compared with 60 patients without dyssynergia in terms of manometry pressures, electromyographic text results, and balloon expulsion testing results (χ, t tests).

RESULTS

Of 125 patients meeting Rome II symptom criteria for constipation, 123 patients underwent defecography and, of these, 63 (51.2%) had evidence of pelvic floor dyssynergia. Patients with and without dyssynergia had a slight difference in mean resting pressures (62.8 mmHg vs 49.5 mmHg, P = .02) and no discernable differences in rectal sensitivity and compliance: first sensation (56.5 vs 62.5, P = .34) and maximum tolerated volume (164.2 vs 191.2, P = .09). It appeared that abnormalities in electromyographic relaxation and balloon expulsion occurred in the same patients: 84.1% of patients with abnormal electromyographic results also did not expel the balloon. However, the presence of these abnormalities, in isolation or together, did not predict the presence of dyssynergia on defecography.

CONCLUSION

Normal electromyographic results or the ability to expel a 60-mL balloon does not exclude the presence of pelvic floor dyssynergia on defecography. It is unclear which of these 3 tests should be used to guide the recommendation for (and to then measure response to) biofeedback.

Authors+Show Affiliations

Division of Gastrointestinal Surgery, Pelvic Floor Disorders Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA. lbordeianou@partners.orgNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21160315

Citation

Bordeianou, Liliana, et al. "Measurements of Pelvic Floor Dyssynergia: Which Test Result Matters?" Diseases of the Colon and Rectum, vol. 54, no. 1, 2011, pp. 60-5.
Bordeianou L, Savitt L, Dursun A. Measurements of pelvic floor dyssynergia: which test result matters? Dis Colon Rectum. 2011;54(1):60-5.
Bordeianou, L., Savitt, L., & Dursun, A. (2011). Measurements of pelvic floor dyssynergia: which test result matters? Diseases of the Colon and Rectum, 54(1), pp. 60-5. doi:10.1007/DCR.0b013e3181fd2373.
Bordeianou L, Savitt L, Dursun A. Measurements of Pelvic Floor Dyssynergia: Which Test Result Matters. Dis Colon Rectum. 2011;54(1):60-5. PubMed PMID: 21160315.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Measurements of pelvic floor dyssynergia: which test result matters? AU - Bordeianou,Liliana, AU - Savitt,Lieba, AU - Dursun,Abdulmetin, PY - 2010/12/17/entrez PY - 2010/12/17/pubmed PY - 2011/2/2/medline SP - 60 EP - 5 JF - Diseases of the colon and rectum JO - Dis. Colon Rectum VL - 54 IS - 1 N2 - PURPOSE: Failure to expel a 60-mL balloon on manometry and abnormal relaxation of anal sphincter on electromyographic testing are frequently used to diagnose pelvic floor dyssynergia. However, the relationship between these 2 test results and their relationship to defecography is poorly characterized. We aimed to describe this relationship and create a predictive model for pelvic floor dyssynergia on defecography. METHODS: From March 2008 to April 2010 consecutive patients with symptoms suggestive of functional constipation were evaluated at our Pelvic Floor Disorders Center 125 and the results of their workups were collected prospectively. Sixty-three patients with pelvic floor dyssynergia on defecography were compared with 60 patients without dyssynergia in terms of manometry pressures, electromyographic text results, and balloon expulsion testing results (χ, t tests). RESULTS: Of 125 patients meeting Rome II symptom criteria for constipation, 123 patients underwent defecography and, of these, 63 (51.2%) had evidence of pelvic floor dyssynergia. Patients with and without dyssynergia had a slight difference in mean resting pressures (62.8 mmHg vs 49.5 mmHg, P = .02) and no discernable differences in rectal sensitivity and compliance: first sensation (56.5 vs 62.5, P = .34) and maximum tolerated volume (164.2 vs 191.2, P = .09). It appeared that abnormalities in electromyographic relaxation and balloon expulsion occurred in the same patients: 84.1% of patients with abnormal electromyographic results also did not expel the balloon. However, the presence of these abnormalities, in isolation or together, did not predict the presence of dyssynergia on defecography. CONCLUSION: Normal electromyographic results or the ability to expel a 60-mL balloon does not exclude the presence of pelvic floor dyssynergia on defecography. It is unclear which of these 3 tests should be used to guide the recommendation for (and to then measure response to) biofeedback. SN - 1530-0358 UR - https://www.unboundmedicine.com/medline/citation/21160315/Measurements_of_pelvic_floor_dyssynergia:_which_test_result_matters L2 - http://Insights.ovid.com/pubmed?pmid=21160315 DB - PRIME DP - Unbound Medicine ER -