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MR Defecography in Assessing Functional Defecation Disorder: Diagnostic Value of the Defecation Phase in Detection of Dyssynergic Defecation and Pelvic Floor Prolapse in Females.
Digestion. 2019; 100(2):109-116.D

Abstract

OBJECTIVE

Dyssynergic defecation (DD) and pelvic floor prolapse often coexist in female functional defecation disorder. A retrospective study was performed to evaluate the ability of dynamic MR sequences with the straining and defecation phase to detect paradoxical puborectalis contraction and occult multiple-compartments disorders.

METHODS

Fifty-three females clinically diagnosed with DD underwent magnetic resonance defecography. The dynamic sequences consist of rest, squeeze, straining, and defecation. The straining phase (pre rectal filling) and defecation phase (post rectal filling) were acquired to assess for pelvic floor relaxation and pelvic organ descent. MR images were analyzed by 2 radiologists with regard to paradoxical puborectalis contraction (changes in the anorectal angle [ARA]) and the presence of pelvic organ prolapse in straining phase and defecation phase independently. Statistical analysis was performed using Wilcoxon's matched-pairs signed-ranks test and Crosstabs test for matched pairs.

RESULTS

Among the 53 patients with DD, 24 individuals (45.3%) were diagnosed DD with multifocal disorders. Comparison between the straining and the defecation phase revealed that there was no significant difference in the change of the ARA (p > 0.05), while significant differences were found in cystocele, vaginal or cervical prolapse, rectocele and descending perineum syndrome between the straining and the defecation phase (p < 0.05). The defecation phase with impaired evacuation distinguished additional anterior/middle compartments findings in female DD patients.

CONCLUSION

The straining phase and the defecation phase have the same ability in assessing paradoxical puborectalis contraction of the DD. Compared with the straining phase, the defecation phase provides the maximum stress to the pelvic floor resulting in complete levator ani relaxation. In addition to diagnosing the abnormal anorectal function, the defecation phase with the discharge of the rectal filling demonstrates maximum anterior/middle pelvic organ descent in DD patients.

Authors+Show Affiliations

Department of Radiology, Beijing Chaoyang Hospital, Affiliated to Capital Medical University, Beijing, China.Department of Radiology, Beijing Chaoyang Hospital, Affiliated to Capital Medical University, Beijing, China, jiangt8166@hotmail.com.Department of Radiology, Beijing Chaoyang Hospital, Affiliated to Capital Medical University, Beijing, China.Department of Colon and Rectum Surgery, Beijing Chaoyang Hospital, Affiliated to Capital Medical University, Beijing, China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30695788

Citation

Li, Min, et al. "MR Defecography in Assessing Functional Defecation Disorder: Diagnostic Value of the Defecation Phase in Detection of Dyssynergic Defecation and Pelvic Floor Prolapse in Females." Digestion, vol. 100, no. 2, 2019, pp. 109-116.
Li M, Jiang T, Peng P, et al. MR Defecography in Assessing Functional Defecation Disorder: Diagnostic Value of the Defecation Phase in Detection of Dyssynergic Defecation and Pelvic Floor Prolapse in Females. Digestion. 2019;100(2):109-116.
Li, M., Jiang, T., Peng, P., & Yang, X. (2019). MR Defecography in Assessing Functional Defecation Disorder: Diagnostic Value of the Defecation Phase in Detection of Dyssynergic Defecation and Pelvic Floor Prolapse in Females. Digestion, 100(2), 109-116. https://doi.org/10.1159/000494249
Li M, et al. MR Defecography in Assessing Functional Defecation Disorder: Diagnostic Value of the Defecation Phase in Detection of Dyssynergic Defecation and Pelvic Floor Prolapse in Females. Digestion. 2019;100(2):109-116. PubMed PMID: 30695788.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - MR Defecography in Assessing Functional Defecation Disorder: Diagnostic Value of the Defecation Phase in Detection of Dyssynergic Defecation and Pelvic Floor Prolapse in Females. AU - Li,Min, AU - Jiang,Tao, AU - Peng,Peng, AU - Yang,Xinqing, Y1 - 2019/01/29/ PY - 2018/06/18/received PY - 2018/10/01/accepted PY - 2019/1/30/pubmed PY - 2020/1/23/medline PY - 2019/1/30/entrez KW - Defecography KW - Dyssynergic defecation KW - Magnetic resonance imaging KW - Obstructive defecation syndrome KW - Paradoxical puborectalis contraction KW - Pelvic floor disorders SP - 109 EP - 116 JF - Digestion JO - Digestion VL - 100 IS - 2 N2 - OBJECTIVE: Dyssynergic defecation (DD) and pelvic floor prolapse often coexist in female functional defecation disorder. A retrospective study was performed to evaluate the ability of dynamic MR sequences with the straining and defecation phase to detect paradoxical puborectalis contraction and occult multiple-compartments disorders. METHODS: Fifty-three females clinically diagnosed with DD underwent magnetic resonance defecography. The dynamic sequences consist of rest, squeeze, straining, and defecation. The straining phase (pre rectal filling) and defecation phase (post rectal filling) were acquired to assess for pelvic floor relaxation and pelvic organ descent. MR images were analyzed by 2 radiologists with regard to paradoxical puborectalis contraction (changes in the anorectal angle [ARA]) and the presence of pelvic organ prolapse in straining phase and defecation phase independently. Statistical analysis was performed using Wilcoxon's matched-pairs signed-ranks test and Crosstabs test for matched pairs. RESULTS: Among the 53 patients with DD, 24 individuals (45.3%) were diagnosed DD with multifocal disorders. Comparison between the straining and the defecation phase revealed that there was no significant difference in the change of the ARA (p > 0.05), while significant differences were found in cystocele, vaginal or cervical prolapse, rectocele and descending perineum syndrome between the straining and the defecation phase (p < 0.05). The defecation phase with impaired evacuation distinguished additional anterior/middle compartments findings in female DD patients. CONCLUSION: The straining phase and the defecation phase have the same ability in assessing paradoxical puborectalis contraction of the DD. Compared with the straining phase, the defecation phase provides the maximum stress to the pelvic floor resulting in complete levator ani relaxation. In addition to diagnosing the abnormal anorectal function, the defecation phase with the discharge of the rectal filling demonstrates maximum anterior/middle pelvic organ descent in DD patients. SN - 1421-9867 UR - https://www.unboundmedicine.com/medline/citation/30695788/MR_Defecography_in_Assessing_Functional_Defecation_Disorder:_Diagnostic_Value_of_the_Defecation_Phase_in_Detection_of_Dyssynergic_Defecation_and_Pelvic_Floor_Prolapse_in_Females_ L2 - https://www.karger.com?DOI=10.1159/000494249 DB - PRIME DP - Unbound Medicine ER -