Are rectoceles the cause or the result of obstructed defaecation syndrome? A prospective anorectal physiology study
Aim To determine the relationship between obstructed defaecation syndrome (ODS) and rectoceles. Method From December 2007 to November 2011, all female patients with ODS were prospectively evaluated with full interview, clinical examination and anorectal physiology testing. The characteristics of pat...
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| Veröffentlicht in: | Colorectal disease 2013-08, Vol.15 (8), p.993-999 |
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| creator | Hicks, C. W. Weinstein, M. Wakamatsu, M. Pulliam, S. Savitt, L. Bordeianou, L. |
| description | Aim
To determine the relationship between obstructed defaecation syndrome (ODS) and rectoceles.
Method
From December 2007 to November 2011, all female patients with ODS were prospectively evaluated with full interview, clinical examination and anorectal physiology testing. The characteristics of patients with and without rectoceles were compared, and logistic regression was utilized to identify factors predictive of patients having a rectocele beyond the introitus.
Results
Of 239 patients with ODS, 90 (mean age: 52.3 ± 1.7 years) had a rectocele. Patients with rectoceles (R+) had a similar prevalence of incomplete emptying compared with patients with no rectocele (R−) (P ≥ 0.21), but only R+ patients reported splinting with defaecation (36.7% vs 0%; P |
| doi_str_mv | 10.1111/codi.12213 |
| format | Article |
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To determine the relationship between obstructed defaecation syndrome (ODS) and rectoceles.
Method
From December 2007 to November 2011, all female patients with ODS were prospectively evaluated with full interview, clinical examination and anorectal physiology testing. The characteristics of patients with and without rectoceles were compared, and logistic regression was utilized to identify factors predictive of patients having a rectocele beyond the introitus.
Results
Of 239 patients with ODS, 90 (mean age: 52.3 ± 1.7 years) had a rectocele. Patients with rectoceles (R+) had a similar prevalence of incomplete emptying compared with patients with no rectocele (R−) (P ≥ 0.21), but only R+ patients reported splinting with defaecation (36.7% vs 0%; P < 0.0001). Anorectal manometry measurements, including mean resting pressure, maximum resting pressure and maximum squeeze pressure, were similar between groups (P ≥ 0.12). There were also no significant differences in rectal compliance (maximum tolerated volume) or rectal sensitivity (volume of first sensation) (P ≥ 0.65). R+ patients had greater difficulty expelling a 60 cm3 balloon (70.1% R+ patients vs 57.5% R− patients; P = 0.05), but the prevalence of pelvic floor dyssynergia, as quantified by nonrelaxation on electromyography (EMG) testing, was similar to that of R− patients (P = 0.49). Logistic regression suggested that only difficulty with balloon expulsion was associated with higher odds of having a rectocele (OR = 3.00; P = 0.002), whereas mean resting pressure, EMG nonrelaxation and symptoms of incomplete emptying were not (P ≥ 0.12).
Conclusion
Rectoceles are not associated with an increased severity of ODS‐type symptoms, anorectal abnormalities or pelvic floor dyssynergia in patients with ODS. This suggests that rectoceles may be the result, rather than the cause, of ODS.</description><identifier>ISSN: 1462-8910</identifier><identifier>EISSN: 1463-1318</identifier><identifier>DOI: 10.1111/codi.12213</identifier><identifier>PMID: 23527537</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Adult ; Aged ; Anal Canal - physiopathology ; anorectal physiology ; Ataxia - diagnosis ; Cohort Studies ; Constipation - complications ; Constipation - physiopathology ; Defecation - physiology ; Electromyography ; Female ; Humans ; Logistic Models ; Manometry - methods ; Middle Aged ; obstructed defaecation syndrome ; Pelvic Floor - physiopathology ; Prospective Studies ; Rectocele ; Rectocele - complications ; Rectocele - physiopathology ; Rectum - anatomy & histology ; Rectum - physiopathology ; Vagina - physiopathology</subject><ispartof>Colorectal disease, 2013-08, Vol.15 (8), p.993-999</ispartof><rights>Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland</rights><rights>Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3673-4df0b39b331f5afb6fbad4c586f09e28c977a4822a324ac4c87d051668f2c4603</citedby><cites>FETCH-LOGICAL-c3673-4df0b39b331f5afb6fbad4c586f09e28c977a4822a324ac4c87d051668f2c4603</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fcodi.12213$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fcodi.12213$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23527537$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hicks, C. W.</creatorcontrib><creatorcontrib>Weinstein, M.</creatorcontrib><creatorcontrib>Wakamatsu, M.</creatorcontrib><creatorcontrib>Pulliam, S.</creatorcontrib><creatorcontrib>Savitt, L.</creatorcontrib><creatorcontrib>Bordeianou, L.</creatorcontrib><title>Are rectoceles the cause or the result of obstructed defaecation syndrome? A prospective anorectal physiology study</title><title>Colorectal disease</title><addtitle>Colorectal Dis</addtitle><description>Aim
To determine the relationship between obstructed defaecation syndrome (ODS) and rectoceles.
Method
From December 2007 to November 2011, all female patients with ODS were prospectively evaluated with full interview, clinical examination and anorectal physiology testing. The characteristics of patients with and without rectoceles were compared, and logistic regression was utilized to identify factors predictive of patients having a rectocele beyond the introitus.
Results
Of 239 patients with ODS, 90 (mean age: 52.3 ± 1.7 years) had a rectocele. Patients with rectoceles (R+) had a similar prevalence of incomplete emptying compared with patients with no rectocele (R−) (P ≥ 0.21), but only R+ patients reported splinting with defaecation (36.7% vs 0%; P < 0.0001). Anorectal manometry measurements, including mean resting pressure, maximum resting pressure and maximum squeeze pressure, were similar between groups (P ≥ 0.12). There were also no significant differences in rectal compliance (maximum tolerated volume) or rectal sensitivity (volume of first sensation) (P ≥ 0.65). R+ patients had greater difficulty expelling a 60 cm3 balloon (70.1% R+ patients vs 57.5% R− patients; P = 0.05), but the prevalence of pelvic floor dyssynergia, as quantified by nonrelaxation on electromyography (EMG) testing, was similar to that of R− patients (P = 0.49). Logistic regression suggested that only difficulty with balloon expulsion was associated with higher odds of having a rectocele (OR = 3.00; P = 0.002), whereas mean resting pressure, EMG nonrelaxation and symptoms of incomplete emptying were not (P ≥ 0.12).
Conclusion
Rectoceles are not associated with an increased severity of ODS‐type symptoms, anorectal abnormalities or pelvic floor dyssynergia in patients with ODS. This suggests that rectoceles may be the result, rather than the cause, of ODS.</description><subject>Adult</subject><subject>Aged</subject><subject>Anal Canal - physiopathology</subject><subject>anorectal physiology</subject><subject>Ataxia - diagnosis</subject><subject>Cohort Studies</subject><subject>Constipation - complications</subject><subject>Constipation - physiopathology</subject><subject>Defecation - physiology</subject><subject>Electromyography</subject><subject>Female</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Manometry - methods</subject><subject>Middle Aged</subject><subject>obstructed defaecation syndrome</subject><subject>Pelvic Floor - physiopathology</subject><subject>Prospective Studies</subject><subject>Rectocele</subject><subject>Rectocele - complications</subject><subject>Rectocele - physiopathology</subject><subject>Rectum - anatomy & histology</subject><subject>Rectum - physiopathology</subject><subject>Vagina - physiopathology</subject><issn>1462-8910</issn><issn>1463-1318</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1v1DAQhq0K1C-49AcgHxFSWn8kTnJCq4V-SBW9LFTiYjn2uA1k11uPQ5t_X-9u2yO-jEd65tHMS8gJZ6c8vzMbXH_KheByjxzyUsmCS9682_5F0bScHZAjxD-McVXzZp8cCFmJupL1IcFZBBrBpmBhAKTpHqg1IwINcdtEwHFINHgaOkxxtAkcdeANWJP6sKI4rVwMS_hKZ3QdA66zrP8H1KzCxmsGur6fsA9DuJsoptFNH8h7bwaEjy_1mPw8_76YXxbXNxdX89l1YaWqZVE6zzrZdlJyXxnfKd8ZV9qqUZ61IBrb1rUpGyGMFKWxpW1qxyquVOOFLRWTx-TzzpvXehgBk172mM8czArCiJqXolWSVarK6JcdavMFGMHrdeyXJk6aM70JWW9C1tuQM_zpxTt2S3Bv6GuqGeA74LEfYPqPSs9vvl29SovdTI8Jnt5mTPyrcxh1pW9_XOh2sbg9l79b_Us-A10UmCs</recordid><startdate>201308</startdate><enddate>201308</enddate><creator>Hicks, C. W.</creator><creator>Weinstein, M.</creator><creator>Wakamatsu, M.</creator><creator>Pulliam, S.</creator><creator>Savitt, L.</creator><creator>Bordeianou, L.</creator><general>Blackwell Publishing Ltd</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201308</creationdate><title>Are rectoceles the cause or the result of obstructed defaecation syndrome? A prospective anorectal physiology study</title><author>Hicks, C. W. ; Weinstein, M. ; Wakamatsu, M. ; Pulliam, S. ; Savitt, L. ; Bordeianou, L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3673-4df0b39b331f5afb6fbad4c586f09e28c977a4822a324ac4c87d051668f2c4603</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Anal Canal - physiopathology</topic><topic>anorectal physiology</topic><topic>Ataxia - diagnosis</topic><topic>Cohort Studies</topic><topic>Constipation - complications</topic><topic>Constipation - physiopathology</topic><topic>Defecation - physiology</topic><topic>Electromyography</topic><topic>Female</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Manometry - methods</topic><topic>Middle Aged</topic><topic>obstructed defaecation syndrome</topic><topic>Pelvic Floor - physiopathology</topic><topic>Prospective Studies</topic><topic>Rectocele</topic><topic>Rectocele - complications</topic><topic>Rectocele - physiopathology</topic><topic>Rectum - anatomy & histology</topic><topic>Rectum - physiopathology</topic><topic>Vagina - physiopathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hicks, C. W.</creatorcontrib><creatorcontrib>Weinstein, M.</creatorcontrib><creatorcontrib>Wakamatsu, M.</creatorcontrib><creatorcontrib>Pulliam, S.</creatorcontrib><creatorcontrib>Savitt, L.</creatorcontrib><creatorcontrib>Bordeianou, L.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Colorectal disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hicks, C. W.</au><au>Weinstein, M.</au><au>Wakamatsu, M.</au><au>Pulliam, S.</au><au>Savitt, L.</au><au>Bordeianou, L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Are rectoceles the cause or the result of obstructed defaecation syndrome? A prospective anorectal physiology study</atitle><jtitle>Colorectal disease</jtitle><addtitle>Colorectal Dis</addtitle><date>2013-08</date><risdate>2013</risdate><volume>15</volume><issue>8</issue><spage>993</spage><epage>999</epage><pages>993-999</pages><issn>1462-8910</issn><eissn>1463-1318</eissn><abstract>Aim
To determine the relationship between obstructed defaecation syndrome (ODS) and rectoceles.
Method
From December 2007 to November 2011, all female patients with ODS were prospectively evaluated with full interview, clinical examination and anorectal physiology testing. The characteristics of patients with and without rectoceles were compared, and logistic regression was utilized to identify factors predictive of patients having a rectocele beyond the introitus.
Results
Of 239 patients with ODS, 90 (mean age: 52.3 ± 1.7 years) had a rectocele. Patients with rectoceles (R+) had a similar prevalence of incomplete emptying compared with patients with no rectocele (R−) (P ≥ 0.21), but only R+ patients reported splinting with defaecation (36.7% vs 0%; P < 0.0001). Anorectal manometry measurements, including mean resting pressure, maximum resting pressure and maximum squeeze pressure, were similar between groups (P ≥ 0.12). There were also no significant differences in rectal compliance (maximum tolerated volume) or rectal sensitivity (volume of first sensation) (P ≥ 0.65). R+ patients had greater difficulty expelling a 60 cm3 balloon (70.1% R+ patients vs 57.5% R− patients; P = 0.05), but the prevalence of pelvic floor dyssynergia, as quantified by nonrelaxation on electromyography (EMG) testing, was similar to that of R− patients (P = 0.49). Logistic regression suggested that only difficulty with balloon expulsion was associated with higher odds of having a rectocele (OR = 3.00; P = 0.002), whereas mean resting pressure, EMG nonrelaxation and symptoms of incomplete emptying were not (P ≥ 0.12).
Conclusion
Rectoceles are not associated with an increased severity of ODS‐type symptoms, anorectal abnormalities or pelvic floor dyssynergia in patients with ODS. This suggests that rectoceles may be the result, rather than the cause, of ODS.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>23527537</pmid><doi>10.1111/codi.12213</doi><tpages>7</tpages></addata></record> |
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| ispartof | Colorectal disease, 2013-08, Vol.15 (8), p.993-999 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adult Aged Anal Canal - physiopathology anorectal physiology Ataxia - diagnosis Cohort Studies Constipation - complications Constipation - physiopathology Defecation - physiology Electromyography Female Humans Logistic Models Manometry - methods Middle Aged obstructed defaecation syndrome Pelvic Floor - physiopathology Prospective Studies Rectocele Rectocele - complications Rectocele - physiopathology Rectum - anatomy & histology Rectum - physiopathology Vagina - physiopathology |
| title | Are rectoceles the cause or the result of obstructed defaecation syndrome? A prospective anorectal physiology study |
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