Defecography,or evacuation proctography,is used for evaluating the posterior (anorectal) compartment. Commonly measured variables include rectal volume, rectal emptying, perineal and pelvic floor muscle function, and anal sphincter function. Although the clinical value of defecography in the evaluation and management of constipation is not well proven, the presence of an obvious anatomic abnormality in a fecally incontinent patient such as a large rectocele, severe intussusception, or prolapse, supports surgical intervention. Furthermore, sigmoidoceles and upper rectal pathology and prolapse may lead to the decision to resect this portion of bowel in severe redundancy. To properly evaluate the sigmoid colon, one must specifically discuss this with the radiologist ahead of time or even perform a formal barium enema study. Concomitant therapy of a large sigmoidocele may allow one to effectively manage coexisting defecatory dysfunction with the prolapse repair.

Evacuation proctography relies on opacification of the rectal vault with barium paste. Instilling the paste is quite cumbersome, requiring a large-caliber enema. Typically, 80 to 300 mL of paste is instilled, often confounded by reflux into the sigmoid colon. Fluoroscopic images are recorded with the patient relaxed and while performing active contraction of the pelvic floor; this should result in elevation of the pelvic floor musculature. The patient is then examined during cough and during maximal straining maneuver, noting any pelvic floor descent or fecal incontinence. Finally, defecation is accomplished, and note is made of any rectocele, incomplete emptying, or need for digital assistance with evacuation (functional phase of the study).

In the cooperative patient, dynamic proctography allows precise identification and quantification of a rectocele, measured as the maximum extent of an anterior rectal bulge beyond the expected line of the rectum. Rectal intussusception may be visible as a circumferential invagination of the rectal wall, presenting as mucosal prolapse through the anus in its most severe form. Limitations of this examination are the cumbersome and potentially painful instillation of rectal barium paste, lack of correlation between the viscosity of the paste and the individual patient's stool, and the inability of many patients to defecate on command. Additionally, the presence of a rectocele in and of itself may be of limited concern, because previous studies have shown that an anterior rectal bulge is often demonstrated in nul-

liparous asymptomatic patients. Furthermore, the presence of, or size of, a rectocele does not correlate well with the completeness of barium evacuation.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

Get My Free Ebook

Post a comment