Measurements

All measurements are taken from rest, squeeze, and push-static films:

Anorectal angle - angle between the axis of the anal canal and the posterior rectal wall (Figure 3-4.1). Puborectalis length - distance between posterior anorectal angle and the anterior symphysis pubis. Perineal plane distance - line drawn from tip of coccyx to anterior pubic symphysis (perineal plane). Perpendicular line drawn from perineal plane to the anorectal angle. This distance measures perineal descent. Increased per-ineal descent (>3cm) in either the resting or squeeze phase correlates to fixed or dynamic descent, respectively (Figure 3-4.2). Sigmoidocele - the degree of descent of the lowest portion of the sigmoid colon. First degree = above the pubococcygeal line; second degree = below the pubococcygeal line and above the ischiococcygeal line; third degree = below the ischiococcygeal line (Figure 3-4.3).

A wealth of information is gained from the dynamic images including the presence and significance of a recto-cele or sigmoidocele (Figure 3-4.3), paradoxical puborec-talis contraction (Figure 3-4.4), intussusception (Figure 3-4.5), prolapse, ability to straighten the anorectal angle, and the ability to empty the rectum. Seven hundred forty-four patients at the Cleveland Clinic Florida underwent defecography,5 60% of whom were constipated; 12.5% had "normal studies," 25.7% had rectoceles, 11% had sig-moidoceles, 12.6% intussusception, and 30% had a combination of findings. The number of significant findings

Figure 3-4.2. Perineal descent on defogram (A) on rest and (B) on push.
Figure 3-4.4. Paradoxical puborectalis contraction on defogram,on rest (A), on squeeze (B),and on push (C).
Figure 3-4.5. Intussusception on defogram.

within this group of patients underscores the need to always correlate radiographic findings with the clinical evaluation.

A normal cinedefecography is expected to demonstrate complete relaxation of the puborectalis muscle, a perineal descent less then 3 cm during rest, and complete evacuation of the rectal contrast.

Defecography is extremely helpful in the evaluation of patients with constipation. The documentation of the ability or inability to empty the rectum leads the physician to focus treatment plans on either the evacuatory mechanism or disorders of intestinal transit. The identification of pathology on the defogram allows the physician to correlate the anatomic abnormality with its impact on the evac-uatory mechanism.

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.

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