Detrusor-rectal neck dyssynergia syndrome. A new syndrome with report of nine cases.

Nine patients with detrusor-rectal neck dyssynergia syndrome are presented. Six were females and three were males. The complaint was constipation and straining at stool in all the patients and fecal soiling in four. Eight subjects with normal rectal functions acted as controls. Investigative results have shown that frequency and weight of stools are within normal range. Rectal neck pressure at rest was lower than the normal values (average 16.2 mmHg), while on voluntary squeeze it was normal (average 146.2 mmHg). The rectal pressure recorded normal values (20.6 mmHg). The recto-inhibitory reflex showed internal sphincter contraction on rectal distension; rectal neck pressure registered an average of 82 mmHg and rectal pressure 68 mmHg. Excessive straining at stool is due to failure of the rectal neck to open on rectal distension as a result of internal sphincter contraction. Fecal soiling could be due to the low pressure zone in the rectal neck at rest. Myectomy effected improvement in strainodynia and prevented internal sphincter contraction on rectal distension. Fecal soiling however did not improve after the operation. Myectomy specimens did not show histologic abnormalities.