Li M, Jiang T, Peng P, Yang X-Q, Wang W-C
Department of Radiology, Beijing Chaoyang Hospital, Affiliated to Capital Medical University, Beijing, China.
Eur Rev Med Pharmacol Sci. 2015 Apr;19(8):1407-15.
Chronic constipation affects more than 17% of the global population worldwide, and up to 50% of patients were outlet obstruction constipation (OOC). Women and the elderly are most likely to be affected, due to female-specific risk factors, such as menopause, parity and multiparity. The aim of our study was to investigate the association of compartment defects in anorectal and pelvic floor dysfunction with female outlet obstruction constipation (OOC) by MR defecography.
Fifty-six consecutive women diagnosed with outlet obstruction constipation from October 2009 to July 2011 were included. They were categorized into the following groups: anorectal disorder only group (27 patients) and anorectal disorder plus multi-compartment pelvic disorder group (29 patients). Relevant measurements were taken at rest, during squeezing and straining.
Anismus was significantly more common in the anorectal disorder group compared to the multi-compartment pelvic disorder group. Conversely, rectocele, rectal prolapse, and descending perineum were significantly more common in the multi-compartment pelvic disorder group compared to the anorectal disorder group. Of the total 56 OOC patients, 34 (60.7%) exhibited anismus and 38 (67.9%) rectocele. Among the anismus patients, there were 8 patients (23.5%) with combined cystocele, and 6 patients (17.6%) with combined vaginal/cervical prolapse. Among the rectocele patients, there were 23 patients (60.5%) with combined cystocele and 18 patients (47.4%) with combined vaginal/cervical prolapse. With respect to anorectal defects, 13 anismus patients (38.2%) were with signal posterior pelvic defects, 4 rectocele patients (10.5%) presented with signal posterior pelvic defects.
Inadequate defecatory propulsion due to outlet obstruction constipation is often associated with multi-compartment pelvic floor disorders, whereas not about dyssynergic defecation.
慢性便秘影响着全球超过17%的人口，高达50%的患者为出口梗阻型便秘（OOC）。女性和老年人受影响的可能性最大，这归因于女性特有的风险因素，如更年期、经产和多产。我们研究的目的是通过磁共振排粪造影研究肛门直肠和盆底功能障碍中的腔室缺陷与女性出口梗阻型便秘（OOC）之间的关联。
纳入了2009年10月至2011年7月期间连续诊断为出口梗阻型便秘的56名女性。她们被分为以下几组：仅肛门直肠疾病组（27例患者）和肛门直肠疾病加多腔室盆腔疾病组（29例患者）。在静息、挤压和用力排便时进行相关测量。
与多腔室盆腔疾病组相比，肛门直肠疾病组中耻骨直肠肌痉挛明显更为常见。相反，与肛门直肠疾病组相比，多腔室盆腔疾病组中直肠膨出、直肠脱垂和会阴下降明显更为常见。在总共56例OOC患者中，34例（60.7%）表现为耻骨直肠肌痉挛，38例（67.9%）表现为直肠膨出。在耻骨直肠肌痉挛患者中，有8例（23.5%）合并膀胱膨出，6例（17.6%）合并阴道/宫颈脱垂。在直肠膨出患者中，有23例（60.5%）合并膀胱膨出，18例（47.4%）合并阴道/宫颈脱垂。关于肛门直肠缺陷，13例耻骨直肠肌痉挛患者（38.2%）存在盆腔后部信号缺陷，4例直肠膨出患者（10.5%）存在盆腔后部信号缺陷。
出口梗阻型便秘导致的排便推进不足通常与多腔室盆底疾病相关，而非排便协同失调。
