Female Pelvic Medicine and Reconstructive Surgery (FPMRS), Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, 9650 Gross Point Road, Suite 3900, Skokie, IL, 60076, USA.
Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
Int Urogynecol J. 2020 Feb;31(2):337-349. doi: 10.1007/s00192-019-03934-9. Epub 2019 Apr 23.
Obstructed defecation symptoms (ODS) are common in women; however, the key underlying anatomic factors remain poorly understood. We investigated rectal mobility and support defects in women with and without ODS using pelvic floor ultrasound and MR defecography.
This prospective case-control study categorized subjects based on questions 7, 8 and 14 on the PFDI-20, which asks about obstructed defecation symptoms. All subjects underwent an interview, examination and pelvic floor ultrasound, and a subset of 16 subjects underwent MR defecography. The cul de sac-to-anorectal junction distance at rest and during maximum strain was measured on ultrasound and MRI images. The 'compression ratio' was calculated by dividing the change in rectovaginal septum length by its rest length to quantify rectal folding and hypermobility during dynamic imaging and to correlate with ODS.
Sixty-two women were recruited, 32 cases and 30 controls. There were no statistically significant differences in age, parity, BMI or stage of rectocele between groups. A threshold analysis indicated the risk of ODS was 32 times greater (OR 32.5, 95% CI 4.8-217.1, p = 0.0003) among women with a high compression ratio (≥ 14) compared with those with a low compression ratio (< 14) after controlling for age, BMI, parity, stool type and BM frequency.
Female ODS are associated with distinct alterations in rectal mobility and support that can be clearly observed on dynamic ultrasound. The defects in rectal support were quantifiable using a compression ratio metric, and these defects strongly predicted the likelihood of symptoms; interestingly, the presence or degree of rectocele defects played no role. These findings may provide new insight into the anatomic factors underlying female ODS.
排便障碍症状（ODS）在女性中很常见；然而，关键的潜在解剖因素仍知之甚少。我们使用盆底超声和磁共振排粪造影研究了有和无 ODS 的女性的直肠活动度和支持缺陷。
这项前瞻性病例对照研究根据 PFDI-20 的问题 7、8 和 14 对受试者进行分类，这些问题询问了关于排便障碍的症状。所有受试者都接受了访谈、检查和盆底超声检查，其中 16 名受试者的一部分接受了磁共振排粪造影检查。在超声和 MRI 图像上测量静息和最大应变时直肠尾骨到肛直肠交界处的距离。“压缩比”通过将直肠阴道隔长度的变化除以其静息长度来计算，以量化动态成像期间的直肠折叠和过度活动，并与 ODS 相关。
共招募了 62 名女性，32 例病例和 30 例对照。两组在年龄、产次、BMI 或直肠前突程度方面无统计学差异。阈值分析表明，在控制年龄、BMI、产次、粪便类型和 BM 频率后，高压缩比（≥14）的女性发生 ODS 的风险是低压缩比（<14）的女性的 32 倍（OR 32.5，95%CI 4.8-217.1，p=0.0003）。
女性 ODS 与直肠活动度和支持的明显改变有关，这些改变可以在动态超声上清晰观察到。直肠支持的缺陷可以使用压缩比指标进行量化，这些缺陷强烈预测了症状的可能性；有趣的是，直肠前突缺陷的存在或程度没有作用。这些发现可能为女性 ODS 的解剖因素提供新的见解。
