Siproudhis L, Dautrème S, Ropert A, Bretagne J F, Heresbach D, Raoul J L, Gosselin M
Service d'Hépato-Gastroentérologie, CHU Pontchaillou, Rennes, France.
Dis Colon Rectum. 1993 Nov;36(11):1030-6. doi: 10.1007/BF02047295.
Herniation of the anterior rectal wall into the lumen of the vagina (so called rectocele) may be encountered in patients who complain of constipation and emptying difficulties but it is difficult to ascertain whether this anatomic abnormality is an etiologic factor or a consequence of the dyschezia.
The aim of our study was to assess symptomatic, anatomic, and physiologic features encountered in women with a clearly defined rectocele in order to determine the predisposing factors, symptoms, functional associations, and effects on quantified rectal emptying.
Clinical, physiologic (manometry), and anatomic (evacuation proctography) assessments were carried out in 26 consecutive women (mean age, 47.6 +/- 12 years) with dyschezia and a large rectocele as evidenced by radiography and compared with a group of 26 consecutive women complaining of dyschezia without a significant rectocele (mean age, 42.6 +/- 14 years). Both groups were similar with respect to mean age, parity, laxative abuse, manual anal evacuation, fecal incontinence, urgency, and weekly stool frequency.
Patients having a rectocele differed significantly from those without a rectocele in having frequent endovaginal digitation during defecation (7 vs. 1, P < 0.05), more frequent symptoms of urinary incontinence (14 vs. 3, P < 0.001), and a surgical history of hysterectomy (9 vs. 2, P < 0.05). The rectocele group differed in having a delayed rectal emptying (55.5 +/- 38 vs. 30.3 +/- 23 seconds, P < 0.005), a more frequent incomplete rectal emptying (23 vs. 11, P < 0.0005), and was more often associated with a manometric anismus (16 vs. 6, P < 0.01). During the straining effort, there was a correlation between the depth of the rectocele and the duration of rectal emptying (rs = 0.3, P < 0.05). In the group without manometric anismus, women with a rectocele (n = 10) had a more incomplete rectal emptying than those without rectocele (8/10 vs. 8/19, P = 0.05).
Some of our results indicate that the rectocele itself could be a contributory factor in difficult evacuation. These results also exhibit the importance of other disorders, such as anismus, in the occurrence of dyschezia. Physiologic examination therefore should be made before considering surgical repair in any patient with rectocele and dyschezia.
直肠前壁疝入阴道腔（即所谓的直肠膨出）可见于主诉便秘和排便困难的患者，但难以确定这种解剖异常是病因还是排便困难的后果。
我们研究的目的是评估明确诊断为直肠膨出的女性的症状、解剖和生理特征，以确定易感因素、症状、功能关联以及对定量直肠排空的影响。
对连续26名（平均年龄47.6±12岁）有排便困难且经影像学证实有巨大直肠膨出的女性进行了临床、生理（测压）和解剖（排粪造影）评估，并与连续26名主诉排便困难但无明显直肠膨出的女性（平均年龄42.6±14岁）进行比较。两组在平均年龄、产次、滥用泻药、手法辅助排便、大便失禁、便急和每周排便次数方面相似。
有直肠膨出的患者与无直肠膨出的患者在排便时频繁阴道内指诊（7例对1例，P<0.05）、更频繁的尿失禁症状（14例对3例，P<0.001）以及子宫切除手术史（9例对2例，P<0.05）方面存在显著差异。直肠膨出组在直肠排空延迟（55.5±38秒对30.3±23秒，P<0.005）、更频繁的直肠排空不完全（23例对11例，P<0.0005）方面存在差异，并且更常与测压性排便障碍相关（16例对6例，P<0.01）。在用力排便时，直肠膨出的深度与直肠排空的持续时间之间存在相关性（rs = 0.3，P<0.05）。在无测压性排便障碍的组中，有直肠膨出的女性（n = 10）直肠排空不完全的情况比无直肠膨出的女性更常见（8/10对8/19，P = 0.05）。
我们的一些结果表明直肠膨出本身可能是排便困难的一个促成因素。这些结果还显示了其他疾病，如排便障碍，在排便困难发生中的重要性。因此，对于任何有直肠膨出和排便困难的患者，在考虑手术修复之前应进行生理检查。
