Kelvin F M, Maglinte D D, Benson J T
Department of Radiology, Methodist Hospital of Indiana, Indianapolis.
Obstet Gynecol. 1994 Feb;83(2):307-14.
Patients with pelvic floor disorders frequently have associated anorectal dysfunction, which can be evaluated by a variety of laboratory tests. Evacuation proctography (defecography) documents the process of rectal evacuation and therefore demonstrates disorders of defecation, particularly those of an obstructive nature. It provides objective information about rectocele size and emptying and demonstrates coexistent enteroceles, many of which are missed on physical examination. This radiographic technique is the method of choice for recognizing rectal intussusception, the mechanism by which rectal prolapse occurs. Proctography suggests the diagnosis of spastic pelvic floor (anismus), a disorder amenable to biofeedback therapy. Proctography has limited application in anal incontinence unless there are associated obstructive symptoms. Evaluation of bladder dysfunction is aided by concomitant cystography. Gynecologists managing pelvic floor disorders should assess coexistent anorectal dysfunction, as undiagnosed enteroceles and disorders of defecation are an important cause of persistent or recurrent symptoms following pelvic floor repair. A comprehensive interdisciplinary approach to pelvic floor disorders is recommended.
盆底功能障碍患者常伴有肛门直肠功能障碍，可通过多种实验室检查进行评估。排粪造影记录直肠排空过程，从而显示排便障碍，尤其是梗阻性排便障碍。它提供有关直肠膨出大小和排空的客观信息，并显示并存的肠膨出，其中许多在体格检查中会被漏诊。这种影像学技术是识别直肠套叠（直肠脱垂发生机制）的首选方法。排粪造影有助于诊断盆底痉挛综合征（失弛缓症），这是一种适合生物反馈治疗的疾病。排粪造影在肛门失禁中的应用有限，除非伴有梗阻性症状。膀胱造影有助于评估膀胱功能障碍。处理盆底功能障碍的妇科医生应评估并存的肛门直肠功能障碍，因为未诊断出的肠膨出和排便障碍是盆底修复后持续或复发症状的重要原因。建议采用综合的多学科方法处理盆底功能障碍。
