Abstract：
OBJECTIVE: Defecation disorders can occur as a consequence of functional or structural anorectal dysfunctions during voiding. The aims of this study is to assess the prevalence of structural (SDD) vs functional (FDD) defecation disorders among patients with clinical complaints of obstructive defecation (OD) and their relationship with patients\' expulsive capacity.
METHODS: Retrospective study of 588 patients with OD studied between 2012 and 2020 with evacuation defecography (ED), and anorectal manometry (ARM) in a subgroup of 294.
RESULTS: 90.3% patients were women, age was 58.5±12.4 years. Most (83.7%) had SDD (43.7% rectocele, 45.3% prolapse, 19.3% enterocele, and 8.5% megarectum), all SDD being more prevalent in women except for megarectum. Functional assessments showed: (a) absence of rectification of anorectal angle in 51% of patients and poor pelvic descent in 31.6% at ED and (b) dyssynergic defecation in 89.9%, hypertonic IAS in 44%, and 33.3% rectal hyposensitivity, at ARM. Overall, 46.4% of patients were categorized as pure SDD, 37.3% a combination of SDD+FDD, and 16.3% as having pure FDD. Rectal emptying was impaired in 66.2% of SDD, 71.3% of FDD and in 78% of patients with both (p=0.017).
CONCLUSIONS: There was a high prevalence of SDD in middle-aged women with complaints of OD. Incomplete rectal emptying was more prevalent in FDD than in SDD although FDD and SDD frequently coexist. We recommend a stepwise therapeutic approach always starting with therapy directed to improve FDD and relaxation of striated pelvic floor muscles.
METHODS: Retrospective study of 588 patients with OD studied between 2012 and 2020 with evacuation defecography (ED), and anorectal manometry (ARM) in a subgroup of 294.
RESULTS: 90.3% patients were women, age was 58.5±12.4 years. Most (83.7%) had SDD (43.7% rectocele, 45.3% prolapse, 19.3% enterocele, and 8.5% megarectum), all SDD being more prevalent in women except for megarectum. Functional assessments showed: (a) absence of rectification of anorectal angle in 51% of patients and poor pelvic descent in 31.6% at ED and (b) dyssynergic defecation in 89.9%, hypertonic IAS in 44%, and 33.3% rectal hyposensitivity, at ARM. Overall, 46.4% of patients were categorized as pure SDD, 37.3% a combination of SDD+FDD, and 16.3% as having pure FDD. Rectal emptying was impaired in 66.2% of SDD, 71.3% of FDD and in 78% of patients with both (p=0.017).
CONCLUSIONS: There was a high prevalence of SDD in middle-aged women with complaints of OD. Incomplete rectal emptying was more prevalent in FDD than in SDD although FDD and SDD frequently coexist. We recommend a stepwise therapeutic approach always starting with therapy directed to improve FDD and relaxation of striated pelvic floor muscles.
摘要：
目的：排便过程中由于功能性或结构性肛门直肠功能障碍而发生排便障碍。这项研究的目的是评估患有阻塞性排便（OD）的患者中结构性排便障碍（SDD）与功能性排便障碍（FDD）的患病率及其与患者排便能力的关系。
方法：回顾性研究了2012-2020年间588例OD患者的疏散排粪造影（ED），和肛门直肠测压（ARM）在294个亚组中。
结果：90.3%的患者是女性，年龄为58.5±12.4岁。大多数(83.7%)患有SDD(43.7%直肠前突，45.3%脱垂,19.3%肠膨出，和8.5%大直肠)，除巨大直肠外，所有SDD在女性中更为普遍。功能评估显示：a）在ED时，51％的患者没有纠正肛门直肠角度，而31.6％的患者骨盆下降不良；b）89.9％的协同排便，44%的高渗IAS，和33.3%的直肠低敏感性，在ARM。总的来说,46.4%的患者被归类为纯SDD，37.3%的SDD+FDD组合，以及16.3%的纯FDD。66.2%的SDD患者直肠排空受损,FDD的71.3%和两者患者的78%(p=0.017)。
结论：在患有OD的中年女性中，SDD的患病率很高。尽管FDD和SDD经常共存，但FDD的直肠排空不完全比SDD更普遍。我们建议采用逐步的治疗方法，始终从旨在改善FDD和放松横纹盆底肌肉的治疗开始。
方法：回顾性研究了2012-2020年间588例OD患者的疏散排粪造影（ED），和肛门直肠测压（ARM）在294个亚组中。
结果：90.3%的患者是女性，年龄为58.5±12.4岁。大多数(83.7%)患有SDD(43.7%直肠前突，45.3%脱垂,19.3%肠膨出，和8.5%大直肠)，除巨大直肠外，所有SDD在女性中更为普遍。功能评估显示：a）在ED时，51％的患者没有纠正肛门直肠角度，而31.6％的患者骨盆下降不良；b）89.9％的协同排便，44%的高渗IAS，和33.3%的直肠低敏感性，在ARM。总的来说,46.4%的患者被归类为纯SDD，37.3%的SDD+FDD组合，以及16.3%的纯FDD。66.2%的SDD患者直肠排空受损,FDD的71.3%和两者患者的78%(p=0.017)。
结论：在患有OD的中年女性中，SDD的患病率很高。尽管FDD和SDD经常共存，但FDD的直肠排空不完全比SDD更普遍。我们建议采用逐步的治疗方法，始终从旨在改善FDD和放松横纹盆底肌肉的治疗开始。
