Open AccessFUNCTIONAL STATE OF THE PELVIC FLOOR MUSCLES IN PATIENTS WITH THE PELVIC PROLAPSE
Author(s) -
Оксана Юрьевна Фоменко,
Ю. А. Шелыгин,
Г. В. Порядин,
А. Ю. Титов,
Alexey Ponomarenko,
А. А. Мудров,
С. В. Белоусова
Publication year - 2017
Publication title -
koloproktologiâ
Language(s) - English
Resource type - Journals
eISSN - 2686-7303
pISSN - 2073-7556
DOI - 10.33878/2073-7556-2017-0-2-55-61
Subject(s) - pelvic floor , defecography , medicine , defecation , anorectal manometry , pelvic floor dysfunction , fecal incontinence , external anal sphincter , pelvic floor muscle , obstructed defecation , pudendal nerve , constipation , intussusception (medical disorder) , rectal prolapse , functional constipation , physical examination , anal canal , surgery , rectum
The article analyzes the functional state (evacuation functions, continence) and innervation of the pelvic floor muscles in patients with rectocele and combination rectocele with internal rectal intussusception, with complaints of obstructive defecation. AIM. The study of the functional state of the pelvic floor muscles in patients with obstructive defecation syndrome (ODS). MATERIALS AND METHODS. The study included 224 women with complaints of obstructive defecation, without pelvic floor surgery. On physical examination, all patients were detected signs of rectocele. The average age - 49,9±15,0 years. 52 (23,2%) patients had complaints to the fecal incontinence of various components. Diagnostic algorithm: physical examination defecography, rectal functional study (high resolution manometry (HRAM), evacuation test, comprehensive sphincterometry, pudendal nerve study). RESULTS. Frequency of functional disorders of defecation (FDD) according to objective methods of study among patients with ODS is high and amounts to 64.7%. In this case, there are no differences in the frequency FDD in patients with a combination of rectocele and internal intussusception compared to patients with only rectocele. There were no correlation between the frequency of anal sphincter failure and FDD. We identified some patients with subclinical incontinence, without complaints but with reduced manometric values and anal sphincter contractility. We have proved the absence of correlation between the presence or absence of pelvic floor muscle innervations violations in the form of neuropathy n. pudendus and the presence or absence of FDD. CONCLUSION. FDD can cause unsatisfactory results of surgical treatment of patients with ODS, even after the restoration of the anatomic relationships due to complaints of evacuation violation. ODS diagnostic algorithm should include not only an assessment of evacuationfunction (HRAM and evacuation test), but also sphincterometry, to assess the content function.