-
spastic pelvic floor syndrome
- obstructed defecation
- anismus
- paradoxical puborectalis muscle contraction
-
sx
- prolonged straining at stool
- feeling of incomplete evacuation
- requirement for manual assistance
- use of laxatives and enemas
-
-
dx tests
- ballon expulsion most reliable
- objective findings:
- manometry: paradoxical elevation of pressure when patient tries to evacuate
-
rx
- biofeed back:balloon expulsion, EMG, manometric
- Botox (6-15 u b/l EAS or PR/ max 3 doses in 3 months)-results short term and temporary
- alternatives described in literature: rectopexy (12%), PR muscle division27%, anal dilation, antegrade colonic irrigation, sacral nerve stimulation
|
|