Rectocele and Its Associated Pelvic Floor Findings

Kim, Tae Hyeon; Kim, Jin Ah; Jin, Kyoung Min; Hye, Cho Kyoo; Choi, Suck Chei; Yoon, Kwon Ha; Nah, Yong Ho

Abstract

BACKGROUND/AIMS: The aim of this study is to evaluate defecographic and anorectal manometric findings in patients with rectocele and to identify associated pelvic floor findings.
METHODS
We reviewed defecography in 90 patients (all females;mean age, 44.7 years) with rectocele, who were collected from 427 patients who underwent defecography. We also reviewed a colon transit time study, and an anorectal manometry examination. 56 healthy volunteers (mean age 36.5, female 30, male 26) were studied.
RESULTS
In the patient group, the depth of rectocele was 2.92+/-0.89 cm, while in the control group, it was 1.62+/- 0.66 cm (p value < 0.001). The mean rest, squeezing, and straining centroid anorectal angle(degrees) in both groups were: 99.7+/-19.3 vs. 126.2+/-19.3; 120.4+/-15.8 vs. 111.5+/-18.9; 132.2+/-14.6 vs. 141.0+/-15.7 (p < 0.05). The mean pelvic floor descent(cm) during rest, squeezing and straining were: 5.90+/-1.26 vs. 5.08+/-1.28 (p < 0.01); 4.89+/- 1.17 vs. 3.65+/-1.13(p < 0.01); 8.61+/-1.6 vs. 7.27+/-1.39(p < 0,001). In 60 of the 90 patients with rectocele, the mean barium trap was 32.7% after defecation. The mean maximal anal resting pressure and squeezing pressure(mmHg) in both groups were: 85.8+/-25.3 vs 47.1+/-9.3(p < 0.01); 138.9+/-35.14 vs. 92.7+/-28.1(p < 0.01). The mean anal canal was opened to 2.52cm in patients with rectocele and to 2.47cm in control subjects during defecation. Associated findings were a pelvic spastic syndrome in 16, pelvic descent syndrome in 37, rectoanal intussusception in 37 and rectal prolapse in 4 of the patients. Colon transit time was more prolonged in the patient group than the control group.
CONCLUSIONS
Rectocele may be associated with various pelvic floor diseases. Careful preoperative investigations are important before surgical treatment of rectocele.