Value Of Dynamic Defecography In Patients With The Spastic Pelvic Floor Syndrome

ObjectiveAnalyse the images of dynamic defecography in patients with the Spastic Pelvic Floor Syndrome, investigate the value of dynamic defecography in patients with the Spastic Pelvic Floor Syndrome.Materials and methods:Collected 66 cases from September 2011 to October 2013 in Shandong Tiffic Hospital. Among them, the images of defecography in 44 cases with SPFS and 22 volunteers were retrospectively analyzed. Among 44 cases with SPFS,25 female (56%) and 19 males (44%), aged 14 to 77 years old; and 6 female (27%)and 16 males (73%) in the other group, aged 19 to 78 years old. Inclusion criteria:all patients had some nonspecific symptoms, such as defecation incompletion difficult of defecation, chronic constipation, or anal straining feeling. All cases were negative for traditional barium enema examination. Using digital rectal examination, all patients have no organic disease. All cases does not have mental disorder. Using OPERA Multifunction Digital X-RAY System (General Medical Merate S. p. A, Italy) and special seat commode, carefully observe the images. The commode with high X-ray radiability is height adjustable, rotating, to keep each patient posture is correct and basically the same. And explanation shoud be give to relax the patients before the examination to ensure the examination go on successfully. Cleaning the rectum and colon, orally take senna leaf (brewing with 9000-15000mg Senna) at 14,16,20 respectively previous day, every times 500ml.Enema with 160%(W/V) of the Barium Sulfate (Type Ⅱ) for Suspension(Qingdao Dongfeng Chemical Co. Ltd, China) 300-400ml.Using disposable enema bag, the pipe is not to insert too deep, fully rectum filling is suitable. Make sure the patient sit sideways on the commode, overlapping dual femur and uprighting upper body, to make sure the pubic symphysis displayed clearly. Under X-ray fluoroscopy, get sagittal images of rectum at resting, lifting anus, refraining, defecating and finally the image of the rectal mucosa. Cooperation and maintainning correct posture is one of the key factors for success. Communication sufficiently with patients is very necessary, try to simulate patients’daily defecation. Static images should be included into pubic symphysis, sacrococcyx and anal canal, with good clarity and high contrast. The measurement standard is established by Professor Lu Renhua (Changhai Hospital). At resting and defecating, measure the anorectal angle, and the difference between them was calculated. T test was used in statistical analysis。Results:The ARA in patients with the Spastic Pelvic Foor Syndrome group at quiescent, defecation and difference between them were(103.2±8.62)°,(92.8±7.38)°and(10.4 ±7.9)°respectively, and those in normal control group were(117.4±12.7)°,(137.1 ±10.4)°and(19.7±12.4)°respectively. There was significant difference in ARA between two groups(P＜0.01).44 cases of Spastic Pelvic floor syndrome patients, anorectal angle does not increase at defecating, maintained at around 90°or less. PRMI appeared in anorectal angle trailing edge, as a semi arc.21 patients with the Spastic Pelvic Floor Syndrome(SPFS) also suffered from AMP (anterior mucosal prolapse),RC (rectocele), or other disease. In order to diagnosis patients with the Spastic Pelvic Floor Syndrome, during defecation,observe dynamic abnormality changes of the rectum; measure anorectal angle at resting, lifting anus, refraining and defecating; observe the depth of pubis rectum muscle spasm;the sensitivity is 69%～86% and the false positive 6%～9%. Some patients with SPFS, the PRMI(puborectalis spasm impression) does not appeared at resting, Puborectalis keep on spasm during defecation.,PRMI (puborectalis spasm impression) also appeared at refraining, defecating, and gradually deepen. Pelvic floor trembling during defecation is a more useful imaging to diagnosis patients with the Spastic Pelvic Floor Syndrome.Conclusion:The imaging manifestations of Dynamic Defecography in Patients with the Spastic Pelvic Floor Syndrome is typical, defecography is economic and usability. Compared with the traditional barium enema, dynamic defecography does not increase the X-ray dose.Other disease, which lead to outlet obstructive constipation, can be diagnosed at the same time. Observe the dynamic changes of pelvic floor, measure the ARA(anorectal angle), dynamic defecography can provide reliable diagnostic basis for the Spastic Pelvic Floor syndrome.