Constipation: a potential cause of pelvic floor damage?

Background: Pelvic floor damage is a major clinical problem usually attributed to obstetric injury. We speculated that constipation may also be an aetiological and preventable factor resulting from repeated stress on the perineum over many years, and this study aimed to test this hypothesis.

Methods: A total of 600 women attending a gynaecological clinic were assessed using a structured questionnaire gathering data on pelvic floor damage, constipation and obstetric trauma.

Persistent symptoms of functional outlet obstruction after rectocele repair.

Background: Rectocele is frequently associated with constipation, but it is not known whether a causal relationship exists.

Objective: To determine the effect of rectocele repair on symptoms of constipation.

Method: Thirty-five women (28-79 years) consecutively operated for rectocele repair (11 transanal approach and 24 transperineal) were included in the prospective study.

Detection of individual motor units of the puborectalis muscle by non-invasive EMG electrode arrays.

Purpose: The purpose of the study was to demonstrate that anatomical features of individual motor units of the puborectalis muscle can be detected with non-invasive electromyography (EMG) and to evaluate differences in electrophysiological properties of the puborectalis muscles in a small group of healthy and pathologic subjects.

Methods: Multichannel EMG was recorded by means of a flexible probe applied on the gloved index finger and carrying an array of eight equally spaced (1.15 mm) electrodes.

Responses of anal constipation to biofeedback treatment.

Objective: Biofeedback is considered an effective treatment for anal constipation, but a substantial proportion of patients fail to improve. Our aim was to identify the key predictors of outcome using a comprehensive standardized evaluation of anorectal function.

Material And Methods: We retrospectively analysed the clinical and physiological data of 148 patients consecutively treated for constipation due to functional outlet obstruction by biofeedback.

The puborectalis muscle.

The role of the levator ani and puborectalis muscle in preserving continence has been underestimated in the past, due predominantly to technical difficulties to investigate its proper function in healthy subjects, and its dysfunction as in patients with incontinence problems. This has recently been overcome by applying new investigational procedures such as a perineal dynamometer which measures the traction exerted by the levator ani on an intrarectal balloon catheter, or by multi-electrode arrays recording the generation of motor unit action potentials from various parts of the puborectalis muscle sling via intrarectal surface electrodes. Both techniques have the potential to provide new insights into the physiology of defecation and the pathophysiology of incontinence and constipation.