Role of age, bowel function and parity on anorectocele pathogenesis according to cinedefecography and anal manometry evaluation

• Published in: Colorectal disease Vol. 11; no. 9; pp. 947 - 950
• Main Authors: Soares, F. A., Regadas, F. S. P., Murad-Regadas, S. M., Rodrigues, L. V., Silva, F. R. S., Escalante, R. D., Bezerra, R. F.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-11-2009
• Subjects: Adult; Aged; Anal Canal; anal manometry; cinedefecography; constipation; Constipation - diagnostic imaging; Constipation - etiology; Cross-Sectional Studies; Defecography; Episiotomy - adverse effects; Female; Humans; Manometry; Middle Aged; Muscle Hypotonia - etiology; obstructed defecation; Parity; Pregnancy; Rectocele; Rectocele - diagnostic imaging; Rectocele - etiology; Risk; Young Adult
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/j.1463-1318.2008.01761.x

Objective  The study aimed to verify the role of parity, age and bowel function in the pathogenesis of anorectocele.
Method  A cross‐sectional study was conducted regarding age, obstetrical history, Cleveland Clinic Constipation Score (CCCS), cinedefecography and anal manometry findings. Forty‐five adult women complaining of obstructed defecation were evaluated; the median age was 46 years and median CCCS, 13. Fifteen patients were nulliparous and 23 multiparous (median parity 2). Eighteen had a history of episiotomy, fourteen delivered large babies and two had forceps‐assisted delivery. Statistical analysis was performed using Spearman’s correlation test and Fisher’s exact test.
Results  Anal hypertonia was found in 14 (31.1%) patients, anal hypotonia in eight (17.8%), anismus in 13 (28.9%) and anorectoceles in 34 (75.6%) [median size 2.8 cm (0–6.4)]. There were no correlations between anorectocele and anal hypertonia (P = 0.7171), anismus (P = 0.4666), parity comparing nulliparous and multiparous patients (P = 1.000), episiotomy (P = 1.0000), forceps assistance (P = 1.0000), delivery of a large baby (P = 1.0000) anal resting pressure (P = 0.0883), anal voluntary pressure (P = 0.7327), parity (P = 0.4987) and age (P = 0.8603). There were correlations between anorectocele and the CCCS (P = 0.0082) and anal hypotonia (P = 0.0141).
Conclusion  Anorectocele is not correlated with parity, age, episiotomy, delivery of a large baby and anismus. It was more frequent in patients with severe constipation and less common in patients with anal hypotonia.