Descending perineum syndrome: Audit of clinical and laboratory features and outcome of pelvic floor retraining

Gavin C. Harewood, Bernard Coulie, Michael Camilleri, Doris Rath-Harvey, John H. Pemberton

Research output: Contribution to journalArticle

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Abstract

Objective: Our aim was to retrospectively analyze the Mayo Clinic experience of descending perineum syndrome from 1987-1997. Methods: Clinical records were abstracted for demographic features, risk factors, results of anorectal and defecation tests, and a mailed questionnaire evaluated outcome and current symptoms. Results: All results are mean ± SD. Clinically, 39 patients (38 women, one man), mean age 53 ± 14 yr, presented with constipation (97%), incomplete rectal evacuation (92%), excessive straining (97%), digital rectal evacuation (38%), and fecal incontinence (15%). Laboratory tests showed anal sphincter resting pressure was 54 ± 26 mm Hg, and squeeze pressure was 96 ± 35 mm Hg; expulsion from the rectum of a 50- ml balloon required > 200 g added weight in 27%; perineal descent was 4.4 ± 1 cm (normal <4 cm) by scintigraphy. Scintigraphic evacuation, rectoanal angle change during defecation, and perineal descent were abnormal in 23%, 57%, and 78% of the patients, respectively. Associated features included female gender (96%), multiparity with vaginal delivery (55%), hysterectomy or cystocele/rectocele repair (74%). On follow-up, 64% responded; 17 of these 25 responders underwent pelvic floor retraining. At 2-yr median follow-up (range, 1-6 yr), 12 still experienced constipation or excessive straining; their perineal descent was greater than in patients who responded to retraining (p = 0.005). Conclusions: Descending perineum syndrome is identifiable by clinical history and examination, and the most prevalent abnormality on testing is perineal descent > 4 cm; rectal balloon expulsion is an insensitive screening test for descending perineum syndrome. Pelvic floor retraining is a suboptimal treatment for this chronic disorder of rectal evacuation; the extent of perineal descent appears to be a useful predictor of response to retraining.

Original languageEnglish (US)
Pages (from-to)126-130
Number of pages5
JournalAmerican Journal of Gastroenterology
Volume94
Issue number1
DOIs
StatePublished - Jan 1999

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Clinical Audit
Perineum
Pelvic Floor
Rectal Diseases
Pressure
Fecal Incontinence
Defecation
Anal Canal
Constipation
Rectum
Demography
Weights and Measures
Therapeutics
Surveys and Questionnaires

ASJC Scopus subject areas

  • Gastroenterology

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Descending perineum syndrome : Audit of clinical and laboratory features and outcome of pelvic floor retraining. / Harewood, Gavin C.; Coulie, Bernard; Camilleri, Michael; Rath-Harvey, Doris; Pemberton, John H.

In: American Journal of Gastroenterology, Vol. 94, No. 1, 01.1999, p. 126-130.

Research output: Contribution to journalArticle

Harewood, Gavin C. ; Coulie, Bernard ; Camilleri, Michael ; Rath-Harvey, Doris ; Pemberton, John H. / Descending perineum syndrome : Audit of clinical and laboratory features and outcome of pelvic floor retraining. In: American Journal of Gastroenterology. 1999 ; Vol. 94, No. 1. pp. 126-130.
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abstract = "Objective: Our aim was to retrospectively analyze the Mayo Clinic experience of descending perineum syndrome from 1987-1997. Methods: Clinical records were abstracted for demographic features, risk factors, results of anorectal and defecation tests, and a mailed questionnaire evaluated outcome and current symptoms. Results: All results are mean ± SD. Clinically, 39 patients (38 women, one man), mean age 53 ± 14 yr, presented with constipation (97{\%}), incomplete rectal evacuation (92{\%}), excessive straining (97{\%}), digital rectal evacuation (38{\%}), and fecal incontinence (15{\%}). Laboratory tests showed anal sphincter resting pressure was 54 ± 26 mm Hg, and squeeze pressure was 96 ± 35 mm Hg; expulsion from the rectum of a 50- ml balloon required > 200 g added weight in 27{\%}; perineal descent was 4.4 ± 1 cm (normal <4 cm) by scintigraphy. Scintigraphic evacuation, rectoanal angle change during defecation, and perineal descent were abnormal in 23{\%}, 57{\%}, and 78{\%} of the patients, respectively. Associated features included female gender (96{\%}), multiparity with vaginal delivery (55{\%}), hysterectomy or cystocele/rectocele repair (74{\%}). On follow-up, 64{\%} responded; 17 of these 25 responders underwent pelvic floor retraining. At 2-yr median follow-up (range, 1-6 yr), 12 still experienced constipation or excessive straining; their perineal descent was greater than in patients who responded to retraining (p = 0.005). Conclusions: Descending perineum syndrome is identifiable by clinical history and examination, and the most prevalent abnormality on testing is perineal descent > 4 cm; rectal balloon expulsion is an insensitive screening test for descending perineum syndrome. Pelvic floor retraining is a suboptimal treatment for this chronic disorder of rectal evacuation; the extent of perineal descent appears to be a useful predictor of response to retraining.",
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