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Clin Colon Rectal Surg 2017; 30(01): 022-029
DOI: 10.1055/s-0036-1593430
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Functional Disorders of Constipation: Paradoxical Puborectalis Contraction and Increased Perineal Descent

Isaac Payne
1   Department of Surgery, University of South Alabama Medical Center, Mobile, Alabama
,
Leander M. Grimm Jr.
2   Division of Colon & Rectal Surgery, Department of Surgery, University of South Alabama, Mobile, Alabama
› Author Affiliations
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Publication History

Publication Date:
22 December 2016 (online)

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Abstract

Paradoxical puborectalis contraction (PPC) and increased perineal descent (IPD) are subclasses of obstructive defecation. Often these conditions coexist, which can make the evaluation, workup, and treatment difficult. After a thorough history and examination, workup begins with utilization of proven diagnostic modalities such as cinedefecography and anal manometry. Advancements in technology have increased the surgeon's diagnostic armamentarium. Biofeedback and pelvic floor therapy have proven efficacy for both conditions as first-line treatment. In circumstances where PPC is refractory to biofeedback therapy, botulinum toxin injection is recommended. Historically, pelvic floor repair has been met with suboptimal results. In IPD, surgical therapy now is directed toward the potentially attendant abnormalities such as rectoanal intussusception and rectal prolapse. When these associated abnormalities are not present, an ostomy should be considered in patients with IPD as well as medically refractory PPC.

Keywords

obstructive defecation syndrome - paradoxical puborectalis contraction - descending perineum syndrome - increased perineal descent - dyssynergic defecation - biofeedback