Pelvic floor dysfunction at transperineal ultrasound and chronic constipation in women with endometriosis

Patients and doctors often define constipation differently. The normal frequency of defaecation is once every 3 days to three times per day, and constipation may be defined as abnormally infrequent defaecation. A change in the normal pattern and frequency for the particular patient is pertinent. There are numerous causes of constipation, and most can be encountered in both primary and secondary care. In patients with chronic constipation without an evident cause, irritable bowel syndrome (IBS) is the cause in 59%, pelvic floor dysfunction in 25%, slow transit in 13%, and a combination of pelvic floor dysfunction and slow transit in 3%. Constipation affects twice as many women as men, with a higher prevalence in pregnant women. Prevalence is also greater in the elderly, affecting ~20% in the community.

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Chronic constipation - the role of clinical assessment and colorectal physiologic tests to obtain an etiologic diagnosis

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032008000100010 ◽

2008 ◽

Vol 45 (1) ◽

pp. 50-57 ◽

Cited By ~ 11

Author(s):

Antônio Lacerda-Filho ◽

Marcílio José Rodrigues Lima ◽

Marisa Fonseca Magalhães ◽

Rodrigo de Almeida Paiva ◽

José Renan da Cunha-Melo

Keyword(s):

Irritable Bowel Syndrome ◽

Differential Diagnosis ◽

Pelvic Floor ◽

Clinical Assessment ◽

Chronic Constipation ◽

Pelvic Floor Dysfunction ◽

Fecal Impaction ◽

Clinical Parameters ◽

Irritable Bowel ◽

Etiologic Diagnosis

BACKGROUND: Diagnosis of subtypes of chronic constipation has been considered difficult to achieve even in specialized centers. Although colorectal physiologic tests have brought an important contribution, it remains unclear in which patients these tests should be indicated for. AIMS: This study aims to establish a differential diagnosis for chronic constipation cases using clinical assessment and physiologic tests and to identify clinical parameters that could predict which patients need physiologic tests. METHODS: One hundred and seventy nine patients (83% females; mean age, 45) with chronic constipation according to Rome II criteria were initially treated by dietary advice and functional reeducation and those unresponsive (110 or 61.5%) were submitted to colonic transit time, defecography, anorectal manometry and electromyography, as needed. RESULTS: A differential diagnosis was achieved in 63.6% of patients tested. However, 61.5% of 179 patients with chronic constipation (69 with no need to tests and 40 with normal tests) have etiologic diagnosis established only on clinical basis. Irritable bowel syndrome (32%), pelvic floor dysfunction (29%) and functional constipation due to faulty diet and life style habits (22%) were the main causes of chronic constipation. Alternating constipation and nausea/vomiting were symptoms significantly related to the diagnosis of irritable bowel syndrome; younger age, larger intervals between bowel movements, occurrence of fecal impaction and necessity of enema were related to the diagnosis of non-chagasic megacolon and digital assistance to evacuate and large rectocele or spastic pelvic floor on rectal exam were associated to pelvic floor dysfunction. Patients with long-standing constipation, fecal impaction, abdominal pain not eased after defecation, necessity for enemas, digital assistance and evidence of rectocele tended to be in need for physiologic tests to define the cause of chronic constipation. CONCLUSIONS: The etiologic diagnosis of chronic constipation can be achieved in most of patients on a clinical basis and some symptoms may be significantly related to specific diagnoses. Indications for physiologic tests should be based on specific clinical parameters.

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Electromyostimulation in the treatment of early forms of postpartum pelvic floor dysfunction

Voprosy ginekologii akušerstva i perinatologii ◽

10.20953/1726-1678-2021-3-63-68 ◽

2021 ◽

Vol 20 (3) ◽

pp. 63-68

Author(s):

O.L. Glazkova ◽

◽

D.Yu. Makeev ◽

S.V. Shmeleva ◽

R.E. Kuznetsov ◽

...

Keyword(s):

Pelvic Floor ◽

Pelvic Floor Dysfunction ◽

Rehabilitation Program ◽

Transperineal Ultrasound ◽

Trauma Patients ◽

Urethral Hypermobility ◽

Electrical Device ◽

First Child ◽

Number Of Patients ◽

Q System

Objective. To study the results of electromyostimulation using an electrical device Tonis in patients with minimal signs of postpartum pelvic floor trauma. Patients and methods. The study included 24 women aged 20–32 years (27.4 (24.4; 29.1)) who were observed 6–12 months after delivery of their first child through vaginal childbirth in a cephalic presentation and whose examination revealed minimal signs of pelvic floor trauma or dysfunction. The electromyostimulation trainer Tonis was used 20 minutes daily (postpartum rehabilitation program) for 3 months. Results. After 3 months of training, in all patients, previously minimal complaints ceased. The POP-Q measurements significantly improved almost in all patients: the uterus was in a higher position, the topography of both the anterior and posterior vaginal walls improved, and the genital hiatus narrowed. Conclusion. Transperineal ultrasound showed a statistically significant improvement in the height of the central tendon of the perineum and in the muscle mass, the number of patients with muscle diastasis decreased, urethral hypermobility also decreased. Key words: postpartum rehabilitation, POP-Q system, transperineal ultrasound, electromyostimulation

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Dynamics of male pelvic floor muscle contraction observed with transperineal ultrasound imaging differ between voluntary and evoked coughs

Journal of Applied Physiology ◽

10.1152/japplphysiol.01225.2013 ◽

2014 ◽

Vol 116 (8) ◽

pp. 953-960 ◽

Cited By ~ 14

Author(s):

Ryan E. Stafford ◽

Stuart Mazzone ◽

James A. Ashton-Miller ◽

Christos Constantinou ◽

Paul W. Hodges

Keyword(s):

Pelvic Floor ◽

Pelvic Floor Muscle ◽

Pelvic Floor Dysfunction ◽

Levator Ani ◽

Transperineal Ultrasound ◽

Intraabdominal Pressure ◽

Voluntary Cough ◽

Bladder Base ◽

History Of ◽

Urological Disorders

Coughing provokes stress urinary incontinence, and voluntary coughs are employed clinically to assess pelvic floor dysfunction. Understanding urethral dynamics during coughing in men is limited, and it is unclear whether voluntary coughs are an appropriate surrogate for spontaneous coughs. We aimed to investigate the dynamics of urethral motion in continent men during voluntary and evoked coughs. Thirteen men (28–42 years) with no history of urological disorders volunteered to participate. Transperineal ultrasound (US) images were recorded and synchronized with measures of intraabdominal pressure (IAP), airflow, and abdominal/chest wall electromyography during voluntary coughs and coughs evoked by inhalation of nebulized capsaicin. Temporal and spatial aspects of urethral movement induced by contraction of the striated urethral sphincter (SUS), levator ani (LA), and bulbocavernosus (BC) muscles and mechanical aspects of cough generation were investigated. Results showed coughing involved complex urethral dynamics. Urethral motion implied SUS and BC shortening and LA lengthening during preparatory and expulsion phases. Evoked coughs resulted in greater IAP, greater bladder base descent (LA lengthening), and greater midurethral displacement (SUS shortening). The preparatory inspiration cough phase was shorter during evoked coughs, as was the latency between onset of midurethral displacement and expulsion. Maximum midurethral displacement coincided with maximal bladder base descent during voluntary cough, but followed it during evoked cough. The data revealed complex interaction between muscles involved in continence in men. Spatial and temporal differences in urethral dynamics and cough mechanics between cough types suggest that voluntary coughing may not adequately assess capacity of the continence mechanism.

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