Assessing Rectocele Depth and Its Association with Symptoms of Pelvic Floor Disorders Using Transperineal Ultrasound

Aim We investigated the clinical features of symptomatic rectoceles, as measured by transperineal ultrasound (TPUS), and evaluated the association between rectocele size and the clinical symptoms of pelvic floor disorders. Method This was a retrospective study using data obtained at a pelvic floor centre between August 2020 and January 2021. A total of 125 patients with defaecation disorders, such as constipation and faecal incontinence, were included. The preoperative questionnaire included the Cleveland Clinic Constipation Scoring System (CCCS, Wexner constipation score), Cleveland Clinic Incontinence Score (CCIS, Wexner incontinence score), faecal incontinence severity index (FISI), and faecal incontinence quality of life (FIQOL) scale. The size of the rectocele was measured on the trans-perineal 2D images. Patients were assigned to three groups based on rectocele size: no rectocele (<10 mm), ≥10 mm rectocele, and ≥15 mm rectocele. Results In the study population, 43 participants (34.4%) had no rectocele, 50 (40.0%) had ≥10 mm rectocele, and 32 (25.6%) had ≥15 mm rectocele. From the no rectocele to ≥15 mm rectocele group, the scores for the symptoms of incontinence and constipation increased, and the quality of life worsened. The CCIS (6.00±4.95 vs 8.62±5.77 vs 11.08±5.63, P = 0.004), FIQOL (13.72±4.19 vs 13.42±4.35 vs 10.38±3.88, P = 0.006), FISI (18.83±17.67 vs 25.15±17.34 vs 33.42±15.49, P = 0.010), and CCCS (7.50±6.26 vs 8.65±5.31 vs 13.11±5.90, P = 0.006), respectively. Conclusion The TPUS was a valuable method for the anatomical evaluation of symptomatic rectocele. The larger the size of the symptomatic rectocele measured using TPUS, the more severe the clinical symptoms.

Assessing the role of the pelvic canal in supporting the gut in humans

The human pelvic canal (true pelvis) functions to support the abdominopelvic organs and serves as a passageway for reproduction (females). Previous research suggests that these two functions work against each other with the expectation that the supportive role results in a narrower pelvic midplane, while fetal passage necessitates a larger opening. In this research, we examine how gut size relates to the size and shape of the true pelvis, which may have implications on how gut size can influence pelvic floor integrity. Pelves and in vivo gut volumes were measured from CT scans of 92 adults (48 female, 44 male). The true pelvis was measured at three obstetrical planes (inlet, midplane, outlet) using 11 3D landmarks. CT volumetry was used to obtain an individual’s gut size. Gut volume was compared to the pelvic planes using multiple regression to evaluate the relationship between gut size and the true pelvis. We find that, in males, larger gut sizes are associated with increased mediolateral canal dimensions at the inlet and midplane. In females, we find that larger gut sizes are associated with more medially-projecting ischial spines and an anteroposteriorly longer outlet. We hypothesize that the association of larger guts with increased canal width in males and increased outlet length in females are adaptations to create adequate space for the gut, while more medially projecting ischial spines reduce the risk of pelvic floor disorders in females, despite its possible spatial consequences for fetal passage.