Gastrointestinal Radiology > Procedures > Defecography > Defecography (13)

Defecography (cont.)

Anorectal Disorders Exhibiting Pathologic Defecograms (cont.)

Dyskinetic Puborectalis Muscle (Spastic Pelvic Floor Syndrome, Anismus)
  • The puborectalis muscle sling normally relaxes when evacuation begins, and its impression on the posterior wall of the distal rectum progressively disappears.
  • In some patients, however, the impression increases because of paradoxical hypertrophic muscular contractions that can be intermittent or continuous. When this occurs, the patient feels a sensation of anal blockage and incomplete evacuation.
  • This disorder may be associated with other problems, such as anal fissure, rectocele, rectal intussusception, and solitary rectal ulcer.
  • In this disorder, defecography shows that the puborectalis muscle impression is increased, the ARA is decreased, and evacuation is stopped despite repeated straining and an open anal canal.
  • However, in some patients with the spastic pelvic floor syndrome, the puborectalis muscle relaxes, but the anal sphincter muscle fails to relax.

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