Dyskinetic Puborectalis Muscle (Spastic
Pelvic Floor Syndrome, Anismus)
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The puborectalis muscle sling normally relaxes when evacuation begins, and
its impression on the posterior wall of the distal rectum progressively
disappears.
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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.
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This disorder may be associated with
other problems, such as anal fissure, rectocele, rectal intussusception,
and solitary rectal ulcer.
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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.
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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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