Anorectal Disorders Exhibiting Pathologic Defecograms (cont.)

• The descending perineum syndrome is believed to be caused by diminished tone in the muscles of the pelvic floor, elongated by years of repeated straining in an effort to evacuate, and may eventually result in denervation of the external anal sphincter by stretching of the pudendal nerve branches.

• It is a clinical condition in which the patient complains of a sensation of obstruction of evacuation, mucous or bloody anal discharge, a vague, dull, aching pain in the perineum, and eventually, fecal incontinence.

• Evacuation is sometimes achieved only by resorting to maneuvers to aid emptying, such as digital removal of stool, direct pressure on the perineum, or pressure on the vagina.

• Defecography reveals abnormaly low pelvic floor position at rest. When a straining effort is made, the pelvic floor descends more than 3.5 cm, and the posterior rectal wall bulges posteriorly between the coccyx and the anus. In some patients, there is an associated rectal intussusception or rectocele.