TY - JOUR
T1 - Increased Grades of Rectal Intussusception
T2 - Role of Decline in Pelvic Floor Integrity and Association with Dyssynergic Defecation
AU - Neshatian, Leila
AU - Triadafilopoulos, George
AU - Wallace, Shannon
AU - Jawahar, Anugayathri
AU - Sheth, Vipul
AU - Shen, Sa
AU - Gurland, Brooke
N1 - Publisher Copyright:
© 2024 Wolters Kluwer Health. All rights reserved.
PY - 2024/5/1
Y1 - 2024/5/1
N2 - INTRODUCTION:The natural history of rectal intussusception (RI) is poorly understood. We hypothesized that decline in pelvic floor integrity and function leads to increasing RI grades.METHODS:Retrospective analysis of a registry of patients with defecatory disorders with high-resolution anorectal manometry and magnetic resonance defecography was performed. Association of risk factors on increasing RI grades was assessed using logistic regression.RESULTS:Analysis included a total of 238 women: 90 had no RI, 43 Oxford 1-2, 49 Oxford 3, and 56 Oxford 4-5. Age (P = 0.017), vaginal delivery (P = 0.008), and prior pelvic surgery (P = 0.032) were associated with increased Oxford grades. Obstructive defecation symptoms and dyssynergic defecation were observed at relatively high rates across groups. Increased RI grades were associated with less anal relaxation at simulated defecation yet, higher rates of normal balloon expulsion (P < 0.05), linked to diminished anal sphincter. Indeed, increased RI grades were associated with worsening fecal incontinence severity, attributed to higher rates of anal hypotension. Levator ani laxity, defined by increased levator hiatus length and its excessive descent at straining, was associated with increasing RI grades, independent of age, history of vaginal delivery, and pelvic surgeries and could independently predict increased RI grades. Concurrent anterior and posterior compartments, and visceral prolapse were associated with higher Oxford grades.DISCUSSION:Our data suggest that decline in pelvic floor integrity with abnormal levator ani laxity is associated with increased RI grades, a process that is independent of age, history of vaginal deliveries, and/or pelvic surgeries, and perhaps related to dyssynergic defecation.
AB - INTRODUCTION:The natural history of rectal intussusception (RI) is poorly understood. We hypothesized that decline in pelvic floor integrity and function leads to increasing RI grades.METHODS:Retrospective analysis of a registry of patients with defecatory disorders with high-resolution anorectal manometry and magnetic resonance defecography was performed. Association of risk factors on increasing RI grades was assessed using logistic regression.RESULTS:Analysis included a total of 238 women: 90 had no RI, 43 Oxford 1-2, 49 Oxford 3, and 56 Oxford 4-5. Age (P = 0.017), vaginal delivery (P = 0.008), and prior pelvic surgery (P = 0.032) were associated with increased Oxford grades. Obstructive defecation symptoms and dyssynergic defecation were observed at relatively high rates across groups. Increased RI grades were associated with less anal relaxation at simulated defecation yet, higher rates of normal balloon expulsion (P < 0.05), linked to diminished anal sphincter. Indeed, increased RI grades were associated with worsening fecal incontinence severity, attributed to higher rates of anal hypotension. Levator ani laxity, defined by increased levator hiatus length and its excessive descent at straining, was associated with increasing RI grades, independent of age, history of vaginal delivery, and pelvic surgeries and could independently predict increased RI grades. Concurrent anterior and posterior compartments, and visceral prolapse were associated with higher Oxford grades.DISCUSSION:Our data suggest that decline in pelvic floor integrity with abnormal levator ani laxity is associated with increased RI grades, a process that is independent of age, history of vaginal deliveries, and/or pelvic surgeries, and perhaps related to dyssynergic defecation.
KW - MRI defecography
KW - anorectal manometry
KW - dyssynergic defecation
KW - fecal incontinence
KW - levator hiatus
KW - obstructive defecation
KW - rectal intussusception
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U2 - 10.14309/ajg.0000000000002605
DO - 10.14309/ajg.0000000000002605
M3 - Article
C2 - 37975595
AN - SCOPUS:85192113531
SN - 0002-9270
VL - 119
SP - 946
EP - 956
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
IS - 5
ER -