puborectalis syndrome
Introduction
Introduction to puborectalis syndrome The puborectalis syndrome (puborectalissyndrome) is a defecation disorder characterized by puborectal tendon hypertrophy, which causes obstruction at the outlet of the pelvic floor. Histological changes are characterized by puborectalis muscle fiber hypertrophy. basic knowledge The proportion of illness: 0.003%-0.004% Susceptible people: no specific people Mode of infection: non-infectious complication:
Cause
Cause of puborectal muscle syndrome
(1) Causes of the disease
The cause is still unclear, and may be related to factors such as the abuse of laxatives and pelvic floor tendon in chronic inflammation around the anal canal (such as abscess in the rectal rectum).
(two) pathogenesis
Currently there are no related content description.
Prevention
Prevention of puborectalis syndrome
1. Avoid eating too little or too fine food, lack of residue, and less stimulation of colonic movement.
2. Avoid the interference of bowel habits: Due to mental factors, changes in lifestyle, excessive fatigue caused by long-distance travel, etc., it is easy to cause constipation.
3. Avoid abuse of laxatives: Abuse of laxatives can weaken the sensitivity of the intestines, creating a dependence on certain laxatives and causing constipation.
4. Arrange the life and work reasonably, and make a combination of work and rest. Appropriate stylistic activities, especially abdominal muscle exercises, are beneficial to the improvement of gastrointestinal function, and are more important for those who are sedentary and mentally concentrated.
5. Develop good bowel habits, regular bowel movements every day, form conditioned reflexes, and establish good rules of defecation. Do not ignore when you have a will, and defecate in time. The environment and posture of defecation are as convenient as possible, so as not to suppress the intention and destroy the habit of defecation.
Complication
Complications of puborectalis syndrome Complication
Excessive forced bowel movements in the elderly can induce transient ischemic attack or defecation syncope, even in the presence of atherosclerosis complicated by myocardial infarction and stroke. Constipation can cause or aggravate hemorrhoids and other perianal diseases. Intestinal obstruction, fecal ulcers, urinary retention and fecal incontinence can occur after fecal impaction.
Symptom
Symptoms of puborectal syndrome common symptoms defecation time is too long puborectal tendon hypertrophy constipation
Clinical manifestations have the following characteristics:
1 slow, progressively worse defecation;
2 defecation requires enema assistance or laxatives, and the dosage of laxatives gradually increases;
3 Excessive exertion during defecation, often loud and loud, sweating;
4 defecation time is too long, often need 0.5 to 1h each time;
5 times frequent, there is a lack of bowel movements;
6 often have anal and posterior pain before and after defecation, or a heavy pressure in the lower rectum.
Examine
Examination of puborectalis syndrome
1. Rectal examination of anal canal tension increased, length of anal canal lengthened, puborectalis muscle is more hypertrophy, sometimes sharp edges, often tender.
2. Anal canal pressure measurement Both static pressure and systolic blood pressure increase, and the length of sphincter function increases, up to 5-6 cm.
3. Airbag ejection test 50ml airbag from the rectal discharge time is extended (usually more than 5min) or can not be discharged.
4. Pelvic floor muscle EMG puborectalis muscle has significant abnormal myoelectric activity.
5. Colonic function tests have obvious rectal retention.
6. The dynamic contrast of defecation dynamic angiography is still normal, but still, sputum and defecation show that the rectal angle becomes smaller, the anal canal becomes longer, the contrast agent is not discharged or less, and the puborectalis muscle "shelf sign", that is, sitting quietly, During the levator ani and force, the rectal muscles of the pubis are flat or unchanged (Fig. 1).
Diagnosis
Diagnosis and diagnosis of puborectalis syndrome
The patient had a history of chronic constipation, which was characterized by progressive defecation and difficulty in defecation, frequent bowel movements, prolonged defecation time; rectal examination, obvious hypertrophy of the puborectal muscle, tenderness; abnormal anal canal defecation and bowel movement, increased sphincter length, and fecal discharge The angiography shows "shelf sign", etc., and the diagnosis can be confirmed.
The disease should be differentiated from the pelvic floor tendon syndrome, which is a functional disease characterized by spasm contraction of the pelvic floor muscles.
When the normal person is at rest, the puborectal muscle is in a contracted state, and the muscle relaxes during defecation to facilitate the discharge of feces. If the puborectal muscle does not relax, but the contraction is strengthened, it will affect the bowel movement. In the angiography, the rectal angle of the anal canal does not increase during sputum and still maintains the original 90° or less. Kujipers believes that this continuous contraction during sputum represents muscle dysfunction of the pelvic floor muscle, rather than defecation dynamics. An arbitrary contraction that occurs during angiography. He named this persistent contraction as the pelvic floor tendon syndrome. The cause of this functional disorder is unclear. Similar to other causes of dysfunction, psychological factors may also arise. Role, the syndrome is also often associated with perineal decline, rectal intussusception, rectal prominence, treatment to restore normal muscle function, and the identification of puborectal muscle syndrome, the former manifested as pelvic floor spasm without Muscle fiber hypertrophy, although the angle of the anus is small, but there is a change in the X-ray film of each state during the dynamic contrast of defecation, and there is no "shelf sign", the latter can be seen more "shelf sign", the anal canal is longer, The rectal angle of the anus is small. During the whole dynamic process of defecation, the expectorant is often not discharged or discharged in a small amount. When the diagnosis is difficult, the rectal examination can assist in the identification. Some people think that the two may be the performance of different stages of the disease.
