Defecography

Defecography is a special test to check pelvic floor disorders. It helps find the causes of bowel and anorectal problems. This test shows how the pelvic floor muscles and rectum work when we poop.

People with long-term issues like constipation or fecal incontinence might need this test. It lets doctors see what’s going on in real-time. This helps them find the exact problem and treat it right.

This test is key in managing pelvic floor disorders. It helps doctors find the best treatment. Knowing about defecography is important for both patients and doctors dealing with these issues.

What is Defecography?

Defecography is a special imaging technique. It looks at how the pelvic floor and rectum work during bowel movements. This test helps understand the muscles, nerves, and organs involved in going to the bathroom.

Defining Defecography

In a defecography test, a contrast material like barium is put into the rectum. The person then tries to have a bowel movement while images are taken. These images show how the pelvic floor, rectum, and anal canal move during defecation.

Purpose of Defecography

The main goal of defecography is to check how well the pelvic floor works. It helps find problems that might cause bowel issues like constipation or incontinence. This test helps doctors see what’s wrong and how to fix it.

Defecography is key in seeing how the pelvic floor muscles work together. It can spot issues like a muscle that contracts the wrong way, causing trouble with bowel movements. It also finds problems like rectoceles or prolapse that block stool flow.

Indications for Defecography

Defecography is a key tool for diagnosing pelvic floor disorders. It helps find the causes of chronic constipation, obstructed defecation, and fecal incontinence. The test shows how the rectum and pelvic floor muscles move during bowel movements.

Chronic Constipation

Chronic constipation often leads to defecography tests. It’s linked to dyssynergic defecation, where muscles don’t work right during bowel movements. This test can spot these issues and suggest treatments.

Obstructed Defecation

Difficulty in passing stool is another reason for defecography. This problem might stem from rectocele or rectal prolapse. The test can find these issues and suggest the best treatment.

Fecal Incontinence

Fecal incontinence greatly affects a person’s life. Defecography can find the reasons, like weak muscles or prolapse. It can also show if dyssynergic defecation is the cause, where muscles contract the wrong way.

Preparing for a Defecography Procedure

Getting ready for a defecography procedure is key to success. Your doctor will give you clear patient instructions before the test. These will cover what to eat and how to prepare your bowels.

You might need to eat less fiber a few days before. This makes it easier to see inside your colon. You could also use a laxative or enema the night before or morning of the test.

On the day of the test, you’ll get a special rectal contrast like barium paste. It helps doctors see the rectum and nearby areas better. Here’s a quick guide on what to do before your defecography:

It’s important to follow your doctor’s patient instructions carefully. This ensures the best results and comfort during the test. If you have any questions, talk to your doctor before the procedure.

The Defecography Procedure

Defecography is a special X-ray technique that looks at the pelvic floor when we poop. It uses a contrast material, like barium sulfate, to see the muscles and rectum clearly.

Rectal Contrast Injection

The first step is to put a thick paste of barium sulfate into the rectum. This paste shows up white on X-rays, making it easy to see the rectal walls and nearby areas. The patient sits on a special commode for the imaging.

Fluoroscopic Imaging

After the paste is in, the patient does different actions like squeezing and straining. These actions are captured in real-time using fluoroscopy. This lets us see how the barium moves through the rectum and anus.

The images are taken at different times during defecation. This includes when the pelvic floor is at rest, when it’s squeezing, when it’s straining, and during evacuation.

Dynamic Imaging Techniques

Some places use more advanced imaging like cinedefecography or magnetic resonance defecography. These methods give detailed, three-dimensional views. They help spot small issues that might not show up on regular X-rays.

Cinedefecography makes a video-like sequence of X-rays. It shows the defecation process in detail. This helps us understand the pelvic floor and anorectal function better.

Interpreting Defecography Results

Defecography gives us a close look at how the pelvic floor works when we poop. Doctors look at the images to find any problems that might be causing symptoms.

Normal Findings

When everything is working right, a few important things happen. The anorectal angle gets wider as the puborectalis muscle relaxes. There should be little perineal descent. And, the rectal emptying should be complete, with no leftover contrast.

Abnormal Findings

Some issues might show up on the test:

• The anorectal angle doesn’t widen enough, meaning the puborectalis muscle isn’t relaxing right
• Too much perineal descent could mean weak pelvic floor muscles
• Not emptying the rectum fully might mean trouble with pooping or muscle issues
• Structural problems like rectocele, prolapse, or intussusception could also appear

These problems help doctors decide on the best treatment. This might include physical therapy, biofeedback, or surgery. By understanding the test results, doctors can make plans to help the pelvic floor work better and ease symptoms.

Pelvic Floor Disorders Diagnosed by Defecography

Defecography is a key tool for finding pelvic floor disorders. It helps spot issues like chronic constipation and fecal incontinence. This method shows the rectum and anal canal during bowel movements. It helps doctors find problems like pelvic organ prolapse and anal sphincter dysfunction.

Rectocele

A rectocele happens when the rectum bulges into the vagina. Defecography shows this by showing the rectum bulging during bowel movements. This can cause trouble with bowel movements and lead to constipation.

Rectal Prolapse

Rectal prolapse is when the rectum comes out through the anus. Defecography can spot this by showing the rectum moving out during bowel movements. This can cause problems with bowel movements and incontinence.

Dyssynergic Defecation

Dyssynergic defecation is when the pelvic floor muscles don’t work right. Defecography can find this by showing the muscles not relaxing during bowel movements. This can cause constipation and trouble with bowel movements.

The table below summarizes the key pelvic floor disorders diagnosed by defecography and their associated symptoms:

Complementary Diagnostic Tests

Defecography gives us a good look at how the pelvic floor works. But, other tests can give us even more information. Anorectal manometry and endoanal ultrasound are two tests that help us understand more about the anus and rectum. They check things like how strong the muscles are, how sensitive the rectum is, and if there are any muscle problems.

Anorectal Manometry

Anorectal manometry measures the pressure and feelings in the rectum and anus. It looks at:

• Resting and squeeze anal sphincter pressure
• Rectal sensation thresholds
• Pelvic floor muscle coordination during simulated defecation

This test can spot problems like weak muscles, trouble feeling when to go, and issues with bowel movements. It helps doctors decide the best treatment and adds to what defecography shows.

Endoanal Ultrasound

Endoanal ultrasound gives a close-up look at the muscles around the anus. It can find:

Endoanal ultrasound finds these problems and helps with what defecography and anorectal manometry show. Together, these tests give a full picture of pelvic floor issues. This helps doctors create treatment plans that really address the root of the problem.

Treatment Options for Pelvic Floor Dysfunction

After a pelvic floor disorder is diagnosed, several treatments are available. Pelvic floor physical therapy is one effective option. It includes exercises to strengthen and relax the pelvic floor muscles. This can help with bowel control, reduce pain, and improve symptoms of disorders like rectocele and dyssynergic defecation.

Biofeedback training is another helpful treatment. It teaches patients to control their pelvic floor muscles. Using sensors, patients learn to manage these muscles during bowel movements. Making lifestyle changes, like eating more fiber and staying hydrated, can also help manage pelvic floor dysfunction.

In severe cases, surgery might be needed. For example, a rectocele may require surgery to fix the weakened rectal wall. Rectal prolapse often needs surgery to fix the rectum’s position. The right surgery depends on the case and the doctor’s expertise.