The following is a summary of “Relevance of the Excessive Perineal Descent in the Obstructed Defecation Syndrome: A Prospective Study of 141 Patients,” published in the November 2023 issue of Gastroenterology by Brillantino, et al.
Many people agree that too much effort and perineal descent are linked, but it’s still not clear what clinical meaning perineal descent has in people with blocked defecation syndrome. For a study, researchers sought to find out how common abnormal perineal descent is in people with blocked defecation syndrome and how it affects the severity of their symptoms. Three hospital pelvic care centers took part in the study from January 2018 to January 2022.
There were 141 continuous adult patients in the study with a blocked defecation syndrome score of 9 or more and no signs of organic GI disease. All of the patients had a dynamic pelvic MRI and anal manometry if they thought they might have paradoxical puborectalis tightness. The primary outcomes were the number of cases of abnormal perineal descent and the relationship between perineal descent and the blocked defecation syndrome score. About 228 patients, or 90.7%, finished the magnetic resonance test and were included in the study. There was a normal perineal descent in 18 of these patients (14.1%) and an excessive perineal descent in 110 of these patients (84.9%). In 46.1% of patients (12/26) with MRI signs of abnormal puborectalis contraction and in 96% of patients (98/102) with normal puborectalis relaxation, the perineum dropped too far down.
A strong link was found between the blocked defecation syndrome score and the deepest fall of the perineum during pushing in this last group of patients (Spearman r test: 0.68; P < 0.0001). The sample size was too small, and the people chosen for the study were very carefully chosen. People who have delayed defecation syndrome and a high symptom score often have excessive perineal descent. It happens almost always in people who don’t have paradoxical puborectalis tightness. In these cases, the greatest perineal drop seems to be strongly linked to how bad their symptoms are.
