Journal of clinical practice and research · 2024
Examination of the Anorectal Angle and Pubococcygeal Line in Adults with Anal Disorders and Defecation Irregularities Using Magnetic Resonance Imaging.
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Kıraç Sedanur Elmalı, Sapmaz Hilal Irmak, Sağlam Sevgi Yılmaz
Аннотация
OBJECTIVE: This study explores the role of pelvic floor (PF) muscles in individuals with anal area diseases and defecation irregularities.
MATERIALS AND METHODS: Anorectal angle (ARA), pubococcygeal line (PCL), and the distance between ARA and PCL were measured retrospectively in 392 images from patients over 18 years old who underwent lower abdomen magnetic resonance (MR) defecography (sagittal, T2 sequence). The patients presented with complaints of fecal incontinence, chronic constipation, anal fissures, hemorrhoids, anal abscesses, and anal or perianal fistulas. Measurements were taken during three phases: rest, Valsalva maneuver, and the final phase of defecation. Patients were categorized according to the World Health Organization's age classification, and average ages for childbirth and menopause were determined using data from the Turkish Statistical Institute.
RESULTS: Across all patients, the ARA did not sufficiently constrict during Valsalva, and was wider in women during all defecation phases. The ARA was wider at rest in patients aged 65 and over, and during the final defecation phase in the 45-64 age group compared to other age groups. Throughout all phases of defecation, the PCL was longer in women and in the 45-64 age group than in others; PF descent during Valsalva and the final phase was greater in these groups as well.
CONCLUSION: The findings highlight that PF insufficiency is more pronounced in the postmenopausal period. Evaluation of the PF should be integrated into the diagnostic and treatment protocols for anal area diseases, with an emphasis on PF rehabilitation.
MATERIALS AND METHODS: Anorectal angle (ARA), pubococcygeal line (PCL), and the distance between ARA and PCL were measured retrospectively in 392 images from patients over 18 years old who underwent lower abdomen magnetic resonance (MR) defecography (sagittal, T2 sequence). The patients presented with complaints of fecal incontinence, chronic constipation, anal fissures, hemorrhoids, anal abscesses, and anal or perianal fistulas. Measurements were taken during three phases: rest, Valsalva maneuver, and the final phase of defecation. Patients were categorized according to the World Health Organization's age classification, and average ages for childbirth and menopause were determined using data from the Turkish Statistical Institute.
RESULTS: Across all patients, the ARA did not sufficiently constrict during Valsalva, and was wider in women during all defecation phases. The ARA was wider at rest in patients aged 65 and over, and during the final defecation phase in the 45-64 age group compared to other age groups. Throughout all phases of defecation, the PCL was longer in women and in the 45-64 age group than in others; PF descent during Valsalva and the final phase was greater in these groups as well.
CONCLUSION: The findings highlight that PF insufficiency is more pronounced in the postmenopausal period. Evaluation of the PF should be integrated into the diagnostic and treatment protocols for anal area diseases, with an emphasis on PF rehabilitation.