Defecographic evaluation of patients with defecation difficulties.

Defecographic studies were carried out in 36 females and 19 males with specific complaints of straining with defecation, incomplete rectal emptying and perineal descent. Of these, 91% had abnormal defecographic findings. Abnormalities were more common in females than in males. The female patients mean anorectal angles were 111.3 degrees (resting), 102.2 degrees (squeezing) and 124.7 degrees (straining). Their mean anterior rectocele size was 1.8 cm and the mean difference between the pelvic floor and the anorectal junction at rest and during maximal straining, the mean Ds-R, was also 1.8 cm. Ninety-one percent of the females had anterior rectoceles, 33% had internal rectal intussusception, 25% had hypertonic puborectalis slings and 22% had a Ds-R > 3 cm. The mean anorectal angles of the males were 116.3 degrees (resting), 102.0 degrees (squeezing) and 132.9 degrees (straining) and the mean Ds-R was 2.0 cm. Sixty-eight percent of the males had hypertonic puborectalis slings, 58% had internal rectal intussusception, and 42% had a Ds-R > 3 cm. All patients with hypertonic puborectalis slings had smaller, more acute straining angles. Males with abnormal perineal descent had a greater Ds-R than patients without perineal descent.