Defecography

Defecography (also known as proctography, defecating/defecation proctography, evacuating/evacuation proctography or dynamic rectal examination) is a type of medical radiological imaging in which the mechanics of a patient's defecation are visualized in real time using a fluoroscope. The anatomy and function of the anorectum and pelvic floor can be dynamically studied at various stages during defecation. Defecating proctography was pioneered in 1945, during World War II. The procedure gained popularity at this time in the midst of an outbreak of whipworm, which is known to cause rectal prolapse. It has since become used for diagnosis of various anorectal disorders, including anismus and other causes of obstructed defecation. It has fallen out of favor due to inadequate training in the technique. It is now only performed at a few institutions. Many radiology residents refer to the procedure as the "Def Proc", "Defogram", or "Stool Finale". Defecography may be indicated for the following reasons: Evaluation of rectal outlet obstruction (obstructed defecation) symptoms Evaluation of all types of rectal (fecal) incontinence. Suspected conditions such as internal rectal intussusception, enterocele, anismus, rectocele or sigmoidocele. To compare pre- and post-surgical repair of rectal outlet obstruction (obstructed defecation). Specifically, defecography can differentiate between anterior and posterior rectocele. Also, in external rectal prolapse that was not directly visualized during examination, this radiographic projection will demonstrate its presence. In females, pre-procedural preparation involves smearing a small amount of barium contrast agent in the vagina, which will help to identify if anterior rectocele, enterocele or sigmoidocele is present. The technique itself involves the insertion of a caulking gun device into the rectum with a subsequent manual infusion of barium paste until there is adequate distension. The patient is then transferred to a portable plastic commode which is situated next to a fluoroscope which records the defecation.

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Obstructed defecation

Obstructed defecation syndrome (abbreviated as ODS, with many synonymous terms) is a major cause of functional constipation (primary constipation), of which it is considered a subtype. It is characterized by difficult and/or incomplete emptying of the rectum with or without an actual reduction in the number of bowel movements per week. Normal definitions of functional constipation include infrequent bowel movements and hard stools.

Fecal incontinence

Fecal incontinence (FI), or in some forms encopresis, is a lack of control over defecation, leading to involuntary loss of bowel contents, both liquid stool elements and mucus, or solid feces. When this loss includes flatus (gas), it is referred to as anal incontinence. FI is a sign or a symptom, not a diagnosis. Incontinence can result from different causes and might occur with either constipation or diarrhea. Continence is maintained by several interrelated factors, including the anal sampling mechanism, and incontinence usually results from a deficiency of multiple mechanisms.

Anismus

Anismus or dyssynergic defecation is the failure of normal relaxation of pelvic floor muscles during attempted defecation. It can occur in both children and adults, and in both men and women (although it is more common in women). It can be caused by physical defects or it can occur for other reasons or unknown reasons. Anismus that has a behavioral cause could be viewed as having similarities with parcopresis, or psychogenic fecal retention. Symptoms include tenesmus (the sensation of incomplete emptying of the rectum after defecation has occurred) and constipation.