Posterior pelvic floor disorders: a prospective comparison using introital ultrasound and colpocystodefecography

Abstract

Objective: To compare introital ultrasound with colpocystodefecography (CCD) in quantifying the anorectal angle and in the diagnosis of posterior pelvic floor disorders.

Methods: Forty-three consecutive women with functional impairment of the posterior pelvic floor were enrolled after a clinical evaluation. Using both CCD and introital ultrasound examination, the anorectal angle was measured during squeezing to evaluate the strength of voluntary muscle contraction and during straining to assess pelvic floor relaxation. Rectocele depth and the presence of intussusception were assessed. The performance of CCD and that of introital ultrasound were compared.

Results: Good concordance was obtained between introital ultrasound and CCD. The intraclass correlation coefficient was 0.82 (95% CI, 0.69-0.89) for measurement of the anorectal angle during squeezing and 0.67 (95% CI, 0.47-0.81) during straining. Rectoceles > 4 cm on CCD were detected by introital ultrasound in 100% of cases, and there was 91% agreement for rectal intussusception. Cohen's kappa index was moderate for rectocele assessment (0.41, P < 0.01) and excellent for intussusception (0.91, P < 0.001). It was also noted that introital ultrasound could be used to detect pelvic floor dyssynergia.

Conclusions: Introital ultrasound is a simple, accurate, non-invasive method with which to assess anorectal dynamics.