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. 2008 May;21(2):138-45.
doi: 10.1055/s-2008-1075863.

Paradoxical puborectalis contraction and increased perineal descent

Ron G Landmann  1 , Steven D Wexner
Affiliations

Paradoxical puborectalis contraction and increased perineal descent

Ron G Landmann et al. Clin Colon Rectal Surg. 2008 May.

Abstract

Paradoxical puborectalis contraction and increased perineal descent are two forms of functional constipation presenting as challenging diagnostic and treatment dilemmas to the clinician. In the evaluation of these disorders, the clinician should take special care to exclude anatomic disorders leading to constipation. Physical examination is supplemented by additional diagnostic modalities such as cinedefecography, electromyography, manometry, and pudendal nerve tefninal motor latency. Generally, these investigations should be used in combination with the two playing the more relied upon techniques. Treatment is typically conservative with biofeedback playing a principal role with favorable results when patient compliance is emphasized. When considering paradoxical puborectalis contraction, failure of biofeedback is usually augmented with botulinum toxin injection. Increased perineal descent is generally treated with biofeedback and perineal support maneuvers. Surgery has little or no role in these conditions. The patient who insists on surgical intervention for either of these two conditions should be offered a stoma.

Keywords: Constipation; biofeedback; botox; colectomy; increased perineal descent; paradoxical puborectalis contraction; stoma.

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Figures

Figure 1
Figure 1
Algorithm for the diagnosis and management of paradoxical puborectalis contraction and increased perineal descent.
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