title: Paradoxical puborectalis contraction in patients after pelvic pouch construction.
abstract: Normal defecation is associated with relaxation of sphincters during the evacuation process. However, obstructive defecation is sometimes seen clinically manifested by abnormal contraction of the puborectalis during defecation rather than relaxing. This condition has not previously been described after pelvic pouch construction.
  
  
  OBJECTIVE
  This study was done to evaluate patients for defecation difficulties caused by paradoxical puborectalis contraction after pelvic pouch procedures.
  
  
  METHODS
  Prospectively, patients with defecation difficulties were questioned. They then underwent electromyography if they met particular criteria. Biofeedback was offered to all patients demonstrating paradox on electromyography. Follow-up was by clinic visits and interviews.
  
  
  RESULTS
  After pelvic pouch construction, 13 patients were found to have paradoxical puborectalis contraction. Twelve of 13 patients elected to have biofeedback therapy. Eleven of these 12 were available for follow-up an average of eight (1-15) months after biofeedback. Nine improved, and two had no change in their defecation difficulty. Of the initial 13, 10 had an event, either pouchitis or abdominal trauma, directly before their defecation problems.
  
  
  CONCLUSIONS
  Paradoxical puborectalis contraction can occur in patients after pelvic pouch surgery. It should be suspected in patients with defecation difficulties in the absence of an anatomic abnormality. Biofeedback is effective treatment.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Foundation, Ohio 44195, USA.
authors.forename: T L
authors.initials: TL
authors.lastname: Hull
authors.forename: V W
authors.initials: VW
authors.lastname: Fazio
authors.forename: T
authors.initials: T
authors.lastname: Schroeder
mesh_terms: D001676:Biofeedback, Psychology; D003248:Constipation / Q000209:etiology* / Q000628:therapy; D003672:Defecation / Q000502:physiology*; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D009119:Muscle Contraction; D016737:Proctocolectomy, Restorative / Q000009:adverse effects* / Q000534:rehabilitation; D011446:Prospective Studies