title: Anal manometric predictors of significant rectocele in constipated patients.
abstract: The diagnosis of significant rectocele is currently made on the basis of cinedefecographic findings. Clinical examination alone will only allow assessment of the presence but not the significance of a rectocele. Therefore, the aim of this study was to determine if anal manometric findings can predict the significance of a rectocele. All patients with a diagnosis of constipation and rectocele confirmed on cinedefecography between 1992 and 1998 were retrospectively reviewed. Significant rectocele was defined as the presence of three of the following five parameters: rectocele >4 cm in diameter as measured during the evacuatory phase of cinedefecography, rectal and/or vaginal symptoms present for longer than 12 months, persistence of rectal or vaginal symptoms for at least four weeks, despite increased dietary fiber (up to 35 g/day), need for rectal and/or vaginal digitation or perineal support maneuvers for rectal evacuation. Statistical analysis was performed using the Mann-Whitney test and Fisher's exact test. A logistic regression model with stepwise selection was used to determine significant prognostic factors. A total of 305 patients (31 men) with rectocele, with a median age of 68 years (range, 12-89) were identified. Of these, 89 (29.2%) had significant rectoceles. There was no difference in the frequency of significant and non-significant rectoceles with respect to gender or age. However, patients with a significant rectocele compared to those with a non-significant rectocele had higher median first sensation volume (45 vs. 30 ml, p=0.0005), median capacity (160 vs. 120 ml, p<0.0001), and median compliance (10 vs. 8 ml H(2)O/mmHg, p=0.05). Calculations based on a logistic regression model determined that with a first sensation of 100 ml, a capacity of 400 ml, and a compliance of 50 ml/mmHg, the probability of a significant rectocele would be 85%. In conclusion, anal manometric findings may be useful in predicting significant rectocele in constipated patients.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL 33331, USA.
authors.forename: N A
authors.initials: NA
authors.lastname: Rotholtz
authors.forename: J E
authors.initials: JE
authors.lastname: Efron
authors.forename: E G
authors.initials: EG
authors.lastname: Weiss
authors.forename: J J
authors.initials: JJ
authors.lastname: Nogueras
authors.forename: S D
authors.initials: SD
authors.lastname: Wexner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002648:Child; D003248:Constipation / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003672:Defecation / Q000502:physiology; D019841:Defecography; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011237:Predictive Value of Tests; D020047:Rectocele / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology*; D012189:Retrospective Studies