title: Role of age, bowel function and parity on anorectocele pathogenesis according to cinedefecography and anal manometry evaluation.
abstract: OBJECTIVE
  The study aimed to verify the role of parity, age and bowel function in the pathogenesis of anorectocele.
  
  
  METHODS
  A cross-sectional study was conducted regarding age, obstetrical history, Cleveland Clinic Constipation Score (CCCS), cinedefecography and anal manometry findings. Forty-five adult women complaining of obstructed defecation were evaluated; the median age was 46 years and median CCCS, 13. Fifteen patients were nulliparous and 23 multiparous (median parity 2). Eighteen had a history of episiotomy, fourteen delivered large babies and two had forceps-assisted delivery. Statistical analysis was performed using Spearman's correlation test and Fisher's exact test.
  
  
  RESULTS
  Anal hypertonia was found in 14 (31.1%) patients, anal hypotonia in eight (17.8%), anismus in 13 (28.9%) and anorectoceles in 34 (75.6%) [median size 2.8 cm (0-6.4)]. There were no correlations between anorectocele and anal hypertonia (P = 0.7171), anismus (P = 0.4666), parity comparing nulliparous and multiparous patients (P = 1.000), episiotomy (P = 1.0000), forceps assistance (P = 1.0000), delivery of a large baby (P = 1.0000) anal resting pressure (P = 0.0883), anal voluntary pressure (P = 0.7327), parity (P = 0.4987) and age (P = 0.8603). There were correlations between anorectocele and the CCCS (P = 0.0082) and anal hypotonia (P = 0.0141).
  
  
  CONCLUSIONS
  Anorectocele is not correlated with parity, age, episiotomy, delivery of a large baby and anismus. It was more frequent in patients with severe constipation and less common in patients with anal hypotonia.
authors.affiliation: Department of Surgery, Medical School, Federal University of Ceará, Fortaleza, Ceará, Brazil. fa-soares@uol.com.br
authors.forename: F A
authors.initials: FA
authors.lastname: Soares
authors.forename: F S P
authors.initials: FS
authors.lastname: Regadas
authors.forename: S M
authors.initials: SM
authors.lastname: Murad-Regadas
authors.forename: L V
authors.initials: LV
authors.lastname: Rodrigues
authors.forename: F R S
authors.initials: FR
authors.lastname: Silva
authors.forename: R D
authors.initials: RD
authors.lastname: Escalante
authors.forename: R F
authors.initials: RF
authors.lastname: Bezerra
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal; D003248:Constipation / Q000000981:diagnostic imaging* / Q000209:etiology*; D003430:Cross-Sectional Studies; D019841:Defecography; D004841:Episiotomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008365:Manometry; D008875:Middle Aged; D009123:Muscle Hypotonia / Q000209:etiology; D010298:Parity; D011247:Pregnancy; D020047:Rectocele / Q000000981:diagnostic imaging* / Q000209:etiology*; D012306:Risk; D055815:Young Adult