title: Perineal descent does not imply a more severe clinical disorder.
abstract: OBJECTIVE
  There is poor consensus in the literature about measuring perineal descent. We aimed to assess symptoms and quality of life in constipated patients with abnormal perineal descent.
  
  
  METHODS
  Constipated patients were categorized into those with obstructed defaecation, colonic inertia, mixed disorders and irritable bowel syndrome constipation types. Anal physiology was performed. KESS score, Irritable Bowel Syndrome Quality of Life and SF-12 questionnaires were completed. The position of the perineum was measured by defaecography. Patients were divided into two groups according to the position of the perineal descent at rest: group 1 (normal < 3.5 cm) and group 2 (abnormal > 3.5 cm).
  
  
  RESULTS
  Fifty-eight patients were identified, 23 (40%) in group 1 and 35 (60%) in group 2. Patients in group 2 were older (P = 0.007), had a higher body mass index (BMI; P = 0.003), a higher rate of hysterectomy (P = 0.04) and more vaginal deliveries (P = 0.001). Obstructed defaecation was the predominant subtype of constipation. Group 1 had more difficulty in initiating defaecation and group 2 presented more cases with intussusception and enterocele (P = 0.03 for both). Group 2 had a lesser degree of perineal descent between rest and straining. Rectal compliance was greater in group 2 (P = 0.03). Symptoms and quality of life scores were similar between the groups.
  
  
  CONCLUSIONS
  Radiologically determined excessive perineal descent is not indicative of worse symptoms or quality of life. This radiological finding does not warrant further investigation.
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: P C
authors.initials: PC
authors.lastname: Alves-Ferreira
authors.forename: B
authors.initials: B
authors.lastname: Gurland
authors.forename: M
authors.initials: M
authors.lastname: Zutshi
authors.forename: T
authors.initials: T
authors.lastname: Hull
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003248:Constipation / Q000145:classification* / Q000209:etiology / Q000503:physiopathology; D003672:Defecation / Q000502:physiology*; D019841:Defecography; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000150:complications; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires