title: Descending perineum syndrome: a review of the presentation, diagnosis, and management.
abstract: OBJECTIVE
  Defecatory dysfunction is a relatively common and challenging problem among women and one that practicing pelvic reconstructive surgeons and gynecologists deal with frequently. A subset of defecatory dysfunction includes obstructed defecation, which can have multiple causes, one of which is descending perineum syndrome (DPS).
  
  
  METHODS
  A literature search was performed to identify the pathophysiology, diagnosis, and management of DPS.
  
  
  RESULTS
  Although DPS has been described in the literature for many decades, it is still uncommonly diagnosed and difficult to manage. A high index of suspicion combined with physical examination consistent with excess perineal descent, patient symptom assessment, and imaging in the form of defecography are required for the diagnosis to be accurately made. Primary management options of DPS include conservative measures consisting of bowel regimens and biofeedback. Although various surgical approaches have been described in limited case series, no compelling evidence can be demonstrated at this point to support surgical intervention.
  
  
  CONCLUSIONS
  Knowledge of DPS is essential for the practicing pelvic reconstructive surgeon to make a timely diagnosis, avoid harmful treatments, and initiate therapy early on.
authors.affiliation: David Geffen School of Medicine, Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of California, Los Angeles, 10833 Le Conte Avenue, 27-139 CHS, Los Angeles, CA, 90095-1740, USA.
authors.forename: Zaid
authors.initials: Z
authors.lastname: Chaudhry
authors.affiliation: David Geffen School of Medicine, Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of California, Los Angeles, 10833 Le Conte Avenue, 27-139 CHS, Los Angeles, CA, 90095-1740, USA. ctarnay@mednet.ucla.edu.
authors.forename: Christopher
authors.initials: C
authors.lastname: Tarnay
mesh_terms: D003672:Defecation; D019468:Disease Management; D005260:Female; D006801:Humans; D059952:Pelvic Floor Disorders / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D010502:Perineum / Q000503:physiopathology*; D012005:Rectal Prolapse / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D013577:Syndrome
keywords: Anal incontinence; Descending perineum syndrome; Obstructed defecation