title: Anismus, Physiology, Radiology: Is It Time for Some Pragmatism? A Comparative Study of Radiological and Anorectal Physiology Findings in Patients With Anismus.
abstract: OBJECTIVE
  Anismus is a functional disorder featuring obstructive symptoms and paradoxical contractions of the pelvic floor. This study aims to establish diagnosis agreement between physiology and radiology, associate anismus with morphological outlet obstruction, and explore the role of sphincteric pressure and rectal volumes in the radiological diagnosis of anismus.
  
  
  METHODS
  Consecutive patients were evaluated by using magnetic resonance imaging proctography/fluoroscopic defecography and anorectal physiology. Morphological radiological features were associated with physiology tests. A categorical analysis was performed using the chi-square test, and agreement was assessed via the kappa coefficient. A Mann-Whitney test was used to assess rectal volumes and sphincterial pressure distributions between groups of patients. A P-value of <0.05 was significant.
  
  
  RESULTS
  Forty-three patients (42 female patients) underwent anorectal physiology and radiology imaging. The median age was 54 years (interquartile range, 41.5-60 years). Anismus was seen radiologically and physiologically in 18 (41.8%) and 12 patients (27.9%), respectively. The agreement between modalities was 0.298 (P = 0.04). Using physiology as a reference, radiology had positive and negative predictive values of 44% and 84%, respectively. Rectoceles, cystoceles, enteroceles and pathological pelvic floor descent were not physiologically predictive of animus (P > 0.05). The sphincterial straining pressure was 71 mmHg in the anismus group versus 12 mmHg. Radiology was likely to identify anismus when the straining pressure exceeded 50% of the resting pressure (P = 0.08).
  
  
  CONCLUSIONS
  Radiological techniques detect pelvic morphological abnormalities, but lead to overdiagnoses of anismus. No proctographic pathological feature predicts anismus reliably. A stronger pelvic floor paradoxical contraction is associated with a greater likelihood of detection by proctography.
authors.affiliation: Department of General Sugery, Raigmore Hospital, Inverness, United Kingdom.; Department of Clinical and Interventional Radiology, Royal Victoria Hospital, Belfast, United Kingdom.
authors.forename: Umberto
authors.initials: U
authors.lastname: Pisano
authors.affiliation: Department of Clinical Physiology, Raigmore Hospital, Inverness, United Kingdom.
authors.forename: Lesley
authors.initials: L
authors.lastname: Irvine
authors.affiliation: Department of General Surgery, Raigmore Hospital, Inverness, United Kingdom.
authors.forename: Justina
authors.initials: J
authors.lastname: Szczachor
authors.affiliation: Department of General Surgery, Raigmore Hospital, Inverness, United Kingdom.
authors.forename: Ahsin
authors.initials: A
authors.lastname: Jawad
authors.affiliation: Department of Radiology, Raigmore Hospital, Inverness, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: MacLeod
authors.affiliation: Department of General Surgery, Raigmore Hospital, Inverness, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Lim
keywords: Anismus; Obstructive defecation; Pelvic dyssynergia; Physiology; Radiology