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Sonographic predictors of obstructive defecatory dysfunction.

D O'Leary1, G Rostaminia, L H Quiroz

  • 1Department of Obstetrics and Gynecology, The University of Oklahoma Health Sciences Center, 920 Stanton L. Young Boulevard, P.O. Box 26901, WP2410, Oklahoma City, OK, 73190, USA, dena-oleary@ouhsc.edu.

International Urogynecology Journal
|October 16, 2014
PubMed
Summary
This summary is machine-generated.

Obstructive defecatory symptoms (ODS) in women are linked to a widened anorectal angle (ARA) and increased levator plate descent angle (LPDA). These pelvic floor imaging findings, particularly ARA >170° and LPDA <9°, significantly increase ODS risk.

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Area of Science:

  • Pelvic Floor Imaging
  • Gastroenterology
  • Women's Health

Background:

  • Obstructive defecatory symptoms (ODS) significantly impact women's quality of life.
  • Understanding the anatomical correlates of ODS is crucial for effective diagnosis and treatment.

Purpose of the Study:

  • To investigate the association between obstructive defecatory symptoms (ODS) and specific pelvic floor anatomical parameters.
  • To evaluate levator ani deficiency (LAD), minimum levator hiatus (MLH), anorectal angle (ARA), and levator-plate descent angle (LPDA) in women with and without ODS.

Main Methods:

  • A cross-sectional study utilized 3D endovaginal ultrasound (3D EVUS) to image the pelvic floor in 100 women.
  • Patients were categorized into ODS and asymptomatic groups based on the Colorectal and Anal Distress Index (CRADI-8).
  • Measurements included levator ani (LA) muscle defect severity, anorectal angle (ARA), and levator-plate descent angle (LPDA), with dichotomization of ARA (±170°) and LPDA (±9°).

Main Results:

  • No significant differences were found in levator ani deficiency (LAD) severity or mean minimal levator hiatus (MLH) between groups.
  • A widened anorectal angle (ARA >170°) was associated with a seven-fold increased odds of ODS (OR=7.01, p=0.0006).
  • Increased levator plate descent angle (LPDA <9°) was associated with a three-fold increased odds of ODS (OR=3.30, p=0.0190).

Conclusions:

  • Widened anorectal angle (ARA) and increased levator plate descent (LPDA) are significantly associated with obstructive defecatory symptoms in women.
  • 3D endovaginal ultrasound is a valuable tool for assessing these anatomical changes related to ODS.
  • These findings highlight specific imaging biomarkers for ODS.