Patient preference of integrated total pelvic floor ultrasound versus defaecatory proctography

Pelvic floor defaecatory dysfunction is traditionally investigated with defaecatory proctography, which examines rectocele, enterocele, intussusception and functional aspects including dyssynergy and completeness of evacuation. Integrated total pelvic floor ultrasound offers a means to investigate these anatomical features as well as muscle co-ordination and propulsion, without the requirement of rectal contrast expulsion on a commode. We explore patient preference for each procedure.

A prospective study was taken of women who had undergone both defaecatory proctography and total pelvic floor ultrasound for defaecatory dysfunction (incomplete evacuation with or without concomitant faecal incontinence). Patients were given a preference questionnaire after each test, which was subsequently qualitatively analysed.

A total of 247 patients underwent defaecatory proctography and total pelvic floor ultrasound with completed data sets for 224. Total pelvic floor ultrasound was preferred by 123 patients, 86 preferred defaecatory proctography and 15 had no preference. Scores for embarrassment, discomfort and anxiety were less for total pelvic floor ultrasound. There was no significant difference in mean pain scores for either test or in their ability to improve patient understanding of the underlying symptom aetiology. There was no significant difference in embarrassment scores between those with or without seepage of barium paste during defaecatory proctography, nor in cases of poor co-ordination or propulsion in either total pelvic floor ultrasound or defaecatory proctography.

More patients preferred total pelvic floor ultrasound due to less embarrassment, discomfort and the absence of oral contrast or rectal paste. This study offers insights into patient perspectives on pelvic floor investigations, serving as an important starting point for patient-centred clinical decision-making.