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Anismus: fact or fiction?

W R Schouten1, J W Briel, J J Auwerda

  • 1Department of Surgery, University Hospital Dijkzigt, Rotterdam, The Netherlands.

Diseases of the Colon and Rectum
|September 18, 1997
PubMed
Summary
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Anismus, or puborectalis muscle contraction during straining, is not exclusively found in patients with obstructed defecation. The diagnostic tests for anismus show poor agreement, questioning its clinical significance.

Area of Science:

  • Gastroenterology and Colorectal Surgery
  • Pelvic Floor Disorders
  • Defecation Physiology

Background:

  • Anismus, characterized by puborectalis muscle contraction during straining, has been considered a primary cause of obstructed defecation.
  • The paradoxical nature of this contraction and its diagnostic criteria have been debated.
  • This study investigates the prevalence and diagnostic reliability of anismus.

Purpose of the Study:

  • To determine if puborectalis muscle contraction during straining is exclusively associated with obstructed defecation.
  • To evaluate the diagnostic agreement of commonly used tests for anismus.

Main Methods:

  • Retrospective review of 121 patients with constipation/obstructed defecation and 147 with fecal incontinence, plus 10 controls.
  • Electromyography (EMG), balloon expulsion test (BET), and evacuation proctography were used.

Related Experiment Videos

  • A prospective study of 49 constipated patients, 28 incontinent patients, and 19 controls using all three tests in different positions.

    • Main Results:

    • Anismus prevalence varied significantly based on the diagnostic test and patient group.
    • In the prospective study, no significant differences in anismus prevalence were found between groups, except for BET in the sitting position.
    • The three main diagnostic tests for anismus demonstrated poor agreement.

    Conclusions:

    • Contraction of the puborectalis muscle during straining is not unique to patients with obstructed defecation.
    • The poor agreement among diagnostic tests raises doubts about the clinical significance of anismus.
    • Further research may be needed to refine diagnostic criteria and understand the condition's impact.